Management of Infantile Periobital Hemangioma: a Prospective Study of a Single- Centre Experience from Saudi Arabia

Background: Although infantile hemangioma is a common benign childhood tumour, it is still a challenging entity in paediatric ophthalmology with many controversial lines of management. Management options include topical, intralesional or systemic steroids, surgical resection or even observation with no active intervention, as Hemangioma usually involutes after a period of growth.

Aim: The current prospective study aimed to evaluate a single-centre experience in the management of infantile periorbital hemangioma in order to find a solution to the highly debated issue of the ideal management modality in this condition.

Patients and Methods: A prospective study over a period of 4 years from January 2011 to December 2014 was carried out on infants diagnosed with periorbital hemangioma. The follow up period was one year from 2014 to 2015. All patients underwent a fine needle histopathological assessment before the start of treatment. All infants had one or more intralesional corticosteroid therapy, which was the first line of treatment in all cases. However, in 4 cases who did not show any improvement, systemic propranolol therapy was instituted.

Results: Eighteen infants were enrolled in the study. There were 13 females and 5 males with the ratio of females to males being 2.6:1. In 11 infants, the tumor shrank within one week after the administration of intralesional glucocorticoids with the fading of tumor color. After one month of injection, the tumor was obviously involuted. The tumor became soft, flat and turned dark red. Two months after the injection, most of tumors continued to involute. Three of the tumors (17.7%), grew at the edge and required retreatment. Eleven patients underwent the treatment once, two patients twice, and one patient thrice. At the end of follow-up, tumors in 14 patients got almost completely involuted, with local telangiectasia left in 6 patients. In 3 patients, the tumor shrank, but did not completely involute. For effects evaluation, the treatment results were labeled as "markedly effective" in 12 cases and "effective" in 2 cases.

Conclusions: Intralesional glucocorticoid therapy is a freely available, economic and effective therapy in the management of capillary periorbital hemangiomas, yet, in some cases of capillary hemangiomas, there is an indication for administering systemic propranolol therapy. The sample size is limited, yet, it may be the initial step in devising a road map for the management of infantile periorbital hemangiomas. It may also play a role in putting to rest a controversial topic in pediatric ophthalmology.