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Comprehensive Management of Infantile Hemangiomas Involving the Periorbital Region
Wei-Liang Chen1, Yu-Qing Lan2, Lei Hong1
1From the Departments of Oral and Maxillofacial Surgery.
Insights
Oral propranolol effectively treats infantile hemangioma around the eye (pIH), preventing vision loss. Early treatment with propranolol yields better outcomes, with higher doses or combined therapies for resistant cases.
Area of Science:
- Ophthalmology
- Pediatric Dermatology
- Pharmacology
Background:
- Periocular infantile hemangioma (pIH) presents a significant risk of vision impairment, necessitating prompt therapeutic strategies.
- Infantile hemangiomas are common benign vascular tumors in infants, with periocular involvement posing unique challenges.
- Effective management of pIH is crucial to prevent long-term visual sequelae.
Purpose of the Study:
- To evaluate the efficacy and safety of oral propranolol in managing periocular infantile hemangioma (pIH).
- To assess the impact of patient age on treatment response to propranolol.
- To determine optimal treatment strategies for propranolol-resistant pIH cases.
Main Methods:
- A cohort of 44 pIH patients (2-6 months old) with superficial, deep, or mixed subtypes were treated with oral propranolol (2 mg/kg/day).
- Treatment outcomes were assessed based on improvement levels (obvious vs. slight).
- Age-related treatment responses and outcomes for propranolol-resistant cases (increased dose, corticosteroid injections, or surgery) were analyzed.
Main Results:
- Oral propranolol demonstrated high efficacy, with 70.5% obvious and 29.5% slight improvement in pIH.
- Patients 3 months or younger showed significantly better response (96.3% obvious improvement) compared to older patients (29.4%) after 4 weeks (P=0.036).
- No amblyopia or ametropia were reported during 12-18 months follow-up; escalated therapies yielded good outcomes in resistant cases.
Conclusions:
- Oral propranolol is a safe and effective first-line treatment for periocular infantile hemangioma.
- Initiating propranolol therapy at an earlier age (≤3 months) is associated with superior treatment outcomes.
- Combination therapy with increased propranolol dosage, corticosteroid injections, or surgery is recommended for propranolol-resistant pIH.
Abstract:
Periocular infantile hemangioma (pIH) is associated with a risk of vision loss and requires urgent medical intervention. We evaluated the outcomes of the comprehensive management of 44 pIH patients (aged 2-6 months) with superficial (n = 11), deep (n = 15), and mixed (n = 18) subtypes, treated with a standard propranolol dose (2 mg kg -1 d -1 ) without any obvious side effects. Obvious and slight improvements were observed in 70.5% and 29.5% of patients, respectively. Obvious improvement was found in 96.3% of patients 3 months or younger but only 29.4% of patients older than 3 months ( P = 0.036) after 4 weeks of treatment. Thirteen patients demonstrated slight improvement and were treated with an increased propranolol dose (3 mg kg -1 d -1 ) in combination with corticosteroid injections or plastic surgery, which led to good outcomes. The patients were followed up for 12 to 18 months, with no cases of amblyopia or ametropia. Oral propranolol was effective in the treatment of pIH. Earlier propranolol use was associated with better outcomes. An increased propranolol dose combined with corticosteroid injections or plastic surgery is appropriate for patients with propranolol resistance.
