Combined Topical Anti-inflammatory and Oral Acetazolamide in the Treatment of Central Serous Chorioretinopathy

• Published in: Optometry and vision science Vol. 96; no. 7; pp. 500 - 506
• Main Authors: Wuarin, Raphael, Kakkassery, Vinodh, Consigli, Andrea, Roquelaure, Daniel, Papanastasiou, Athanasios, Schutz, James Scott, Thumann, Gabriele, Chronopoulos, Argyrios
• Format: Journal Article
• Language: English
• Published: United States 01.07.2019
• Subjects: Acetazolamide - therapeutic use; Administration, Ophthalmic; Administration, Oral; Adult; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Benzeneacetamides - therapeutic use; Carbonic Anhydrase Inhibitors - therapeutic use; Central Serous Chorioretinopathy - diagnosis; Central Serous Chorioretinopathy - drug therapy; Central Serous Chorioretinopathy - physiopathology; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Male; Middle Aged; Phenylacetates - therapeutic use; Pilot Projects; Retinal Pigment Epithelium; Subretinal Fluid; Tomography, Optical Coherence - methods; Visual Acuity - physiology
• ISSN: 1040-5488; 1538-9235
• DOI: 10.1097/OPX.0000000000001394

Central serous chorioretinopathy (CSCR) is still a therapeutic challenge with no criterion standard treatment. However, anatomic changes at the level of the retinal pigment epithelium could prove of predictive value in the course of the disease for selective treatment in cases of increased risk of chronicity. This pilot study analyzes the efficacy for treating acute CSCR with combined systemic acetazolamide 250 mg twice a day and nepafenac 0.1% eye drops three times a day in comparison with an untreated control group. It also evaluates the presence a pigment epithelial detachment (PED) as a risk factor for chronic CSCR. Nineteen consecutive patients (group 1) with new or new onset of recurrent CSCR were treated with oral acetazolamide and nepafenac eye drops for at least 2 months. A control group of 14 patients (group 2) with new or new onset of recurrent CSCR were untreated while under regular observation for 4 months. Primary end points were central macular thickness and best-corrected visual acuity after 4 months. Secondary end points were complete regression of subretinal fluid at 3 months and association of PED at baseline with recurrent or chronic CSCR imaged by optical coherence tomography. Group 1 showed significantly faster resolution of subretinal fluid with a mean central macular thickness at 4 months of 271 ± 85 μm compared with 322 ± 79 μm for group 2 (P < .05), but with no functional benefit with a best-corrected visual acuity at 4 months of 0.8 ± 0.2 for group 1 compared with 0.9 ± 0.1 for the control group (P < .05). Patients with a small flat PED were at a higher risk of developing chronic CSCR compared with patients with a dome-shaped or no PED (P < .05). Central serous chorioretinopathy remains a therapeutic challenge. This pilot study shows faster resolution of subretinal fluid with treatment but without functional benefit compared with observation. The presence of small, flat PED was associated with development of chronic CSCR.