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Alanna Nattis, Robert G Josephberg; Rifampin Therapy for Central Serious Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3722.
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To investigate the clinical efficacy of oral Rifampin therapy for chronic and acute central serous chorioretinopathy (CSC).
This was a retrospective observational case series. Active chart review and data collection was performed on patients treated in a private retina practice for chronic and acute CSC. Patients treated with rifampin were selected for data collection and analysis. Clinical course, documented eye examinations, optical coherence tomography (OCT) and fluorescein angiography (FA) data were reviewed and analyzed.
Four patients treated with rifampin for chronic and acute CSC were identified, the average time of follow up care ranged from 2 months to ten years. All patients had subretinal fluid demonstrated on exam and OCT. Two of the patients were treated with other modalities prior to initiation of rifampin therapy (Patient 1: topical ketorolac and a series of bevacizumab injections; Patent 2: 2 bevacizumab injections, methotrexate). These patients experienced periodic resolution, but ultimately had reaccumulation of subretinal fluid and decline in vision. After initiation of rifampin therapy, all patients experienced improved vision (average Snellen line improvement 3.75 (SD± 2.75)) and complete resolution of subretinal fluid as demonstrated by fundoscopy and OCT (average decreased macular thickness of 106.5μm).
Our case series supplements current literature highlighting the efficacy of rifampin for treatment of chronic and acute CSC. In concordance with previous reports, our patients showed decreased subretinal fluid and improvement in visual acuity after just a few weeks, perhaps through rifampin’s anti-glucocorticoid properties. Rifampin appears to be a promising, cost-effective and efficacious therapy for CSC. It would be interesting to further explore rifampin as a treatment option for acute CSC, especially in patients where excellent depth perception and visual acuity is vital to their career/lifestyle (e.g. pilots, operators of heavy machinery, professional athletes). Then, we could explore the optimal treatment period/duration, as well as incidence of recurrence of CSC in those treated for acute CSC episodes after rifampin therapy.
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