The status the oral drugs for chronic central serous chorioretinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Jiang Xiaoshuang , Li Wei , Li Yanan ,  Zhang Junjun

Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

Zhang Junjun, Email: zhangjunjun@medmail.com.cn

Keywords：

Central serous chorioretinopathy/drug therapy; Receptors, mineralocorticoid/antagonists & inhibitors; Receptors, glucocorticoid/antagonists & inhibitors; Review

DOI：

10.3760/cma.j.issn.1005-1015.2017.06.033

Video：

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Chronic central serous chorioretinopathy (CSC) usually demonstrates frequent recurrence, diffuse leakage and persistent subretinal fluid, which cannot be absorbed, thus lead to photoreceptor damage and poor visual acuity. As glucocorticoids have been implicated in the pathogenesis of chronic CSC, various anti-glucocorticoids oral drugs were used in the clinic to promote retinal fluid absorption and reduce the central retinal thickness of the macula and improve the vision outcomes. In addition, the 5α-reductase-specific inhibitor finasteride, the P450-3A4 inducer rifampicin, circadian rhythmic regulator melatonin, and systemic anti-inflammatory drug methotrexate have also been put into clinical trials for chronic CSC, and achieved certain effects. However, most of the clinical studies on these oral drugs were case reports, but not multi-center randomized clinical trials. The long-term effects of these oral drugs need to be observed and studied further.

Citation： Jiang Xiaoshuang, Li Wei, Li Yanan, Zhang Junjun. The status the oral drugs for chronic central serous chorioretinopathy. Chinese Journal of Ocular Fundus Diseases, 2017, 33(6): 665-668. doi: 10.3760/cma.j.issn.1005-1015.2017.06.033 Copy

