The use of propranolol in the treatment of periocular infantile haemangiomas: a review

Abstract

Infantile haemangiomas (IH) are benign vascular tumours characterised by their very rapid growth. Although usually innocuous, periocular IH can cause serious visual loss through induction of strabismic, deprivational or anisometropic astigmatism. Common treatment modalities for these IH include intralesional and systemic oral steroids; however, both treatments are associated with potentially severe side effects. A report was published recently demonstrating the impressive effect of propranolol in the treatment of IH. This exciting finding has provoked a paradigm shift in the management of this condition. So far little has been reported in the specific ophthalmologic literature, although case reports are emerging. This review gives an overview of the recent findings and includes the authors' experience with 10 patients treated with propranol.

Serum concentrations of VEGF and bFGF in the course of propranolol therapy of infantile hemangioma in children: Are we closer to understand the mechanism of action of propranolol on hemangiomas?

“…7,[34][35][36] Visible changes between the 1 st and the 3 rd day of therapy are explained with vasospasms following the reduction of nitric oxide release. 4 In the study group, a change of color or reduction of tension in the 1 st week of treatment was observed in 70% of patients, while at the end of the 1 st month it was noted in over 90% of children.…”

“…35,37,38 Too early or rapid withdrawal may result in recurrence. 29,36 In the study group, the mean duration of the treatment with the full therapeutic dose was 8.7 months. The best results were obtained by comparing the status between the beginning of the drug withdrawal and the pretreatment condition (r = −0.76).…”

Diagnosis and Management of Infantile Hemangioma

“…Numerous case series suggest success not only in controlling the growth and size of the lesion but also in improvement of astigmatism. [302][303][304] Unfortunately, perceived successes with propranolol therapy may, in some cases, lead to delayed ophthalmologic referral for more subtle sequelae, resulting in irreversible changes and limiting treatment alternatives, underscoring the need for early ophthalmologic evaluation.…”

Distribution of Propranolol in Periocular Tissues: A Comparison of Topical and Systemic Administration

“…Although oral propranolol is considered a safe and welltolerated medication even in children, 19 systemic side effects of propranolol in the treatment of CHs have been reported, and careful monitoring of patients with CHs during propranolol therapy is generally required. 13 The results in Fig.…”

“…18 Oral propranolol is more clinically acceptable for periocular CHs than corticosteroid treatments due to the well-known side effects of corticosteroid treatment and effectiveness of propranolol therapy. 19 Currently, propranolol is only administered systemically despite the potential side effects associated with systemic propranolol. There is no generally accepted protocol for CH therapy using oral propranolol, and the dosing regimen is usually based on the clinical experience of physicians.…”