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Cyrus Golshani, Patricia J Pahk, Steven A Teich, Dalia S Nagel, Alan H Friedman; Combined Alpha-1 and Beta Adrenergic Blockade for Recurrent or Severe Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5924.
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© ARVO (1962-2015); The Authors (2016-present)
No treatment is of proven efficacy for central serous chorioretinopathy (CSC) patients with frequent recurrences or the chronic severe variant with diffuse pigment epitheliopathy and chronic subretinal fluid. There is clinical and experimental evidence of autonomic nervous system dysfunction with sympathetic system over activity in CSC but questionable efficacy of beta adrenergic blocking agents. We evaluated the use of labetalol in a prospective series to test the hypothesis that combined alpha-1 and beta-1 and 2 blockade could reduce the number and duration of episodes of CSC.
A total of 5 patients were included. 4 patients had frequent recurrent disease and 1 had the chronic severe variant with pigment epitheliopathy and subretinal fluid bilaterally. All findings were confirmed by fluorescein angiography and/or OCT. Subjects were all male with ages ranging from 44 to 52 years old at presentation. Treatment was initiated with labetalol, an alpha-1 and beta-1 and 2 adrenergic blocking drug which has been shown to have increased affinity for melanin in the retinal pigment epithelium and choroid. All patients had received medical clearance by their internist prior to initiating labetalol.
All 5 patients had improvement in vision with resolution of neurosensory retinal detachments, reduced or no frequency of recurrences, and absence of leakage on fluorescein angiography. Duration of therapy ranged from 2.5 months to 10 years. 1 patient had a positive challenge, de-challenge, and re-challenge with labetalol. 3 patients had side effects of lethargy. 1 patient discontinued the drug and 1 continued at a reduced dosage. Follow-up ranged from 8.5 months to greater than 10 years at last visit.
The results of this prospective series support the hypothesis that some patients with CSC have an underlying autonomic nervous dysfunction with sympathetic system over activity that may be amenable to pharmacologic therapy. CSC episodes may be triggered by other factors that exacerbate this dysfunction. These may include psychological stress, use of adrenergic agents, exogenous or endogenous corticosteroids, sleep disorders, pregnancy, or other factors. Blockade of both alpha-1 and beta adrenergic receptors therefore seems to be a rational approach to treat patients with frequent recurrences or the severe variant. We believe this treatment is worthy of further investigation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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