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Arpine Barsegian, Nora Silverman, Roman Shinder; Ocular Pyogenic Granulomas Treated with Topical Timolol. Invest. Ophthalmol. Vis. Sci. 2018;59(9):92.
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© ARVO (1962-2015); The Authors (2016-present)
Pyogenic granulomas (PG) are common acquired benign vascular lesions that occur on cutaneous and mucosal surfaces. Ocular PG develop as a sequela of inflammation from ophthalmic surgery, trauma or chalazia. They can cause foreign body sensation, spontaneously bleed, or be cosmetically bothersome. Treatment options include topical steroids, excision, cryotherapy, electrocautery and laser ablation. Recent reports have revealed that timolol, a non-selective ß-blocker, may be an alternative, non-invasive treatment option. Here we report our experience in treating ocular PG with topical timolol.
Retrospective interventional study of 17 consecutive patients with ocular PG who were treated with topical 0.5% timolol given twice daily between 7/2010 and 10/2016. All patients were followed weekly with serial exams, measurement and photography. Treatment was aborted after 6 weeks if resolution was not noted and surgical excision was undertaken. Exclusion criteria included: pregnancy, recurrent disease on presentation or follow-up < 6 months.
A summary of patient data is illustrated in Figure 1. Nine females and 8 males had a mean age of 23 years (range, 3-67). Mean duration of disease was 3.81 months (range, 0.25-11). Fifteen (88%) lesions were located on the palpebral conjunctiva, while 2 (12%) involved the bulbar conjunctiva. Fifteen (88%) patients had lesion resolution (Fig 2) with a mean treatment duration of 3.07 weeks (range, 2-5). Two (12%) patients underwent excision after 6 weeks of timolol treatment failed to yield resolution. Of the 15 patients who showed resolution on timolol, there were no recurrences noted with a mean follow up of 9.47 months (range, 6-27). No patients experienced adverse events of timolol during treatment.
Topical timolol appears to be a safe and effective non-surgical treatment of ocular PG in both children and adults. The authors believe this to be the largest series of PG treated with timolol to date. Similar to their known success in the treatment of vascular infantile hemangiomas, ß-blockers may cause vasoconstriction within ocular PG and inhibit vascular growth factors and induce apoptosis. Clinicians may wish to consider its use as a first line agent rather than topical steroids, given their inherent risk of ocular hypertension and glaucoma, or surgical excision. Future studies using controls may prove timolol to be the preferred treatment for ocular PG.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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