1
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Chan K, O T, Broude C, Waner S, Ceisler E, Fay A, Pacicco L, Waner M. Advantages of Early Surgical Management of Periorbital Infantile Hemangiomas. Facial Plast Surg Aesthet Med 2024. [PMID: 38946543 DOI: 10.1089/fpsam.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background: Early evaluation and treatment of periorbital infantile hemangiomas (POIH) were associated with lower rates of ophthalmological complications. Objective: To evaluate age and characteristics associated with improved anisometropic astigmatism (anisoastigmatism) and eye symmetry measured by diopters and a 5-point scale, respectively, in patients with POIH treated with surgical excision. Methods: A retrospective study was performed on patients with POIH. Patient characteristics and eye symmetry were analyzed between patients with resolved and unresolved anisoastigmatism after surgery. Statistical analyses included the Mann-Whitney U tests, chi-square tests, and linear regression models. Results: In total, 54 patients were included (male: 20, female: 34). Upper medial eyelid was the most commonly affected site (resolved: 45%, unresolved: 43%), followed by upper lateral and upper central. Fifty-six percent (31/55) had postoperative resolution of anisoastigmatism, whereas 44% (24/55) did not. Earlier surgical evaluation (median: 4.5 vs. 6.0 months, p = 0.047) and excision (median: 5.0 vs. 12.0 months, p = 0.005) were associated with reversible anisoastigmatism. Good and suboptimal eye symmetry were not associated with earlier surgical excision (median: 6 vs. 6.5 months, p = 0.87). Follow-up ranged from 1 month to 12 years. Conclusion: Earlier surgical excision was associated with reversing anisoastigmatism but was not significant for improving eye symmetry.
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Affiliation(s)
- Kimberly Chan
- Vascular Birthmark Institute of New York, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Teresa O
- Vascular Birthmark Institute of New York, New York, New York, USA
- Department of Otolaryngology-Lenox Hill Hospital & Manhattan Eye, Ear and Throat Hospital, New York, New York, USA
| | - Caroline Broude
- Vascular Birthmark Institute of New York, New York, New York, USA
| | - Stefan Waner
- Department of Mathematics, Hofstra University, Hempstead, New York, USA
| | - Emily Ceisler
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, USA
| | - Aaron Fay
- Vascular Birthmark Institute of New York, New York, New York, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Pacicco
- Vascular Birthmark Institute of New York, New York, New York, USA
| | - Milton Waner
- Vascular Birthmark Institute of New York, New York, New York, USA
- Department of Otolaryngology-Lenox Hill Hospital & Manhattan Eye, Ear and Throat Hospital, New York, New York, USA
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2
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O TMJ, Ceisler E, Broude C, Chan K, Pacicco L, Fay A, Waner M. Distribution and Clinical Characteristics of Periorbital Infantile Hemangiomas. Facial Plast Surg Aesthet Med 2023; 25:172-178. [PMID: 36473202 DOI: 10.1089/fpsam.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Periorbital infantile hemangiomas (POIHs) are associated with a high incidence of visual complications. Objective(s): To analyze the sites of predilection of POIHs and to determine whether certain sites require earlier intervention due to their higher rate of visual complications. Methods: A retrospective case series study was conducted on patients from two tertiary care centers for 25 years. The location of POIHs was determined from clinical photographs, medical records, and radiological studies. The presence or absence of anisometropic astigmatism (anisoastigmatism) and amblyopia was recorded. Data were analyzed using a chi-square test. Results: There were 486 patients, of which 302 patients had ophthalmology evaluations and 245 patients had refractive error data. At presentation, 10% of patients already had amblyopia and 44% had anisoastigmatism. Medial eyelid lesions had the highest risk of developing anisoastigmatism (anisoastigmatism correlates with eyelid position, p = 0.0001). Segmental and upper medial lesions had the highest risk of amblyopia at initial evaluation. Conclusion: The site of POIH is an important indicator for developing clinically significant anisoastigmatism and amblyopia, underlining the need for early ophthalmologic assessment and management.
