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Das S, Tiple S, Kimmatkar P, Muralidhara A, Nehashree, Mehta A, Patidar N, Jain E. Treatment outcomes of oral propranolol in the treatment of periocular infantile capillary hemangioma and factors predictive of recurrence and incomplete resolution: A multi-centric study. Oman J Ophthalmol 2023; 16:75-81. [PMID: 37007245 PMCID: PMC10062112 DOI: 10.4103/ojo.ojo_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 09/06/2022] [Accepted: 12/10/2022] [Indexed: 02/23/2023] Open
Abstract
AIM This study aims to evaluate the treatment outcomes of periocular capillary hemangioma with oral propranolol (OP) and list the factors predictive of recurrence and incomplete resolution after treatment. METHODOLOGY Data were collected by retrospective review of medical files of patients with infantile hemangioma (IH) treated with OP during January 2014-December 2019 from two tertiary eye institutes from India. Patients presenting with symptoms of IH with/without any history of prior treatment were included. All patients were started on OP with the dose of 2-2.5 mg/Kg body weight and continued till complete resolution or till the lesion reached a plateau response. Details about the ophthalmic examination at each visit and availability of imaging findings were noted down from the records. Primary outcome: Study the treatment outcome of patients treated with OP and discussed our observations regarding factors that may predict nonresponse, poor response, or recurrence. Secondary outcome: complications/side effects of therapy. Response to treatment was judged as fair, good, and excellent depending on resolution <50%, >50%, and complete resolution, respectively. Univariate analysis of factors related to treatment response was judged as fair, good, and excellent depending on resolution <50%, >50%, outcome and recurrence was studied using Mann-Whitney U test and Fisher's exact test. RESULTS A total of 28 patients were included in the study, out of which 17 were female and 11 were male. The mean age of onset of the lesion was 1.08 (± 1.484) months, 11 being congenital in origin. The mean age at presentation was 4.15 (± 2.92) months. 46.43% (n = 13) of patients showed complete resolution, while 25% (n = 7) showed more than 50% reduction in lesion size. Fair response was noted in 28.57% (n = 8). The mean duration of follow-up after stopping OP was 17.7 (± 20.774) months. The recurrence rate noted was 14.28%. The factors which were associated with incomplete resolution were age at presentation >3 months, later age of appearance of the lesion, superficial lesions with no orbital involvement. Male gender and congenital lesions responded best to OP therapy. Minor complications were noted with a rate of 25% (n = 7). Younger age at presentation was more commonly associated with complications. CONCLUSION OP is a safe and effective treatment for capillary hemangioma except for a smaller subset of patients who show suboptimal response to this drug. However, specific factors responsible for suboptimal response or recurrence after OP therapy remain elusive. Although not statistically significant, there was an increasing trend toward higher age at presentation, low birth weight, and superficial lesions with a poorer response. Furthermore, these factors along with the male gender were commonly associated with recurrence in our series. Larger prospective studies focused on evaluating clinical factors responsible for incomplete resolution and recurrence will help in prognosticating and suggesting alternative treatment regimes.
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Abstract
Orbital hemangiomas are the most common primary neoplasm of the orbit and manifest as two distinct pathologic entities: infantile hemangiomas and cavernous hemangiomas. In this article, both infantile and cavernous hemangiomas are reviewed, with special attention paid to the natural history, clinical presentation, and management teams and approaches involved. An example case of each type of hemangioma is presented along with pearls and tips a reader can take away after reading this article.
