The use of propranolol in the treatment of periocular infantile hemangiomas

Abstract

Purpose Infantile capillary hemangiomas (IH) are the most common tumours of the eyelid and orbit in infants. Despite their self‐limited course, IH can impair visual function. Recently, the use of propranolol was found to reduce the size of IH. We will present our own case series of patients with periocular IH treated with propranolol to illustrate these findings. Methods We conducted a retrospective study on 10 children with IH treated with propranolol. After exclusion of any contra‐indication, propranolol was initiated at a dose of 1 mg/kg/d. After 10‐14 days, patients were checked again for side‐effects. If these were absent, propranolol was increased to 2 mg/kg/d. Further follow‐up consists of monthly clinical and photographical evaluations of the IH, monitoring of treatment compliance and tolerance. Success of treatment is defined as stopping growth or reducing size. The response to treatment was rated by 3 blinded, independent observers. Results The age range at start of treatment with propranolol was between 2 and 19 months (mean 6,8 months). The mean age at stopping propranolol was 14,4 months. The mean duration of treatment was 7,6 months and only 1 patient had to stop treatment because of side effects. Two patients (20%) had a rebound after temporary stop of propranolol. The success rate in our case serie was 100%. Half of the group had excellent results, 30% had a good response and 20% had a fair response. We also obtained objective measures of astigmatism and anisometropia in 6 patients. We report a reduction in anisometropic astigmatism in 5 of these 6 patients. Conclusion These data support the current perception that propranolol is a highly effective first line treatment for IH with very limited and mild side effects.