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Zac B. Ravage, Kirk H. Packo; Rifampin for Treatment of Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2137.
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Anti-glucocorticoid therapy has been used successfully in limited trials for the treatment of chronic central serous chorioretinopathy (CSC). Rifampin is known to reduce systemic levels of endogenous glucocorticoids via induction of hepatic metabolism. We therefore sought to evaluate the efficacy of oral rifampin for the treatment of CSC.
A retrospective interventional case series of five patients treated with oral rifampin for CSC was performed. Rifampin was considered as off-label treatment after observing improvement of chronic CSC in a patient on multi-drug antibiotic therapy for presumed latent tuberculosis, an effect maintained on rifampin monotherapy. All patients were male. Mean patient age was 50 (range 45-61). Duration of active disease was ≤ 1 month in 2 patients, 1 year in 1 patient and > 1 year in 2 patients. 3 patients had a remote history of steroid use. 1 patient received previous treatment with intravitreal avastin (IVA) for CSC. Snellen visual acuity, complete ophthalmic examination, fluorescein angiography (FA) and optical coherence tomography (OCT) were performed at baseline. Patients were treated with rifampin 600 mg per day then re-examined at approximately weeks 1, 8 and 12. OCT was repeated at all visits, FA was performed at the discretion of the treating physician. The primary endpoint was reduction in retinal pigment epithelial (RPE) leakage and neurosensory retinal detachments. The secondary endpoint was lines of vision gained.
Follow-up was 8 weeks for 2 patients and 12 weeks for 3 patients. 1 patient self-discontinued rifampin after 3 weeks of treatment. 1 patient developed choroidal neovascularization after 2 months, treated with IVA and excluded from further analysis. Reported side effects of treatment include headache in 1 patient and nausea in 1 patient. Mean change in central macular thickness (CMT) from baseline OCT was -99 (SD±167) µm at week 1, -102 (SD±215) µm at week 8 and -93 (SD±91) µm at week 12. Change in CMT for each patient was -440, -217, -64, 1 and 118 µm. 3 patients gained 0 lines of vision, 2 patients gained ≥ 3 lines of vision.
Rifampin may be of potential benefit to patients with CSC. Acute cases appear to respond most favorably. Sub-retinal fluid may decrease with treatment, while sub-RPE fluid often persists. These early findings suggest a novel method for the treatment of chronic CSC and warrants further study.
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