Abstract
Purpose :
We studied the effects of prednisolone eye drops in chronic central serous chorioretinopathy (cCSC), a pachychoroid related disease. Treatment with topical steroids is counterintuitive, as systemic steroidal use is associated with cCSC. However, favorable outcomes of topical steroids were observed in peripapillary pachychoroid syndrome, another pachychoroid related disease (Pothof et al., Retin Cases Brief Rep., 2023). Due to the verteporfin shortage, and the subsequent inability to perform photodynamic therapy, the use of topical steroids in eyes with cCSC was explored.
Methods :
This retrospective study included 40 patients (45 eyes) with a diagnosis of cCSC based on multi-modal imaging, who received prednisolone acetate 1% eye drops 3-times daily. Changes in functional and structural outcomes were evaluated between the baseline and the first follow-up visit. The follow-up visit was at a mean of 40.3 ± 14.2 days after prednisolone eye drops initiation. The primary outcome was the effect on sub- or intraretinal fluid, evaluated by the change in macular volume on optical coherence tomography within the 6 mm-diameter-circle of the ETDRS grid. Secondary outcomes were foveal and complete resolution of fluid; and the change in visual acuity (VA).
Results :
In the 45 studied eyes, the macular volume decreased significantly from 8.9 ± 1.1mm3 at baseline to 8.6 ± 1.0mm3 at follow-up (p<0.001). The macular volume decreased in 31 eyes (69%), remained stable in 10 eyes (22%), and increased in 4 eyes (9%). Foveal and complete resolution of intra- and subretinal fluid was seen in 24% and 9% of the eyes, respectively. VA did not change (69.1 ± 20.7 to 69.0 ± 20.4 ETDRS letters, p=0.973). Intraocular pressure had increased to 25 mmHg or higher in 16% of the eyes.
Conclusions :
Anatomical improvement after therapy with prednisolone eye drops was observed in cCSC, already at short follow-up. In the natural course of cCSC, (sub)retinal fluid can resolve spontaneously, however, the resolution rate in this study is higher than the reported short-term spontaneous resolution rate in cCSC (Lotery et al, Lancet, 2020). By studying the effect of topical steroids in pachychoroid spectrum diseases, the pathophysiology can be further elucidated. Topical steroids might be an effective treatment option in a subset of cCSC patients, but randomized controlled trials that compare prednisolone eye drops with placebo are needed.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.