Intralesional Bevacizumab in Periorbital Recurrence of an Orbital Lymphaticovenous Malformation

Introduction

Lymphaticovenous malformations (LVMs) of the orbit, formerly known as orbital lymphangiomas, are vascular, venous, or lymphatic dominant malformations, accounting for 1 – 4% of all orbital lesions [1], [2], [3]. They are primarily seen within the first two decades of life [4] and can grow in size due to reaction of the lymphatic tissue during infection [5], thrombosis, or hemorrhage [6]. LVMs may involve the superficial parts of the ocular adnexa, including eyelids, conjunctiva, and the anterior orbit, leading to disfigurement, as well as deeper parts of the orbit, with the risk of optic nerve compression, proptosis, diplopia, reduced vision, or amblyopia [2], [7]. LVMs can be classified as macrocytic (> 1 cm³) and microcytic (< 1 cm³), referring to the size of the cysts forming the lesion [8]. Management of LVMs has always been challenging due to the diffuse growth of the lesions. Conservative observation of small and asymptomatic LVMs is preferred. There are different treatment modalities [6] if reduction of size is necessary, including tumor debulking, radiation, or injection of sclerosing agents, e.g., bleomycin [6], [9]. However, the recurrency rates as well as intra- and postoperative bleeding complications call for therapeutic alternatives. Understanding that vascular endothelial growth factor (VEGF) takes part in lymphangiogenesis brought up the idea to use it as a therapeutic target and to treat LVMs with an anti-VEGF drug like bevacizumab [6], [10]. We describe the case of a patient with periorbital recurrence of a periorbital LVM that was successfully treated with an intralesional injection of bevacizumab.

Publication History

Received: 22 December 2022

Accepted: 13 July 2023

Accepted Manuscript online:
14 July 2023

Article published online:
06 September 2023

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