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Affiliation(s)
- Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Hutchinson AK, Kraker RT, Pineles SL, VanderVeen DK, Wilson LB, Galvin JA, Lambert SR. The Use of β-Blockers for the Treatment of Periocular Hemangiomas in Infants: A Report by the American Academy of Ophthalmology. Ophthalmology 2018; 126:146-155. [PMID: 30075202 DOI: 10.1016/j.ophtha.2018.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 07/27/2018] [Accepted: 07/27/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To review the published literature assessing the efficacy of β-blockers for the treatment of periocular hemangioma in infants. METHODS Literature searches were conducted in May 2018 in PubMed with no date restrictions and limited to studies published in English and in the Cochrane Library database without any restrictions. The combined searches yielded 437 citations. Of these,16 articles were deemed appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist. RESULTS None of the 16 studies included in this assessment were rated level I, 3 were rated level II, and 13 were rated level III. The most common treatment regimen was 2 mg/kg daily oral propranolol, but intralesional and topical β-blockers were also used. Treatment effect was most often measured in terms of reduction in the size of the lesions, which occurred in the majority of patients. β-Blockers were consistently shown to reduce astigmatism, but this reduction was shown to be statistically significant in only 2 series. The effect of β-blockers on amblyopia was not adequately documented. β-Blockers were generally well tolerated and had mild side effects (fatigue, gastrointestinal upset/diarrhea, restlessness/sleep disturbances, minor wheezing, and cold extremities). Complications severe enough to require cessation of treatment occurred in only 2 patients out of a total of 229 who received β-blockers. CONCLUSIONS There is limited evidence to support the safety and efficacy of both topical and systemic β-blockers to promote regression of periocular hemangiomas. Additional research may confirm the best dosage and route of administration to maximize efficacy in reducing induced astigmatism and amblyopia associated with periocular hemangiomas while minimizing side effects.
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Affiliation(s)
- Amy K Hutchinson
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lorri B Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Jennifer A Galvin
- Eye Surgery Associates, LLC, and Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Robertson SA, Kimble RM, Storey KJ, Gee Kee EL, Stockton KA. 3D photography is a reliable method of measuring infantile haemangioma volume over time. J Pediatr Surg 2016; 51:1552-6. [PMID: 27179423 DOI: 10.1016/j.jpedsurg.2016.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Infantile haemangiomas are common lesions of infancy. With the development of novel treatments utilised to accelerate their regression, there is a need for a method of assessing these lesions over time. Volume is an ideal assessment method because of its quantifiable nature. This study investigated whether 3D photography is a valid tool for measuring the volume of infantile haemangiomas over time. METHOD Thirteen children with infantile haemangiomas presenting to the Vascular Anomalies Clinic, Royal Children's Hospital/Lady Cilento Children's Hospital treated with propranolol were included in the study. Lesion volume was assessed using 3D photography at presentation, one month and three months follow up. Intrarater reliability was determined by retracing all images several months after the initial mapping. Interrater reliability of the 3D camera software was determined by two investigators, blinded to each other's results, independently assessing infantile haemangioma volume. RESULTS Lesion volume decreased significantly between presentation and three-month follow-up (p<0.001). Volume intra- and interrater reliability were excellent with ICC 0.991 (95% CI 0.982, 0.995) and 0.978 (95% CI 0.955, 0.989), respectively. CONCLUSION This study demonstrates images taken with the 3D LifeViz™ camera and lesion volume calculated with Dermapix® software is a reliable method for assessing infantile haemangioma volume over time.
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Affiliation(s)
| | - Roy M Kimble
- Centre for Children's Health Research, Brisbane, Australia; Lady Cilento Children's Hospital, Brisbane, Australia.
| | | | - Emma L Gee Kee
- Centre for Children's Health Research, Brisbane, Australia.
| | - Kellie A Stockton
- Centre for Children's Health Research, Brisbane, Australia; Physiotherapy, Bond Institute of Health & Sport, Bond University, Gold Coast, Australia.
