Corticosteroid treatment of periorbital haemangioma of infancy: a review of the evidence

Abstract

Aim: To systematically review the literature for corticosteroid treatment of periorbital haemangioma of infancy (HOI) and determine the relative efficacy and safety of oral, topical and intralesional corticosteroids. Methods: PubMed and the Cochrane Library were queried using keywords, and further articles were obtained by reviewing bibliographies. Inclusion and exclusion criteria were applied to create a subset of literature for analysis. Results: Systematic review revealed 81 original reports of periorbital HOI cases treated with steroids. Most studies and case series failed to document refractive error or visual acuity before and after treatment. Of cases meeting inclusion criteria, five patients received topical steroids and 25 patients received intralesional steroids. Patients receiving intralesional injections tended to demonstrate reduced astigmatism at follow up after treatment (21 of 28). The lack of studies with relevant objective ophthalmological end points prevented statistical meta-analysis. Conclusion: Intralesional injections may reduce refractive error, while the efficacy of topical steroids is unclear. Studies measuring objective ophthalmic data before and after treatment are sparse, and more studies are needed to determine the relative efficacy of different steroids. There are insufficient data to estimate the incidence of steroid side effects in patients treated with steroids for periorbital HOI or complications of intralesional injections in particular.

Intralesional and sub-Tenon's infusion of corticosteroids for treatment of refractory periorbital and orbital capillary haemangioma

“…This study shows that in infants with refractory massive periorbital and orbital haemangiomas, a combination of local corticosteroid treatment to the posterior subTenon's space 13 in the orbital region and directly to the lesion in the periorbital area is associated with significant improvement, both anatomically and functionally without ocular complications.…”

Abordagem terapêutica dos hemangiomas cutâneos na infância

“…28 The use of topical corticotherapy is also controversial in the literature and some authors have reported significant side effects and poorer efficacy when this form of treatment is used compared with intralesional corticosteroids. 12 In the present study, topical corticosteroids were used in four patients (4.1%), resulting in partial cure in three cases and complete cure in the remaining patient. Three patients had ulceration with bleeding in lesions located in the perineum and all three used the medication once a day for three weeks, often in association with a healing cream.…”

“…11 Response is generally poorer than that observed with intralesional corticosteroid therapy and side effects may occur. 12 Intralesional corticosteroid therapy is used principally in cases of periocular hemangiomas or in smaller lesions; however, its use is controversial because of possibly severe side effects. 3,13 Interferon is indicated for the treatment of alarming hemangiomas when there is a risk of death and the tumor fails to respond to treatment with oral corticoids.…”

Hemangioma pada Anak

“…14,15 Regresi spontan terjadi pada 80% hingga 85% kasus pada usia 9 tahun. Seperti telah dikemukakan di atas untuk memprediksi kemungkinan terjadinya giant hemangioma sangatlah sulit sehingga perlu dijelaskan pada orang tua untuk kontrol teratur 3-6 bulan sekali atau lebih cepat.…”

“…Ukurannya sangat bervariasi mulai dari beberapa millimeter hingga sentimeter. 14,15 Hemangioma dapat juga mengenai organ viseral seperti hati, limpa, usus, jatung bahkan otak yang dapat mengancam jiwa penderita. Sering tidak diketahui adanya hemangioma pada organ viseral ini sampai muncul tanda -tanda klinis yang jelas, misalnya terjadi gagal jantung pada hemangioma yang mengenai jantung, juga dapat terjadi gangguan fungsi hati jika hemangioma mengenai hati pada daerah yang cukup luas.…”