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Bentivegna K, Saba NJ, Shinder R, Grant-Kels JM. Ocular and orbital tumors in childhood. Clin Dermatol 2024; 42:396-405. [PMID: 38301859 DOI: 10.1016/j.clindermatol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Pediatric tumors of the eye and orbit can be benign or malignant as well as congenital or acquired and are usually distinctively different than those seen in adults. Although most of these neoplasms are benign (eg, dermoid cyst, chalazion, molluscum), their location near and within a vital organ can result in serious dermatologic and ophthalmologic sequelae. Lesions discussed include vascular lesions, retinoblastomas (the most common primary pediatric intraocular malignancy), rhabdomyosarcoma (the most common primary pediatric orbital malignancy), Langerhans cell histiocytosis, and metastatic lesions to the orbit (neuroblastoma, Ewing sarcoma). Although cysts and ocular melanoma can occur within the pediatric population, these conditions are covered in other contributions in this issue of Clinics in Dermatology.
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Affiliation(s)
- Kathryn Bentivegna
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nicholas J Saba
- Department of Ophthalmology, SUNY Downstate, Brooklyn, New York, USA
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate, Brooklyn, New York, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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Ghahvehchian H, Kashkouli MB, Ghanbari S, Karimi N, Abdolalizadeh P, Abri Aghdam K. Long-Term Results of Oral Propranolol Treatment Protocol for Periocular Infantile Hemangioma: Should There Be Any Contraindication? Ophthalmic Plast Reconstr Surg 2024; 40:61-69. [PMID: 38241619 DOI: 10.1097/iop.0000000000002507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE The authors report long-term results of the oral propranolol treatment protocol for periocular infantile hemangioma regardless of conventional indications. METHODS This is a retrospective study (2008-2018) on children with propranolol treatment protocol for periocular infantile hemangioma and last follow-up (FU) of ≥4 months after treatment and age of >24 months. After systemic evaluation, it was started with 0.5 and increased by 0.5 every 3 days to reach 2 mg/kg/day. If there was no good response, it would be gradually increased up to 3 mg/kg/day. Tapering (0.5 mg/kg/day every 4 weeks) was started when patients were on treatment for ≥6 months and ≥12 months old and there was no change in the infantile hemangioma size for ≥3 months. Rebound growth was based on the parents' report and would be treated by increasing the dose to at least 2 mg/kg/day for 3 months. FU was either in-person or via social media. Change in periocular infantile hemangioma size on the photos was scored by 3 masked observers (visual analog scale) and presented as excellent (≥50% reduction), good (1%-49%), fair (no change), and failure (enlarged). RESULTS Forty-three patients were included. Orbital involvement was in 49%, ptosis in 58%, and risk of amblyopia in 63%. Mean treatment, tapering, and FU duration were 37, 13, and 74 months, respectively. Mean age at presentation, start of propranolol treatment protocol, tapering, stop, and last FU were 1.5, 5, 29, 42, and 78 months, respectively. Twenty-seven patients received 2, seven 2.5, and nine 3 mg/kg/day. Mean visual analog scale significantly increased from 43% (FU1) to 92% (last FU) when 97.6% of patients showed an excellent response. The remaining skin lesions were observed in 35%. No side effect was reported. CONCLUSIONS Long-term results of the propranolol treatment protocol for periocular infantile hemangioma showed an excellent response in 97.6% of patients with no side effects. A residual skin lesion was observed in 1/3 of the patient.
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Affiliation(s)
- Hossein Ghahvehchian
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
| | - Shaghayegh Ghanbari
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nasser Karimi
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Department of Ophthalmology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Kaveh Abri Aghdam
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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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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Analysis of Therapeutic Decisions for Infantile Hemangiomas: A Prospective Study Comparing the Hemangioma Severity Scale with the Infantile Hemangioma Referral Score. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121851. [PMID: 36553295 PMCID: PMC9777170 DOI: 10.3390/children9121851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND In view of the high incidence of infantile hemangioma (IH) in infants and young children, a comprehensive and reasonable evaluation scale for referral is urgently needed. This study compared the influence of the Hemangioma Severity Scale (HSS) and the Infantile Hemangioma Referral Score (IHReS) on treatment decisions for infantile hemangioma patients. OBJECTIVE We aimed to establish a reliable and effective evaluation method for referral. METHODS This was a prospective study to determine whether treatment was needed for IH patients after evaluation with the HSS and IHReS. RESULTS A total of 266 consecutive referred IH patients were evaluated for the risk of IH, and the treatment rate was 80.8%. The area under the curve (AUC) of the subject receiver operating characteristic curve (ROC) of treatment decision making after referral by the HSS was 0.703 (95% CI: 0.634-0.772), and after referral by the IHReS was 0.892 (95% CI: 0.824-0.960). LIMITATIONS This was a single-center study. CONCLUSIONS For decisions regarding the treatment of IH patients, the IHReS has a higher efficiency and sensitivity than the HSS. However, the specificity of the IHReS is lower than that of the HSS.
