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Surgical Intervention of Periocular Infantile Hemangiomas in the Era of β-Blockers
Clara J Men1, Lilangi S Ediriwickrema1, Ji Sun Paik1
1Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, La Jolla, CA.
Insights
Surgical resection is effective for periocular infantile hemangiomas that persist after propranolol treatment. Adjuvant surgery improves vision and appearance with minimal complications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Dermatology
Background:
- Infantile hemangiomas are common benign vascular tumors.
- Systemic propranolol is the first-line treatment.
- Some cases require surgical intervention due to residual disease or intolerance.
Purpose of the Study:
- To evaluate the role of adjuvant surgical resection for periocular infantile hemangiomas after systemic beta-blocker therapy.
- To assess surgical outcomes in patients with residual lesions or treatment intolerance.
Main Methods:
- Multicentered retrospective study.
- Patients received standard oral propranolol therapy.
- Surgical indications included visual axis obstruction, amblyopia, or disfigurement.
- Procedures involved complete excision or debulking of hemangiomas.
Main Results:
- 15 patients (11 female, 4 male) underwent surgery at a mean age of 34.4 months.
- Surgery was needed for side effects (n=4) or residual lesions (n=11).
- All patients achieved ptosis resolution and visual axis clearing; no recurrences or complications were observed.
Conclusions:
- Adjuvant surgical treatment is crucial for periocular infantile hemangiomas unresponsive to propranolol.
- Surgical debulking and ptosis repair yield excellent functional and aesthetic results.
- Surgery offers a safe and effective option for persistent lesions, improving outcomes with minimal side effects.
Purpose:
To examine the role of adjuvant surgical resection of infantile hemangiomas after systemic β-blocker therapy.
Methods:
This is a multicentered retrospective study. Standard protocol for oral propranolol was employed by the referring physicians. Ocular indications for surgery included ptosis obstructing the visual axis, high degrees of astigmatism causing amblyopia, or disfigurement from residual tumor. Patients underwent complete excision or debulking.
Results:
Eleven girls and 4 boys were surgically treated with mean operative age of 34.4 months. Patients were followed for a mean of 19.6 months after surgery. Four patients required surgical treatment due to an inability to tolerate medical therapy secondary to drug-related side effects (including bradycardia). The other 11 patients proceeded to surgery due to residual eyelid and orbital lesions despite medical treatment. All 15 patients underwent orbitotomy for residual hemangioma excision. Four patients also underwent simultaneous levator advancement at the time of excision. In all cases, there was resolution of ptosis with clearing of the visual axis. No complications were incurred during the surgical treatment and there were no hemangioma recurrences.
Conclusions:
This is the first study to report surgical management of periocular infantile hemangiomas recalcitrant to standard therapy in the β-blocker era. In patients with infantile hemangioma who have failed medical therapy, adjuvant surgical treatment still plays an important role. For patients with persistent tumor causing ocular sequelae, surgical intervention aimed at soft tissue debulking and ptosis repair can be successful in achieving excellent functional and aesthetic outcomes with minimal side effects.For patients with periocular infantile hemangiomas with residual soft tissue deformity following propranolol therapy, surgical treatment plays an important role in improving functional and cosmetic outcomes with minimal side effects.
