Propranolol-Therapie bei infantilen Hämangiomen im Lid- und Orbitabereich

 

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Zusammenfassung

Infantile Hämangiome im Lid- und Orbitabereich können trotz ihres selbstlimitierenden natürlichen Verlaufs zu funktionellen Defiziten infolge einer Amblyopie oder Optikuskompression führen oder ein ästhetisch störendes Erscheinungsbild entwickeln. Seit der „zufälligen“ Entdeckung des Effekts von Propranolol (unselektiver Betablocker) auf infantile Hämangiome im Jahr 2008 wird diese Substanz zur Behandlung komplizierter Hämangiome eingesetzt, die ansonsten den Einsatz von Kortikosteroiden, Laser oder operativen Verfahren erfordert hätten. Dargestellt werden Pathogenese, Klassifikation, Indikation zur Therapie, Therapieoptionen für infantile Hämangiome sowie eigene Ergebnisse nach systemischer Propranololtherapie bei Kindern mit therapiebedürftigen infantilen Hämangiomen im Lid- und Orbitabereich. Bei Bestätigung der bisherigen Daten hat Propranolol das Potenzial, die komplikationsträchtige medikamentöse Therapie von Hämangiomen im Lid- und Orbitabereich mit hochdosierten Kortikosteroiden und die chirurgische Therapie aufgrund einer deutlich günstigeren Nutzen-Risiko-Bilanz zu ersetzen. Weitere klinische Studien zur Optimierung von Dosierung, Behandlungsdauer, Art der Anwendung (lokal oder systemisch) sind jedoch erforderlich. Propranolol wird zukünftig bei komplizierten peri- und orbitalen Hämangiomen als Therapie der ersten Wahl unter pädiatrisch-kardiologischer Kontrolle eingesetzt werden.

Abstract

In spite of the self-limiting natural course of infantile haemangiomas of the eyelids and orbit, the effects of amblyopia, compression of the optic nerve, and impairment of the aesthetic appearance may develop. Since the serendipitous discovery of the effects of propranolol, a non-selective beta-blocker, on infantile haemangioma in 2008, it has largely replaced the former standard treatments with corticosteroids, laser or surgical procedures. This review discusses the pathogenesis, classification, indication for treatment, and treatment options for infantile haemangiomas. In addition, the results of patients with infantile haemangiomas of the eyelids and orbit treated with systemic propranolol are shown. With additional confirmation of data, including a positive effect-risk-analysis, propranolol will potentially replace high-dose corticosteroids and surgery in the treatment of infantile haemangiomas in the eyelids and orbit. Further clinical studies are necessary to optimise the dosage, treatment period, and application modalities (oral or topical). In the future, propranolol accompanied with paediatric-cardiological monitoring should emerge as the first-line therapy for problematic infantile haemangiomas.

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