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Christopher Weller, Ravi Patel, Jason R Mayer, Michael Wilkinson, Ingrid U Scott, Ajay Soni; Current Practice Patterns in the Treatment of Periocular Infantile Hemangiomas.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):139. doi: https://doi.org/.
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To investigate whether the emergence of systemic and topical non-selective beta-blocker therapy has altered the practice patterns of pediatric ophthalmologists when treating infantile hemangiomas in the periocular region.
An anonymous fourteen question survey was constructed using surveymonkey.com. Participants were recruited for voluntary participation through advertisement in an AAPOS newsletter and postings on a pediatric ophthalmology listserv.
A total of 205 fellowship trained pediatric ophthalmologists completed the survey. Respondents chose private (48%), academic (30%), or combination (22%) when asked to characterize their current practice landscape. Most respondents (71%) completed training greater than ten years ago. A majority (81%) noted their approach to the treatment of infantile hemangiomas changed over the past 5 years, with the most common change being the use of non-selective beta blocker therapy as identified by freetext response. For the treatment of non-vision threatening lesions, 43% of respondents selected observation as their preferred intervention, while 24% and 20% identified topical and systemic non-selective beta blocker therapy, respectively. Timolol 0.5% gel was the most commonly preferred topical therapy (38%). When treating vision-threatening lesions, 86% of respondents identified systemic non-selective beta blocker therapy as their preferred intervention. Prior to initiating systemic beta-blocker therapy, 92% utilized a pre-treatment screening protocol, 28% of which included inpatient observation, while only 27% employed a pre-treatment screening protocol prior to initiation of local beta-blocker therapy.
The discovery of non-selective beta-blocker therapy for the treatment of infantile hemangiomas has altered the approach of pediatric ophthalmologists when treating such lesions in the periocular region. A predominant percentage of those polled identified systemic non-selective beta-blocker therapy as their preferred intervention for vision-threatening lesions and employed a pre-treatment screening protocol prior to initiation of therapy. No clear-cut approach to non-vision threating lesions was identified. In such cases, the determination for intervention may be guided by factors not explored in our survey, such as aesthetic concerns or ambylogenic potential; this serves as a potential area for future investigation.
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