Infantile Capillary Hemangiomas Research Articles

Surgical treatment of primary cardiac tumors in children

ObjectiveSummarizing the treatment experience of primary cardiac tumors in children.MethodsThe date of 24 children with primary cardiac tumors who underwent surgery in our department from July 2003 to September 2022 was collected and analyzed treatment efficacy.ResultsAll patients completed the surgery successfully, including 21 cases of complete tumor resection, 2 cases of partial tumor resection, and 1 case of tumor biopsy. The location: 5 cases in the right atrium, 5 cases in the right ventricle, 6 cases in the left atrium, 6 cases in the left ventricle, 1 case in the left, right ventricle and ventricular septum, and 1 case in the ventricular septum. 23 cases were benign: 11 cases of myxoma, 7 cases of fibroma, 3 cases of rhabdomyoma, 1 case of infantile capillary hemangioma, and 1 case of lipoma. There was 1 case of borderline or malignant tumor. 23 patients were discharged successfully, 1 patient died of cardiac failure on the first day after operation. Follow-up was done from 5 months to 19 years and 2 months, 2 cases were lost to follow-up, and 1 case died of cardiac failure in the second year after operation due to severe mitral regurgitation. There was 1 case of tumor biopsy with space-occupying lesion gradually shrinking during follow-up. The prognosis of another 19 children with complete or partial tumor resection was good. There was no recurrence, enlargement, or reoperation of the tumor during the follow-up period.ConclusionsPrimary cardiac tumors in children are mostly benign. Surgery is effective, but the timing of surgery depends on the patient's condition.

Treatment outcomes of oral propranolol in the treatment of periocular infantile capillary hemangioma and factors predictive of recurrence and incomplete resolution: A multi-centric study.

This study aims to evaluate the treatment outcomes of periocular capillary hemangioma with oral propranolol (OP) and list the factors predictive of recurrence and incomplete resolution after treatment. Data were collected by retrospective review of medical files of patients with infantile hemangioma (IH) treated with OP during January 2014-December 2019 from two tertiary eye institutes from India. Patients presenting with symptoms of IH with/without any history of prior treatment were included. All patients were started on OP with the dose of 2-2.5 mg/Kg body weight and continued till complete resolution or till the lesion reached a plateau response. Details about the ophthalmic examination at each visit and availability of imaging findings were noted down from the records. Primary outcome: Study the treatment outcome of patients treated with OP and discussed our observations regarding factors that may predict nonresponse, poor response, or recurrence. Secondary outcome: complications/side effects of therapy. Response to treatment was judged as fair, good, and excellent depending on resolution <50%, >50%, and complete resolution, respectively. Univariate analysis of factors related to treatment response was judged as fair, good, and excellent depending on resolution <50%, >50%, outcome and recurrence was studied using Mann-Whitney U test and Fisher's exact test. A total of 28 patients were included in the study, out of which 17 were female and 11 were male. The mean age of onset of the lesion was 1.08 (± 1.484) months, 11 being congenital in origin. The mean age at presentation was 4.15 (± 2.92) months. 46.43% (n = 13) of patients showed complete resolution, while 25% (n = 7) showed more than 50% reduction in lesion size. Fair response was noted in 28.57% (n = 8). The mean duration of follow-up after stopping OP was 17.7 (± 20.774) months. The recurrence rate noted was 14.28%. The factors which were associated with incomplete resolution were age at presentation >3 months, later age of appearance of the lesion, superficial lesions with no orbital involvement. Male gender and congenital lesions responded best to OP therapy. Minor complications were noted with a rate of 25% (n = 7). Younger age at presentation was more commonly associated with complications. OP is a safe and effective treatment for capillary hemangioma except for a smaller subset of patients who show suboptimal response to this drug. However, specific factors responsible for suboptimal response or recurrence after OP therapy remain elusive. Although not statistically significant, there was an increasing trend toward higher age at presentation, low birth weight, and superficial lesions with a poorer response. Furthermore, these factors along with the male gender were commonly associated with recurrence in our series. Larger prospective studies focused on evaluating clinical factors responsible for incomplete resolution and recurrence will help in prognosticating and suggesting alternative treatment regimes.

