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J. S. Nielsen, A. Bacchawat, L. M. Jampol; Oral Mifepristone for Chronic Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):764.
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Chronic central serous chorioretinopathy (CSC) can result in permanent loss of vision from retinal thinning and RPE atrophy. Many cases of chronic CSC do not respond to treatment. Glucocorticoids have been implicated in the pathogenesis of CSC, and blocking glucocorticoid action may be helpful its treatment. Our purpose is to see if Mifepristone (Mifeprex, RU486, Danco Laboratories), an oral glucocorticoid receptor antagonist, may be helpful in cases of chronic CSC.
Seven patients with varying degrees of chronic CSC not amenable to treatment with thermal laser or PDT were enrolled in an IRB approved open label treatment protocol with oral mifepristone 200mg daily for 12 weeks. Visual acuity, clinical examination, angiography, and OCT were performed prior to enrollment and repeated every four weeks over the course of treatment. LFTs were obtained for all subjects at enrollment and were rechecked after 4 weeks of treatment and upon conclusion of the protocol. Pregnancy was ruled out by serum bHCG in female subjects.
All patients completed the 12 week mifepristone protocol without adverse events. No elevation of liver enzymes were found in any patients over the course of treatment. Two patients demonstrated a clinical response to oral mifepristone. One patient had vision improve from 20/80 to 20/50 with complete resolution of subretinal fluid and retinal edema. Another patient had vision improve from CF3FT to 20/200 with a significant reduction in retinal edema.
Daily oral mifepristone does have a beneficial effect in treating some cases of chronic CSC. Further study is warranted.
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