A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel: Amy K. Hutchinson, MD,4 Raymond T. Kraker, MSPH,2 Stacy L. Pineles, MD,3 Deborah K. VanderVeen, MD,4 Lorri B. Wilson, MD,5 Jennifer A. Galvin, MD,6 Scott R. Lambert, MD,7
Ophthalmology, Vol. 126, Issue 1, p146–155 © 2018 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Purpose: To review the published literature assessing the efficacy of β-blockers for the treatment of periocular hemangioma in infants.
Methods: Literature searches were conducted in May 2018 in PubMed with no date restrictions and limited to studies published in English and in the Cochrane Library database without any restrictions. The combined searches yielded 437 citations. Of these,16 articles were deemed appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist.
Results: None of the 16 studies included in this assessment were rated level I, 3 were rated level II, and 13 were rated level III. The most common treatment regimen was 2 mg/kg daily oral propranolol, but intralesional and topical β-blockers were also used. Treatment effect was most often measured in terms of reduction in the size of the lesions, which occurred in the majority of patients. β-Blockers were consistently shown to reduce astigmatism, but this reduction was shown to be statistically significant in only 2 series. The effect of β-blockers on amblyopia was not adequately documented. β-Blockers were generally well tolerated and had mild side effects (fatigue, gastrointestinal upset/diarrhea, restlessness/sleep disturbances, minor wheezing, and cold extremities). Complications severe enough to require cessation of treatment occurred in only 2 patients out of a total of 229 who received β-blockers.
Conclusions: There is limited evidence to support the safety and efficacy of both topical and systemic β-blockers to promote regression of periocular hemangiomas. Additional research may confirm the best dosage and route of administration to maximize efficacy in reducing induced astigmatism and amblyopia associated with periocular hemangiomas while minimizing side effects.
1 Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
2 Jaeb Center for Health Research, Tampa, Florida.
3 Jules Stein Eye Institute, Los Angeles, California
4 Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
5 Casey Eye Institute, Oregon Health & Science University, Portland, OregonDepartment of Ophthalmology, Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio
6 Eye Physicians & Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
7 Department of Ophthalmology, Stanford University School of Medicine, Stanford, California