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Andrew Hendrick, Jeremy Lavine, Amitha Domalpally, Amol Kulkarni, T Michael Nork, Justin Gottlieb, Ron Danis, Michael M Altaweel, Barbara A Blodi, Suresh Chandra, Michael S Ip; Propranolol for Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6345.
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© ARVO (1962-2015); The Authors (2016-present)
Panretinal photocoagulation (PRP) can induce complications (e.g. visual field defects) such that treatment is typically considered only when eyes develop proliferative diabetic retinopathy (PDR) (DRS, 1981). Serial anti-vascular endothelial growth factor (VEGF) injections can reduce retinopathy severity, but require a substantial treatment burden, and carry the risk of complications (DRCR Protocol S, 2015). Beta-adrenergic blockade has anti-VEGF activity (Ristori et al, 2011), but its specific effect on PDR has not been examined. This pilot study examines the effect of propranolol on subjects with PDR to determine an effect in reducing neovascular burden.
12 eyes of 10 subjects were prospectively recruited. Adult subjects were eligible with PDR if they had non-high risk PDR or persistent neovascularization despite ‘complete’ PRP laser in one or both eyes. Subjects were excluded who received laser or anti-VEGF injections within 3 months, were already on a beta-blocker, or had other contraindications. Subjects were given a daily dose of 120 mg oral propranolol extended release over 12 weeks and were assessed with serial bilateral 7-field fundus photographs, fluorescein angiograms (FA), and optical coherence tomography (OCT). Outcome measures included (1) degree of neovascular leakage on FA, (2) ETDRS grading of retinopathy severity, and (3) OCT central subfield (CSF) thickness.
Serial FA images were only available in 4 eyes with at least one follow up visit. FA leakage ranged from 5.7-13.3 disc areas without any significant change noted during follow up. Figures 1 and 2 summarize ETDRS grading and OCT results. OCT data were available for 8 eyes with median CSF that remained stable over 12 weeks.
Medical treatment of diabetic retinopathy may become an important tool to combat the visually threatening consequences of this disease. In this pilot study, propranolol did not substantially affect retinal neovascular activity. This study was designed to safely optimize the potential effect in a carefully selected patient population in whom laser can be considered. It is possible that the anti-VEGF activity of propranolol is too insubstantial to have a clinical consequence. However, alternative beta-blockers, higher doses, or treatment at an earlier stage may have increased benefit and are worthwhile future directions.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Figure 1: ETDRS grading of fundus photographs
Figure 2: OCT central subfield thickness
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