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Serendipity, the humble case report and modern health science challenges

Middle East African Journal of Ophthalmology
Medknow Publications
Publication Date
DOI: 10.4103/0974-9233.90132
  • Commentary
  • Communication
  • Medicine


Any expecting parent would be devastated when their dear little infant is born with an unsightly periocular capillary hemangioma. These tumors often present at birth or soon thereafter may be small and of no clinical significance. However, when they are large and unsightly, both parents and physicians are motivated to intervene therapeutically. Given their predilection for the upper lid, the risk of the mass precluding normal visual development is high. Sensory deprivation, induced astigmatism and anisometropia contribute to the risk of developing amblyopia which is as high as 64%.1 All clinicians who treat these tumors are keenly aware of the inadequacies of conventional treatment modalities and for many years a need has existed for simpler and more effective therapies which have, until recently, evaded us. It was therefore with great excitement and expectation that the landmark paper by Léauté-Labrèze et al, was received by clinicians when it first appeared in 2008 describing propranolol for the treatment of hemangiomas.2 Propranolol was serendipitously found to induce early involution in capillary hemangiomas and this was reported in a prestigious journal in the format of a “humble” letter to the editor (a form of scientific communication belittled by many modern editors of international medical journals). The authors admitted that the regulators of hemangioma growth were still poorly understood and that exactly how propranolol, a non-selective β-adrenergic antagonist, induced such remarkable regression in capillary hemangiomas was uncertain but they nevertheless reported their convictions. They suggested vasoconstriction and induction of apoptosis in capillary endothelial cells as possible mechanisms. Since that communication several others, mostly in the form of editorials and letters, have appeared on the subject and mostly in nonophthalmic literature.3–5 In their report “Oral Propranolol for the Treatment of Periorbital Infantile Hemangioma: A Preliminary Report from Oman” the authors present

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