The efficacy and safety of bleomycin injection as the primary management of orbital venolymphatic malformations: A systematic review.

Orbital venolymphatic malformation (OVLM) consists of abnormal vascular channels lined by endothelial cells with venous and lymphatic components. OVLM tends to re-grow after treatment, with a recurrence rate of 71.4% after surgery. The use of sclerotherapy injection has emerged as a nonsurgical procedure as extensive surgery may cause iatrogenic damage to vital structures within the orbit. Therefore, exploring the efficacy and safety profile of bleomycin injection for OVLM in achieving proptosis reduction, recurrence rate, visual acuity improvement or stabilization, and the complication of bleomycin is considered important. Current studies showed bleomycin resulted in proptosis reduction in 87.78% of patients and stayed stable in 12.22% of patients, with a median of 6 months' follow-up. The recurrence rate was 0.76% since only one patient had the recurrence due to rebleed and chocolate cyst formation. Visual acuity improved in 63.64% of patients, while 36.36% remained stable. Minimal complications were reported, including periocular hyperpigmentation (14.5%) and inflammation (8.40%). Bleomycin injection as a sclerotherapy is considered an effective and safe treatment modality for OVLM.