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Hassanpour K, Nourinia R, Gerami E, Mahmoudi G, Esfandiari H. Ocular Manifestations of the Sturge-Weber Syndrome. J Ophthalmic Vis Res 2021; 16:415-431. [PMID: 34394871 PMCID: PMC8358762 DOI: 10.18502/jovr.v16i3.9438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Sturge-Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a non-inherited congenital disorder characterized by neurologic, skin, and ocular abnormalities. A somatic activating mutation (R183Q) in the GNAQ gene during early embryogenesis has been recently recognized as the etiology of vascular abnormalities in SWS. Approximately, half of the patients with SWS manifest ocular involvement including glaucoma as the most common ocular abnormality followed by choroidal hemangioma (CH). The underlying pathophysiology of glaucoma in SWS has not been completely understood yet. Early onset glaucoma comprising 60% of SWS glaucoma have lower success rates after medical and surgical treatments compared with primary congenital glaucoma. Primary angle surgery is associated with modest success in the early onset SWS glaucoma while the success rate significantly decreases in late onset glaucoma. Filtration surgery is associated with a higher risk of intraoperative and postoperative choroidal effusion and suprachoroidal hemorrhage. CH is reported in 40-50% of SWS patients. The goal of treatment in patients with CH is to induce involution of the hemangioma, with reduction of subretinal and intraretinal fluid and minimal damage to the neurosensory retina. The decision for treating diffuse CHs highly depends on the patient's visual acuity, the need for glaucoma surgery, the presence of subretinal fluid (SRF), its chronicity, and the potential for visual recovery.
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Affiliation(s)
- Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Gerami
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghavam Mahmoudi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Chaves L, Messias A, Correa Z, Jorge R. Intravitreal metoprolol for circumscribed choroidal hemangiomas: a phase I clinical trial. Graefes Arch Clin Exp Ophthalmol 2021; 259:2837-2841. [PMID: 33914160 DOI: 10.1007/s00417-021-05153-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/17/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022] Open
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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Affiliation(s)
- Leandro Chaves
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900 Bandeirantes Avenue, Ribeirão Preto, SP, 14049-900, Brazil
| | - André Messias
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900 Bandeirantes Avenue, Ribeirão Preto, SP, 14049-900, Brazil
| | - Zelia Correa
- Ocular Oncology Service, Bascom Palmer Eye Institute and Sylvester Cancer Center, University of Miami, Miami, USA
| | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900 Bandeirantes Avenue, Ribeirão Preto, SP, 14049-900, Brazil.
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El Mourad S, Al-Nawaiseh S, Szurman P, Stanzel BV. [Retinal capillary hemangioblastoma in the maculopapillary bundle]. Ophthalmologe 2021; 119:190-194. [PMID: 33595688 DOI: 10.1007/s00347-021-01331-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/16/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Salaheddin El Mourad
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
| | - Sami Al-Nawaiseh
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
| | - Peter Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland.,Klaus Heimann Eye Research Institute, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
| | - Boris V Stanzel
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland. .,Klaus Heimann Eye Research Institute, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland.
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de Paiva MRB, Arribada RG, da Silva CN, Ribeiro MCS, Jorge R, Fialho SL, Silva-Cunha A. Assessment of the safety of intravitreal injection of metoprolol tartrate in rabbits. Doc Ophthalmol 2021; 142:75-85. [PMID: 32623534 DOI: 10.1007/s10633-020-09781-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To verify the safety of different doses of intravitreal metoprolol tartrate (MT) after intravitreal injection in rabbit eyes. METHODS Animals were randomly assigned into 2 groups: group I received 50 µg of MT and group II 100 µg of MT. A volume of 0.05 mL of the drug solution was administered through an intravitreal injection, while the control eyes received an equal volume of saline solution. Safety was assessed by clinical observation, electroretinography (ERG) and histological evaluation. RESULTS No evidence of clinical toxicity was observed. ERG waveforms from the MT treated eyes were similar to those recorded from the control eyes in dark-adapted state, amplitude and the implicit time are similar between the groups in light-adapted state, and their retinas had no signs of toxicity by histological evaluation 7 days after intravitreal injection. CONCLUSIONS The intravitreal use of metoprolol at 50 and 100 µg dosages does not cause short-term retinal toxicity in rabbits.
