Periorbital Infantile Hemangioma Research Articles

Advantages of Early Surgical Management of Periorbital Infantile Hemangiomas.

Background: Early evaluation and treatment of periorbital infantile hemangiomas (POIH) were associated with lower rates of ophthalmological complications. Objective: To evaluate age and characteristics associated with improved anisometropic astigmatism (anisoastigmatism) and eye symmetry measured by diopters and a 5-point scale, respectively, in patients with POIH treated with surgical excision. Methods: A retrospective study was performed on patients with POIH. Patient characteristics and eye symmetry were analyzed between patients with resolved and unresolved anisoastigmatism after surgery. Statistical analyses included the Mann-Whitney U tests, chi-square tests, and linear regression models. Results: In total, 54 patients were included (male: 20, female: 34). Upper medial eyelid was the most commonly affected site (resolved: 45%, unresolved: 43%), followed by upper lateral and upper central. Fifty-six percent (31/55) had postoperative resolution of anisoastigmatism, whereas 44% (24/55) did not. Earlier surgical evaluation (median: 4.5 vs. 6.0 months, p = 0.047) and excision (median: 5.0 vs. 12.0 months, p = 0.005) were associated with reversible anisoastigmatism. Good and suboptimal eye symmetry were not associated with earlier surgical excision (median: 6 vs. 6.5 months, p = 0.87). Follow-up ranged from 1 month to 12 years. Conclusion: Earlier surgical excision was associated with reversing anisoastigmatism but was not significant for improving eye symmetry.

Infantile hemangioma of the upper eyelid in one very and in two extremely preterm infants

Introduction. Infantile hemangiomas (IHs) are the most common vascular tumors of infancy whose frequency increases with decreasing gestational age. Although rare, periorbital IHs (PIHs) have a high complication rate, with a substantial risk of impaired vision and aesthetic consequences. Because they are considered high-risk IH, such patients must be treated. In the available literature, there is little information about the treatment o f I Hs in very and extremely preterm newborns and infants. Case report. We present three male infants (one very and two extremely prematurely born) with PIHs involving the upper eyelid. In all three cases, IHs were solitary but with different subtypes according to soft-tissue depth (superficial, combined, deep). No additional congenital anomalies were found in any of these cases. An individualized approach to the management of each patient was applied. All infants were treated with oral administration of propranolol, with careful monitoring for potential side effects of the drug and adjustment of treatment, following their eventual occurrence. The introduction of oral propranolol was carried out in a hospital setting, with a gradual increase of the drug dose until the target dose was reached. Conclusion. In the case of PIH, an ophthalmologist is an inevitable part of the medical team. Very and extremely preterm infants are already under the supervision of an ophthalmologist due to mandatory screening for retinopathy of prematurity; how-ever, if they also have PIHs, monitoring must be particularly detailed and long-lasting.

Distribution and Clinical Characteristics of Periorbital Infantile Hemangiomas.

Background: Periorbital infantile hemangiomas (POIHs) are associated with a high incidence of visual complications. Objective(s): To analyze the sites of predilection of POIHs and to determine whether certain sites require earlier intervention due to their higher rate of visual complications. Methods: A retrospective case series study was conducted on patients from two tertiary care centers for 25 years. The location of POIHs was determined from clinical photographs, medical records, and radiological studies. The presence or absence of anisometropic astigmatism (anisoastigmatism) and amblyopia was recorded. Data were analyzed using a chi-square test. Results: There were 486 patients, of which 302 patients had ophthalmology evaluations and 245 patients had refractive error data. At presentation, 10% of patients already had amblyopia and 44% had anisoastigmatism. Medial eyelid lesions had the highest risk of developing anisoastigmatism (anisoastigmatism correlates with eyelid position, p = 0.0001). Segmental and upper medial lesions had the highest risk of amblyopia at initial evaluation. Conclusion: The site of POIH is an important indicator for developing clinically significant anisoastigmatism and amblyopia, underlining the need for early ophthalmologic assessment and management.