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Frommelt P, Juern A, Siegel D, Holland K, Seefeldt M, Yu J, Uhing M, Wade K, Drolet B. Adverse Events in Young and Preterm Infants Receiving Topical Timolol for Infantile Hemangioma. Pediatr Dermatol 2016; 33:405-14. [PMID: 27246751 DOI: 10.1111/pde.12869] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The success of oral propranolol for treatment of infantile hemangiomas (IHs) has led practitioners to use topical β-blockers. In preterm infants, clinicians frequently turn to topical timolol, with the presumption that topical application will result in less systemic absorption. We used Holter monitoring to assess for drug-induced bradycardia in high-risk infants. METHODS We retrospectively reviewed the charts of 22 at-risk infants who received a Holter monitor to assess for association between timolol administration and development of significant bradycardia. RESULTS Four infants had episodic bradycardia detected by Holter monitoring. Two of these infants were full term; weighed more than 3,000 g; and had rare, brief, asymptomatic episodes unrelated to the timing of the timolol application. The other two infants had symptomatic bradycardia while on timolol and were the only two babies that weighed less than 2,500 g at initiation of therapy. Both were young (postmenstrual age [PMA] 34 and 37 wks) at initiation and had a timolol dose above the average exposure for the cohort. CONCLUSION In this cohort of at-risk infants, topical timolol appeared to provide safe treatment for IHs in full-term infants receiving a dose of less than 0.2 mg/kg/day, but infants with a PMA of less than 44 weeks and weight at treatment initiation of less than 2,500 g may be at risk of adverse events, including bradycardia, hypotension, apnea, and hypothermia. We recommend close monitoring of temperature, blood pressure, and heart rate in premature and low-birthweight infants with IHs at initiation of and during therapy with topical timolol.
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Affiliation(s)
- Peter Frommelt
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anna Juern
- Department of Dermatology , Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dawn Siegel
- Department of Dermatology , Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kristen Holland
- Department of Dermatology , Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - JiaDe Yu
- Department of Dermatology , Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Uhing
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kelly Wade
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beth Drolet
- Department of Dermatology , Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Propranolol versus corticosteroids: what should be the treatment of choice in infantile hemangiomas? Ann Plast Surg 2015; 74:237-41. [PMID: 24051459 DOI: 10.1097/sap.0b013e318299cd4e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infantile hemangiomas (IHs) are common and benign vascular tumors and usually involute spontaneously. Nevertheless, in some cases, treatment with systemic corticosteroids or propranolol is required. No randomized controlled studies, in which both treatment options were compared, have been performed. METHODS A systematic literature review and a retrospective cohort study in the Academic Medical Centre of 56 patients (mean age, 5.5 months; range, 0-40 months; SD, 7.6) with IHs were carried out. These patients were treated with either systemic corticosteroids or propranolol. The outcomes of both treatment options were evaluated and compared. RESULTS The literature review showed that propranolol resulted in an involution in 100% of the patients, whereas corticosteroids only reached involution in 89%. The mean first response of the IH to propranolol was 3.2 days and of corticosteroids was 8.5 days. In our study sample, the patients treated with propranolol showed a faster and better response than the patients treated with corticosteroids. This is in line with literature findings. CONCLUSIONS Systemic propranolol treatment is more effective for IHs than systemic corticosteroid treatment. Secondly, propranolol elicits a faster response than corticosteroids.
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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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Abstract
BACKGROUND AND PURPOSE Infantile hemangiomas (IH) often pose a significant risk to visual development. The lesions interfere with visual development by causing deprivation, astigmatism, or strabismus. Propranolol has been suggested as the new standard of care for treatment of IH. Alternative treatments such as intralesional steroids or surgery may need to be considered as equal or better treatments in some cases. The purpose of this study was to evaluate the potential risks and benefits of the various modalities for periocular IH. METHOD A literature search was conducted for IH and propranolol, steroids, and surgery. The pertinent published literature on surgical resection of IH were reviewed and summarized. A retrospective analysis was also performed of the Vanderbilt Children's Hospital (VCH) surgical case series of twelve children who underwent surgical resection of a sight threatening IH. RESULTS Seven articles reported twenty or more patients treated with propranolol for IH. Many of these patients only had a partial response to propranolol in spite of months of treatment. In addition to the impact on IH, propranolol has been demonstrated to block neural pathways critical for learning and memory. Twelve children underwent surgical resection of a visual threatening IH at VCH. Two of these children had failed treatment with oral propranolol. The average time of surgery was 80 minutes. All twelve children had immediate resolution of the visual compromise. CONCLUSION Early surgical intervention can successfully and quickly result in excellent visual and anatomic outcomes. Propranolol may have unrecognized neurocognitive impact and should be reserved for those lesions unamenable to surgical or local steroid injection.