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Affiliation(s)
- Mayara Rodrigues Brandão de Paiva
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Pharmaceutical Research and Development, Ezequiel Dias Foundation, CEP 30510-010, Belo Horizonte, Brazil
| | | | | | | | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Silvia Ligório Fialho
- Pharmaceutical Research and Development, Ezequiel Dias Foundation, CEP 30510-010, Belo Horizonte, Brazil
| | - Armando Silva-Cunha
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Karimi S, Arabi A, Shahraki T, Safi S. Von Hippel-Lindau Disease and the Eye. J Ophthalmic Vis Res 2020; 15:78-94. [PMID: 32095212 PMCID: PMC7001024 DOI: 10.18502/jovr.v15i1.5950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022] Open
Abstract
Retinal hemangioblastoma (also referred to as retinal capillary hemangioma) is a benign lesion originating from the endothelial and glial components of the neurosensory retina and optic nerve head. Historically known as a manifestation of the von Hippel-Lindau (VHL) disease, it can be seen as an isolated finding or in association with some rare ocular conditions. In addition to characteristic ophthalmoscopic features, results of numerous ancillary tests including angiography, ultrasound, optical coherence tomography, and genetic tests may support the diagnosis and differentiate it from similar conditions. Because of serious life-threatening complications of VHL disease, every ocular approach to retinal hemangioblastomas should be in relationship with additional multidisciplinary diagnostic and therapeutic efforts. In addition, any patient with actual or probable diagnosis of VHL disease should be screened for ocular involvement. Unfavorable visual loss can occur early, and ocular complications of VHL range from exudative retinopathy to tractional retinal detachment, neovascular glaucoma, and phthisis bulbi. Accordingly, various treatment methods have been tested with overall acceptable responses, including photocoagulation, cryotherapy, photodynamic therapy, plaque radiotherapy, vitrectomy, and more novel intravitreal injections of anti-vascular endothelial growth factors and propranolol.
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Affiliation(s)
- Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toktam Shahraki
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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González-Rodríguez B, Villar Gómez de Las Heras K, Aguirre DT, Rodríguez-Padial L, Albiñana V, Recio-Poveda L, Cuesta AM, Botella LM, Jiménez-Escribano RM. Evaluation of the safety and effectiveness of oral propranolol in patients with von Hippel-Lindau disease and retinal hemangioblastomas: phase III clinical trial. BMJ Open Ophthalmol 2019; 4:e000203. [PMID: 31245608 PMCID: PMC6557078 DOI: 10.1136/bmjophth-2018-000203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background von Hippel-Lindau disease (VHL) is a multisystem cancer syndrome caused by mutations in the VHL gene. Retinal hemangioblastoma is one of the most common tumours, and when it appears near the optic nerve, its treatment is challenging and risky. To date, no treatment has proven effective in changing the course of the disease. This study was designed to evaluate the safety and effectiveness of propranolol in controlling these tumours. Methods Seven patients were included. All patients took a daily dose of 120 mg of propranolol for 1 year. Clinical variables were assessed at baseline, and at 1, 3, 6, 9 and 12 months. The primary endpoint of the study was the number and size of retinal hemangioblastomas. On every visit, retinal outcomes and blood biomarkers (such as vascular endothelial growth factor (VEGF) and miR210) were analysed. Results Number and size of retinal hemangioblastomas remained stable in all patients. All of them had initially increased levels of VEGF and miR210. There was a gradual reabsorption of retinal exudation in two patients, correlating with a progressive decrease of both biomarkers. The only adverse effect reported was hypotension in one patient. Conclusions Propranolol could be used to treat retinal hemangioblastomas in VHL patients, although more studies are needed to determine the ideal dose and long-term effect. VEGF and miR210 should be explored as biomarkers of disease activity. As far as we know, these are the first biomarkers proposed to monitor the VHL disease activity. Trial registration number 2014-003671-30.
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Affiliation(s)
- Beatriz González-Rodríguez
- Ophthalmology, Retina Service, Complejo Hospitalario de Toledo, Servicio de Salud de Castilla-La Mancha, Toledo, Spain
| | - Karina Villar Gómez de Las Heras
- DG Asistencia Sanitaria, Servicio de Salud de Castilla-La Mancha, Toledo, Spain.,Alianza VHL, Alianza de Familias de von Hippel-Lindau, Toledo, Spain
| | - Daniel T Aguirre
- Neurosurgery, Familial Neuro-Oncology Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Rodríguez-Padial
- Cardiology, Complejo Hospitalario de Toledo, Servicio de Salud de Castilla-La Mancha, Toledo, Spain
| | - Virginia Albiñana
- Centro de Investigaciones Biológicas-CIB, Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Lucía Recio-Poveda
- Centro de Investigaciones Biológicas-CIB, Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Angel M Cuesta
- Centro de Investigaciones Biológicas-CIB, Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Luisa Mª Botella
- Centro de Investigaciones Biológicas-CIB, Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Rosa María Jiménez-Escribano
- Ophthalmology, Retina Service, Complejo Hospitalario de Toledo, Servicio de Salud de Castilla-La Mancha, Toledo, Spain
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