Abstract

Research Article

Periocular capillary hemangioma treated with low dose oral propranolol - presentation and outcome of 30 patients

Soma Rani Roy* and Murtuza Nuruddin

Published: 31 December, 2021 | Volume 5 - Issue 1 | Pages: 037-041

Purpose: To evaluate the presentation and outcome of periocular capillary hemangioma treated with low-dose oral propranolol.
Method: Thirty cases of periocular capillary hemangioma prospectively studied from 1st June 2015 to 31st May 2017 who received oral propranolol on an outpatient basis. Hemangioma causing any threat to vision or disfigurement was included and age below 3 months and multiple lesions were excluded. Starting dose of propranolol was 1 mg/kg and increased to 2 mg/kg after 2 weeks as a maintenance dose. The tapering dose was 1 mg/kg of body weight before discontinuing the medication. Treatment was continued till the child is 1 year of age or no further change in color or size of the lesion in two successive follow-ups. 
Results: Presenting age was 6.36 ± 3.36 months (ranged 3–24 months) with female predominance (70%). In 86.6% of cases, the vision was Central Steady and Maintained and cycloplegic refraction showed marked astigmatism in 3 children which resolved after treatment. Forty-six percent of children showed color change as an initial response to treatment. Most children (33.3%) responded completely within 5 months after starting the treatment. One third patients (33.3%) showed 100% resolution, 50% showed 90% to 70% resolution. Pretreatment and post-treatment lesion size was1.60 ± 0.86 cm2 and 0.30 ± 0.40 cm2 respectively (p - value < 0.0005). None showed any significant adverse effect of oral propranolol.
Conclusion: Low-dose oral propranolol is an effective and cost-effective treatment modality for periocular capillary hemangioma and is safe as an outpatient basis. 

Read Full Article HTML DOI: 10.29328/journal.apcr.1001027 Cite this Article Read Full Article PDF

Keywords:

