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

Hannakaisa Eloranta,1 Eeva Castrén,2,3 Päivi Salminen,3 Kristiina Kyrklund,3 Anna Majander11Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; 2Department of Otorhinolaryngology and Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; 3Department of Pediatric Surgery, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, FinlandCorrespondence: Hannakaisa Eloranta, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, POB 225 / Paciuksenkatu 8 A, Helsinki, 00029 HUS, Finland, Tel +358947173400, Email [email protected]: 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.Keywords: infantile hemangioma, periocular hemangioma, propranolol, atenolol, therapy