title: Visual acuity and astigmatism in periocular infantile hemangiomas treated with oral beta-blocker versus intralesional corticosteroid injection.
abstract: BACKGROUND
  Periocular infantile hemangiomas (PIH) can induce anisometropic astigmatism, a risk factor for amblyopia. Oral beta-blocker therapy has largely supplanted systemic or intralesional corticosteroids. The purpose of this study was to evaluate the effect and time course of these treatment modalities on visual acuity and induced astigmatism.
  
  
  METHODS
  The medical records of patients with PIH treated with oral propanolol between November 2008 and July 2013 were retrospectively reviewed for data on visual acuity and astigmatism. Patients with incomplete pre- and post-treatment ophthalmic examinations were excluded. Results were compared to those of a similar cohort treated with intralesional corticosteroid injection.
  
  
  RESULTS
  Mean astigmatism in affected eyes was 1.90 D before propranolol and 1.00 D after; patients showed a monophasic reduction in astigmatism over 12 months. By comparison, patients treated with corticosteroid injection showed a biphasic response, with an immediate steep decrease followed by a slow monophasic decline, paralleling propranolol-treated patients. Oral propranolol treatment caused a 47% reduction in mean induced astigmatism, less than the 63% reduction reported for the cohort treated with corticosteroid. No patient had visual acuity in the affected eye more than 1 standard devation below the age-matched norm, and none experienced significant side effects when treated with oral propranolol.
  
  
  CONCLUSIONS
  In this patient cohort oral beta-blocker was well-tolerated. Treatment was therefore often initiated prior to the induction of significant astigmatism, with treatment effects comparable to steroid treatment. Visual outcomes were good. Early treatment may minimize the potential effect of astigmatism on postnatal visual development.
authors.affiliation: Department of Surgery, Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle. Electronic address: Erin.herlihy@seattlechildrens.org.
authors.forename: Erin P
authors.initials: EP
authors.lastname: Herlihy
authors.affiliation: Department of Surgery, Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle.
authors.forename: John P
authors.initials: JP
authors.lastname: Kelly
authors.affiliation: Department of Medicine, Division of Dermatology, Seattle Children's Hospital, Seattle.
authors.forename: Robert
authors.initials: R
authors.lastname: Sidbury
authors.affiliation: Department of Surgery, Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
authors.affiliation: Department of Surgery, Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle.
authors.forename: Avery H
authors.initials: AH
authors.lastname: Weiss
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001251:Astigmatism / Q000503:physiopathology*; D005142:Eyelid Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D018324:Hemangioma, Capillary / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D009918:Orbital Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D011433:Propranolol / Q000627:therapeutic use; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D005938:Glucocorticoids; D011433:Propranolol