title: Refractive and structural changes in infantile periocular capillary haemangioma treated with propranolol.
abstract: OBJECTIVE
  To evaluate the optical and anatomical effects of oral propranolol treatment for infantile periocular capillary haemangioma.
  
  
  METHODS
  All children diagnosed with infantile capillary haemangioma in 2008-2010 at a tertiary paediatric medical centre underwent comprehensive evaluation, including imaging, by a multidisciplinary team followed by oral propranolol treatment. Clinical follow-up was performed regularly until the lesions disappeared. Main outcome measures included changes in anatomical extraocular extension, refractive sphere and cylindrical power, and spherical equivalent in the involved eye before and after treatment and between the two eyes.
  
  
  RESULTS
  A total of 30 patients (8 male; mean age at diagnosis, 1.6±2.8 months) participated. The lesions affected the left eye in 53.3% and were located preseptally in 83.3%. Four patients (13.3%) received steroids before propranolol. A treatment dosage of 2 mg/kg per day was started at mean age 5.0±4.5 months, 3.3±4.3 months from disease onset. Side effects occurred in 11 patients and warranted a dose reduction (to 1 mg/kg per day) in 3 and treatment termination in 1. Findings were significant for mean reduction in involved extraocular area (P<0.0001), post-treatment reduction in mean cylindrical power in involved eyes (P=0.02), pre- and post-treatment differences in mean cylindrical power between involved and uninvolved eyes (P=0.02 and P=0.01, respectively), and post-treatment change in absolute values of mean spherical power between involved and uninvolved eyes (P=0.025).
  
  
  CONCLUSIONS
  Early diagnosis of infantile periocular capillary haemangioma and prompt treatment with propranolol lead to a significant reduction in the involved ocular area, in astigmatism, and prevent ocular/facial disfiguration/deformation, without rebound. Propranolol is recommended as the preferred treatment compared with other accepted therapies.
authors.affiliation: Unit of Pediatric Ophthalmology, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel. msnir@clalit.org.il
authors.forename: M
authors.initials: M
authors.lastname: Snir
authors.forename: U
authors.initials: U
authors.lastname: Reich
authors.forename: R
authors.initials: R
authors.lastname: Siegel
authors.forename: A
authors.initials: A
authors.lastname: Zvulunov
authors.forename: R
authors.initials: R
authors.lastname: Friling
authors.forename: N
authors.initials: N
authors.lastname: Goldenberg-Cohen
authors.forename: Y
authors.initials: Y
authors.lastname: Ron
authors.forename: D
authors.initials: D
authors.lastname: Ben-Amitay
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D005142:Eyelid Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D018324:Hemangioma, Capillary / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D009386:Neoplastic Syndromes, Hereditary / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D009918:Orbital Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D011433:Propranolol / Q000627:therapeutic use*; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol