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Ashima V. Kumar, Ramanath Bhandari, Lauren Yeager, James Deutsch, Monica Dweck, Douglas R. Lazzaro, Baljeet Purewal; Capillary Hemangioma, Is Propranolol The Treatment Of Choice?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1590.
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To evaluate the efficacy of systemic administration of propranolol, a non-selective β-blocker, in the treatment of capillary hemangioma in the proliferative and involutional stages.
A retrospective case series of three cases (2 proliferative, 1 involutional) in which propranolol was used as initial therapy for infantile periocular and orbital capillary hemangioma is presented. Patients were selected for treatment based on astigmatism greater that 1.50 D or threatened sensory deprivation amblyopia. A target dose of 2 mg/kilogram of propranolol was achieved in infants while monitoring the children for systemic side effects. Reduction of astigmatism as measured by cycloplegic refraction and reduction of tumor mass as measured by MRI and clinical exam were the target end points.
Propranolol decreased tumor mass by greater than 1 cm in all cases reviewed. The treatement was effective in patients in the proliferative and involutional stages. In addition, cycloplegic refraction revealed a reduction in astigmatism of >1.50 D over the first 6 months of treatment. All patients tolerated systemic administration of propranolol without any adverse effects.
In this small case series, propranolol was well tolerated, despite its documented potential adverse effects and resulted in complete resolution of the capillary hemangioma without the associated side-effects of intralesional or systemic steroid administration. We report the first case in which systemic administration of propranolol is effective in the treatment of capillary hemangioma in the involutional stage. A larger randomized prospective trial is required to establish the role of non-selective beta-blockers as compared to intralesional and systemic steroids.
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