088 Mullerian anomaly as incidental finding in a neonate with vaginal bleeding

Objective: Overt vaginal bleeding in newborns occurs in up to 11% of patients secondary to effects of hormone exposure present in utero [ [1] Söderström H.F. Carlsson A. Börjesson A. Elfving M. Vaginal bleeding in prepubertal girls: etiology and clinical management. J Pediatr Adolesc Gynecol. 2016; 29: 280-285 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar ]. Designated as “mini menses”, presentation includes blood-tinged vaginal discharge in the first ten days of life. While “mini-menses” are physiologic, heavier or persistent bleeding has been described in underlying vascular and vaginal anomalies, as well as rare tumors [ 2 Handel L.N. Scott S.M. Giller R.H. Greffe B.S. Lovell M.A. Koyle M.A. New perspectives on therapy for vaginal endodermal sinus tumors. J Urol. 2002; 168: 687-690 Crossref PubMed Scopus (28) Google Scholar , 3 Melcer Y. Smorgick N. Fuchs N. Vaknin Z. Lotan G. Pansky M. Vaginal müllerian cyst: an unusual cause of vaginal bleeding in a 16-month-old girl. J Pediatr Adolesc Gynecol. 2014; 27: e21-e22 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 4 Ganti A.K. Ray J. Mooney K.L. Zambrano E. Hillard P.J. Fok W. Unusual cause of pediatric vaginal bleeding: infantile capillary hemangioma of the cervix. J Pediatr Adolesc Gynecol. 2019; 32: 80-82 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ]. To our knowledge, there are no reported cases of neonatal vaginal bleeding associated with uterus didelphys. We present a case of a neonate with atypical vaginal bleeding who was found to have a congenital uterine anomaly (CUA).

Effect of Oral Propranolol on Periocular Infantile Capillary Hemangioma: Outcomes Based on Extent of Involvement.

PURPOSE:To evaluate the efficacy of oral propranolol in the treatment of periocular infantile capillary hemangioma (CHI) based on the involvement of embryological facial placodes and their extent of anatomical involvement.METHODS:Retrospective study of 27 patients.RESULTS:The mean age at the presentation of periocular CHI was 4 months (median, 3 months; range, <1–14 months). There were 11 (41%) males and 16 (59%) females. Based on embryological facial placodes, the involvement was focal in 16 (59%) cases and segmental in 11 (41%) cases. Based on the anatomical distribution, the lesions were preseptal in 4 (15%), postseptal in 13 (48%), and combined in 10 (37%) cases. The duration of use of oral propranolol was 10 months (median, 10 months; range, 4–16 months). Overall, the mean % resolution of periocular CHI was 78% (median, 90%; range, 20%–100%). The mean percentage resolution of focal lesions was 69% (median, 83%; range, 20%–100%), and segmental lesions were 92% (median, 95%; range, 70%–100%). The mean percentage resolution of preseptal component of lesions was 94% (median, 95%; range, 80%–100%) and postseptal component was 74% (median, 85%; range, 20%–100%) over a mean follow-up period of 16 months (median, 15 months; range, 4–37 months). Four (15%) patients exhibited flare-up of lesion after tapering oral propranolol.CONCLUSION:Oral propranolol is effective in the treatment of periocular CHI. Segmental and preseptal lesions respond better to the treatment compared to focal and postseptal lesions.

Role of topical beta blockers in regression of infantile capillary hemangioma.

Objective:To observe efficacy of Timolol maleate 0.5% by topical and surface application in infantile superficial capillary hemangioma of eyelid.Methods: This multi-centered clinical case series was carried out at Ophthalmology Department of Bilawal Medical College and Institute of Ophthalmology, LUMHS, Jamshoro from November 2019 to May 2020. We included 14 subjects. All the patients were subjected to detailed clinical examination. Before starting the topical beta blockers, the enrolled subjects had obtained the expert opinion by pediatrician to rule out any preexisting developmental cardio vascular disease. Topical beta blockers 0.5% drops were thus started with, against the ongoing finding of superficial capillary hemangioma of eyelid.Results:There was significant regression in size of infantile hemangioma after treating with topical timolol maleate 0.5%. We included 14 subjects in this study. Mean±SD age of patients was 4.94. Complete regression was seen in 08 subjects at the end of 12 weeks (64%) while 03 were completely cured at 08 weeks (21%) and 01 patient lost follow up with us. No significant ocular and systemic side effects were noted.Conclusion: Topical timolol maleate 0.5% can be the first-line treatment modality for superficial capillary hemangiomas due to its better safety and efficacy.

