Pingyangmycin as first-line treatment for low-flow orbital or periorbital venous malformations: evaluation of 33 consecutive patients

JAMA Ophthalmol. 2014 Aug;132(8):942-8. doi: 10.1001/jamaophthalmol.2013.8229.


Importance: Low-flow orbital or periorbital venous malformation (OVM) is the most common periorbital vascular lesion that may produce an appearance defect, visual dysfunction, internal hemorrhage, and thrombosis. Intralesional injection of pingyangmycin as a minimally invasive, gentle intervention may have better outcomes in treating low-flow OVMs compared with other currently used methods.

Objective: To investigate the efficacy and safety of intralesional injection of pingyangmycin for treatment of low-flow OVM.

Design, setting, and participants: A retrospective, noncomparative, interventional case series was conducted in a single medical center. Thirty-three consecutive patients with low-flow OVMs undergoing intralesional injection of pingyangmycin were included in the study.

Interventions: Injections of 1 to 5 mL of a pingyangmycin 1.5-mg/mL mixture with lidocaine hydrochloride, 2%, were given. Each patient received 1 to 4 injections at an interval of 6 to 8 weeks between February 2002 and January 2013. Mixture volume was determined on a basis of 0.5 mL of solution per cubic centimeter of the lesion. The maximum dose for 1 injection was 8 mg. Clinical observations were well documented before and after treatment.

Main outcomes and measures: Reduction of lesion volume based on ultrasound-measured volume; overall appearance, including blue color and thickness of lesions before and after treatment; and adverse events were evaluated.

Results: Patients received a median of 2 (range, 1-4) intralesional injections of pingyangmycin. The mean pretreatment volume was 4.4 cm3 and posttreatment volume was 1.0 cm3 (t = 4.63; P < .001), with a mean decrease of 84% (range, 28%-100%). Marked to moderate improvement in the volume of the lesions was noticed in 31 eyes (94%; 25 of 33 [76%] with marked improvement and 6 of 33 [18%] with moderate improvement). Improvement occurred in 95% (18 of 19) of superficial lesions, 100% (3 of 3) of deep lesions, and 91% (10 of 11) of combined lesions. We noticed significant improvements in blue color and thickness on the basis of investigator scores from clinical photographs taken before and after treatment. None of the patients had recurrence noted at their final follow-up. Adverse events were limited to swelling of the conjunctiva and localized subcutaneous atrophy.

Conclusions and relevance: The results of intralesional pingyangmycin injection for treatment of low-flow OVM are encouraging and associated with a low risk of adverse events.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antibiotics, Antineoplastic / therapeutic use*
  • Bleomycin / adverse effects
  • Bleomycin / analogs & derivatives*
  • Bleomycin / therapeutic use
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Injections, Intralesional
  • Male
  • Middle Aged
  • Orbit / blood supply*
  • Retrospective Studies
  • Vascular Malformations / drug therapy*
  • Veins / abnormalities


  • Antibiotics, Antineoplastic
  • Bleomycin
  • bleomycetin