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Affiliation(s)
- Teresa Min-Jung O
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA
| | - Emily Ceisler
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, USA
| | - Caroline Broude
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA
| | - Kimberly Chan
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA.,College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Lauren Pacicco
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA
| | - Aaron Fay
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Milton Waner
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA
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3
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Lam M, Suh D. Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121939. [PMID: 36553382 PMCID: PMC9777216 DOI: 10.3390/children9121939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.
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Affiliation(s)
- Matthew Lam
- Creighton University School of Medicine Phoenix Regional Campus, Phoenix, AZ 85012, USA
| | - Donny Suh
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA
- Correspondence:
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4
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Jpn J Radiol 2020; 38:287-342. [PMID: 32207066 PMCID: PMC7150662 DOI: 10.1007/s11604-019-00885-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, School of Medicine, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Irumagun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke’s International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke’s International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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5
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese Clinical Practice Guidelines for Vascular Anomalies 2017. J Dermatol 2020; 47:e138-e183. [PMID: 32200557 PMCID: PMC7317503 DOI: 10.1111/1346-8138.15189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety and systematizing treatment, employing evidence‐based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQ) were decided based on the important clinical issues. For document retrieval, key words for published work searches were set for each CQ, and work published from 1980 to the end of September 2014 was searched in PubMed, Cochrane Library and Japana Centra Revuo Medicina databases. The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System technique. A total of 33 CQ were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence‐based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, School of Medicine, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Iruma-gun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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6
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Pediatr Int 2020; 62:257-304. [PMID: 32202048 PMCID: PMC7232443 DOI: 10.1111/ped.14077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Irumagun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke's International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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Zhao J, Huang AH, Rainer BM, Kryatova MS, Eghrari AO, Wang J, Puttgen KB, Cohen BA. Periocular infantile hemangiomas: Characteristics, ocular sequelae, and outcomes. Pediatr Dermatol 2019; 36:830-834. [PMID: 31448460 DOI: 10.1111/pde.13925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify clinical factors associated with complications of periocular infantile hemangioma (IH) and monitor improvement in complication rates post-treatment. METHODS Retrospective cohort study. Eighty-nine patients diagnosed with periocular IH at a pediatric dermatology clinic of a tertiary care center between 2001 and 2013 were included with parental approval. Parents were interviewed by telephone between July and September of 2015, then again in January 2018 to inquire about ophthalmologic follow-up. Electronic medical records were reviewed from January 2001 through January 2018. RESULTS Sixty percent of patients demonstrated ocular sequelae, including astigmatism (33%), visual axis obstruction (29%), nasolacrimal duct obstruction (7%), ptosis (4%), amblyopia (3%), and strabismus (1%). Compared with superficial IH, deep and mixed IH had higher odds, 3.4 (P = 0.025) and 3.8 (P = 0.034), respectively, of developing ocular sequelae. All patients with astigmatism prior to involution of IH received systemic therapy, with a significant post-treatment decrease in the proportion of patients with astigmatism (40% to 18%, P = 0.027). Three-quarters of patients experienced complete IH involution by time of enrollment in kindergarten. Fifty-one (57.3%) patients received formal ophthalmologic evaluation confirmed through chart review or phone interview, with average follow-up duration of 51.2 months (range: 1.9, 99.3). CONCLUSION Deep and mixed IH were more likely to demonstrate ocular complications than superficial IH. Rate of astigmatism decreased with systemic therapy. Our study suggests that patients with periocular IH have a lower rate of amblyopia now compared with the prepropranolol era and emphasizes the importance of early treatment of periocular IH to prevent permanent visual sequelae.