Diagnosis and treatment of periorbital infantile hemangiomas: Case series and literature review

ObjectiveInfantile hemangiomas (IHs) are the most common benign tumor in infancy. Periorbital IHs may lead to visual dysplasia so prompt and effective treatment should be adopted. In this study, we retrospectively analyzed the diagnosis and treatment of periorbital IHs treated in our clinic and give the strategy for clinical practice. MethodsFrom Jan. 2006 to Dec. 2018, 35 patients with periorbital IHs were enrolled into this study, including 13 males. The initial age of treatment ranged from 0.6 to 7 months. The clinical manifestations, imaging examination results, treatment measures and follow-up results were analyzed. Then diagnosis and treatment strategy were summarized. ResultsAll patients were examined by ultrasound to confirm the depth of tumor, evaluate the effect of treatment and provide the evidence for drug withdrawal. For patients with deep hemangiomas, enhanced CT were added. Intralesional injection of glucocorticoids and oral propranolol were applied. All patients achieved good results. Ocular symptoms were avoided in most of the patients. ConclusionPeriorbital IHs have special growth features and can be diagnosed by the appearance, ultrasound, CT scan, and propranolol experimental therapy if necessary. In consideration of potential complications, oral propranolol is the first treatment option for periorbital IHs.

β-blockers in the treatment of periocular infantile hemangioma.

To evaluate the medical literature on the use of β-blockers, through different routes, for the treatment of periorbital infantile hemangiomas and to summarize the recommendations available on dosage and monitoring. β-blockers for the treatment of infantile hemangioma are now considered to be first-line treatment. Growing literature on the role of oral propranolol confirmed its efficacy but also presented its multiple side-effects including hypotension, bradycardia, hypoglycemia, and bronchospasm. No universal guidelines exist concerning pretreatment evaluation, dosage, monitoring, and duration of treatment but different protocols have been created.In the aim of minimizing side-effects, other routes of administration and more selective β-blockers have emerged. Many studies showed promising results for topical timolol especially in the treatment of superficial hemangiomas. Few studies evaluated intralesional propranolol. Limited data exist on the use of more selective β-blockers promising similar results to propranolol with fewer side-effects. Oral β-blockers are now the mainstay of treatment for periorbital hemangiomas but still with no consensus on their administration and monitoring. The topical form or more selective β-blockers may be the solution to minimize side-effects.

Clinical Practice Guideline for the Management of Infantile Hemangiomas.

Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs.

Clinical Outcomes of Infants With Periorbital Hemangiomas Treated With Oral Propranolol

Periorbital infantile hemangiomas (IHs) require early intervention because they have the potential risk of causing visual disturbances. In recent years, propranolol has shown promise in the effective management of periocular and periorbital IHs. The objective of our study was to assess the clinical outcomes, efficacy, and safety of propranolol in the management of infants with high-risk periorbital IHs. This retrospective study was conducted at the Stomatological Hospital affiliated with China Medical University. The medical records of infants with periorbital hemangiomas who were treated with systemic propranolol at a dose of 1.0 to 1.5mg/kg per day between January 2014 and June 2015 were reviewed. We excluded infants who did not qualify for propranolol treatment and infants who received previous therapy or other treatments. The records were reviewed for treatment response, adverse events during treatment, length of treatment, and recurrences. Treatment response was classified using a 4-point scale system based on reduction in volume as poor (<25%), moderate (25 to 50%), good (50to 75%), or excellent (>75 to 100%) and change in color, as well as surface texture, by a panel of 3 plastic surgeons using 2-dimensional photographs, clinical examination, and Doppler ultrasonography measurements taken before and after treatment. Of 38 infants with periorbital hemangiomas, 26 were treated with systemic propranolol at a dose of 1.0 to 1.5mg/kg administered once daily. A total of 11 male and 15 female infants with a mean age of 5.2months (range, 2 to 12months) were treated. The mean length of treatment was 22weeks (range, 4 to 41weeks). Adverse events of diarrhea (n= 3) and sleep changes (n= 1) were encountered during treatment in 4 patients. The overall treatment response was scored as excellent in 17 patients, good in 7, moderate in 2, and poor in 0. No patients required discontinuation of treatment because of adverse events, and there were no cases of recurrence or tumor regrowth noted during the mean follow-up period of 6.5months (range, 3 to 10months). Oral propranolol at a dose of 1.0 to 1.5mg/kg per day (age ≤3months, 1.0mg/kg; age>3months, 1.5mg/kg) was effective and well tolerated for the management of 26 Chinese infants with high-risk periorbital IHs. Early intervention should be considered to reduce risk of visual impairment and improve esthetic outcomes.

