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This is a retrospective review of 16 eyes which underwent intralesional / sub-conjunctival injections of bleomycin sclerotherapy for conjunctival lymphatic malformations (lymphangiomas). The mean age was 18 (range three to 59 years). Four of the lesions were microcystic and 12 had a conjunctival mass. Four were limited to the conjunctiva only, two patients also had lid involvement, and 10 more extensive lesions including the orbit and eyelids. Six eyes had three clock hours or less involved, eight had three to six clock hours, and two had seven to nine clock hours. All cases were treated with intralesional bleomycin 2 IU/ml mixed 50/50 with lignocaine and adrenaline. Injections were given under direct observation, without any image guidance. The dose varied with the extent of the lesion, with 1-2 IU being given to purely conjunctival lesions, and up to 6 IU for orbital ones. Treatment was repeated after a month if necessary, and the average number of treatment sessions was 1.6 (range one to three). Pre- and post-injection photographs were used to assess the response to treatment. Complete resolution occurred in six, >75% resolution in five, 50-75% in four and 25-50% in one. None had less than 25% response. Post-injection chemosis occurred in all cases, but none was severe, and all resolved. Mild transient restriction of motility occurred in two patients, and one patient required surgical debulking for an incomplete response. There was sustained regression after a follow-up of 30 months (minimum 24 months), but two patients had a recurrence. Microcystic lesions responded better than conjunctival mass lesions. Surgical removal has been associated with significant complications, and sclerotherapy offers an effective treatment, although some degree of residual disease is common.

Two-year outcomes of transcutaneous non-image guided bleomycin sclerotherapy in conjunctival lymphatic malformations: a protocol-based management in 16 eyes.
Dave TV, Walvekar P.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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