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Margaret E. Phillips, James C. Fleming; Propranolol and Infantile Hemangioma: A Proposed Treatment Protocol. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6752.
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To determine the necessary duration of propranolol treatment in infantile hemangioma.
A retrospective review of infantile hemangioma patients presenting in 2009 and 2010.
A total of nine patients were evaluated for periocular and orbital infantile hemangioma in 2009 and 2010. Propranolol was started on all nine patients, with just one being lost to follow-up. The mean age of the patient at propranolol initiation was 87 days, and treatment was continued for an average of 324 days. Patients were tapered off of propranolol beginning at one year of age, if their hemangioma was stable in size for at least 2 mos. Seven of nine patients had been seen after propranolol cessation, with no recurrence of the hemangioma on follow-up. No adverse side effects were reported with propranolol use. Also, a more detailed analysis will be presented at the conference.
Propranolol is an effective treatment for infantile hemangioma. The dosage, method of delivery, and drug response have been well documented with no outline for the treatment duration. We recommend early propranolol initiation for periocular and orbital infantile hemangiomas, in cases where contraindications do not exist. Propranolol use should continue through the proliferation phase, which persists for at least one year. Beginning at one year of age, a stable size should be documented for two months prior to cessation of the drug. Continuing propranolol beyond this point likely does not yield additional medicinal benefit. The protocol outlined above is constructed from a small, retrospective review. A larger, prospective study is necessary to validate this protocol.
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