Reduction in Astigmatism Using Propranolol as First-Line Therapy for Periocular Capillary Hemangioma

• Published in: American journal of ophthalmology 2011, Vol.151 (1), p.53-58
• Main Authors: Fabian, Ido Didi, Ben-Zion, Itay, Samuel, Claude, Spierer, Abraham
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Astigmatism - drug therapy; Astigmatism - physiopathology; Biological and medical sciences; Blood Pressure; Eyelid Neoplasms - drug therapy; Eyelid Neoplasms - pathology; Family medical history; Female; Follow-Up Studies; Heart Rate; Hemangioma, Capillary - drug therapy; Hemangioma, Capillary - pathology; Humans; Hypothyroidism; Infant; Male; Medical sciences; Miscellaneous; Ophthalmology; Pediatrics; Propranolol - adverse effects; Propranolol - therapeutic use; Refraction, Ocular - physiology; Retrospective Studies; Review boards; Signal transduction; Vision disorders; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2010.07.022

Purpose To examine the shift in astigmatic error following the use of oral propranolol as first-line treatment for periocular capillary hemangioma. Design Retrospective observational study. Methods study population: Three healthy infants (1 male) clinically diagnosed with periocular capillary hemangioma. Cycloplegic refraction measurements were obtained at presentation. After a comprehensive clinical evaluation, oral propranolol therapy was starting with a loading dose and titrated up to 2 mg/kg/day under monitoring of heart rate, blood pressure, and blood glucose alterations. Clinical follow-up and repeating cycloplegic refraction measurements were undertaken at the 1-week and 1- and 3-month follow-up visits. intervention: Oral propranolol therapy for infants diagnosed with periocular capillary hemangioma. main outcome measures: Astigmatic refractive errors before and after propranolol treatment. Results The infants' mean age at the initiation of propranolol therapy was 6.3 months (range: 3.0–8.0 months). A rapid therapeutic effect was noticed in all cases, including a major change in lesion size and color. No complications were recorded during or following treatment. The mean astigmatic error decreased from 2.83 diopters before propranolol treatment to 1.33 diopters after 1 month of treatment. The drug was well tolerated by all 3 patients and no side effects were noted. Conclusions Infants can benefit from a rapid, meaningful reduction in periocular capillary hemangioma – induced astigmatism following oral propranolol treatment. Propranolol seems to be an effective and safe drug, which can be used as a steroid-sparing first-line treatment modality in this patient population.