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Comprehensive Management of Infantile Hemangiomas Involving the Periorbital Region. Ann Plast Surg 2022; 89:391-394. [PMID: 36149979 DOI: 10.1097/sap.0000000000003272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
ABSTRACT Periocular infantile hemangioma (pIH) is associated with a risk of vision loss and requires urgent medical intervention. We evaluated the outcomes of the comprehensive management of 44 pIH patients (aged 2-6 months) with superficial (n = 11), deep (n = 15), and mixed (n = 18) subtypes, treated with a standard propranolol dose (2 mg kg -1 d -1 ) without any obvious side effects. Obvious and slight improvements were observed in 70.5% and 29.5% of patients, respectively. Obvious improvement was found in 96.3% of patients 3 months or younger but only 29.4% of patients older than 3 months ( P = 0.036) after 4 weeks of treatment. Thirteen patients demonstrated slight improvement and were treated with an increased propranolol dose (3 mg kg -1 d -1 ) in combination with corticosteroid injections or plastic surgery, which led to good outcomes. The patients were followed up for 12 to 18 months, with no cases of amblyopia or ametropia. Oral propranolol was effective in the treatment of pIH. Earlier propranolol use was associated with better outcomes. An increased propranolol dose combined with corticosteroid injections or plastic surgery is appropriate for patients with propranolol resistance.
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Sun LM, Xu Y, Xu MN, Wang M, Su Y, Yuan SM. Diagnosis and treatment of periorbital infantile hemangiomas: Case series and literature review. Int J Pediatr Otorhinolaryngol 2020; 136:110157. [PMID: 32544638 DOI: 10.1016/j.ijporl.2020.110157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Infantile hemangiomas (IHs) are the most common benign tumor in infancy. Periorbital IHs may lead to visual dysplasia so prompt and effective treatment should be adopted. In this study, we retrospectively analyzed the diagnosis and treatment of periorbital IHs treated in our clinic and give the strategy for clinical practice. METHODS From Jan. 2006 to Dec. 2018, 35 patients with periorbital IHs were enrolled into this study, including 13 males. The initial age of treatment ranged from 0.6 to 7 months. The clinical manifestations, imaging examination results, treatment measures and follow-up results were analyzed. Then diagnosis and treatment strategy were summarized. RESULTS All patients were examined by ultrasound to confirm the depth of tumor, evaluate the effect of treatment and provide the evidence for drug withdrawal. For patients with deep hemangiomas, enhanced CT were added. Intralesional injection of glucocorticoids and oral propranolol were applied. All patients achieved good results. Ocular symptoms were avoided in most of the patients. CONCLUSION Periorbital IHs have special growth features and can be diagnosed by the appearance, ultrasound, CT scan, and propranolol experimental therapy if necessary. In consideration of potential complications, oral propranolol is the first treatment option for periorbital IHs.
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Affiliation(s)
- Li-Ming Sun
- Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Bengbu Medical College, Nanjing, Jiangsu, 210002, China
| | - Yuan Xu
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Meng-Nan Xu
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Yu Su
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, 210002, China.
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Bengbu Medical College, Nanjing, Jiangsu, 210002, China; Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, 210002, China.
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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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Abstract
Infantile haemangioma (IH) are the most frequent skin tumors in childhood. The diagnosis is usually established from the clinical picture and typical course of growth. Sectional imaging procedures are indicated in segmental, especially facial haemangiomas. The vast majority of IH are uncomplicated and do not require any treatment. In complicated IH, treatment should be initiated as soon as possible in order to avoid permanent damage. Propranolol is the treatment of choice for complicated IH.
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Affiliation(s)
- Antonia Reimer
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Hauptstr. 7, 79104, Freiburg, Deutschland.
| | - Hagen Ott
- Fachbereich Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Deutschland
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Samuelov L, Kinori M, Mancini AJ, Kruse LL, Wagner A, Yoon H, Chamlin SL. Ocular Complications in PHACE Syndrome: A True Association or a Coincidence? J Pediatr 2019; 204:214-218.e2. [PMID: 30270159 DOI: 10.1016/j.jpeds.2018.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize the risk for ocular complications in patients with PHACE syndrome. STUDY DESIGN This study included consecutive patients with PHACE syndrome who were seen at Lurie Children's Hospital of Chicago from January 2000 through May 2017. A complete ophthalmic examination was performed in all patients, with extra attention for findings typically associated with PHACE syndrome. RESULTS Thirty patients (67% female, median age of onset 0.08 months) were included: 38 (93%) demonstrated a segmental infantile hemangioma distribution. Twenty-one (70%) cases had a periocular involvement, and 47% had an infantile hemangioma with a deep component. Among 21 patients with periocular distribution, 9 had ocular complications secondary to the periocular location (mainly ptosis, nasolacrimal duct obstruction, and refractive errors), and one had an ocular complication specifically associated with PHACE syndrome (Horner syndrome). None of the patients without periocular distribution had an ocular complication. CONCLUSIONS In patients with PHACE syndrome who have a periocular infantile hemangioma, a complete eye examination is recommended. Although specific ocular anomalies related to PHACE syndrome are rare, serious ocular complications secondary to the location of the hemangioma may be present. Eye examination in patients with PHACE syndrome without a periocular infantile hemangioma distribution is likely of low yield.
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Affiliation(s)
- Liat Samuelov
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - Michael Kinori
- The Goldschleger Eye Institute, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Anthony J Mancini
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Lacey L Kruse
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Annette Wagner
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Hawke Yoon
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Sarah L Chamlin
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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