Kassif Y, Rehany U, Rumelt S
1Department of Ophthalmology, Western Galilee, Nahariya Medical Center, Nahariya, Israel.
Eye (Lond). 2004 Jan;18(1):41-3. doi: 10.1038/sj.eye.6700507.
Noninfectious uveitis is usually managed by topical and systemic corticosteroids and in refractory cases by immunosuppressive drugs.
To describe a patient with noninfectious anterior and posterior uveitis, refractory to corticosteroids, and immunosuppressive therapy, which responded to systemic metoprolol.
A 49-year-old patient was treated for 3 years with topical and systemic corticosteroids and systemic cyclosporin A for a bilateral anterior and posterior uveitis of unknown origin. The treatment did not result in resolution of the uveitis. A bilateral uveitic glaucoma developed and necessitated neodymium : YAG laser iridotomies and antiglaucoma medications. A systemic beta-blocker, metoprolol tartrate 50 mg b.i.d., was administered for palpitations because of idiopatic paroxysmal supraventricular tachycardia and short ventricular tachycardia.
Following administration of metoprolol tartrate, the bilateral uveitis resolved. The corticosteroids and the cyclosporin A were withdrawn after 6 weeks without any recurrence. A trial to discontinue metoprolol after 6 months resulted in flare-up of the disease and only following its readministration the inflammation resolved. The patient is currently under metoprolol for a year without flare-ups.
The use of metoprolol tartrate in this patient resulted in resolution of bilateral noninfectious uveitis. This is the first report of non-antiinfectious, antiinflammatory, or immunosuppressive drug effective for uveitis. It is possible that a subgroup of resistant uveitis may respond to drugs other than the traditional drugs, such as metoprolol, and that other forms of uveitis of unidentified origin exist.
非感染性葡萄膜炎通常采用局部和全身使用皮质类固醇治疗，难治性病例则使用免疫抑制药物。
描述一名患有非感染性前、后葡萄膜炎的患者，该患者对皮质类固醇和免疫抑制治疗无效，但对全身使用美托洛尔有反应。
一名49岁患者因不明原因的双侧前、后葡萄膜炎接受局部和全身皮质类固醇以及全身环孢素A治疗3年。治疗未能使葡萄膜炎消退。双侧葡萄膜炎性青光眼发展，需要进行钕：YAG激光虹膜切开术和抗青光眼药物治疗。因特发性阵发性室上性心动过速和短阵室性心动过速导致心悸，给予全身β受体阻滞剂酒石酸美托洛尔50毫克，每日两次。
服用酒石酸美托洛尔后，双侧葡萄膜炎消退。6周后停用皮质类固醇和环孢素A，无任何复发。6个月后尝试停用美托洛尔导致疾病复发，仅在重新给药后炎症才消退。该患者目前服用美托洛尔一年，无疾病复发。
该患者使用酒石酸美托洛尔使双侧非感染性葡萄膜炎消退。这是关于对葡萄膜炎有效的非抗感染、抗炎或免疫抑制药物的首例报告。可能存在一部分耐药性葡萄膜炎患者对美托洛尔等传统药物以外的药物有反应，并且存在其他不明原因的葡萄膜炎形式。