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.

Comparison of Intralesional Corticosteroid and Propranolol Treatment of Periorbital Infantile Hemangiomas: An Outcome Study of 61 Cases

To compare intralesional corticosteroid (IC) injections with oral propranolol in children with periorbital infantile hemangioma (IH). Children were diagnosed with IH and treated with IC (n = 29) or propranolol (n = 14). In cases in which no further improvement was seen, treatment was stopped and the outcome measured. Type, duration, and complications of treatment and supportive or additional therapies were scored, along with outcomes of visual measurements, at the start and end of therapy. Twenty-one of the 29 children (72%) treated with IC injections were given a second injection and 16 (55%) were given more than two. Median duration of IC therapy was 15.9 months (interquartile range (IQR) 10.28), compared with 6.5 months (IQR 4.87) for propranolol (p&lt;0.001). The complications reported after IC injections were bleeding (n = 9) and ulceration (n = 7). No complications were noted in the propranolol group. Additional therapy consisting of oral prednisolone therapy was applied in one child from the steroid-treated group. The levels of amblyopia and the median absolute improvement did not significantly differ between the groups. The IC injections and oral propranolol medication equally improved amblyopia in children with IH of the periorbital and cheek region; however, propranolol was associated with fewer complications and additional or supportive treatment was not indicated. We prefer oral propranolol medication over IC injections in cases in which IH threatens to hamper visual acuity.

Propranolol and Infantile Hemangiomas Four Years Later: A Systematic Review

To systematically review the literature evaluating efficacy and adverse events of propranolol treatment for infantile hemangiomas, we searched the MEDLINE and Cochrane databases for all studies examining the response of infantile hemangiomas (IHs) to propranolol published between June 12, 2008, and June 15, 2012. Forty-one studies with 1,264 patients were included; 74% of patients were female and approximately 30% had received other treatments before propranolol. Propranolol was initiated at a mean age of 6.6months at a mean dose of 2.1mg/kg/day and for a mean treatment duration of 6.4months. The response rate for patients with IHs treated with propranolol was 98% (range 82%-100%), with response rate defined as any improvement with propranolol. Treatment response rates were comparable for studies evaluating IHs at specific sites, such as periorbital IHs. Studies that followed patients after treatment completion reported IH rebound growth in 17% of patients. There were 371 adverse events reported in 1,189 patients. The most common adverse events were changes in sleep (n=136) and acrocyanosis (n=61). Serious adverse events were rare, with reports of symptomatic hypotension in five patients, hypoglycemia in four, and symptomatic bradycardia in one. This systematic review of 1,264 patients treated with propranolol for IHs showed a high rate of efficacy and a low rate of serious adverse events.

Oral propranolol for the treatment of periorbital infantile hemangioma: A preliminary report from Oman

Purpose:To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects.Materials and Methods:Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated.Results:Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy.Conclusions:Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing vision-threatening complications, oral propranolol can be the primary therapy.

Letter Regarding: Early Laser Treatment of Periorbital Infantile Hemangiomas May Work, but Is It Really the Best Treatment Option?

Letter Regarding: Early Laser Treatment of Periorbital Infantile Hemangiomas May Work, but Is It Really the Best Treatment Option?

Letter Regarding: Early Laser Treatment of Periorbital Infantile Hemangiomas May Work, but Is It Really the Best Treatment Option?

*Dermatology Cosmetic Laser Associates of La Jolla, La Jolla, CA †Dermsurgery Laser Center, Houston, TX ‡Department of Dermatology, University of Texas Houston Medical School, Houston, TX §Department of Dermatology, Weill Cornell Medical College, Methodist Hospital, Houston, TX

The treatment of periorbital infantile hemangioma with intralesional corticosteroid.

A series of 25 patients with periorbital hemangiomas was treated with intralesional corticosteroid injection. This resulted in a marked involution of the tumor in 16 patients, a moderate involution in 5 patients, and a minimal response in 4. No local or systemic complications were noted. The overall incidence of ocular complications in the form of amblyopia or strabismus secondary to the hemangiomas was 16 percent.

The Treatment of Periorbital Infantile Hemangioma with Intralesional Corticosteroid

The Treatment of Periorbital Infantile Hemangioma with Intralesional Corticosteroid