Sir,
I read with interest Yassif and coworkers' description of a challenging case of panuveitis responding to oral metoprolol therapy.1 This is indeed a finding that deserves further investigation to elucidate the mechanisms involved, and clinical implications thereof.
Some early data in this regard have already been published; Er et al2 demonstrated that topical beta blockade using timolol maleate was able to reduce aqueous levels of proinflammatory cytokines interleukin-6, interleukin-8, and tumour necrosis factor-α in a rabbit model of ocular inflammation. In the case described, the patient was commenced on topical timolol in order to treat the secondary glaucoma; however, this had no effect on the inflammatory process. It is possible that that oral metoprolol was effective because it had a higher bioavailability within the posterior segment, as well as anteriorly. It was thus effective in suppressing ocular inflammation through the mechanisms described above.
References
Kassif Y, Rehany U, Rumelt S . Metoprolol responding uveitis. Eye 2004; 18: 41–43.
Er H, Doganay S, Evereklioglu C, Cekmen M, Daglioglu MC, Isci N . Effects of l-NAME and timolol on aqueous IL-1beta, IL-6, IL-8, TNF-alpha and NO levels after Nd : YAG laser iridotomy in rabbits. Eur J Ophthalmol 2002; 12: 281–286.
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Masood, I. Metoprolol responding uveitis. Eye 19, 719–720 (2005). https://doi.org/10.1038/sj.eye.6701616
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DOI: https://doi.org/10.1038/sj.eye.6701616