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A clinical update and radiologic review of pediatric orbital and ocular tumors. JOURNAL OF ONCOLOGY 2013; 2013:975908. [PMID: 23577029 PMCID: PMC3610355 DOI: 10.1155/2013/975908] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 01/14/2013] [Accepted: 01/20/2013] [Indexed: 12/15/2022]
Abstract
While pediatric orbital tumors are most often managed in tertiary care centers, clinicians should be aware of the signs of intraocular and orbital neoplasms. In the pediatric population, a delay in diagnosis of orbital and intraocular lesions, even if benign, can lead to vision loss and deformity. Intraocular lesions reviewed are retinoblastoma, medulloepithelioma, and retinal astrocytic hamartoma. Orbital neoplasms reviewed are rhabdomyosarcoma, neuroblastoma metastases, optic pathway glioma, plexiform neurofibroma, leukemia, lymphoprolipherative disease, orbital inflammatory syndrome, dermoid and epidermoid inclusion cysts, and Langerhans' cell histiocytosis. Vascular lesions reviewed are infantile hemangioma and venous lymphatic malformation. In conjunction with clinical examination, high-resolution ophthalmic imaging and radiologic imaging play an important role in making a diagnosis and differentiating between benign and likely malignant processes. The radiologic imaging characteristics of these lesions will be discussed to facilitate prompt diagnosis and treatment. The current treatment modalities and management of tumors will also be reviewed.
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Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE, Chun RH, Garzon MC, Holland KE, Liberman L, MacLellan-Tobert S, Mancini AJ, Metry D, Puttgen KB, Seefeldt M, Sidbury R, Ward KM, Blei F, Baselga E, Cassidy L, Darrow DH, Joachim S, Kwon EKM, Martin K, Perkins J, Siegel DH, Boucek RJ, Frieden IJ. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics 2013; 131:128-40. [PMID: 23266923 PMCID: PMC3529954 DOI: 10.1542/peds.2012-1691] [Citation(s) in RCA: 325] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Infantile hemangiomas (IHs) are common neoplasms composed of proliferating endothelial-like cells. Despite the relative frequency of IH and the potential severity of complications, there are currently no uniform guidelines for treatment. Although propranolol has rapidly been adopted, there is significant uncertainty and divergence of opinion regarding safety monitoring, dose escalation, and its use in PHACE syndrome (PHACE = posterior fossa, hemangioma, arterial lesions, cardiac abnormalities, eye abnormalities; a cutaneous neurovascular syndrome characterized by large, segmental hemangiomas of the head and neck along with congenital anomalies of the brain, heart, eyes and/or chest wall). A consensus conference was held on December 9, 2011. The multidisciplinary team reviewed existing data on the pharmacologic properties of propranolol and all published reports pertaining to the use of propranolol in pediatric patients. Workgroups were assigned specific topics to propose protocols on the following subjects: contraindications, special populations, pretreatment evaluation, dose escalation, and monitoring. Consensus protocols were recorded during the meeting and refined after the meeting. When appropriate, protocol clarifications and revision were made and agreed upon by the group via teleconference. Because of the absence of high-quality clinical research data, evidence-based recommendations are not possible at present. However, the team agreed on a number of recommendations that arose from a review of existing evidence, including when to treat complicated IH; contraindications and pretreatment evaluation protocols; propranolol use in PHACE syndrome; formulation, target dose, and frequency of propranolol; initiation of propranolol in infants; cardiovascular monitoring; ongoing monitoring; and prevention of hypoglycemia. Where there was considerable controversy, the more conservative approach was selected. We acknowledge that the recommendations are conservative in nature and anticipate that they will be revised as more data are made available.