Hemangioma; Propanolol; Proliferative stage; Involutional stage

References

  1. Dasgupta R, Fishman SJ. ISSVA classification. Semin Pediatr Surg. 2014; 23: 158‑161. PubMed: https://pubmed.ncbi.nlm.nih.gov/25241091/
  2. Buckmiller L, Dyamenahalli U, Richter GT. Propranolol for airway hemangiomas: Case report of novel treatment. Laryngoscope. 2009; 119: 2051–2054. PubMed: https://pubmed.ncbi.nlm.nih.gov/19650125/
  3. Garza G, Fay A, Rubin PA. Treatment of pediatric vascular lesions of the eyelid and orbit. Int Ophthalmol. Clin. 2001; 4: 43–55. PubMed: https://pubmed.ncbi.nlm.nih.gov/11698737/
  4. Haik BG, Karcioglu ZA, Gordon RA, Pechous BP. Capillary hemangioma (infantile periocular hemangioma) Surv Ophthalmol. 1994; 38: 399–426. PubMed: https://pubmed.ncbi.nlm.nih.gov/8009426/
  5. Dickison P, Christou E, WargonO. Aprospective study of infantile hemangiomas with a focus on incidence and risk factors. Pediatr Dermatol. 2011; 28: 663‑669. PubMed: https://pubmed.ncbi.nlm.nih.gov/21995808/
  6. Bauland CG, Smit JM, Scheffers, Bartels RH, van den Berg P, Zeebregts CJ, et al. Similar risk for hemangiomas after amniocentesis and transabdominal chorionic villus sampling. J Obstet Gynaecol Res. 2012; 38: 371‑375. PubMed: https://pubmed.ncbi.nlm.nih.gov/22229643/
  7. Chen XD, Ma G, Chen H, Ye XX, Jin YB, et al. Maternal and perinatal risk factors for infantile hemangioma: A case-control study. Pediatr Dermatol. 2013; 30: 457‑461. PubMed: https://pubmed.ncbi.nlm.nih.gov/23278441/
  8. Bang GM, Setabutr P. Periocular capillary hemangiomas: Indications and options for treatment. Middle East Afr J Ophthalmol. 2010; 17: 121‑128. PubMed: https://pubmed.ncbi.nlm.nih.gov/20616917/
  9. Bang GM, Setabutr P. Periocular Capillary Hemangiomas: Indications and Options for Treatment. Middle East Afr J Ophthalmol. 2010; 17: 121-128. PubMed: https://pubmed.ncbi.nlm.nih.gov/20616917/
  10. Grabb WC, Dingman RO, O’Neal RM, et al. Facial hamartomas in children:Neurofibroma, lymphangioma,and hemangioma. Plast Reconstr Surg. 1980; 66: 509-527. PubMed: https://pubmed.ncbi.nlm.nih.gov/7208665/
  11. Hernandez JA, Chia A, Quah BL, Seah LL. Periocular capillary hemangioma: Management practices in recent years. Clin Ophthalmol. 2013; 7: 1227‑1232. PubMed: https://pubmed.ncbi.nlm.nih.gov/23814460/
  12. Hermans DJJ, Bauland CG, Zweegers J, van Beynum IM, van der Vleuten CJM. Propranolol in a case series of 174 patients with complicated infantile haemangiomas: indications, safety and future directions. Br J Dermatol. 2011; 168: 817–843. PubMed: https://pubmed.ncbi.nlm.nih.gov/23278381/
  13. Levitt M, Coumou AD, Groeneveld L, Freling NJM, van der Horst CM, et al. Propranolol as first line treatment in orbital infantile haemangiomas. Orbit Informa J. 2014; 33: 178-183. PubMed: https://pubmed.ncbi.nlm.nih.gov/24568543/
  14. Le’aute-Labre ze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, et al. Propranolol for severe haemangiomas of infancy. N Engl J Med. 2008; 158: 2649–2651. PubMed: https://pubmed.ncbi.nlm.nih.gov/18550886/
  15. van der Horst CM, Saeed P. Propranolol as First-Line Treatment in Orbital Infantile Haemangiomas: A Case Series. 2014; 33: 178–183. PubMed: https://pubmed.ncbi.nlm.nih.gov/24568543/
  16. Xue K, Hildebrand GD. Deep periocular infantile capillary hemangiomas responding to topical application of timolol maleate, 0.5%, drops. JAMA Ophthalmol. 2013; 131: 1246‑1248. PubMed: https://pubmed.ncbi.nlm.nih.gov/23846584/
  17. Jefferson RJ, Hildebrand GD. Topical timolol treatment for periocular infantile haemangioma in the developing world. Trop Doct. 2019; 49: 246-248.PubMed: https://pubmed.ncbi.nlm.nih.gov/31014195/
  18. Missoi TG, Lueder TG, Gilbertson K, Bayliss SJ. Oral propranolol for treatment of periocular infantile hemangiomas. Arch Ophthalmol. 2011; 129: 899–903. PubMed: https://pubmed.ncbi.nlm.nih.gov/21402978/
  19. Haider KM, Plager DA, Neely DE, et al. Outpatient treatment of periocular infantile haemangiomas with oral propranolol. J AAPOS. 2010; 14: 251–256. PubMed: https://pubmed.ncbi.nlm.nih.gov/20603059/
  20. Al Dhaybi R, Superstein R, Milet A, Powell J, Dubois J, et al. Treatment of periocular infantile hemangiomas with propranolol: a caseseries of 18 children. Ophthalmology. 2011; 118: 1184–1188. PubMed: https://pubmed.ncbi.nlm.nih.gov/21292326/
  21. Thoumazet F, Leaute-Labreze C, Colin J, Mortemousque B. Efficacy of systemic propranolol for severe infantile haemangioma of the orbit and eyelid: a case study of eight patients. Br J Ophthalmol. 2012; 96: 370–374. PubMed: https://pubmed.ncbi.nlm.nih.gov/21673014/
  22. Cornish KS, Reddy AR. The use of propranolol in the management of periocular capillary haemangioma-a systematic review. Eye. 2011; 25:1277–1283. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194317/
  23. Saba T. Alniemi BS, Griepentrog GJ, Diehl N, Mohney BG. Incidence and Clinical Characteristics of Periocular Infantile Hemangiomas. Arch Ophthalmol. 2012; 130: 889-894.PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673779/
  24. Alniemi ST, Griepentrog GJ, Diehl N, Mohney BG. Incidence and Clinical Characteristics of Periocular Infantile Hemangiomas. Arch Ophthalmol. 2012; 130: 889-893. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673779/
  25. Hernandez JA, Chia A, Quah BL,Seah LL. Periocular capillary hemangioma: management practices in recent years. Clinical Ophthalmology Clinical Cannady SB, Kahn TA, Traboulsi EI, Koltai PJ. PHACE syndrome: Report of a case with a glioma of the anterior skull base and ocular malformations. Int J Pediatr Otorhinolaryngol. 2006; 70: 561-564
  26. Pope E, Krafchik BR, Macarthur C, Stempak D, Stephens D, et al. Oral versus high-dose pulse corticosteroids for problematic infantile haemangiomas: a randomized, controlled trial. 2007; 119: e1239-47. PubMed: https://pubmed.ncbi.nlm.nih.gov/17485449/
  27. Taylor H R. Infantile Periocular Haemangioma: Optimising the Therapeutic Response. Paediatr drugs. 2016; 18: 157-160. PubMed: https://pubmed.ncbi.nlm.nih.gov/27043724/
  28. Storch CH, Hoeger PH. Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action. Bri J Dermatol. 2010; 163: 269–274. PubMed: https://pubmed.ncbi.nlm.nih.gov/20456345/

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