Non-image-guided injection of bleomycin to treat orbital-adnexal lymphatic malformations: Effect of lesion morphology and previous treatment on outcomes.

PURPOSE: To evaluate the long-term outcomes of non-image-guided intralesional injection of bleomycin to treat patients with orbital-adnexal lymphatic malformations (OA-LM).

METHODS

Study design : Retrospective study.

Setting

Single center, tertiary care referral institute. Patient population/selection: All consecutive patients of OA-LM (treatment-naïve or previously treated) from January 2019 to December 2023 (5 years). Intervention: We used lignocaine 2% to reconstitute bleomycin, which was then injected into the core of the OA-LM lesion as a sclerosant. We planned a minimum of three injections per patient at 1-month intervals; any additional injections were planned after clinical and radiological evaluation. Outcome measures: Defined according to the clinical regression of OA-LMs as excellent (>75%), good (>50-75%), fair (>25-50%), and poor (<25%). A minimum follow-up of 1 year after the last injection was ensured.

RESULTS

All 51 cases (39 males, 76.5%, 2 transgender people) had unilateral involvement, and the mean age at presentation was 27.5 years. The majority were of microcystic variant (n = 29, 60.4%), macrocystic variant (9, 18.75%), and mixed variant (n = 13, 28.1%). Twenty-two (43.14%) were previously treated with oral steroids (n = 18), intralesional steroids (n = 12), intralesional 5-fluorouracil (n = 5), and surgical excision (n = 9) (overlapping numbers). At a mean follow-up of 1.5 years, excellent outcomes were noted in 18 (35.3%), good in 20 (39.2%), fair in 6 (11.8%), and poor in 7 (13.7%) patients. Nine patients (17.6%) had transient hyperpigmentation of the overlying skin, while none had systemic complications.

CONCLUSION

Non-image-guided, protocol-based bleomycin mono-sclerotherapy injection is a safe and effective procedure for both treatment-naïve and previously treated OA-LMs.