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Affiliation(s)
- Jiawei Zhao
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy H Huang
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara M Rainer
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Maria S Kryatova
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allen O Eghrari
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Katherine B Puttgen
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bernard A Cohen
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Marey HM, Elmazar HF, Mandour SS, Khairy HA. Combined Oral and Topical Beta Blockers for the Treatment of Early Proliferative Superficial Periocular Infantile Capillary Hemangioma. J Pediatr Ophthalmol Strabismus 2018; 55:37-42. [PMID: 28991344 DOI: 10.3928/01913913-20170703-12] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/26/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of combined oral and topical beta blockers for the treatment of superficial periocular infantile hemangioma at the early proliferative stage. METHODS This was a randomized, controlled comparison trial involving 25 patients. Patients were randomly enrolled into two groups: the topical and systemic treatment and systemic treatment only groups. The topical and systemic treatment group was treated with oral propranolol (1 mg/kg per day initially, increased to 2 mg/kg per day gradually in 2 weeks) and timolol maleate 0.5% gel. The systemic treatment only group received oral propranolol (1 mg/kg per day initially, increased to 2 mg/kg per day gradually in 2 weeks) and simple eye ointment to be applied to the lesion. The Hemangioma Activity Score was used to record the proliferative activity of the hemangioma. The main outcomes of the study were the change in the hemangioma size, the proliferative activity, and the treatment side effects. RESULTS At the end of the treatment period, the Hemangioma Activity Score was significantly improved in both groups from their values before treatment. However, the score obtained after treatment was significantly better in the topical and systemic treatment group (P < .05). Regarding the response to treatment, 10 and 3 cases in the topical and systemic treatment and systemic treatment only groups, respectively, showed a good response, with a significant difference between the two groups (P < .50). There were no recorded serious local or systemic complications during treatment in either group. CONCLUSIONS The results from combining topical with oral beta blockers showed that topical beta blockers are of additive value in treating superficial periocular infantile hemangioma in the early proliferative stage. [J Pediatr Ophthalmol Strabismus. 2018;55(1):37-42.].
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9
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Lee JH, Jo SH, Yang JW. Treatment of Periorbital Infantile Capillary Hemangioma with Propranolol. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.5.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Hoo Lee
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Hwan Jo
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Yang
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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10
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Padmanaban S, Sumathi P, Kandoth P, Dharmendra RP. Congenital capillary hemangioma arising from palpebral conjunctiva of a neonate. Indian J Ophthalmol 2017; 65:1221-1223. [PMID: 29133659 PMCID: PMC5700601 DOI: 10.4103/ijo.ijo_487_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Capillary hemangioma is the most common benign vascular eyelid tumor in childhood. The periocular lesion appears within the first few weeks after birth and usually has superficial or deep components. Primary conjunctival capillary hemangiomas are rarely reported. We present the case of a 2-day-old child with a pedunculated capillary hemangioma arising from superior palpebral conjunctiva. A complete surgical excision was performed under general anesthesia, and the child was asymptomatic at follow-up of two months.
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Affiliation(s)
- S Padmanaban
- Department of Ophthalmology, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India
| | - P Sumathi
- Department of Ophthalmology, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India
| | - Prayagi Kandoth
- Department of Ophthalmology, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India
| | - R P Dharmendra
- Department of Paediatric Surgery, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India
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11
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Abstract
Tumors of the Ocular Surface clinically manifest with a very wide spectrum and include several forms of epithelial, stromal, caruncular, and secondary tumors. As a group, these tumors are seen commonly in the clinical practice of a comprehensive ophthalmologist, cornea specialist, and an ocular oncologist. This review is aimed to discuss the common tumors of the ocular surface and emphasize on their clinical diagnosis and appropriate management.
