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

Wuarin, Raphael MD1; Kakkassery, Vinodh MD2; Consigli, Andrea MD1; Roquelaure, Daniel MD1; Papanastasiou, Athanasios MD1; Schutz, James Scott MD1; Thumann, Gabriele MD1; Chronopoulos, Argyrios MD1,3*

Optometry and Vision Science: July 2019 - Volume 96 - Issue 7 - p 500–506
doi: 10.1097/OPX.0000000000001394
ORIGINAL INVESTIGATIONS
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SIGNIFICANCE 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.

PURPOSE 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.

METHODS 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.

RESULTS 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).

CONCLUSIONS 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.

1Department of Ophthalmology, University Clinics and School of Medicine, Geneva, Switzerland

2Department of Ophthalmology, University of Luebeck, Luebeck, Germany

3Department of Ophthalmology, Hospital of Ludwigshafen, Ludwigshafen am Rhein, Germany

*aris_c@web.de

Submitted: August 22, 2018

Accepted: February 28, 2019

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Study Registration Information: Ethical committee of the University Hospitals and School of Medicine of Geneva, Switzerland (no. 2016-00045).

Author Contributions: Conceptualization: VK, ACh; Data Curation: RW, VK, ACo, DR, AP, JSS, GT, ACh; Formal Analysis: RW, VK, ACo, DR, AP, JSS, ACh; Methodology: VK, JSS, GT, ACh.

© 2019 American Academy of Optometry