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Original article
Efficacy of systemic propranolol for severe infantile haemangioma of the orbit and eyelid: a case study of eight patients
  1. F Thoumazet1,
  2. C Léauté-Labrèze2,
  3. J Colin1,
  4. B Mortemousque1
  1. 1Ophthalmology Department, Centre Hopsitalo-Universitaire Pellegrin, Place Amélie Raba Léon, Bordeaux, France
  2. 2Pediatric Dermatology Department, Centre Hopsitalo-Universitaire Pellegrin, Place Amélie Raba Léon, Bordeaux, France
  1. Correspondence to F Thoumazet, Service d'ophtalmologie, CHU Pellegrin, Place Amelie Raba Leon, 33000 Bordeaux, France; francois.thoumazet{at}chu.bordeaux.fr

Abstract

Aim To assess the efficacy of systemic propranolol for severe capillary haemangiomas involving eyelid and orbit.

Method This was a longitudinal retrospective study that began in November 2007, involving eight children with disfiguring orbit and eyelid capillary haemangioma who received oral propranolol therapy. Three patients with life-threatening haemangiomas spreading to the orbit were first treated with systemic corticosteroids and beta-adrenergenic blocking agents. The remaining five patients with functional visual impairment received propranolol only. All children were given propranolol at a dose of 2 mg/kg body weight per day. The treatment was initiated between 2 and 36 months of age, with a follow-up period ranging from 6 to 30 months. Beta-blocking agents were used for 3–10 months.

Results We observed a successful 100% regression: that is, clinical regression by flattening 24 h after the start of treatment, regression on colour Doppler ultrasound imaging with an increase in resistance index of blood vessels, or regression seen on MRI. No re-growth was observed after the trial ended.

Conclusion Despite their self-limiting course, infantile orbital and eyelid haemangiomas can cause visual impairment or disfigurement. Corticosteroids are used as first-line therapeutic agents for problematic infantile haemangiomas. Other options include interferon-α and vincristine, which present problematic side effects. In our series, propranolol was shown to inhibit haemangioma tumour growth with a better benefit/risk ratio. In the absence of any randomised study comparing the effects of systemic corticosteroids and propranolol, we propose that beta-blockers could be used as first-line therapy for severe periocular haemangiomas.

  • Eyelid
  • infantile haemangioma
  • orbit
  • propranolol
  • immunology
  • infection
  • tears
  • pathology
  • eye (globe)
  • child health (paediatrics)
  • genetics
  • treatment other
  • ocular surface
  • cornea
  • conjunctiva
  • vision
  • muscles
  • clinical trial
  • experimental and laboratory
  • treatment medical
  • inflammation
  • neoplasia
  • pathology
  • orbit
  • drugs

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Footnotes

  • Oral presentation at SFO congress, Paris, May 2009, and SOPREF congress, Paris, May 2009

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics committee CHU de Bordeaux.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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