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Affiliation(s)
- Santosh G Honavar
- Department of Ophthalmic Plastic Surgery and Ocular Oncology, Centre for Sight, Hyderabad, India
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12
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Xue L, Sun C, Xu DP, Liu ZM, Wang XK. Clinical Outcomes of Infants With Periorbital Hemangiomas Treated With Oral Propranolol. J Oral Maxillofac Surg 2016; 74:2193-2199. [DOI: 10.1016/j.joms.2016.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
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13
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Léaute-Labrèze C, Boccara O, Degrugillier-Chopinet C, Mazereeuw-Hautier J, Prey S, Lebbé G, Gautier S, Ortis V, Lafon M, Montagne A, Delarue A, Voisard JJ. Safety of Oral Propranolol for the Treatment of Infantile Hemangioma: A Systematic Review. Pediatrics 2016; 138:peds.2016-0353. [PMID: 27688361 DOI: 10.1542/peds.2016-0353] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Given the widespread use of propranolol in infantile hemangioma (IH) it was considered essential to perform a systematic review of its safety. The objectives of this review were to evaluate the safety profile of oral propranolol in the treatment of IH. METHODS We searched Embase and Medline databases (2007-July 2014) and unpublished data from the manufacturer of Hemangiol/Hemangeol (marketed pediatric formulation of oral propranolol; Pierre Fabre Dermatologie, Lavaur, France). Selected studies included ≥10 patients treated with oral propranolol for IH and that either reported ≥1 adverse event or effect (AE) or planned to capture AEs. Data capture was standardized and extracted study design, demographic characteristics, IH characteristics, intervention, and safety outcomes. AEs were assigned a system organ class and preferred term. RESULTS A total of 83 of 398 identified literature records met the inclusion criteria, covering 3766 propranolol-treated patients. The manufacturer's data for 3 pooled clinical trials (435 propranolol-treated patients) and 1 Compassionate Use Program (1661 patients) were included. AE data were reported for 1945 of 5862 propranolol-treated patients. The most frequently reported AEs included a range of sleep disturbances, peripheral coldness, and agitation. The most serious AEs (atrioventricular block, bradycardia, hypotension, bronchospasm/bronchial hyperreactivity, and hypoglycemia-related seizures) were managed by decreasing doses or temporary/permanent discontinuation of propranolol. Limitations included the variety of included study designs; monitoring, collection, and reporting of AE data; small sample sizes for some articles; and the wide scope of review. CONCLUSIONS Oral propranolol is well tolerated if appropriate pretreatment assessments and within-treatment monitoring are performed to exclude patients with contraindications and to minimize serious side effects during treatment.
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Affiliation(s)
- Christine Léaute-Labrèze
- Unité de Dermatologie Pédiatrique et Centre d'Investigation Clinque Pédiatrique 1401, Hôpital Pellegrin-Enfants, Bordeaux, France;
| | - Olivia Boccara
- Service de Dermatologie, Hôpital Necker Enfants Malades, Paris, France
| | - Caroline Degrugillier-Chopinet
- Service Explorations Cardiovasculaires et de Cardiologie Pédiatrique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Juliette Mazereeuw-Hautier
- Service de Dermatologie et Centre de Référence des Maladies Rares de la Peau, Hôpital Larrey, Toulouse, France
| | - Sorilla Prey
- Unité de Dermatologie Pédiatrique et Centre d'Investigation Clinque Pédiatrique 1401, Hôpital Pellegrin-Enfants, Bordeaux, France
| | | | | | | | - Martine Lafon
- Institut de Recherche Pierre Fabre, Toulouse, France; and
| | - Agnès Montagne
- Institut de Recherche Pierre Fabre, Toulouse, France; and
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14
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Fowell C, Monaghan A, Nishikawa H. Infantile haemangiomas of the head and neck: current concepts in management. Br J Oral Maxillofac Surg 2016; 54:488-95. [DOI: 10.1016/j.bjoms.2016.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 02/23/2016] [Indexed: 01/19/2023]
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15
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Abstract
Oral propranolol is now established as the first-line treatment for infantile haemangiomas, and used in up to 20 % of all cases. Propranolol use in infants is most commonly instigated in a controlled environment to monitor for potential serious adverse events such as hypoglycaemia and hypotension. Two test doses are recommended, the first one of 300 μg/kg followed by 2-hourly monitoring. On the subsequent day, a further dose of 650 μg/kg is administered with the same monitoring. A dose of 2 mg/kg divided into three is started from the next day. Parents/carers need to be warned of common adverse effects, of which disturbed sleep is the commonest. Treatment is recommended for up to a year to avoid rebound growth and the need to restart the treatment.
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Affiliation(s)
- Robert H Taylor
- Eye Department, York Hospital, Wigginton Road, York, YO31 8HE, England.