Ocular and Periocular Tumors in Asian Indian Children and Adolescents

To describe eye tumors in Indian children (age £ 21 years) presenting to a multi-tier ophthalmology hospital network in India. Hospital-record review. During the 3-year study period (November, 2015-October, 2018), 2911 children were diagnosed with 3003 eye tumors. The three most common benign tumors included conjunctival nevus (445, 22%), orbital dermoid cyst (206, 10%), and periocular infantile capillary hemangioma (181, 9%). The three most common malignant tumors included retinoblastoma (835, 88%), xeroderma pigmentosa related ocular surface squamous neoplasia (38, 4%), and rhabdomyosarcoma (17, 2%). Based on the age group, retinoblastoma (n=834, 28%) was the most common tumor in all groups, except adolescence where conjunctival nevus (n=194, 21%) was the most common. Overall, retinoblastoma is the most common tumor in children encountered in a referral based comprehensive ocular oncology practice in India.

Evaluation of the Efficacy of Captopril Versus Propranolol and Timolol as a Treatment of Infantile Capillary Hemangioma

Evaluation of the Efficacy of Captopril Versus Propranolol and Timolol as a Treatment of Infantile Capillary Hemangioma

Clinical and Ultrasonographic Evaluation of Infantile Periocular Hemangioma Treated With Oral Propranolol.

To evaluate the clinical and ultrasonographic response of periocular infantile capillary hemangioma during treatment with oral propranolol. Patients with infantile periocular hemangioma and visual or cosmetic concerns were enrolled in this prospective interventional case series. Propranolol was given at a dose of 2 mg/kg per day for at least 6 months. Evaluation of treatment response was performed at month 3 (time point 1) and month 6 (time point 2). Gray scale ultrasonography and color Doppler imaging were performed at baseline and month 3. Thirty-one patients with mean age of 4.1 ± 2.3 months were eligible for analysis. Complete or near complete clinical resolution was observed in 4 patients (12.9%) at time point 1 and 21 patients (67.7%) at time point 2. Longitudinal diameter, transverse diameter, thickness, arterial peak systolic velocity, and end diastolic velocity reduced significantly from baseline to 3-month follow up. Complete clinical response at time point 2 was significantly higher in patients with peak systolic velocity reduction >50% from baseline to month 3 than patients with peak systolic velocity reduction of 10% to 50% and <10%. Propranolol is safe and effective for infantile periocular hemangioma. Ultrasonography and color Doppler imaging are useful modalities to monitor and predict the treatment response.

Treatment of Periorbital Infantile Capillary Hemangioma with Propranolol

Treatment of Periorbital Infantile Capillary Hemangioma with Propranolol

Combined Oral and Topical Beta Blockers for the Treatment of Early Proliferative Superficial Periocular Infantile Capillary Hemangioma.

To evaluate the safety and efficacy of combined oral and topical beta blockers for the treatment of superficial periocular infantile hemangioma at the early proliferative stage. This was a randomized, controlled comparison trial involving 25 patients. Patients were randomly enrolled into two groups: the topical and systemic treatment and systemic treatment only groups. The topical and systemic treatment group was treated with oral propranolol (1 mg/kg per day initially, increased to 2 mg/kg per day gradually in 2 weeks) and timolol maleate 0.5% gel. The systemic treatment only group received oral propranolol (1 mg/kg per day initially, increased to 2 mg/kg per day gradually in 2 weeks) and simple eye ointment to be applied to the lesion. The Hemangioma Activity Score was used to record the proliferative activity of the hemangioma. The main outcomes of the study were the change in the hemangioma size, the proliferative activity, and the treatment side effects. At the end of the treatment period, the Hemangioma Activity Score was significantly improved in both groups from their values before treatment. However, the score obtained after treatment was significantly better in the topical and systemic treatment group (P < .05). Regarding the response to treatment, 10 and 3 cases in the topical and systemic treatment and systemic treatment only groups, respectively, showed a good response, with a significant difference between the two groups (P < .50). There were no recorded serious local or systemic complications during treatment in either group. The results from combining topical with oral beta blockers showed that topical beta blockers are of additive value in treating superficial periocular infantile hemangioma in the early proliferative stage. [J Pediatr Ophthalmol Strabismus. 2018;55(1):37-42.].

