Reduction in Astigmatism Using Propranolol as First-Line Therapy for Periocular Capillary Hemangioma

PURPOSE: To examine the shift in astigmatic error following the use of oral propranolol as first-line treatment for periocular capillary hemangioma. DESIGN: Retrospective observational study. METHODS: STUDY POPULATION: Three healthy infants (1 male) clinically diagnosed with periocular capillary hemangioma. Cycloplegic refraction measurements were obtained at presentation. After a comprehensive clinical evaluation, oral propranolol therapy was starting with a loading dose and titrated up to 2 mg/kg/day under monitoring of heart rate, blood pressure, and blood glucose alterations. Clinical follow-up and repeating cycloplegic refraction measurements were undertaken at the 1-week and 1- and 3-month follow-up visits. INTERVENTION: Oral propranolol therapy for infants diagnosed with periocular capillary hemangioma. MAIN OUTCOME MEASURES: Astigmatic refractive errors before and after propranolol treatment. RESULTS: The infants' mean age at the initiation of propranolol therapy was 6.3 months (range: 3.0-8.0 months). A rapid therapeutic effect was noticed in all cases, including a major change in lesion size and color. No complications were recorded during or following treatment. The mean astigmatic error decreased from 2.83 diopters before propranolol treatment to 1.33 diopters after 1 month of treatment. The drug was well tolerated by all 3 patients and no side effects were noted. CONCLUSIONS: Infants can benefit from a rapid, meaningful reduction in periocular capillary hemangioma induced astigmatism following oral propranolol treatment. Propranolol seems to be;An effective and safe drug, which can be used as a steroid-sparing first-line treatment modality in this patient population. (Am J Ophthalmol 2011; 151:53-58. (c) 2011 by Elsevier Inc. All rights reserved.)