Peri-operative propranolol – a useful adjunct for glaucoma surgery in Sturge Weber Syndrome

Abstract Objective or Purpose Ocular manifestations of Sturge Weber Syndrome (SWS) include choroidal hemangioma and glaucoma Intraocular pressure (IOP) reduction in these patients is commonly associated with sight-threatening choroidal effusions. Oral propranolol is the standard of care for infantile cutaneous hemangioma, but its role in choroidal haemangioma is largely unexplored. We studied the role of peri-operative oral propranolol during glaucoma surgery (including Trabeculectomy, combined trabeculotomy with trabeculectomy, and Glaucoma drainage device implantation) in Sturge Weber Syndrome. Design Prospective non-randomized case series with historical controls. Participants 14 eyes of 12 patients with SWS scheduled for glaucoma surgery were included, and the outcome compared to historical controls without propranolol (15 eyes of 14 patients). Methods, Intervention, or Testing Patients in the prospective cohort received oral propranolol 2 mg/kg body weight daily, in two divided doses, one week before surgery, continued for six weeks post-operatively. There was no modification (eg. posterior sclerotomies) in the existing surgical technique. The historical control group was identified from records and SWS diagnosis validated by chart review. Main Outcome Measures The incidence and extent of post-operative choroidal effusion, additional procedures required and adverse effects of the drug in the prospective cohort compared to the control group. Results Average follow-up was 25.7±12.1 months (95% C.I. 19.3; 32.1 months). The IOP reduced from 25.2 ±9.7 mmHg at presentation to 16.25±6.2, 14.6±4.5, 13.7 ± 6.4, and 16.5 ± 8.0 mm Hg at one week, one month, three months and one-year post-operatively respectively. In the peri-operative propranolol group, no patient developed sight-threatening choroidal effusion within the vascular arcades. In the two patients with bilateral disease, both eyes of each patient had peripheral choroidal effusion, which settled with medical treatment. It was a repeat surgery in 3 of the four eyes. There were no adverse effects of propranolol in any patient. In the control group, 5 of 12 eyes had peripheral choroidal effusion after primary glaucoma surgery, while 5 of 6 eyes who had previous failed glaucoma surgery developed sight-threatening choroidal effusion requiring surgical intervention. Conclusions Oral propranolol appears to be an effective modality to minimize the development of sight-threatening choroidal effusions following glaucoma surgery in SWS.