Early and Late Histological and Ultrastructural Findings in Resected Infantile Capillary Hemangiomas Following Treatment with Topical Beta-Blocker Timolol Maleate 0.5%

Background: Infantile capillary hemangiomas (IHs) affect approximately 4-5% of infants. The systemic nonselective β-adrenergic antagonist, propranolol, has become the standard first-line treatment for severe IHs. The topical β-antagonist, timolol maleate, has also demonstrated efficacy and safety in treating superficial and some deep capillary hemangiomas. Despite their therapeutic success and prevalent use, the mechanism of action of β-adrenergic antagonists in the treatment of IHs is not well understood. Methods: Histopathological and electron microscopic evaluation of two periocular IHs excised at 1 week and 24 months following topical timolol treatment was performed. Results: Distinct morphological differences were observed between spontaneously regressed and β-antagonist-treated IHs. The former was characterized by diffuse collagen deposition and interstitial fibrosis, while the latter showed organized concentric collagen IV deposition within obliterated vessel lumen, suggestive of waves of endothelial cell apoptosis, leaving behind layers of basement membrane deposits as a stress response. Conclusions: Based on these observations, we hypothesize that, apart from their well-known cardiac and vasodilatory effects, β-antagonists could induce endothelial cell apoptosis in IH leading to endovascular occlusion and we present supporting evidence to explain why this response might be specific to hypoxic tissue.

Unusual Cause of Pediatric Vaginal Bleeding: Infantile Capillary Hemangioma of the Cervix

Infantile hemangiomas (IH) are the most common soft tissue tumors of infants and children which characteristically spontaneously resolve by 7-10 years of age. IH generally require no intervention, but rarely can cause disfiguration, functional impairment, bleeding or infection. Here we present a unique case of cervical infantile hemangioma in a 6 yo who presented with vaginal bleeding requiring transfusion. Patient is a 6 year 10 month-old female with history of unexplained intermittent vaginal bleeding since 6 months of age. On current presentation, she presented to an outside hospital with acute vaginal bleeding, accompanied by a 5 unit drop in Hgb over 24 hours, requiring transfusion. Previous evaluation by Pediatric and Adolescent Gynecology service at 28 months with vaginoscopy revealed normal anatomy but evidence of vaginitis and cervicitis, which was treated with topical estrogen. She was subsequently followed by pediatric endocrinology, with findings of no evidence of precocious puberty, and labs consistent with prepubertal state. Upon presentation to the outside hospital requiring transfusion, she had a normal pelvic ultrasound showing a prepubertal uterus and ovaries. She was transferred to our medical center for ongoing management where she underwent an urgent exam under anesthesia and repeat vaginoscopy which revealed a <1 cm cervical raised papule that was biopsied. Hemostasis was achieved with vaginal packing which was uneventfully removed POD 1. Pathology was consistent with infantile capillary hemangioma, with capillary vascular proliferation and positive staining for GLUT-1. Follow up MRI with contrast did not show evidence of a vascular lesion or pelvic mass. The differential diagnoses for vaginal bleeding in the prepubertal child include vaginal foreign body, trauma, neoplasm, precocious puberty, and vascular malformations. Only a single case report of infantile hemangioma of the cervix has previously been reported in the literature. In non-cutaneous cases, diagnosis must rely on imaging and pathology. MRI is used to delineate the location and extent of IH, and differentiate it from other high-flow vascular lesions such as arteriovenous malformations. In this case, however, the lesion could not be appreciated on imaging, likely due to its small size. Pathological assessment was crucial to our diagnosis. The cervical biopsies taken at time of vaginoscopy demonstrated capillary vascular proliferation, GLUT-1 and WT-1 positivity, but PROX-1 negativity. GLUT-1 is a sensitive and specific marker for both proliferating and involuting IH. It is not found in other vascular neoplasms or malformations. Profuse bleeding is a rare complication of IH and has been most noted in the hemangiomas of the GI tract. IH in GI system can be treated with medication corticosteroids with or without propranolol, or may require surgical resection. Follow up treatment for this patient will consist of a 6 month trial of propranolol with repeat vaginoscopy and possible excision. In the future, physicians should consider infantile hemangioma of the vagina or cervix as part of the differential diagnosis in patients presenting with prepubertal bleeding.

Expression and significance of the proteins in TSP-1 and NF-κB signal pathways of infantile capillary hemangioma

