Ocular Safety of Intravitreal Propranolol and Its Efficacy in Attenuation of Choroidal Neovascularization.

PURPOSE: Determine the safe dose of intravitreal propranolol (IVP), and evaluate its inhibitory effect on laser-induced choroidal neovascularization (CNV). METHODS: To determine the IVP safe dose, 32 rabbits were divided into 4 groups. Three of these groups received IVP (15 µL) corresponding to 15 µg (group B), 30 µg (group C), and 60 µg (group D). The control group (A) received 15 µL saline. Safety was assessed by ocular examination, electroretinography (ERG), routine histopathologic evaluation, immunohistochemistry for glial fibrillary acidic protein (GFAP), and real-time qPCR for GFAP, VEGF, thrombospondin 1 (TSP1), and pigment epithelium-derived factor (PEDF). A similar experiment was performed in 24 mice by using a 100-fold lower amount of propranolol (0.15, 0.3, and 0.6 µg in 2 µL) based on vitreous volume. For assessment of the angioinhibitory effects of IVP, CNV was induced in 42 mice via laser burns. Mice were divided into two groups: group 1 received the safe dose of IVP (0.3 µg in 2 µL) and group 2 received saline. Neovascularization area was quantified by intercellular adhesion molecule (ICAM)-2 immunostaining of choroidal-scleral flat mounts by using ImageJ software. RESULTS: According to clinical, ERG, and histopathologic findings, 30 µg IVP was chosen as the safe dose in rabbit eyes, comparable to 0.3 µg IVP in mouse eyes. As compared to the control eyes, the development of CNV was attenuated (4.8-fold) in mice receiving 0.3 µg IVP. CONCLUSIONS: Intravitreal propranolol injection up to the final dose of 30 µg in rabbits and 0.3 µg in mice was safe, and was effective in attenuation of CNV in mice.

Posterior Ischemic Optic Neuropathy following Herpes Zoster Ophthalmicus.

PURPOSE: To report a case of posterior ischemic optic neuropathy (PION) following herpes zoster ophthalmicus (HZO). CASE REPORT: A 58-year-old woman with history of recent HZO in her right eye presented with acute painless loss of vision in the same eye to no light perception.Examination revealed a positive relative afferent pupillary defect and a normal appearing optic disc. Inflammatory and infiltrative lesions of the optic nerve were ruled out by laboratory and imaging studies. The patient received systemic acyclovir and prednisolone. Three months later, visual acuity improved to counting fingers, but the optic disc became pale and atrophic leading to a presumptive diagnosis of PION.Considering the positive PCR test for varicella zoster virus and the short time interval between the two presentations, HZO was considered as the most probable cause of the optic neuropathy. CONCLUSION: Herpes zoster ophthalmicus can be associated with PION.