Orbital Venous Malformations: Current Multidisciplinary Treatment Approach | Congenital Defects | JAMA Ophthalmology | JAMA Network
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Clinical Sciences
August 2004

Orbital Venous Malformations: Current Multidisciplinary Treatment Approach

Author Affiliations

From the Department of Ophthalmology, Cullen Eye Institute (Drs OzkanArat and Boniuk) and the Department of Radiology (Dr Mawad), Baylor Collegeof Medicine, Houston, Tex. The authors have no relevant financial interestin this article.

Arch Ophthalmol. 2004;122(8):1151-1158. doi:10.1001/archopht.122.8.1151
Abstract

Objective  To evaluate the clinical, radiological, and histopathological features,treatment, and outcome of a series of orbital venous flow malformations (OVMs)with the aim of delineating a more systematic approach for treatment.

Methods  A 38-year retrospective review of 22 patients with OVMs followed upat 1 institute.

Results  Eighteen of 22 patients (13 women and 9 men) showed clinical or radiologicalevidence of distensibility. The mean age at the initial manifestation was28.3 and 50.7 years in patients with distensible and nondistensible OVMs,respectively. Eight patients (36.3%) had deep orbital lesions, 6 (27.3%) hadsuperficial orbital lesions, and 8 (36.3%) had combined orbital lesions. All3 patients with deep nondistensible OVMs had a sudden onset of proptosis andpain or diplopia secondary to thrombosis or hemorrhage. Seventeen patientsrequired treatment. All 4 nondistensible lesions were treated by surgicalexcision. A variety of techniques were used to treat distensible OVMs includingcarbon dioxide laser ablation, percutaneous alcohol sclerotherapy, or embolizationwith Guglielmi detachable coils after surgical exposure and surgical excision.Of the 14 patients with follow-up, 8 had complete resolution of the signsand symptoms and 6 patients showed marked improvement following surgery. Meanfollow-up was 57.8 months.

Conclusion  If intervention is indicated, less invasive methods such as carbon dioxidelaser ablation and percutaneous alcohol sclerotherapy for superficial andcombined orbital lesions and endovascular treatment by Guglielmi detachablecoil embolization for deep orbital lesions should be considered before proceedingwith more invasive procedures.

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