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16
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Abstract
Infantile hemangiomas are a common vascular birthmark with heterogeneous presentations and unique growth characteristics with early rapid growth and eventual self-involution. Hemangiomas that develop around the eye have the potential for inducing amblyopia by several mechanisms and may eventually result in permanent visual impairment in otherwise healthy infants. Segmental periocular hemangiomas carry the additional risk of associated structural anomalies and PHACE syndrome. In recent years, the treatment of periocular hemangiomas has been revolutionized by the serendipitous discovery of the effectiveness of beta-blockers (systemic and topical), with most experts viewing these as first-line therapies. The management of periocular hemangiomas should involve a close partnership between an ophthalmologist and dermatologist or other relevant specialists familiar with the unique clinical features, differential diagnosis, treatment approaches, and potential complications.
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17
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Xu DP, Cao RY, Xue L, Sun NN, Tong S, Wang XK. Treatment of Severe Infantile Hemangiomas With Propranolol: An Evaluation of the Efficacy and Effects of Cardiovascular Parameters in 25 Consecutive Patients. J Oral Maxillofac Surg 2015; 73:430-6. [DOI: 10.1016/j.joms.2014.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 01/17/2023]
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Burne R, Taylor R. Monitoring propranolol treatment in periocular infantile haemangioma. Eye (Lond) 2014; 28:1281-4; quiz 1285. [PMID: 25323853 PMCID: PMC4274300 DOI: 10.1038/eye.2014.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/06/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To develop a tool for assessing amblyopic risk and monitoring the treatment effect of propranolol in periocular haemangioma management. METHODS We present a study of nine children with periocular haemangioma who underwent propranolol treatment at York Hospital between 2009 and 2013.A proposed measure of amblyogenic risk based on the induced anisometropia resulting from a periocular haemangioma was calculated in the form of a single quantitative value, measured in dioptres. This calculation used published work and developed it to produce a new function, termed the delta defocus equivalent (DFE-∂).Refraction measurements were retrospectively collected from patients' notes in order to measure the trend of DFE-∂ over the treatment period with propranolol. RESULTS The average DFE-∂ at commencement of propranolol was 1.54 (±0.62) D. The average at the end of treatment was 0.39 (±0.38) D. CONCLUSION This work presents a possible tool for assessing amblyopic risk in cases of periocular infantile haemangioma. The DFE-∂ gives a measure in dioptres, which may represent the true amblyopic risk, and so be useful in supporting treatment decisions in paediatric ophthalmology.
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Affiliation(s)
- R Burne
- Hull York Medical School, Heslington, York, UK
| | - R Taylor
- Ophthalmology Department, York Hospital, York, UK
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19
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Sethuraman G, Yenamandra VK, Gupta V. Management of infantile hemangiomas: current trends. J Cutan Aesthet Surg 2014; 7:75-85. [PMID: 25136206 PMCID: PMC4134656 DOI: 10.4103/0974-2077.138324] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Infantile hemangiomas (IH) are common vascular tumours. IH have a characteristic natural course. They proliferate rapidly during the early infantile period followed by a period of gradual regression over several years. Most of the uncomplicated IH undergo spontaneous involution, with a small proportion of cases requiring intervention. These are children with IH in life-threatening locations, local complications like haemorrhage, ulceration and necrosis and functional or cosmetic disfigurements. Systemic corticosteroids have been the first line of treatment for many years. Recently, non-selective beta-blockers, such as oral propranalol and topical timolol, have emerged as promising and safer therapies. Other treatment options include interferon α and vincristine which are reserved for life-threatening haemangiomas that are unresponsive to conventional therapy. This review mainly focuses on the current trends and evidence-based approach in the management of IH.
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Affiliation(s)
- Gomathy Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vamsi K Yenamandra
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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20
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Xu S, Jia R, Ge S, Lin M, Fan X. Treatment of periorbital infantile haemangiomas: a systematic literature review on propranolol or steroids. J Paediatr Child Health 2014; 50:271-9. [PMID: 24754793 DOI: 10.1111/jpc.12464] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 12/17/2022]
Abstract
AIM The aim of this study was to compare the efficacy and safety of propranolol versus corticosteroids for the treatment of periorbital infantile haemangiomas (IHs). METHODS A literature review using PubMed, Ovid Medline, EBSCO, Springer, Web of Knowledge, Cochrane Library, CNKI and associated references before 2 March 2013 was conducted. The main outcomes were distribution of locations, response rate, rebound growth rate, spherical and cylinder power before and after treatment, amblyopia rate and adverse events. RESULTS Thirty-one studies including 425 patients met the inclusion criteria. A total of 70.6% of patients were female, 89.6% of the periorbital IHs were located in the upper or lower eyelid area. The most common administration routes involved oral propranolol and intralesional injection of corticosteroids. The mean response rate was 94.0% for propranolol and 82.3% for corticosteroid (P = 0.001). The rebound growth rate was 13.9% for propranolol and 12.0% for steroids (P = 0.71). Astigmatism was reduced in both propranolol and steroid studies (P < 0.0001, P < 0.0001), but a significant reduction in spherical power was only demonstrated in propranolol studies (P = 0.005). A total of 31.1% of patients treated with corticosteroids developed post-operative amblyopia compared with 16.7% of patients treated with propranolol (P = 0.04). Oral propranolol seemed to induce more temporary adverse events than intralesional corticosteroids administration (24.0% vs. 9.6%, P = 0.006). CONCLUSION Propranolol may represent an effective therapy for periorbital IHs compared with the use of corticosteroids; however, further randomised control studies are needed to compare adverse events.
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Affiliation(s)
- Shiqiong Xu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Honavar SG, Manjandavida FP. Recent Advances in Ophthalmic Plastic Surgery: Part 1-Eyelid. Asia Pac J Ophthalmol (Phila) 2013; 2:328-40. [PMID: 26107037 DOI: 10.1097/apo.0000000000000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The objective of this study was to provide an update of the current literature in ophthalmic and facial plastic surgery, specifically related to disorders of the eyelid. DESIGN This was a review of published literature from January 2012 to June 2013 METHODS: The authors conducted a PubMed literature search of English-language articles published between January 2012 and June 2013 using the following search terms: eyelid, congenital, acquired, infection, inflammation, trauma, tumor, ptosis, entropion, ectropion, lagophthalmos, botulinum toxin, fillers, blepharoplasty, and miscellaneous topics related to the disorders of the eyelid. The authors included original articles, review articles, and case reports with relevant new information that is of potential clinical use to a comprehensive ophthalmologist as well as to the subspecialist. RESULTS Current literature on the disorders of the eyelid is replete with useful clinical information of relevance to a practicing ophthalmologist. Major advances have been reported in understanding of the surgical anatomy and its applications, ptosis, entropion, ectropion, lagophthalmos, infection, inflammation, trauma, and tumors. CONCLUSIONS There seems to be tremendous excitement in revisiting the anatomy and pathology and modifying the management protocols and surgical procedures to achieve optimal results, as the subspecialty continues to advance at a brisk pace.
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Affiliation(s)
- Santosh G Honavar
- From the *Department of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Centre for Sight, Hyderabad, India; and †Department of OphthalmicPlastic Surgery, Orbit and Ocular Oncology, C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
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Xu SQ, Jia RB, Zhang W, Zhu H, Ge SF, Fan XQ. Beta-blockers versus corticosteroids in the treatment of infantile hemangioma: an evidence-based systematic review. World J Pediatr 2013; 9:221-9. [PMID: 23929254 DOI: 10.1007/s12519-013-0427-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 05/14/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The efficacy and safety of beta-blockers versus corticosteroids in the treatment of infantile hemangiomas (IHs) is controversial. This study aimed to summarize evidence described in the literature and to assess the quality of studies involving beta-blockers and corticosteroids for the treatment of cutaneous IHs. METHODS Comparative studies were collected from 15 online electronic databases, including OVID Medline, PubMed, ISI Web of Science, CENTRAL, CNKI, ChiCTR, JPCTR, CTRIndia, IranCTR, SLCTR, ISRCTRN, NLCTR, GCTR, ANCTR, ClinicalTrial. gov, and associated references. Studies without a control group were excluded, and the remaining studies were assessed by two reviewers independently using the Downs & Black scale for reported quality. The main areas assessed in the included studies were volume changes, overall improvement in appearance, eye function, and adverse events. RESULTS Ten comparative studies were included with a total of 419 children. A meta-analysis was not performed due to the considerable heterogeneity across studies. Some evidence showed that beta-blockers are superior to steroids in reducing volume and improving the overall appearance of IHs, such as lightening of the color and flattening of the surface. Conclusions regarding improved eye function and adverse events were divided, and no consensus has been reached on the superiority of one treatment over another. No episodes of severe-onset asthma, hypotension, or bradycardia occurred in the beta-blocker treatment due to the rigorous exclusion of patients with contraindications. CONCLUSIONS Available studies indicate that beta-blockers are an alternative option to corticosteroids for IH treatment with respect to volume shrinkage and improvement in appearance. No evidence has shown a significant difference in improved eye function and adverse events between beta-blockers and corticosteroids in the treatment of IH; indeed, there is a lack of well-designed, high-quality randomized control trials.