1.	Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: recent findings and new physiopathology hypothesis [J]. Prog Retin Eye Res, 2015, 48: 82-118. DOI: 10.1016/j.preteyeres.2015.05.003.
2.	Ma J, Meng N, Xu X, et al. System review and meta-analysis on photodynamic therapy in central serous chorioretinopathy[J]. Acta Ophthalmol, 2014, 92(8): 594-601. DOI: 10.1111/aos.12482. DOI: 10.1111/aos.12482.
3.	Tseng CC, Chen SN. Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy[J]. Br J Ophthalmol, 2015, 99(8): 1070-1077. DOI: 10.1136/bjophthalmol-2014-305353.
4.	Kim YK, Ryoo NK, Woo SJ, et al. Choroidal thickness changes after photodynamic therapy and recurrence of chronic central serous chorioretinopathy[J]. Am J Ophthalmol, 2015, 160(1): 72-84. DOI: 10.1016/j.ajo.2015.04.011.
5.	Salz DA, Pitcher JD, Hsu J, et al. Oral eplerenone for treatment of chronic central serous chorioretinopathy: a case series [J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(4): 439-444. DOI: 10.3928/23258160-20150422-06.
6.	Bousquet E, Beydoun T, Zhao M, et al. Mineralocorticoid receptor antagonism in the treatment of chronic central serous chorioretinopathy: a pilot study [J]. Retina, 2013, 33(10): 2096-2102. DOI: 10.1097/IAE.0b013e318297a07a.
7.	Herold TR, Prause K, Wolf A, et al. Spironolactone in the treatment of central serous chorioretinopathy:a case series [J]. Graefe’s Arch Clin Exp Ophthalmol, 2014, 252(12): 1985-1991. DOI: 10.1007/s00417-014-2780-6.
8.	Nielsen JS, Jampol LM. Oral mifepristone for chronic central serous chorioretinopathy [J]. Retina, 2011, 31(9): 1928-1936. DOI: 10.1097/IAE.0b013e31821c3ef6.
9.	Steinle NC, Gupta N, Yuan A, et al. Oral rifampin utilisation for the treatment of chronic multifocal central serous retinopathy [J]. Br J Ophthalmol, 2012, 96(1): 10-13. DOI: 10.1136/bjophthalmol-2011-300183.
10.	Shulman S, Goldenberg D, Schwartz R, et al. Oral rifampin treatment for longstanding chronic central serous chorioretinopathy [J]. Graefe’s Arch Clin Exp Ophthalmol, 2016, 254(1): 15-22. DOI: 10.1007/s00417-015-2989-z.
11.	Gramajo AL, Marquez GE, Torres VE, et al. Therapeutic benefit of melatonin in refractory central serous chorioretinopathy [J]. Eye (Lond), 2015, 29(8): 1036-1045. DOI: 10.1038/eye.2015.104.
12.	Kurup SK, Oliver A, Emanuelli A, et al. Low-dose methotrexate for the treatment of chronic central serous chorioretinopathy: a retrospective analysis [J]. Retina, 2012, 32(10): 2096-2101. DOI: 10.1097/IAE.0b013e31825dd281.
13.	Bouzas EA, Scott MH, Mastorakos G, et al. Central serous chorioretinopathy in endogenous hypercortisolism [J]. Arch Ophthalmol, 1993, 111(9): 1229-1233.
14.	Thoelen AM, Bernasconi PP, Schmid C, et al. Central serous chorioretinopathy associated with a carcinoma of the adrenal cortex [J]. Retina, 2000, 20(1): 98-99.
15.	Ross A, Ross AH, Mohamed Q. Review and update of central serous chorioretinopathy [J]. Curr Opin Ophthalmol, 2011, 22(3): 166-173. DOI: 10.1097/ICU.0b013e3283459826.
16.	Clark RD. Glucocorticoid receptor antagonists [J]. Curr Top Med Chem, 2008, 8(9): 813-838.
17.	Rocha EM, Wickham LA, da Silveira LA, et al. Identification of androgen receptor protein and 5alpha-reductase mRNA in human ocular tissues [J]. Br J Ophthalmol, 2000, 84(1): 76-84.
18.	Wickham LA, Gao J, Toda I, et al. Identification of androgen, estrogen and progesterone receptor mRNAs in the eye [J]. Acta Ophthalmol Scand, 2000, 78(2): 146-153.
19.	Grieshaber MC, Staub JJ, Flammer J. The potential role of testosterone in central serous chorioretinopathy [J]. Br J Ophthalmol, 2007, 91(1): 118-119. DOI: 10.1136/bjo.2006.098277.
20.	Roy R, Panigrahi PK, Saurabh K, et al. Central serous chorioretinopathy following oral tadalafil intake [J]. Clin Exp Optom, 2014, 97(5): 473-474. DOI: 10.1111/cxo.12141.
21.	Gordon-Bennett P, Rimmer T. Central serous chorioretinopathy following oral tadalafil [J]. Eye (Lond), 2012, 26(1): 168-169. DOI: 10.1038/eye.2011.250.
