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EDITORIAL
Year : 2013  |  Volume : 3  |  Issue : 3  |  Page : 85-86

New therapeutic strategy for recalcitrant eyelid and orbital diseases


Department of Ophthalmology, National University Hospital, Taipei, Taiwan

Date of Web Publication22-Aug-2013

Correspondence Address:
Shu Lang Liao
Department of Ophthalmology, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.tjo.2013.07.001

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How to cite this article:
Liao SL. New therapeutic strategy for recalcitrant eyelid and orbital diseases. Taiwan J Ophthalmol 2013;3:85-6

How to cite this URL:
Liao SL. New therapeutic strategy for recalcitrant eyelid and orbital diseases. Taiwan J Ophthalmol [serial online] 2013 [cited 2022 Jan 21];3:85-6. Available from: https://www.e-tjo.org/text.asp?2013/3/3/85/203879





Infantile hemangiomas are vascular tumors characterized by a hypercellular proliferation phase and a long involutional phase. They are the most common periorbital and orbital vascular tumors of infancy.[1] They appear shortly after birth and usually begin to involute spontaneously in early childhood. Most infantile hemangiomas do not need to be treated, but about 20% are extremely disfiguring and destructive to normal tissue, which may result in amblyopia due to astigmatism, ptosis, or globe displacement.[2] Such hemangi-omas must be treated. Therapeutic options include intralesional or systemic corticosteroids as a first line of treatment,[3] and interferon, vincristine, focal laser photocoagulation, and surgical excision as secondary therapeutic choices.[4] In 2008, the successful effect of oral pro-pranolol therapy on severe infantile hemangiomas was reported by Léauté-Labrèze et al[5] in patients treated for hypertrophic cardiomyop-athy. Recent studies also show that nonselective β-blockers, including systemic propranolol and topical timolol, are a promising new therapy for infantile hemangioma.[6] The mechanism of action remains uncertain, but possible theories include vasoconstriction, modulation of prosurvival signal transduction pathways, and endothelial cell apoptosis. Potentially serious adverse effects resulting from the systemic use of propranolol to treat infantile hemangioma include brady-cardia, hypotension, bronchospasm, hypoglycemia, and electrolyte disturbance. More common side effects are sleep and gastrointestinal disturbances. Topical timolol application for localized, superficial tumors may have similar effect as oral propranolol, while reducing systemic effects. In this issue, the review article entitled “Areview of infantile capillary hemangiomas and their current treatmentmodalities” discusses the off-label use of corticosteroids, propranolol, timolol, vincristine, and interferon for the treatment of capillary hemangi-omas. Christopher B. Chambers presents the classification of capillary hemangioma, possible complications, traditional treatment options, and new treatment options of β blocker therapy. He also reviews the detail dosage for systemic β blocker administration as well as the efficacy and complications for this new therapeutic option.

Graves’ ophthalmopathy (GO) is an autoimmune inflammatory disorder of the orbital adipose and connective tissues and the extra-ocular muscles. This condition occurs closely in association with Graves’ disease, and recent evidence implicates the TSH receptor as an important orbital autoantigen in GO.[7],[8],[9] The characteristic clinical manifestations of GO, including proptosis, chemosis, periorbital edema, and extraocular muscle dysfunction, result from the intraor-bital inflammatory process and the enlargement of the adipose tissue and muscles within the orbit. Although the identity of the primary autoantigens is unclear, lymphocytic infiltration in extraoc-ular muscle and orbital fat tissue and the fibrosis of extraocular muscle and increase of orbital fat volume are characteristic histolog-ical features of GO.[10],[11],[12],[13] There are many treatment modalities for GO including systemic corticosteroids, orbital radiation, systemic immunotherapy, and, recently, cytokines or B cell target therapy. Generally speaking, systemic corticosteroid remains the treatment of choice for GO. Systemic corticosteroids are sometimes effective, but the flare-up of symptoms is not uncommon during the tapering, or withdrawal of corticosteroids. In this issue, the efficacy of the combination of orbital radiation and intravenous corticosteroids for patients with refractory GO was investigated. Six patients with active moderate-to-severe GO refractory to corticosteroid therapy were treated with combined orbital radiotherapy and systemic cor-ticosteroids. All patients achieved complete cessation of corticoste-roid therapy and stabilization of disease without recurrence. The authors concluded that combined orbital radiotherapy and systemic corticosteroids can achieve greater improvement in clinical activity, soft tissue inflammation, and ocular motility. It can stabilize disease without recurrence in patients with refractory GO.



 
  References Top

1.
Weiss AH, Kelly JP. Reappraisal of astigmatism induced by periocular capillary hemangioma and treatment with intralesional corticosteroid injection. Ophthalmology 2008;115:390-7.   Back to cited text no. 1
    
2.
Bruckner AL, Frieden IJ. Infantile hemangiomas. J Am Acad Dermatol 2006;55: 671-82.  Back to cited text no. 2
    
3.
Frieden IJ, Haggstrom AN, Drolet BA, Mancini AJ, Friedlander SF, Boon L, et al. Infantile hemangiomas: current knowledge, future directions: proceedings of a research workshop on infantile hemangiomas, April 7-9, 2005, Bethesda, Maryland, USA. PediatrDermatol 2005;22:383-406.  Back to cited text no. 3
    
4.
Sans V, de la Roque ED, Berge J, Grenier N, Boralevi F, Mazereeuw-Hautier J, et al. Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics 2009;124:423-31.  Back to cited text no. 4
    
5.
Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008;358:2649-51.  Back to cited text no. 5
    
6.
Taban M, Goldberg RA. Propranolol for orbital hemangioma. Ophthalmology 2010;117. 195-195.e4.  Back to cited text no. 6
    
7.
Bahn RS, Dutton CM, Natt N, Joba W, Spitzweg C, Heufelder AE. Thyrotropin receptor expression in Graves’ orbital adipose/connective tissues: potential auto-antigen in Graves’ ophthalmopathy. J Clin Endocrinol Metab 1998;83:998-1002.  Back to cited text no. 7
    
8.
Starkey KJ, Janezic A, Jones G, Jordan N, Baker G, Ludgate M. Adipose thyrotrophin receptor expression is elevated in Graves’ and thyroid eye diseases ex vivo and indicates adipogenesis in progress in vivo. JMolEndocrinol 2003;30:369-80.  Back to cited text no. 8
    
9.
Valyasevi RW, Erickson DZ, Harteneck DA, Dutton C, Jyonouchi S, Bahn RS. Differentiation of human orbital preadipocyte fibroblasts induces expression of functional thyrotropin receptor. JClin Endocrinol Metab 1999;84:2557-62.   Back to cited text no. 9
    
10.
Bahn RS, Heufelder AE. Pathogenesis of Graves’ ophthalmopathy. N Engl J Med 1993;329:1468-75.  Back to cited text no. 10
    
11.
Tallstedt MI, Norberg R. Immunohistochemical staining of normal and Graves’ extraocular muscle. Invest Ophthalmol Vis Sci 1988;29:175-84.   Back to cited text no. 11
    
12.
Weetman AP, Cohen S, Gatter KC, Fells P, Shine B. Immunohistochemical analysis of retrobulbar tissues in Graves’ ophthalmopathy. Clin Exp Immunol 1989;75:222-7.  Back to cited text no. 12
    
13.
Kahaly G, Hansen C, Felke B, Dienes HP. Immunohistochemical staining of ret-robulbar adipose tissue in Graves’ ophthalmopathy. Clin Immunol Immunopathol 1994;73:53-62.  Back to cited text no. 13
    




 

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