Propranolol treatment promising for infantile capillary hemangioma

Hana Leiba

SAN DIEGO — Since the publication of the successful use of propranolol for severe hemangioma of infancy in 2008, one pediatric ophthalmologist said here that her practice, among others, has established a protocol for using this agent as the primary treatment in these cases.

In a case series of children treated with propranolol for infantile capillary hemangioma, there was marked improvement of 10 children who had undergone treatment, Hana Leiba, MD, said at the American Association for Pediatric Ophthalmology and Strabismus meeting.

"In all cases we saw dramatic effect after 24 hours since the first dose," Dr. Leiba said, with lesions becoming smaller, softer and discolored.

The study was intended to verify efficacy and safety, and to quantify response and healing rates. Nine of 10 children in the study were younger than 6 months at the initiation of therapy, even though resolution occurs in 75% to 85% of children by age 7 years to 8 years. Indications for treatment were obscured visual axis, astigmatism and strabismus. Mean follow-up was 20 months.

"The main indication for treatment was amblyopia prevention," Dr. Leiba said.

Treatment duration averaged 12 months, with some difficulty seen during weaning in that recurrence occurred in five of 10 cases. Reinstitution of therapy yielded good response in those cases, however. Therapy was stopped in one patient in whom there was no effect from treatment; that patient was later found to have Sturge-Weber syndrome.

Adverse side effects were transient and non-life-threatening.

"Propranolol seems to be very effective and safe, even beyond the proliferative stage," Dr. Leiba said.

Disclosure: Dr. Leiba reports no relevant financial disclosures.