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Affiliation(s)
| | | | - Sarah L. Chamlin
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Anita Haggstrom
- Departments of Dermatology and Pediatrics, Indiana University, Indianapolis, Indiana
| | - Nancy M. Bauman
- Department of Otolaryngology, Children’s National Medical Center, Washington, District of Columbia
| | | | | | | | | | | | | | - Anthony J. Mancini
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | | | - Marcia Seefeldt
- Department of Dermatology, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Robert Sidbury
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Kendra M. Ward
- Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Francine Blei
- Departments of Hematology & Oncology, Vascular Birthmark Institute of New York, New York, New York
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Laura Cassidy
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David H. Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia; and
| | | | | | | | | | | | - Robert J. Boucek
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Ilona J. Frieden
- Departments of Dermatology & Pediatrics, University of California San Francisco, San Francisco, California
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Betlloch-Mas I, Martínez-Miravete M, Lucas-Costa A, Martin de Lara A, Selva-Otalaurruchi J. Outpatient Treatment of Infantile Hemangiomas With Propranolol: A Prospective Study. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Murthy GJ, Goswami M. Management of adult onset orbital hemangioma by oral propranalol: a case report. Orbit 2012; 31:373-5. [PMID: 22877318 DOI: 10.3109/01676830.2012.711891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adult hemangiomas are usually benign vascular tumors presenting as painless progressive proptosis, sometimes accompanied by serious visual loss due to compression of the optic nerve. The current treatment modality for these hemangiomas is excision through orbitotomy. However, this may be associated with potentially serious side effects like injury to optic nerve, double vision, squint and ptosis. Many reports have been published demonstrating the impressive effect of systemic propranolol in the management of infantile hemangiomas. We report the successful use of systemic propranolol in a 56-year-old lady who had an extraconal apical orbital hemangioma, compressing the optic nerve. To our knowledge, this is the first reported case of adult onset hemangioma, resolving almost completely with oral propranolol treatment.
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Affiliation(s)
- Gowri Jayadev Murthy
- Glaucoma and Cataract Service, Prabha Eye Clinic and Research Centre, Bangalore, India
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Betlloch-Mas I, Martínez-Miravete MT, Lucas-Costa A, Martin de Lara AI, Selva-Otalaurruchi J. Outpatient treatment of infantile hemangiomas with propranolol: a prospective study. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:806-15. [PMID: 22727954 DOI: 10.1016/j.ad.2012.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/08/2012] [Accepted: 01/15/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of oral propranolol (OP) in the treatment of infantile hemangiomas. MATERIAL AND METHOD We conducted a prospective study of infantile hemangiomas (IHs) treated with oral propranolol between October 2008 and March 2011. We included fast-growing IHs in the proliferative phase, IHs affecting vital structures, ulcerated IHs, and IHs that could cause functional or aesthetic problems after the proliferative phase. The patients received oral propranolol 2mg/kg/d and were monitored on an outpatient basis. Response to treatment was assessed by volume reduction, lightening of color, improvement of symptoms, and parent satisfaction. Time of initial and peak response, as well as side effects and sequelae, were recorded. RESULTS We analyzed 20 IHs, corresponding to 17 girls and 3 boys. The main sites of involvement were around the eyes (20%), the nose (15%), the neck (15%), and the trunk (15%). Ninety percent of the hemangiomas were focal and in the proliferative phase. Treatment was started between the ages of 2 and 19 months and the main reason for starting treatment was rapid growth (50% of cases). Initial response was observed in 70% of cases and only in 2 of them it took over a month. Peak response occurred at 3 months. All the IHs responded to treatment; response was excellent in 55% of cases, good in 35%, and minimal in 10%. The following factors were predictive of response: focal IH, proliferative phase, periorbital location, and ulceration. No serious side effects were observed. CONCLUSION Oral propranolol was clinically effective in reducing the volume and color of infantile hemangiomas, although the reduction was not complete and telangiectasia and scarring persisted after treatment. Oral propranolol also proved to be safe for use in outpatients.
