Primary Response to β-Blocker Therapy in Periocular Infantile Hemangioma - A Proposal for Ophthalmological Indicators.

Abstract

Purpose: To determine primary ocular response to β-blocker therapy in periocular infantile hemangioma (IH) and to apply defined ophthalmological indicators for the response assessment.

Patients and methods: A retrospective study of 85 infants treated for periocular IH with β-blocker between June 2008 and December 2020. IH characteristics, associated ocular features, and implementation of β-blocker therapy were recorded. Ophthalmological treatment indications were reevaluated, and response to treatment was defined as the resolution of indications according to the following categories: 1) anisoastigmatism ≥ 1.0 diopter, 2) progressive eyelid closure, 3) exophthalmos, 4) other ocular defect, 5) prophylaxis, and 6) non-ocular indication.

Results: β-blocker therapy was initiated at a median age of 3.0 months (IQR 2.0-5.0) and continued for a median of 9.0 months (IQR 7.0-16.5). Primary ocular response was achieved in 89% (95% CI: 79-95) of the patients. Seven patients were left with ≥ 1.0 diopter residual anisoastigmatism and mean cylinder power 1.50 D (range 1.25-3.00 D), one patient had partial eyelid closure, and three patients inadequate cosmesis despite complete ocular response. In isolated cases, astigmatism enhanced during β-blocker therapy. Repeated treatment periods were administered to 13 (15%) patients. No factors predictive of incomplete response or retreatment could be identified.

Conclusions: Ocular complications of periocular IH resolved in most patients during β-blocker therapy. The application of the defined ophthalmological response indicators allowed for simple and consistent outcome assessment. Careful monitoring is essential during and after therapy.