Abstract
Purpose :
Central serous chorioretinopathy (CSCR) is the 4th most frequent retinopathy, classically affecting young males with type A personalities, with 31-50% of patients having recurrent events. Observation is the primary methodology of treatment, with focal PDT or argon laser in persistent cases. Mineralocorticoid antagonists have also been shown to reduce duration of flares in chronic and recurrent cases. CSCR has been observed to resolve spontaneously within 6 months, however shortening the duration may improve quality of life. We hypothesize that the application of non-steroidal anti-inflammatory (NSAID) drops four times a day may decrease the length of active disease.
Methods :
In this retrospective series of 41 eyes in 41 patients newly diagnosed with CSR, patients were started on NSAID topical eyedrops. Patients were monitored until fluid resolution. BCVA and OCT CST parameters were measured throughout. With persistent cases, adjunct therapy was administered, resulting in subsequent fluid resolution.
Results :
With use of NSAID drops, 71% (n = 30) of patients had resolution of subretinal fluid without need for adjunct therapies. Mean time to resolution was 78 days and median was 76 days with a min of 34 and max of 155. BCVA improved an average of 1.3 lines. CST was reduced an average of 186.2um, ranging 25-635.
In 12% (n = 5) of cases, spironolactone 50-100mg BID was added to NSAID therapy. In 15% (n = 6) of cases, laser therapy was performed. BCVA in this combined cohort improved an average of 1.4 lines. CST decreased an average of 234um. The mean time to resolution in persistent cases treated with adjunct therapy was 187 days with a median of 152 days, ranging from 121-328.
Conclusions :
Our results are consistent with the hypothesis that topical NSAID drops are a potential treatment in reducing the length of active CSR flare-ups. As previously reported, 20-30% of recalcitrant cases may require adjunct treatment, but as a low-risk and low-cost therapy, topical drops may represent an option for first-line therapy leading to expedited resolution. Further analysis will be needed to elucidate the role of concurrent use of topical NSAIDs and mineralocorticoid antagonists as well as to compare the response to different topical NSAID doses.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.