title: Combined low-dose oral propranolol and oral prednisolone as first-line treatment in periocular infantile hemangiomas.
abstract: OBJECTIVE
  The purpose of this report was to describe 2 cases of periocular infantile hemangiomas (IHs) that were successfully treated with low-dose oral propranolol alone and in combination with oral prednisolone.
  
  
  METHODS
  Two infants aged 3 months and 6 weeks, respectively, were referred for management of vision-threatening periocular IHs causing ocular displacement and obscuration of the visual axis. The first infant had a superficial left upper eyelid capillary hemangioma with extraconal extension and the second infant had a deep preseptal capillary hemangioma in the right lower eyelid with intraconal extension. Both cases were started on oral propranolol 0.5 mg/kg/day in divided doses and titrated up to 1.5 mg/kg/day as first-line therapy. The first infant was also given oral prednisolone 2 mg/kg/day during the initial first month of treatment.
  
  
  RESULTS
  Rapid regression in sizes of the hemangiomas was seen within the first 3 days of treatment. By 2 months of therapy, both infants had achieved normal ocular alignment. The second infant experienced a transient period of hypotension after the first dose of propranolol was started but recovered spontaneously. Both infants did not experience any adverse effects of propranolol throughout the treatment period.
  
  
  CONCLUSIONS
  Low-dose oral propranolol is an effective first-line therapy for the management of vision-threatening IH. Dose escalation in combination with oral prednisolone after pediatric assessment might be useful in avoiding adverse effects of propranolol in young infants.
authors.affiliation: Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Adrian Choon Aun
authors.initials: AC
authors.lastname: Koay
authors.forename: May May
authors.initials: MM
authors.lastname: Choo
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Nathan
authors.forename: Asma
authors.initials: A
authors.lastname: Omar
authors.forename: Chin Theam
authors.initials: CT
authors.lastname: Lim
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005141:Eyelid Diseases / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D018324:Hemangioma, Capillary / Q000151:congenital* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D008297:Male; D009386:Neoplastic Syndromes, Hereditary; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D005938:Glucocorticoids; D011239:Prednisolone; D011433:Propranolol