Clinical and Radiological Evaluation of Periocular Infantile Hemangioma Treated With Oral Propranolol: A Case Series

Am J Ophthalmol. 2018 Jan:185:48-55. doi: 10.1016/j.ajo.2017.10.021. Epub 2017 Nov 15.

Abstract

Purpose: To evaluate the efficacy of propranolol (3 mg/kg/day) in the treatment of periocular infantile hemangioma (IH) based on clinical and radiological findings.

Design: Prospective interventional case series.

Methods: Study of previously untreated infants with IH conducted at the ophthalmology outpatient service of HC-FMUSP (Brazil). The patients were submitted to a complete ophthalmologic examination, gray-scale and Doppler ultrasonography, and nuclear magnetic resonance imaging. Lesion regression was evaluated clinically and radiologically during follow-up. The sample consisted of potentially amblyogenic and disfiguring lesions. The dose was increased at weekly intervals, from 0.5 mg to 3 mg/kg/day. The age at onset of treatment was 2-28 months. Follow-up lasted up to 48 months.

Results: Nine infants with periocular IH were treated with propranolol (oral) for 2-12 months (mean: 7.1 months). Clinical regression (attenuation of color and reduction in size) was observed in 88% during the first days of treatment. Partial recurrence was observed during follow-up in a patient treated for 6 months. On Doppler ultrasonography, during the first 6 months of treatment lesion volume and vascular density decreased while the arterial resistivity index (RI) increased, followed by a decline.

Conclusion: Propranolol at 3 mg/kg/day was clinically and radiologically efficacious against deep IH in the proliferative stage, with no recurrence in patients treated for 12 months. RI might help determine when treatment can be safely interrupted.

MeSH terms

  • Administration, Oral
  • Adrenergic beta-Antagonists / administration & dosage
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Hemangioma, Capillary / diagnosis
  • Hemangioma, Capillary / drug therapy*
  • Humans
  • Infant
  • Magnetic Resonance Spectroscopy / methods*
  • Male
  • Orbit
  • Propranolol / administration & dosage*
  • Prospective Studies
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / drug therapy*
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler

Substances

  • Adrenergic beta-Antagonists
  • Propranolol