Abstract
Background
Choroidal hemangioma is a visual threatening condition for which treatments is neither uniform nor widely available. New management options are necessary. The purpose of this study is to assess the safety and early outcome of intravitreal metoprolol tartrate in five patients with CCH.
Methods
Five eyes of five patients diagnosed with subfoveal or peripapillary CCH and unsuccessfully treated with intravitreal anti-VEGF agents were enrolled and received off-label intravitreal injections of metoprolol (50μg/0.05 ml). Baseline and follow-up evaluations included best-corrected visual acuity, intraocular pressure measurement, assessment of anterior chamber cellular score/flare and vitritis, retinography, fundus autofluorescence, and ERG. Patients were followed for a period of 30 days. Statistical analysis involved comparison of pre- and post-treatment findings using a paired t-test.
Results
There was no significant difference in all ERG parameters regarding a- and b-wave amplitude and implicit time, and oscillatory potentials’ maximal amplitude. There were no significant changes in visual acuity. None of the patients developed clinical signs of intraocular inflammation. The subretinal and/or intraretinal fluid improved in 3 out of 5 patients 4 weeks after the metoprolol injection.
Conclusions
Patients with CCH treated with a single injection of 50μg/0.05ml intravitreal metoprolol injections showed no signs of acute ocular toxicity. This pilot study did not assess long-term retinal toxicity, different concentrations, drug resistance, and complications from repeated-intravitreal injections.
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Acknowledgements
We thank Renata Moreto M.D, Talitha Aguiar M.D, and Annelise Nicotti M.D for recording the electrophysiological exam, and Ms. Lucelia Albiéri, Ms. Andréia Baptista, and Ms. Alessandra Moraes (ophthalmic technicians and patient advisor) for imaging acquisition and patient counseling.
Funding
CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), FAEPA (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo), and CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico), grant 305299/2018.
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L. Chaves and R. Jorge are the primary contributors to research design. R. Jorge, L. Chaves, and A. Messias are responsible for research execution and data acquisition. All authors were primary contributors to data analysis and interpretation. Manuscript was prepared by R. Jorge, L. Chaves, and A. Messias with critical revision by Z. Correa, and final version approved by all authors.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ribeirão Preto Medical School at University of São Paulo and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (CAAE 14280219.7.0000.5440).
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Informed consent was obtained from all individual participants included in the study.
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Chaves, L., Messias, A., Correa, Z. et al. Intravitreal metoprolol for circumscribed choroidal hemangiomas: a phase I clinical trial. Graefes Arch Clin Exp Ophthalmol 259, 2837–2841 (2021). https://doi.org/10.1007/s00417-021-05153-9
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DOI: https://doi.org/10.1007/s00417-021-05153-9