Title

INTRAVITREAL METOPROLOL INJECTIONS: IS IT A SAFE OPTION FOR CHOROIDAL HEMANGIOMA?

Introduction

Purpose: To evaluate the ocular toxicity of intravitreal metoprolol injections in five eyes with circumscribed choroidal hemangioma.

Methods

Methods: Five eyes of five subjects diagnosed with circumscribed choroidal hemangioma and unsuccessfully treated with intravitreal anti‐VEGF agents were enrolled and received off label intravitreal injections of metoprolol (50µg/0.05 ml). Basal and follow-up tests included best-corrected visual acuity, intraocular pressure assessment, anterior chamber cellular score/flare, vitreitis classification, retinography, fundus autofluorescence, and ISCEV full-field scotopic and photopic standard protocols. The follow-up period was 30 days, and the results of the tests were compared using a paired t-test: pre vs. post-treatment.

Results

Results: There were no significant changes in visual acuity, tonometry, retinography and fundus autofluorescence. The subretinal and/or intraretinal fluid improved in three patients four weeks after the metoprolol injection. There was no significant difference in all ISCEV recommended ERG parameters regarding a- and b-wave amplitude and implicit time, and oscillatory potentials maximal amplitude. No subject developed any clinical sign of intraocular inflammation.

Discussion

Conclusion: No signs of acute ocular toxicity of 50µg/0.05ml intravitreal metoprolol injections in patients with circumscribed choroidal hemangioma were identified. Long term retinal toxicity, different concentrations, drug resistance and complications form repeated-intravitreal injections were not accessed. The off‐label use of intravitreal metoprolol tartrate (50 mcg/0,05ml) may be of interest to possible new therapeutic approaches.

Keywords

intravitreal injection, b-blocker, metoprolol, ocular toxicity, electroretinogram

Area

CLINICAL CASE

Authors

Leandro Jerez Chaves, André Messias, Rodrigo Jorge