Oral Treatment of Central Serous Chorioretinopathy Patients Using Propranolol Tablets.

Li-Chai Chen,Po-Chuen Shieh,Jui-Wen Ma,Chi-Ting Horng

doi:10.3390/ph13110336

Abstract

Purpose: To evaluate the pharmacological effects of propranolol treatment of patients with central serous chorioretinopathy (CSCR) over 4 months. Results: Among the 89 male and 31 female patients, the mean BCVA decreased to 0.42 ± 0.08 logMAR during CSCR attacks. Oral propranolol showed good effectiveness in reducing CSCR signs after at least 4 months of treatment. The final BCVA of the patients in groups 1 and 2 was 0.09 ± 0.01 and 0.19 ± 0.03 logMAR, respectively (p < 0.05). Moreover, the mean complete remission time in groups 1 and 2 was 1.9 and 3.5 months, respectively (p < 0.05), while the “success” rate in groups 1 and 2 was 95.0% (57/60) and 78.3% (47/60), respectively (p < 0.05). The recurrence rate in groups 1 and 2 was 5.3% (3/57) and 25.5% (12/47) after a further 5 months of follow-up, respectively (p < 0.05). Materials and Methods: One hundred and twenty patients were enrolled and randomly divided into two groups that both underwent a visual acuity test and optical coherence tomography (OCT) scanning, between April and December 2017. The 60 patients in group 1 were requested to take propranolol for 4 months, while the other 60 subjects (group 2) received placebo therapy during the same period. The best-corrected visual acuity (BCVA) of every volunteer and an OCT image of each patient were checked and recorded at the beginning of the study and each week thereafter. If the signs of CSCR disappeared completely from the OCT scans, the case was considered a “success” and treatment stopped at once. However, the “success” subjects were further evaluated in follow-ups throughout the next 5 months to determine the rate of recurrence in groups 1 and 2. The time of total complete remission of CSCR from the OCT scans was also measured in groups 1 and 2. Conclusion: CSCR patients revealed an excellent prognosis and success rate of 95.0% after taking propranolol. The treatment was able to enhance subretinal fluid (SRF) absorption, shorten the time to total complete remission, and significantly decrease CSCR recurrence. As such, we suggest that taking propranolol may be an alternative and viable choice for CSCR patients, given that the new method was shown to be safe, cheap, effective, well tolerated and convenient.

Highlights

Central serous chorioretinopathy (CSCR) is a type of macular disease that is characterized by serious retinal detachment, with retinal pigment epithelium (RPE) detachment and choroidal hyperpermeability
Older patients are more likely to present with a diffuse loss of RPE, cystoid macular edema (CME), irregular serous macular detachment, secondary choroidal neovascularization (CNV) formation, and long-standing intraretinal cystoid cavities, which may lead to blindness [1]
Most of the patients in group 1 revealed an improvement in best-corrected visual acuity (BCVA) and the complete disappearance of the dome shape from the optical coherence tomography (OCT) scans (Table 1)

Summary

Introduction

Central serous chorioretinopathy (CSCR) is a type of macular disease that is characterized by serious retinal detachment, with retinal pigment epithelium (RPE) detachment and choroidal hyperpermeability. The main pathophysiology of CSCR is the accumulation of subretinal fluid (SRF) in the posterior pole. The exact pathophysiology of CSCR is its choroid circulatory abnormalities and RPE disturbance, resulting in SRF leaking from the impaired tight junction [1]. CSCR is considered a benign and self-limiting disease, it has a tendency to recur, resulting in SRF absorption for some patients. While most CSCR patients show spontaneous visual recovery at an average of four months, nearly one-third of patients suffer from significant visual acuity impairment [3]. In the majority of cases, CSCR can disappear spontaneously, a few patients suffer relapses of varying degrees. Older patients are more likely to present with a diffuse loss of RPE, cystoid macular edema (CME), irregular serous macular detachment, secondary choroidal neovascularization (CNV) formation, and long-standing intraretinal cystoid cavities, which may lead to blindness [1]

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