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Affiliation(s)
- Shi-Qiong Xu
- Department of Ophthalmology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
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Sadykov RR, Podmelle F, Sadykov RA, Kasimova KR, Metellmann HR. Use of propranolol for the treatment infantile hemangiomas in the maxillofacial region. Int J Oral Maxillofac Surg 2013; 42:863-7. [PMID: 23618833 DOI: 10.1016/j.ijom.2013.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/05/2013] [Accepted: 03/18/2013] [Indexed: 11/28/2022]
Abstract
Propranolol has been used successfully in a limited number of children with infantile hemangiomas (IHs). This study describes the efficacy and adverse effects of propranolol in IH. Seventy-one infants with IHs were treated with oral propranolol, administered at a dose of 2 mg/kg/day, for at least 12 weeks. A photograph-based severity scoring assessment was performed by five observers to evaluate efficacy, utilizing a score of 10 as the original IHs before treatment and 0 as completely normal skin. The mean of the five independent measurements was used in the analysis. Propranolol was a rapid and effective treatment for IHs at 4 weeks (P<0.001), at 8 weeks (P<0.001 compared with the value at 4 weeks), at 12 weeks (P<0.05 compared with the value at 8 weeks), and thereafter up to 32 weeks (P<0.01 compared with the value at 16 weeks). The response of IHs to propranolol was similar regardless of gender, age at the onset of treatment, type of involvement (local and extended), facial segments affected, special locations (eyelid, nasal tip, and parotid regions), ulceration, and depth of IHs. In the series of patients in this study, oral propranolol at a dosage of 2 mg/kg/day was a well-tolerated and effective treatment for IHs.
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Affiliation(s)
- R R Sadykov
- Department of General Surgery with Plastic Operations, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
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Chu MB, Searcy G, Siegfried E. Efficacy of topical brimonidine-timolol for haemangioma of infancy and perils of off-label prescribing. BMJ Case Rep 2013; 2013:bcr2013009365. [PMID: 23598940 PMCID: PMC3645229 DOI: 10.1136/bcr-2013-009365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report three patients with superficial haemangiomas treated topically with Combigan ophthalmic solution (brimonidine 0.2%-timolol 0.5%), a combination selective α-2-adrenergic agonist and non-selective β-blocker Food and Drug Administration-approved for use in glaucoma. Topical brimonidine 0.2%-timolol 0.5% therapy improved the appearance of haemangiomas in all the cases. Two patients did not experience any adverse effects. One patient had hypothermic episodes which were initially thought to be because of brimonidine 0.2%-timolol 0.5% therapy. However, an episode occurred a few weeks after discontinuation and brimonidine 0.2%-timolol 0.5% therapy was ruled out as a cause. Despite the benefit, off-label use of brimonidine 0.2%-timolol 0.5% therapy served as a pitfall in the evaluation of an unusual constellation of worrisome symptoms. In conclusion, brimonidine 0.2%-timolol 0.5% therapy is a promising alternative in the topical treatment of haemangiomas. It may have synergistic effects and increased efficacy by targeting haemangiomas via two mechanisms (α-agonism and β-inhibition), but the risk of unforeseen adverse effects must always be considered when prescribing off-label treatment, especially in infants.
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Affiliation(s)
- Melinda B Chu
- Department of Dermatology, St Louis University, St Louis, Missouri, USA.
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