Purpose:
Infantile hemangioma is the most common benign solid tumor of the ocular adnexa of children, causing significant functional and cosmetic deformity, with a 43%-60% incidence of astigmatic or occlusion amblyopia when either the eyelid or orbit is affected. Numerous modalities have been used to treat infantile hemangiomas, but no single uniformly safe, effective local or systemic method has yet been found. Léauté-Labrèze et al recently discovered that propranolol can inhibit growth and cause regression of severe facial infantile hemangioma without serious adverse effects. The purpose of this study is to present a case series of children with periocular infantile hemangioma. We report their outcomes and side effect profile of each patient.
Methods:
A retrospective chart review of children with periocular hemangioma treated with propranolol at the West Virginia University Eye Institute from February 2008 to present was performed. Demographics, treatment outcome and adverse effects were recorded.
Results:
Six infants, ages 2 to 7 months, with complex (superficial & orbital) hemangioma, segmental hemangioma, and isolated orbital hemangioma were treated with propranolol for an average of 8.2 months. There was a significant decrease in the size, color, and firmness of the hemangiomas based on review of serial photographs and clinical measurements. Two patients had evidence of reduction in the size of the lesion based on imaging. One patient experienced temporary hypotension at initiation of propranolol, requiring a slower increment of propranolol dose. There were no episodes of hypoglycemia.
Conclusions:
Propranolol is an effective agent for the treatment of infantile hemangioma with many potential advantages. A pediatric pretherapy evaluation to monitor vital signs and blood glucose levels at initiation, as well as maintaining frequent pediatric follow-ups is essential to minimize any potential adverse effects. As exemplified by our case series, propranolol is highly promising as an alternative pharmacologic agent and may emerge as the preferred treatment for periocular infantile hemangioma.Below shows the effect of 10 months of propranolol treatment.