In the JournalsPerspective

Systemic propranolol effective in infantile capillary hemangiomas of eyelid

Systemic oral propranolol was effective in treating infantile capillary hemangiomas of the eyelid with minimal risk of complications, according to a study.

In a prospective, interventional case series, 14 patients with a mean age of 20.85 months who had infantile capillary hemangiomas of the eyelid underwent oral treatment with systemic propranolol.

Mean administration of treatment was 2.5 months. Treatment was discontinued after 2 months in one case due to hypotension and after 3 months in another case due to allergy. Mean follow-up was 10.64 months.

Ten patients younger than 1 year showed full regression of the lesion with treatment. Two patients older than 5 years significantly benefited from treatment but did not show full regression.

Four patients had existing amblyogenic astigmatism, which decreased from 1.25 D before treatment to 0.25 D at final visit with no observed recurrence after treatment.

The study authors said that 4 months of treatment appears to be ideal for the highest effectiveness.

Systemic oral propranolol was effective in treating infantile capillary hemangiomas of the eyelid with minimal risk of complications, according to a study.

In a prospective, interventional case series, 14 patients with a mean age of 20.85 months who had infantile capillary hemangiomas of the eyelid underwent oral treatment with systemic propranolol.

Mean administration of treatment was 2.5 months. Treatment was discontinued after 2 months in one case due to hypotension and after 3 months in another case due to allergy. Mean follow-up was 10.64 months.

Ten patients younger than 1 year showed full regression of the lesion with treatment. Two patients older than 5 years significantly benefited from treatment but did not show full regression.

Four patients had existing amblyogenic astigmatism, which decreased from 1.25 D before treatment to 0.25 D at final visit with no observed recurrence after treatment.

The study authors said that 4 months of treatment appears to be ideal for the highest effectiveness.

    Perspective

    This prospective study shows great success with oral propranolol alleviating vision-threatening capillary hemangiomas with treatment of up to 4 months’ duration in children younger than 1 year of age, while longer duration of treatment did not have a greater effect on the decrease in size of the lesion in older children. Side effects were rare and limited in this study to one child with hypotension and another with an allergic skin rash to the medication. The bottom line in the treatment of capillary hemangiomas today is that unless contraindicated from a cardiac or respiratory standpoint, propranolol is considered by most to be the first-line treatment ahead of oral or intralesional steroids, as well as any surgical intervention. A team approach to follow the child by pediatric specialists including ophthalmology, cardiology and hematology/oncology is certainly appropriate to achieve the best results for the patient.

    • Robert S. Gold, MD
    • OSN Pediatrics/Strabismus Section Editor

    Disclosures: Gold has no relevant financial disclosures.