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High Injection Pressure During Intralesional Injection of Corticosteroids Into Capillary Hemangiomas
James E. Egbert, MD;
Saurav Paul, PhD;
W. Keith Engel, MD;
C. Gail Summers, MD
Arch Ophthalmol. 2001;119:677-683.
Background Intralesional injection of corticosteroids is an effective treatment
for tumors of the head and neck. Complications are rare but include permanent
loss of vision. We designed a study to investigate the mechanism for this
complication.
Methods Three fellowship-trained pediatric ophthalmologists participated in
the study in a nonmasked fashion. Four patients received 5 separate treatment
sessions of an intralesional injection of a 50-50 mixture of triamcinolone
diacetate (40 mg/mL) and betamethasone sodium phosphate and betamethasone
acetate (6 mg/mL) into capillary hemangiomas. Injection pressure was obtained
in real time using a cannula designed for this purpose. Maximum pressure,
mean pressure, and volume of corticosteroid were measured from each injection.
Results A total of 71 injections (range, 8-33 injections per patient) was performed.
The total volume of corticosteroid ranged from 0.9 to 2.1 mL. In 63 of 71
injections, the maximum pressure exceeded 100 mm Hg (range, 18.65-842.18 mm
Hg). Each surgeon produced injection pressures greater than the systemic arterial
pressures of each patient.
Conclusions Injection pressures exceeding the systemic arterial pressures routinely
occur during intralesional injections of corticosteroids into capillary hemangiomas.
Experienced surgeons participating in a nonmasked protocol were unable to
prevent high injection pressures of corticosteroid. A sufficient volume of
corticosteroid injected at high injection pressure would account for the embolization
of corticosteroid particles into the ocular circulation from retrograde arterial
flow. We recommend limiting the volume of corticosteroid and performing indirect
ophthalmoscopy on all patients receiving injections of long-acting corticosteroids
into the orbit and periorbital soft tissue.
From the Departments of Ophthalmology (Drs Egbert, Engel, and Summers),
Biomedical Engineering (Dr Paul), Otolaryngology (Dr Paul), and Pediatrics
(Dr Summers), University of Minnesota, Minneapolis.
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