22.	Forooghian F, Meleth AD, Cukras C, et al. Finasteride for chronic central serous chorioretinopathy[J]. Retina, 2011, 31(4): 766-771. DOI: 10.1097/IAE.0b013e3181f04a35.
23.	Guengerich FP. Cytochrome P-450 3A4: regulation and role in drug metabolism [J]. Annu Rev Pharmacol Toxicol, 1999, 39: 1-17. DOI: 10.1146/annurev.pharmtox.39.1.1.
24.	Venkatesan K. Pharmacokinetic drug interactions with rifampicin [J]. Clin Pharmacokinet, 1992, 22(1): 47-65. DOI: 10.2165/00003088-199222010-00005.
25.	Ravage ZB, Packo KH, Creticos CM, et al. Chronic central serous chorioretinopathy responsive to rifampin. Annual Meeting of the American Society of Retina Specialists, Vancouver, Canada, 2010.
26.	Pandi-Perumal SR, Trakht I, Spence DW, et al. The roles of melatonin and light in the pathophysiology and treatment of circadian rhythm sleep disorders [J]. Nat Clin Pract Neurol, 2008, 4(8): 436-447. DOI: 10.1038/ncpneuro0847.
27.	Tosini G, Baba K, Hwang CK, et al. Melatonin: an underappreciated player in retinal physiology and pathophysiology [J]. Exp Eye Res, 2012, 103: 82-89. DOI: 10.1016/j.exer.2012.08.009.
28.	Esposito E, Cuzzocrea S. Anti-inflammatory activity of melatonin in central nervous system [J]. Curr Neuropharmacol, 2010, 8(2): 228-242. DOI: 10.2174/157015910792246155.
29.	Shukla P, Sun C, O’rourke ST. Melatonin inhibits nitric oxide signaling by increasing PDE5 phosphorylation in coronary arteries [J]. Am J Physiol Heart Circ Physiol, 2012, 303(12): 1418-1425. DOI: 10.1152/ajpheart.00211.2012.
30.	Sáenz DA, Turjanski AG, Sacca GB, et al. Physiological concentrations of melatonin inhibit the nitridergic pathway in the Syrian hamster retina [J]. J Pineal Res, 2002, 33(1): 31-36.
31.	Lissoni P, Rovelli F, Malugani F, et al. Anti-angiogenic activity of melatonin in advanced cancer patients [J]. Neuro Endocrinol Lett, 2001, 22(1): 45-47.
32.	Hoijman E, Rocha Viegas L, Keller Sarmiento MI, et al. Involvement of Bax protein in the prevention of glucocorticoid-induced thymocytes apoptosis by melatonin [J]. Endocrinology, 2004, 145(1): 418-425. DOI: 10.1210/en.2003-0764.
33.	Cronstein BN. Low-dose methotrexate: a mainstay in the treatment of rheumatoid arthritis [J]. Pharmacol Rev, 2005, 57(2): 163-172. DOI: 10.1124/pr.57.2.3.
34.	Winquist EW, Laskey J, Crump M, et al. Ketoconazole in the management of paraneoplastic Cushing’s syndrome secondary to ectopic adrenocorticotropin production [J]. J Clin Oncol, 1995, 13(1): 157-164. DOI: 10.1200/JCO.1995.13.1.157.
35.	Chou SC, Lin JD. Longterm effects of ketoconazole in the treatment of residual or recurrent Cushing’s disease [J]. Endocr J, 2000, 47(4): 401-406.
36.	Golshahi A, Klingmuller D, Holz FG, et al. Ketoconazole in the treatment of idiopathic central serous chorioretinopathy. Jahrestagung der DOG Deutsche Ophthalmologische Gesellschaft e.V. 23, Berlin, 2004.
37.	Meyerle CB, Freund KB, Bhatnagar P, et al. Ketoconazole in the treatment of chronic idiopathic central serous chorioretinopathy [J]. Retina, 2007, 27(7): 943-946. DOI: 10.1097/IAE.0b013e318050ca69.
38.	Golshahi A, Klingmüller D, Holz FG, et al. Ketoconazole in the treatment of central serous chorioretinopathy: a pilot study [J]. Acta Ophthalmol, 2010, 88(5): 576-581. DOI: 10.1111/j.1755-3768.2008.01467.x.
39.	Sun J, Tan J, Wang Z, et al. Effect of catecholamine on central serous chorioretinopathy [J]. J Huazhong Univ Sci Tech Med Sci, 2003, 23(3), 313-316.
40.	Frambach DA, Fain GL, Farber DB, et al. Beta adrenergic receptors on cultured human retinal pigment epithelium [J]. Invest Ophth Vis Sci, 1990, 31(9): 1767-1772.
41.	Tatham A, Macfarlane A. The use of propranolol to treat central serous chorioretinopathy: an evaluation by serial OCT [J]. J Ocul Pharmacol Ther, 2006, 22(2): 145-149. DOI: 10.1089/jop.2006.22.145.

1. Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: recent findings and new physiopathology hypothesis [J]. Prog Retin Eye Res, 2015, 48: 82-118. DOI: 10.1016/j.preteyeres.2015.05.003.
2. Ma J, Meng N, Xu X, et al. System review and meta-analysis on photodynamic therapy in central serous chorioretinopathy[J]. Acta Ophthalmol, 2014, 92(8): 594-601. DOI: 10.1111/aos.12482. DOI: 10.1111/aos.12482.
3. Tseng CC, Chen SN. Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy[J]. Br J Ophthalmol, 2015, 99(8): 1070-1077. DOI: 10.1136/bjophthalmol-2014-305353.
4. Kim YK, Ryoo NK, Woo SJ, et al. Choroidal thickness changes after photodynamic therapy and recurrence of chronic central serous chorioretinopathy[J]. Am J Ophthalmol, 2015, 160(1): 72-84. DOI: 10.1016/j.ajo.2015.04.011.
5. Salz DA, Pitcher JD, Hsu J, et al. Oral eplerenone for treatment of chronic central serous chorioretinopathy: a case series [J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(4): 439-444. DOI: 10.3928/23258160-20150422-06.
6. Bousquet E, Beydoun T, Zhao M, et al. Mineralocorticoid receptor antagonism in the treatment of chronic central serous chorioretinopathy: a pilot study [J]. Retina, 2013, 33(10): 2096-2102. DOI: 10.1097/IAE.0b013e318297a07a.
7. Herold TR, Prause K, Wolf A, et al. Spironolactone in the treatment of central serous chorioretinopathy:a case series [J]. Graefe’s Arch Clin Exp Ophthalmol, 2014, 252(12): 1985-1991. DOI: 10.1007/s00417-014-2780-6.
8. Nielsen JS, Jampol LM. Oral mifepristone for chronic central serous chorioretinopathy [J]. Retina, 2011, 31(9): 1928-1936. DOI: 10.1097/IAE.0b013e31821c3ef6.
9. Steinle NC, Gupta N, Yuan A, et al. Oral rifampin utilisation for the treatment of chronic multifocal central serous retinopathy [J]. Br J Ophthalmol, 2012, 96(1): 10-13. DOI: 10.1136/bjophthalmol-2011-300183.
10. Shulman S, Goldenberg D, Schwartz R, et al. Oral rifampin treatment for longstanding chronic central serous chorioretinopathy [J]. Graefe’s Arch Clin Exp Ophthalmol, 2016, 254(1): 15-22. DOI: 10.1007/s00417-015-2989-z.
11. Gramajo AL, Marquez GE, Torres VE, et al. Therapeutic benefit of melatonin in refractory central serous chorioretinopathy [J]. Eye (Lond), 2015, 29(8): 1036-1045. DOI: 10.1038/eye.2015.104.
12. Kurup SK, Oliver A, Emanuelli A, et al. Low-dose methotrexate for the treatment of chronic central serous chorioretinopathy: a retrospective analysis [J]. Retina, 2012, 32(10): 2096-2101. DOI: 10.1097/IAE.0b013e31825dd281.
13. Bouzas EA, Scott MH, Mastorakos G, et al. Central serous chorioretinopathy in endogenous hypercortisolism [J]. Arch Ophthalmol, 1993, 111(9): 1229-1233.
14. Thoelen AM, Bernasconi PP, Schmid C, et al. Central serous chorioretinopathy associated with a carcinoma of the adrenal cortex [J]. Retina, 2000, 20(1): 98-99.
15. Ross A, Ross AH, Mohamed Q. Review and update of central serous chorioretinopathy [J]. Curr Opin Ophthalmol, 2011, 22(3): 166-173. DOI: 10.1097/ICU.0b013e3283459826.
16. Clark RD. Glucocorticoid receptor antagonists [J]. Curr Top Med Chem, 2008, 8(9): 813-838.
17. Rocha EM, Wickham LA, da Silveira LA, et al. Identification of androgen receptor protein and 5alpha-reductase mRNA in human ocular tissues [J]. Br J Ophthalmol, 2000, 84(1): 76-84.
18. Wickham LA, Gao J, Toda I, et al. Identification of androgen, estrogen and progesterone receptor mRNAs in the eye [J]. Acta Ophthalmol Scand, 2000, 78(2): 146-153.
19. Grieshaber MC, Staub JJ, Flammer J. The potential role of testosterone in central serous chorioretinopathy [J]. Br J Ophthalmol, 2007, 91(1): 118-119. DOI: 10.1136/bjo.2006.098277.
20. Roy R, Panigrahi PK, Saurabh K, et al. Central serous chorioretinopathy following oral tadalafil intake [J]. Clin Exp Optom, 2014, 97(5): 473-474. DOI: 10.1111/cxo.12141.