To explore the significance of the relative proteins in thrombin sensitive protein(TSP-1) and nuclear factor kappa B (NF-κB) signal pathways by detecting their expressions in different phases of hemangioma and the relations between them and microvessel density(MVD). Forty cases with hemangioma were randomly selected and divided into proliferative group(n =21) and involutional group(n =19) according to Mulliken standard.The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK,NF-κBp65,p-IκBα,p-IKKβ,VEGF and CD34 in endothelial cells were detected by immunohistochemistry.The relevance between the proteins in TSP-1 and NF-κB signal pathways and MVD were compared and analyzed respectively. The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK in proliferative hemangioma were all lower than those in involutional hemangioma (F=32.582,47.575,11.645,18.824,13.140;P =0.000,0.000,0.002,0.000,0.001).Conversely, the expressions of NF-κBp65,p-IκBα,p-IKKβ,VEGF in proliferative hemangioma were higher than those in involutional hemangioma(F =7.807,6.323,5.988,4.216;P =0.009,0.018,0.021,0.049).Meanwhile,MVD were different between the two groups(F =7.256,P =0.012).The expressions of TSP-1, CD36, p59fyn and MVD showed a negative relationship(rs =-0.420,-0.519,-0.388;P =0.021,0.003,0.034). Conversely, the expressions of NF-κBp65,pvIκBα,VEGF and MVD showed a positive relationship(rs =0.666,0.611,0.515;P =0.000,0.000,0.004).The expression of TSP-1 and NF-κBp65 showed a negative relationship (rs =-0.413,P =0.023). TSP-1 signal pathway and NF-κBp65 signal pathway may be interactive in evolution of infantile hemangioma, which has a potential role by effecting the progress of angiogenesis.

β-Blocker versus triamacinolone acetate in the treatment of infantile periocular hemangioma

Purpose The aim of this study was to evaluate the effectiveness of systemic and intralesional β-blockers in the treatment of periocular infantile capillary hemangiomas and to compare the effect of intralesional triamcinolone acetonoid injection and β-blockers. Patients and methods Totally, 60 patients with infantile periocular hemangioma were included in the study and were divided into three groups. Group 1 included 20 patients treated with systemic β-blocker. Group 2 included another 20 patients treated with intralesional triamcinolone acetate. Group 3 included 20 patients treated with intralesional β-blocker. Results In group 1, 55% of patients showed excellent response, 30% of patients showed good response, 10% of patients showed fair response, and 5% of patients showed poor response. In group 2, 50% of patients showed excellent response, 35% of patients showed good response, 15% of patients showed fair response, and no patients showed poor response. In group 3, 40% of patients showed excellent response, 25% of patients showed good response, 25% of patients showed fair response, and 10% of patients showed poor response. Conclusion Systemic propranolol is a good alternative for treating periorbital infantile hemangiomas. Systemic propranolol is superior to intralesional steroid because systemic propranolol has fewer side effects. Propranolol provides a more safe and effective modality of treatment of periocular infantile capillary hemangioma with a lower incidence of systemic side effects.

Efficacy of propranolol in infantile hemangioma

Hemangiomas, are the most common benign tumors of infancy. Despite their selflimited course, infantile capillary hemangiomas can cause local complications e.g. pain, ulceration, bleeding etc. The usual treatments include oral/intralesional steroids, alpha interferon, cytotoxins, pulsed dye laser and cosmetic surgery resection. These treatments are not free of multiple complications and toxic side effects. We report our experience with the use of propranolol in 2 children with haemangiomas along with review of relevant literature. Both the hemangioma cases promptly responded to low-dose oral propranolol. DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22561 Bang Med J (Khulna) 2014; 47 : 32-35

Oral Propranolol in Treatment of Infantile Peri - Ocular and Orbital Capillary Hemangioma : A Prospective Study

Objectives: To evaluate the effect of oral propranolol in the treatment of infantile peri-orbital and/ or orbital capillary hemangioma. Methods: We conducted a prospective study at Prince Rashid Bin Al Hassan military hospital between 5 th of August 2012 and 29 th of January 2013. Eleven patients with peri-orbital and/or orbital capillary hemangiomas were included in this study. All patients underwent complete ophthalmic examination. Capillary hemangiomas were assessed, reporting their size, location, extension, and effect on the surrounding structures. Follow up duration ranged from two to six months. Results: The age of patients with peri-orbital and/ or orbital capillary hemangiomas ranged from three to 17 months with a mean of 7 ± 4.92 months. Male: female ratio was 1: 1.75. The upper eyelid was involved in seven (64%) cases, all of them had ptosis, three (43%) had dystopia, one (14%) had imbrication, and one (14%) had squint. The lower eyelid was involved in two (18%) cases; one of them was associated with lower lip capillary hemangioma. Orbital involvement was seen in eight (73%) cases, six (75%) of them were associated with upper eyelid involvement and two (25%) with lower eyelid involvement. Concurrent extra-ocular localization of hemangiomas was present in five (45%) cases (one in lip, one in tongue, 2 in forehead, and one in cheek). Duration of treatment ranged between one and 30 weeks with an average of 14.2 ± 11.4 SD weeks. The dose of propranolol ranged between 12 mg/kg with an average of 1.2 mg/kg and only one patient with upper eyelid and forehead extension needed 4 mg/kg. The color blanched in all patients after one week. The capillary hemangioma decreased in size after one week of treatment in two (18%) patients, and in all of them after one month. Complete regression of the hemangioma was seen in two (18%) cases one after two months and the other after 4 months of treatment. Five (45%) cases had astigmatism before the start of treatment (mean ±SD, 0.9 ± 0.379 D) diopters and improved to mean ±SD, 0.56 ± 0.586 D. Conclusion: Oral propranol can be used as a modality for therapy of infantile capillary hemangioma.