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Affiliation(s)
- I Betlloch-Mas
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
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Aletaha M, Salour H, Bagheri A, Raffati N, Amouhashemi N. Successful treatment of orbital hemangioma with propranolol in a 5-year-old girl. Orbit 2012; 31:18-20. [PMID: 22132796 DOI: 10.3109/01676830.2011.604899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a 5-year-old girl, who presented with proptosis due to an orbital capillary hemangioma. After 8 months of treatment with oral propranolol at a dose of 2 mg/kg/day, the mass reduced significantly in size and regrowth was not observed within 20 months of follow-up.
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Affiliation(s)
- Maryam Aletaha
- Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Ophthalmic Research Center, Boostan 9 St. Pasdaran Ave., Tehran, Iran.
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Snir M, Reich U, Siegel R, Zvulunov A, Friling R, Goldenberg-Cohen N, Ron Y, Ben-Amitay D. Refractive and structural changes in infantile periocular capillary haemangioma treated with propranolol. Eye (Lond) 2011; 25:1627-34. [PMID: 21921959 PMCID: PMC3234475 DOI: 10.1038/eye.2011.233] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 07/26/2011] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate the optical and anatomical effects of oral propranolol treatment for infantile periocular capillary haemangioma. METHODS All children diagnosed with infantile capillary haemangioma in 2008-2010 at a tertiary paediatric medical centre underwent comprehensive evaluation, including imaging, by a multidisciplinary team followed by oral propranolol treatment. Clinical follow-up was performed regularly until the lesions disappeared. Main outcome measures included changes in anatomical extraocular extension, refractive sphere and cylindrical power, and spherical equivalent in the involved eye before and after treatment and between the two eyes. RESULTS A total of 30 patients (8 male; mean age at diagnosis, 1.6±2.8 months) participated. The lesions affected the left eye in 53.3% and were located preseptally in 83.3%. Four patients (13.3%) received steroids before propranolol. A treatment dosage of 2 mg/kg per day was started at mean age 5.0±4.5 months, 3.3±4.3 months from disease onset. Side effects occurred in 11 patients and warranted a dose reduction (to 1 mg/kg per day) in 3 and treatment termination in 1. Findings were significant for mean reduction in involved extraocular area (P<0.0001), post-treatment reduction in mean cylindrical power in involved eyes (P=0.02), pre- and post-treatment differences in mean cylindrical power between involved and uninvolved eyes (P=0.02 and P=0.01, respectively), and post-treatment change in absolute values of mean spherical power between involved and uninvolved eyes (P=0.025). CONCLUSIONS Early diagnosis of infantile periocular capillary haemangioma and prompt treatment with propranolol lead to a significant reduction in the involved ocular area, in astigmatism, and prevent ocular/facial disfiguration/deformation, without rebound. Propranolol is recommended as the preferred treatment compared with other accepted therapies.
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Affiliation(s)
- M Snir
- Unit of Pediatric Ophthalmology, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel.
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Reply re: “Propranolol for the Treatment of Orbital Infantile Hemangiomas”. Ophthalmic Plast Reconstr Surg 2011. [DOI: 10.1097/iop.0b013e31822671c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Re: “Propranolol for the Treatment of Orbital Infantile Hemangiomas”. Ophthalmic Plast Reconstr Surg 2011; 27:392; author reply 393. [DOI: 10.1097/iop.0b013e31822671ae] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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