BACKGROUND: There has been a dramatic increase in the off-label use of ophthalmic timolol maleate, a beta-blocker used for infantile hemangioma (IH) treatment as a topical counterpart to oral propranolol. Its safety and efficacy in a pediatric population with IH have not been evaluated in a large cohort. Our goal was to retrospectively assess timolol's effectiveness, discern characteristics associated with response, and document reported adverse events. METHODS: A multicenter retrospective cohort study of 731 patients treated with topical timolol was completed at 9 centers. Inclusion required an IH suitable for timolol in the treating physician's judgment and access to clinical details including photographs. Logistic regression analysis and descriptive statistics were performed. Primary outcome measures were efficacy assessed by using visual analog scales for color and for size, extent, and volume from review of digital photographs taken as standard of care. RESULTS: Most IHs were localized (80.1%) and superficial (55.3%). Risk of disfigurement was the most common indication for therapy (74.3%). Duration of therapy (P < .0001), initial thinness (P = .008), and subtype (P = .031) were significant predictors of response. Best response occurred in superficial IHs < 1 mm thick. Fifty-three (7.3%) required subsequent therapy with systemic beta-blocker. Adverse events were mild, occurring in 25 (3.4%) patients. No cardiovascular side effects were documented. CONCLUSIONS: Timolol seems to be a well-tolerated, safe treatment option with moderate to good effectiveness, demonstrating best response in thin, superficial IHs regardless of pretreatment size. Timolol can be recommended as an alternative to systemic beta-blockers and watchful waiting for many patients.
[1]Johns Hopkins Sch Med, Baltimore, MD USA.
[2]Cincinnati Childrens Hosp, Cincinnati, OH USA.
[3]Hosp Sick Children, Toronto, ON, Canada.
[4]St Justine Hosp, Montreal, PQ, Canada.
[5]Univ Calif San Francisco, San Francisco, CA 94143 USA.
[6]Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA.
[7]Hosp Santa Creu & Sant Pau, Barcelona, Spain.
[8]Med Coll Wisconsin, Milwaukee, WI 53226 USA.
[9]Columbia Univ, New York, NY USA.
[10]Childrens Mercy Hosp, Kansas City, MO 64108 USA.
[11]Fudan Univ, Childrens Hosp, Shanghai, Peoples R China.
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