Effects of Ketoconazole On Clinical Recovery In Central Serous Chorioretinopathy

Abstract

Background: Hypercortisolism has long been correlated with choroidal vasorelaxation in central serous chorioretinopathy (CSCR). This may explain the inconsistency of therapeutic responses of the mineralocorticoid receptor (MR) antagonist since hyperaldosteronism has rarely been detected in such cases. Hence, an early treatment using ketoconazole, the first line cortisol inhibitor that also blocks the MR ligand, appears to be rational. This study aimed to evaluate the effects of ketoconazole on CSCR, and to analyze correlations between choroidal thickness and steroid hormones.Method: In this three-center retrospective cohort, forty-one naïve CSCR eyes of 41 patients were categorized into control (20 eyes) and treatment group (21 eyes). Patients in the treatment group were given oral ketoconazole at a daily dose of 400 or 600 mg for three to six weeks. At week 12, rescue laser therapy was applied to patients exhibiting persistent subretinal fluid (SRF). We performed a survival analysis to determine the time interval from presentation to clinical resolution of SRF. The secondary outcomes consisted of proportion of eyes with persistent SRF, and factors affecting therapeutic response.Results: Mean 24-hour urinary free cortisol (UFC) were elevated at 181 ± 70 and 150 ± 68 µg/day (range = 20-150) in the treatment and control group (p = 0.21). After controlling for age and gender, baseline UFC levels demonstrated a positive correlation with choroidal thickness in both eyes (p < 0.05). Ketoconazole significantly accelerated the resolution of CSCR with the median time to resolution of 7 versus 16 weeks (p < 0.01), and reduced the proportion of eyes receiving rescue therapy at 12 weeks (23.8% versus 50%, p = 0.01). Prolonged CSCR durations were likely found in elderly patients who had thick choroid in fellow eyes.Conclusions: Elevated glucocorticoids are likely responsible for the pathogenesis of CSCR. Therefore, a temporary decrease in choroidal hyperpermeability using the cortisol blocker could reduce the persistency of CSCR.

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

“… 31 In a retrospective cohort study with a total of 41 naive CSC eyes, it was found that ketoconazole treatment could shorten the disease duration through promoting SRF absorbtion. 32 Another effective glucocorticoid antagonist, mifepristone, was used in CSC treatment. Mifepristone 200 mg was administered orally to 16 chronic CSC cases and showed that systemic glucocorticoid receptor antagonism promoted improvement and remission of retinal detachment.…”

Central Serous Chorioretinopathy Development following Cessation of Terbinafine Treatment

“…After 4 weeks of treatment, the treatment and control groups demonstrated no significant change in BCVA or pigment epithelial detachment thickness. In a recent study by Chantarasorn et al [12], the efficacy of ketoconazole 400 or 600 mg per day was evaluated in 21 patients and compared to 20 patients who served as controls. Ketoconazole shortened the time to resolution (7 vs. 16 weeks; p < 0.01) and reduced the need for rescue laser treatment (23.8% vs. 50%; p = 0.01).…”

“…Case Reports in Ophthalmology toward an anti-steroid effect of terbinafine [10]. The effect of other antifungal medications such as ketoconazole on CSCR has been previously explored as well; however, data have been inconsistent [11][12][13]. Meyerle et al [13] reported on 5 patients with CSCR treated for 4 weeks with ketoconazole 600 mg/day.…”