More evidence that oral propranolol is effective for periocular infantile hemangiomas

The authors of this retrospective study evaluated the efficacy of oral propranolol for the treatment of periocular infantile hemangiomas and found that it reduced the size of all hemangiomas in the 17 patients studied, with a median 39 percent reduction in surface area and 33 percent reduction in astigmatism. These results, which were reported in the July issue of the Archives of Ophthalmology, suggest that early treatment with propranolol is an effective, low-cost and easy-to-administer therapy for periocular infantile hemangiomas and the prevention of associated vision loss, with minimal adverse effects.

Study participants were identified through a medical record review for patients who received oral propranolol for periocular infantile hemangiomas at one children's hospital. They were treated three times daily, with outpatient monitoring of adverse effects. The starting dosage was 0.5 mg/kg/d for one week, followed by 1 mg/kg/d the next week and 2 mg/kg/d for the remaining duration of treatment. Amblyopia was treated with part-time occlusion therapy.

There were 19 periocular hemangiomas among the subjects, who had a median age of 4.5 months at the start of treatment. The median treatment duration was 6.8 months. Mild rebound growth that did not necessitate retreatment was found in two patients (12 percent). One patient (6 percent) experienced a benign episode of bradycardia. Seven patients (41 percent) had amblyopia. Vision equalized in all but one child, who continued to receive amblyopia therapy and was 25 months old at the onset of propranolol therapy due to having been adopted from another country.

The authors say the success reported in this study may be due to the highly favorable response to propranolol and treatment before the secondary effects of excess skin and amblyopia developed. They conclude that although the number of patients studied was relatively small, the results provide further evidence of the efficacy and safety of the treatment and suggest that outpatient treatment and monitoring can be a safe alternative to inpatient monitoring.