Role of Rifampicin and Ketoconazole in Chronic Central Serous Chorioretinopathy: A Comparative Study

Abstract

To compare the outcome of Rifampicin (RFN) & Ketoconazole (KTZ) in treatment of chronic central serous chorioretinopathy (CSCR). TYPE OF STUDY Prospective interventional case series. MATERIAL & METHODS It is a prospective study of 22 eyes of 22 patients having chronic CSCR who attended the ophthalmology OPD of a tertiary care hospital of Western Odisha from 1 st March 2015 to 1 st September 2015. All patients were male & belonged to age group of 25-60 years. Patients underwent examination using Snellen's chart, Direct & Indirect ophthalmoscope, Slit-lamp biomicroscopy with +90 D and Optical Coherence Tomography (OCT). Chronic cases were identified with OCT findings i.e. fibrinous aggregation at subretinal fluid & with history of unresolving CSCR of more than 6 weeks. 13 patients were given tab. RFN 600 mg per day orally for 4 weeks after evaluation in Pulmonary Medicine OPD to exclude Tuberculosis (TB). 9 patients were given KTZ 200 mg twice daily orally for 4 weeks. They were evaluated with OCT in their followup visits at 4 weeks after starting the treatment. RESULTS 10 patients out of 13 having RFN and 5 out of 9 patients having KTZ showed decrease in fluid height in central macula and decreased aggregation of fibrinous exudates. After 4 weeks of RFN treatment, BCVA improved in 12 patients out of 13 (92.3%) and after KTZ treatment for the same period, BCVA improved in 5 patients out of 9 (55.6%). In RFN group, fluid height decreased from 250 µm±133 µm to 70 µm±123 µm (p=0.001) and in KTZ group fluid height decreased from 176 µm±110 µm to 78 µm±69 µm after 4 weeks of treatment (p=0.038). CONCLUSION RFN showed better result than KTZ in patients having chronic CSCR. But as Indian subcontinent is an endemic zone for TB and recent studies showing increasing prevalence of multi-drug resistant TB, we are suggesting KTZ for treatment of Chronic CSCR before opting for RFN. However, Liver function should be monitored when using KTZ.