Treatment Of Periocular Infantile Hemangioma Research Articles

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 and Radiological Evaluation of Periocular Infantile Hemangioma Treated With Oral Propranolol: A Case Series

To evaluate the efficacy of propranolol (3mg/kg/day) in the treatment of periocular infantile hemangioma (IH) based on clinical and radiological findings. Prospective interventional case series. Study of previously untreated infants with IH conducted at the ophthalmology outpatient service of HC-FMUSP (Brazil). The patients were submitted to a complete ophthalmologic examination, gray-scale and Doppler ultrasonography, and nuclear magnetic resonance imaging. Lesion regression was evaluated clinically and radiologically during follow-up. The sample consisted of potentially amblyogenic and disfiguring lesions. The dose was increased at weekly intervals, from 0.5mg to 3mg/kg/day. The age at onset of treatment was 2-28months. Follow-up lasted up to 48months. Nine infants with periocular IH were treated with propranolol (oral) for 2-12months (mean: 7.1months). Clinical regression (attenuation of color and reduction in size) was observed in 88% during the first days of treatment. Partial recurrence was observed during follow-up in a patient treated for 6months. On Doppler ultrasonography, during the first 6months of treatment lesion volume and vascular density decreased while the arterial resistivity index (RI) increased, followed by a decline. Propranolol at 3mg/kg/day was clinically and radiologically efficacious against deep IH in the proliferative stage, with no recurrence in patients treated for 12months. RI might help determine when treatment can be safely interrupted.

Review of the Treatment of Periocular Infantile Hemangiomas With Beta Blockers.

International Ophthalmology Clinics 57(1):p 169-176, Winter 2017. | DOI: 10.1097/IIO.0000000000000147

Beta Blockers in the Treatment of Periocular Infantile Hemangiomas: A Review.

Infantile hemangiomas (IH) are the most common benign tumor of infancy, and in the periocular region can be associated with permanent visual impairment from amblyopia. Previous treatment options included systemic and local corticosteroids, surgical excision, laser therapy, and in rare cases immunomodulatory therapy, many of which had variable outcomes with undesirable side effect profiles. Since their initial use for IH in 2008, beta blockers have become the mainstay of therapy for periocular IH due to their excellent clinical efficacy and tolerability. While the exact mechanism of action of beta blockers in IH has not been fully elucidated, both oral and topical therapy have demonstrated low rates of adverse events and improved outcomes in the management of periocular IH. This review summarizes the most recent studies on the clinical outcomes, management, and guidelines for the treatment of periocular IH with topical and oral beta blockers.

Alternative treatment modality for periocular infantile hemangioma

Background: Capillary hemangiomas are the most common tumors of the eyelids and orbit in children. They typically appear at or shortly after birth, with approximately 90% being clinically obvious by 2 months of age. Complications include functional sequelae like anisometropia, amblyopia, visual axis impairment; cosmetic sequelae like scarring, ulceration, bleeding, displacement of the globe, proptosis and even optic nerve compression. Therapeutic options include corticosteroids, beta-blockers, pulse dye laser, topical imiquimod, interferon-α, vincristine, cyclophosphamide and surgery. Aim: The aim of our study is to investigate the efficacy of intralesional triamcinolone and combination of intralesional triamcinolone with topical timolol in treatment of periocular infantile hemangioma & its recurrence. Method: This prospective study was performed in 24 patients with periocular hemangiomas requiring intervention. Patients were arranged in two groups: Triamcinolone acetonide intralesional injection alone & combination of triamcinolone acetonide intralesional injection with timolol maleate local application. Patients were followed up for three months. The size of the hemangioma was measured in mm2. Result: In Group 1, 66.66% of patients showed good response while in group 2, 88.89% of patients showed good response. Group 2 showed less recurrence rate than group 1. None of the patients developed local side effects during or after injection. Conclusion: Beta blocker and intralesional steroid both are relatively safe and effective for the periocular capillary hemangioma. Beta blocker with intralesional steroid has less chances of recurrence than beta blocker and steroid alone. Keywords: Infantile hemangioma, Triamcinolone acetonide, Timolol maleate.

Treatment of Periocular Infantile Hemangiomas with Propranolol: Case Series of 18 Children

To study the efficacy of propranolol in the treatment of periocular infantile hemangiomas (IHs). Retrospective interventional case series. Eighteen children presenting periocular IH with occlusion of the pupil, anisometropic astigmatism, proliferating eyelid IH, or cosmetically disfiguring periocular IH. All patients received treatment with propranolol started at 0.5 mg/kg/day with an incremental increase by 0.5 mg/kg/day every 4 days, up to a maximum of 2 to 3 mg/kg/day. Complete eye examinations and serial photographs were obtained before, during, and after treatment. Doppler ultrasound and magnetic resonance imaging performed pre- and post-treatment were compared when available. Evolution of the treated IH was evaluated with respect to astigmatism, amblyopia, and size of the lesion. The IH size decreased in 17 of 18 patients. We noted a greater reduction when treatment was administered during the proliferative phase of growth of IHs. At the conclusion of treatment, none of our patients had amblyopia. The mean value of amblyogenic astigmatism (n = 7) decreased from 2.71 diopters (D) pretreatment to 1.03 D post-treatment. On radiology, 8 patients had significant regression of the lesion size of their IH and 1 patient had a limited progression. Propranolol had to be temporarily discontinued in only 1 patient because of symptomatic hypotension. Propranolol seems to be an effective modality of treatment for periocular IH. It seems to be most efficacious when initiated in the proliferative phase of IH but may be beneficial even in the later stage. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Outpatient treatment of periocular infantile hemangiomas with oral propranolol

Outpatient treatment of periocular infantile hemangiomas with oral propranolol

Outpatient treatment of periocular infantile hemangiomas with oral propranolol

Propranolol has recently been reported to be useful in the treatment of infantile hemangiomas. However, there are still many questions regarding the dosage, duration, and method of delivery. In this retrospective, observational case series, all patients had complete eye examinations and were found to have vision-threatening hemangiomas. All patients had a baseline electrocardiogram. Outpatient, oral propranolol therapy was initiated between 3 weeks and 12 months of age. The dosage was slowly increased to 2 mg/kg daily over the course of 1-2 weeks. Response to therapy was deemed "excellent" (>50% reduction in size), "good" (decreased size but <50%), "fair" (no further growth), or "poor" (continued growth or intolerable adverse effects). A total of 17 patients were treated with oral therapy. Of these, 10 had excellent results, 6 had a good response, 1 fair, and none poor. Mild adverse effects were noted in 6 of the 17 patients and included the following: increased gastric reflux lasting 1 week, intermittent fatigue during the first 2 weeks, gastrointestinal upset, and slight "shakiness" with a missed dose. No symptoms were severe enough to discontinue treatment. All families were satisfied with the treatment. Outpatient propranolol treatment reduced the size or stopped the growth of all hemangiomas treated, with excellent response in more than half of all patients treated and only minor side effects. Although this is a small initial series, we are encouraged with the efficacy of this treatment modality in comparison with other currently available treatment options.

Evaluation of new treatment of periocular infantile hemangioma

Evaluation of new treatment of periocular infantile hemangioma