Abstract ID: 26-363
Orbital venolymphatic malformations: A challenging management strategy
Author: ChaiTeck Choo Base Hospital / Institution: Singapore National Eye Centre
Presentation Type: Video Presentation
Purpose
Orbital venolymphatic malformations (VLM) are challenging due to their infiltrative nature. While sclerotherapy is commonly used, massive or recurrent lesions may worsen and require surgical intervention.
A 50-year-old woman with an 18-year history of recurrent orbital VLM, presenting with severe pain, visual decline, and marked proptosis. MRI showed a large retrobulbar mass occupying the orbit. Initial sclerotherapy led to acute worsening, prompting surgery.
Methods
After discussion with the neurosurgical team and avoiding a craniotomy approach, an extended superolateral orbitotomy was performed via a brow incision. After bone flap creation, meticulous microdissection was used to separate the lesion from encased normal structures. The recti muscles were displaced but preserved. Tisseel glue was injected to solidify the lesion, facilitating controlled dissection and debulking, with careful hemostasis.
Orbital structures were reconstructed with restoration of volume and anatomical integrity.
Results
Despite prolonged postoperative edema, the patient eventually achieved excellent functional and cosmetic recovery.
Conclusion
Extended superolateral orbitotomy could be a salvage approach for massive VLM refractory to sclerotherapy, with microsurgical precision critical to preserving vision and ocular motility.
References:
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4. Tsai YJ, Chao A, et al.Classification, diagnosis, and management of orbital venous-lymphatic malformations: Current state-of-the-art. Taiwan J Ophthalmol. 2025 Mar 10;15(1):4-13.