Topical Timolol for Infantile Haemangioma of the Orbit

Abstract

Infantile haemangiomas (IHs) are the most common benign tumours of the eyelid and orbits in infancy. Beta-blockers, in the form of oral propranolol, have become first-line treatment in severe cases with functionally significant or disfiguring IH. However, adverse drug reactions of oral propranolol in infants are reported in 1 in 11 and serious or potentially life-threatening systemic side effects in 1 in 38, including dyspnoea, hypotension, hyperkalaemia, hypoglycaemia, and cyanosis, therefore requiring careful and close monitoring during the course of systemic treatment. More recently, two large meta-analyses have shown topical beta-blockers, such as timolol maleate 0.5%, to be as effective as oral propranolol in superficial IH, but with no or significantly fewer adverse effects, and have advocated that topical beta-blockers replace oral propranolol as the first-line treatment of superficial IH. We have previously reported the therapeutic response of deep periocular IH to primary topical timolol maleate 0.5% monotherapy. Here we also describe the first successful treatments of large orbital IHs with primary topical timolol maleate 0.5% monotherapy in four infants, resulting in immediate cessation of progression and rapid clinical improvement or resolution in all cases. No adverse effects and no recurrence during long-term follow-up of up to 2.5 years after cessation were seen in any of the patients treated with topical timolol maleate 0.5%.

Zusammenfassung

Infantile Hämangiome (IH) sind die häufigsten gutartigen Tumoren des Augenlids und der Augenhöhlen im Säuglingsalter. Betablocker in Form von oralem Propranolol sind in schweren Fällen mit funktionell signifikantem oder entstellendem IH zur Erstlinienbehandlung geworden. Unerwünschte Arzneimittelnebenwirkungen von oralem Propranolol werden jedoch in 1 von 11 Säuglingen und schwerwiegende oder potenziell lebensbedrohliche Nebenwirkungen in 1 von 38 Säuglingen berichtet, einschließlich Dyspnoe, Hypotonie, Hyperkaliämie, Hypoglykämie und Zyanose, die daher eine sorgfältige und genaue Überwachung während der oralen Behandlung erfordern. In jüngerer Zeit haben 2 große Metaanalysen gezeigt, dass topische Betablocker wie Timololmaleat 0,5% bei oberflächlichem IH genauso wirksam sind wie orales Propranolol, jedoch ohne oder mit signifikant weniger Nebenwirkungen, und befürworten die Ersetzung von oralem Propranolol durch topische Betablocker als Erstlinienbehandlung von oberflächlichem IH. Wir haben bereits über das therapeutische Ansprechen von tiefen periokulären IH auf eine primäre topische Timololmaleat-0,5%-Monotherapie berichtet. Hier beschreiben wir die ersten erfolgreichen Behandlungen von großen orbitalen IH mit topischem Timololmaleat 0,5% bei 4 Säuglingen, was in allen Fällen zu einem sofortigen Ende des klinischen Fortschreitens und einer schnellen klinischen Verbesserung oder vollständigen Heilung führte. Bei keinem der Patienten, die mit topischem Timololmaleat 0,5% behandelt worden waren, wurden während der Behandlung Nebenwirkungen oder nach Beendigung der Behandlung während der Langzeitnachbeobachtung von bis zu 2,5 Jahren ein Wiederauftreten beobachtet.

Key words

topical timolol - beta-blockers - orbital infantile hemangioma - orbital infantile haemangioma - orbital capillary haemangioma

Schlüsselwörter

Timololtropfen - Betablocker - orbitales infantiles Hämangiom - orbitales kapilläres Hämangiom

Publication History

Received: 08 September 2021

Accepted: 10 September 2021

Article published online:
18 October 2021

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