Intralesional photocoagulation of periorbital hemangiomas

The purpose of this study was to examine the effects of intralesional bare fiber photocoagulation with the KTP and Nd:YAG lasers on periorbital hemang iomas of infancy. Initial reports by Apfelberg and Gregory suggest that int ralesional laser therapy may have a role in the treatment of hemangiomas. I ntralesional photocoagulation may be preferred to superficial laser treatme nt for several reasons. It may decrease cutaneous skin damage and more effe ctively reduce bulky, deep lesions. Twenty-three patients with periorbital hemangiomas were treated (KTP, n = 7; Nd:YAG, n = 16). An 18-g Angiocath wa s placed into the lesion to pass the fiber through. Laser energy was delive red by means of a 0.6-mm bare fiber at 10 to 15 J (KTP) or 75 (Nd:YAG). Tre atments were done under general anesthesia. Patients were followed closely for 1 month and then monthly to assess results and complications. Results a re as follows: 61 percent demonstrated 50-percent or more reduction at 3 mo nths; 22 percent demonstrated 50-percent or more reduction in 3 to 8 months , i.e., 83 percent of patients had 50-percent or more reduction within 8 mo nths. To achieve these results, two patients required two treatments. The r emaining 17 percent had 10- to 14-percent reduction at 1 to 3 months. Two o f these patients had two treatments. A subgroup of patients had a very dram atic response. Thirty-five percent (8 of 23) had 50- to 90-percent reductio n in 1 month. It is unclear why these patients responded so dramatically. W e expected some ulceration during the healing phase. Seventeen percent deve loped ulceration. Complications were limited (4 percent) to one wound infec tion. Intralesional photocoagulation treatment with the KTP and Nd:YAG lase rs is effective and safe for the treatment of periorbital hemangiomas in th e majority of patients with minimal complications. Further study is necessa ry to identify factors that result in dramatic or limited responses.