Oral Propranolol for Treatment of Periocular Infantile Hemangiomas

Abstract

To evaluate the efficacy and adverse effects of oral propranolol for treatment of periocular infantile hemangioma. Methods: Participants were treated with oral propranolol 3 times daily, with outpatient monitoring of adverse effects. The starting dosage was 0.5 mg/kg/d for 1 week, then 1 mg/kg/d for the following week, then 2 mg/kg/d for the remaining duration of treatment. Serial examinations and external photography documented the size of the hemangiomas. Complete ophthalmic examinations included assessing for amblyopia with cycloplegic refraction and visual diagnostic testing. Amblyopia was treated with part-time occlusion therapy. Results: Nineteen periocular hemangiomas from 17 children (71% girls) were studied. The median age at the start of treatment was 4.5 months (interquartile range, 2.2-5.6 months). The median treatment duration was 6.8 months (interquartile range, 4.1-7.2 months). Treatment with oral propranolol reduced the size of all hemangiomas. Median change in the surface area was 61% (interquartile range, 32%-64%) of the original size. Mild rebound growth that did not necessitate retreatment was found in 2 patients (12%). One patient (6%) experienced a benign episode of bradycardia. Seven patients (41%) had amblyopia. Conclusions: Oral propranolol for treatment of infantile hemangiomas was effective in all patients, with 33% reduction in astigmatism and 39% reduction in surface area. Vision equalized in all but 1 child, who receives ongoing amblyopia therapy. Our results suggest that early treatment with propranolol is remarkably effective in treating and preventing loss of visual acuity associated with periocular infantile hemangiomas.

Treatment of Severe Infantile Hemangiomas With Propranolol: An Evaluation of the Efficacy and Effects of Cardiovascular Parameters in 25 Consecutive Patients

“…However, a few studies reported recurrence of hemangiomas after termination of therapy. 17,18 The recurrence of hemangiomas after propranolol seems to be inversely correlated with age and the duration of treatment. 19,20 In our series none of the patients were younger than 2 months, and we administered propranolol to patients for at least 6 months in all cases, which could explain the absence of recurrence.…”

Safety of Oral Propranolol for the Treatment of Infantile Hemangioma: A Systematic Review

“…Of the 32 events with outcome details, all resolved; 1 specified resolution was after no change in treatment, 8 after dose adjustments/temporary discontinuation (the majority were retitrated to the planned dose), and 12 after early discontinuation of treatment. 27 Bradycardia was reported in ≥5% of patients per article in 7 articles 47,49,50,71,81,84,89 ; all 33 events were considered mild/ not clinically significant, transient, or asymptomatic. Dyme et al 49 observed a significant reduction in HR within 1 hour of propranolol administration (nonsignificant variation observed up to 5 hours).…”

Monitoring propranolol treatment in periocular infantile haemangioma

“…Qualitative approaches have included the use of visual analogue scales to assess the lesion with respect to its colour, size and growth. 8 Imaging with ultrasound, MRI 9 , and photographic surface area measurement 10 have also been used. Ophthalmic quantitative measurements have mainly focused on calculating an amblyogenic astigmatic error from the difference in cylinder power between the affected and unaffected eyes.…”

“…Ophthalmic quantitative measurements have mainly focused on calculating an amblyogenic astigmatic error from the difference in cylinder power between the affected and unaffected eyes. [10][11][12] Where cylinder axis and spherical equivalent are similar, the proposed formula for calculating the amblyogenic risk will have little advantage. However, this will ignore oblique axes induced by the haemangioma (eg patients A, B, and F) as well as over playing the cylinder power significance if the spherical equivalent is similar (eg patient D).…”