Visual acuity and astigmatism in periocular capillary hemangiomas treated with oral beta-blocker versus intralesional corticosteroid injection

Periocular infantile capillary hemangiomas (PCH) can induce anisometropic astigmatism, a risk factor for amblyopia. Oral beta-blocker therapy has largely supplanted systemic or intralesional steroid for vision-threatening lesions.

Deep Periocular Infantile Capillary Hemangiomas Responding to Topical Application of Timolol Maleate, 0.5%, Drops

Deep Periocular Infantile Capillary Hemangiomas Responding to Topical Application of Timolol Maleate, 0.5%, Drops

Treatment of Infantile Capillary Hemangioma of the Eyelid with Systemic Propranolol

To assess the efficacy and safety of systemic propranolol for infantile capillary hemangiomas of the eyelid. Prospective, interventional cases series. All patients with eyelid infantile capillary hemangiomas at risk of developing amblyopia seen between January 2009 and January 2012 at the University Federico II, Naples, Italy, were treated with systemic propranolol (2 mg/kg body weight per day). Maximum length of treatment was 4 months, and propranolol was suspended when complete regression of lesions was obtained or in case of collateral effects. Minimum follow-up was 6 months. Of 17 patients with eyelid infantile capillary hemangiomas, 3 were excluded for asthma and 14 (7 males, 7 females; mean age, 20.85 ± 29.7 months; range, 1 to 72 months) underwent treatment with systemic propranolol. Capillary hemangiomas involved the upper eyelid in 10 cases and the lower eyelid in 4 cases. Propranolol was stopped in 1 case for hypotension and in 1 case for allergy. Treatment was administered over a mean of 2.5 ± 1.3 months (range, 1 to 4 months); the mean follow-up was 10.64 ± 8.7 months (range, 6 to 39 months). Ten patients were younger than 1 year and demonstrated complete regression. Two patients older than 5 years also benefited from treatment. In 4 cases, amblyogenic astigmatism was present and decreased from 1.25 ± 0.5 diopters before treatment to 0.25 ± 0.2 diopters after treatment. No regrowth was observed. Four months of treatment with oral propranolol for eyelid infantile capillary hemangiomas led to complete regression of the lesion in patients younger than 1 year. No major collateral effects were observed. Treatment also may be considered in patients older than 5 years to reduce astigmatism and for aesthetic purposes.

The use of propranolol in the treatment of periocular infantile hemangiomas

AbstractPurpose Infantile capillary hemangiomas (IH) are the most common tumours of the eyelid and orbit in infants. Despite their self‐limited course, IH can impair visual function. Recently, the use of propranolol was found to reduce the size of IH. We will present our own case series of patients with periocular IH treated with propranolol to illustrate these findings.Methods We conducted a retrospective study on 10 children with IH treated with propranolol. After exclusion of any contra‐indication, propranolol was initiated at a dose of 1 mg/kg/d. After 10‐14 days, patients were checked again for side‐effects. If these were absent, propranolol was increased to 2 mg/kg/d. Further follow‐up consists of monthly clinical and photographical evaluations of the IH, monitoring of treatment compliance and tolerance. Success of treatment is defined as stopping growth or reducing size. The response to treatment was rated by 3 blinded, independent observers.Results The age range at start of treatment with propranolol was between 2 and 19 months (mean 6,8 months). The mean age at stopping propranolol was 14,4 months. The mean duration of treatment was 7,6 months and only 1 patient had to stop treatment because of side effects. Two patients (20%) had a rebound after temporary stop of propranolol. The success rate in our case serie was 100%. Half of the group had excellent results, 30% had a good response and 20% had a fair response. We also obtained objective measures of astigmatism and anisometropia in 6 patients. We report a reduction in anisometropic astigmatism in 5 of these 6 patients.Conclusion These data support the current perception that propranolol is a highly effective first line treatment for IH with very limited and mild side effects.