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Visual acuity and astigmatism in periocular infantile hemangiomas treated with oral beta-blocker versus intralesional corticosteroid injection.
J AAPOS. 2016 Feb; 20(1):30-3.JA

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+Show Affiliations

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.Department of Surgery, Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle.Department of Medicine, Division of Dermatology, Seattle Children's Hospital, Seattle.Department of Surgery, Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle.Department of Surgery, Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26917068

Citation

Herlihy, Erin P., et al. "Visual Acuity and Astigmatism in Periocular Infantile Hemangiomas Treated With Oral Beta-blocker Versus Intralesional Corticosteroid Injection." Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus, vol. 20, no. 1, 2016, pp. 30-3.
Herlihy EP, Kelly JP, Sidbury R, et al. Visual acuity and astigmatism in periocular infantile hemangiomas treated with oral beta-blocker versus intralesional corticosteroid injection. J AAPOS. 2016;20(1):30-3.
Herlihy, E. P., Kelly, J. P., Sidbury, R., Perkins, J. A., & Weiss, A. H. (2016). Visual acuity and astigmatism in periocular infantile hemangiomas treated with oral beta-blocker versus intralesional corticosteroid injection. Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus, 20(1), 30-3. https://doi.org/10.1016/j.jaapos.2015.10.014
Herlihy EP, et al. Visual Acuity and Astigmatism in Periocular Infantile Hemangiomas Treated With Oral Beta-blocker Versus Intralesional Corticosteroid Injection. J AAPOS. 2016;20(1):30-3. PubMed PMID: 26917068.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Visual acuity and astigmatism in periocular infantile hemangiomas treated with oral beta-blocker versus intralesional corticosteroid injection. AU - Herlihy,Erin P, AU - Kelly,John P, AU - Sidbury,Robert, AU - Perkins,Jonathan A, AU - Weiss,Avery H, PY - 2015/06/16/received PY - 2015/10/05/revised PY - 2015/10/12/accepted PY - 2016/2/27/entrez PY - 2016/2/27/pubmed PY - 2016/10/8/medline SP - 30 EP - 3 JF - Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus JO - J AAPOS VL - 20 IS - 1 N2 - 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. SN - 1528-3933 UR - https://www.unboundmedicine.com/medline/citation/26917068/Visual_acuity_and_astigmatism_in_periocular_infantile_hemangiomas_treated_with_oral_beta_blocker_versus_intralesional_corticosteroid_injection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1091-8531(16)00016-1 DB - PRIME DP - Unbound Medicine ER -