21. Gordon-Bennett P, Rimmer T. Central serous chorioretinopathy following oral tadalafil [J]. Eye (Lond), 2012, 26(1): 168-169. DOI: 10.1038/eye.2011.250.
22. Forooghian F, Meleth AD, Cukras C, et al. Finasteride for chronic central serous chorioretinopathy[J]. Retina, 2011, 31(4): 766-771. DOI: 10.1097/IAE.0b013e3181f04a35.
23. Guengerich FP. Cytochrome P-450 3A4: regulation and role in drug metabolism [J]. Annu Rev Pharmacol Toxicol, 1999, 39: 1-17. DOI: 10.1146/annurev.pharmtox.39.1.1.
24. Venkatesan K. Pharmacokinetic drug interactions with rifampicin [J]. Clin Pharmacokinet, 1992, 22(1): 47-65. DOI: 10.2165/00003088-199222010-00005.
25. Ravage ZB, Packo KH, Creticos CM, et al. Chronic central serous chorioretinopathy responsive to rifampin. Annual Meeting of the American Society of Retina Specialists, Vancouver, Canada, 2010.
26. Pandi-Perumal SR, Trakht I, Spence DW, et al. The roles of melatonin and light in the pathophysiology and treatment of circadian rhythm sleep disorders [J]. Nat Clin Pract Neurol, 2008, 4(8): 436-447. DOI: 10.1038/ncpneuro0847.
27. Tosini G, Baba K, Hwang CK, et al. Melatonin: an underappreciated player in retinal physiology and pathophysiology [J]. Exp Eye Res, 2012, 103: 82-89. DOI: 10.1016/j.exer.2012.08.009.
28. Esposito E, Cuzzocrea S. Anti-inflammatory activity of melatonin in central nervous system [J]. Curr Neuropharmacol, 2010, 8(2): 228-242. DOI: 10.2174/157015910792246155.
29. Shukla P, Sun C, O’rourke ST. Melatonin inhibits nitric oxide signaling by increasing PDE5 phosphorylation in coronary arteries [J]. Am J Physiol Heart Circ Physiol, 2012, 303(12): 1418-1425. DOI: 10.1152/ajpheart.00211.2012.
30. Sáenz DA, Turjanski AG, Sacca GB, et al. Physiological concentrations of melatonin inhibit the nitridergic pathway in the Syrian hamster retina [J]. J Pineal Res, 2002, 33(1): 31-36.
31. Lissoni P, Rovelli F, Malugani F, et al. Anti-angiogenic activity of melatonin in advanced cancer patients [J]. Neuro Endocrinol Lett, 2001, 22(1): 45-47.
32. Hoijman E, Rocha Viegas L, Keller Sarmiento MI, et al. Involvement of Bax protein in the prevention of glucocorticoid-induced thymocytes apoptosis by melatonin [J]. Endocrinology, 2004, 145(1): 418-425. DOI: 10.1210/en.2003-0764.
33. Cronstein BN. Low-dose methotrexate: a mainstay in the treatment of rheumatoid arthritis [J]. Pharmacol Rev, 2005, 57(2): 163-172. DOI: 10.1124/pr.57.2.3.
34. Winquist EW, Laskey J, Crump M, et al. Ketoconazole in the management of paraneoplastic Cushing’s syndrome secondary to ectopic adrenocorticotropin production [J]. J Clin Oncol, 1995, 13(1): 157-164. DOI: 10.1200/JCO.1995.13.1.157.
35. Chou SC, Lin JD. Longterm effects of ketoconazole in the treatment of residual or recurrent Cushing’s disease [J]. Endocr J, 2000, 47(4): 401-406.
36. Golshahi A, Klingmuller D, Holz FG, et al. Ketoconazole in the treatment of idiopathic central serous chorioretinopathy. Jahrestagung der DOG Deutsche Ophthalmologische Gesellschaft e.V. 23, Berlin, 2004.
37. Meyerle CB, Freund KB, Bhatnagar P, et al. Ketoconazole in the treatment of chronic idiopathic central serous chorioretinopathy [J]. Retina, 2007, 27(7): 943-946. DOI: 10.1097/IAE.0b013e318050ca69.
38. Golshahi A, Klingmüller D, Holz FG, et al. Ketoconazole in the treatment of central serous chorioretinopathy: a pilot study [J]. Acta Ophthalmol, 2010, 88(5): 576-581. DOI: 10.1111/j.1755-3768.2008.01467.x.
39. Sun J, Tan J, Wang Z, et al. Effect of catecholamine on central serous chorioretinopathy [J]. J Huazhong Univ Sci Tech Med Sci, 2003, 23(3), 313-316.
40. Frambach DA, Fain GL, Farber DB, et al. Beta adrenergic receptors on cultured human retinal pigment epithelium [J]. Invest Ophth Vis Sci, 1990, 31(9): 1767-1772.
41. Tatham A, Macfarlane A. The use of propranolol to treat central serous chorioretinopathy: an evaluation by serial OCT [J]. J Ocul Pharmacol Ther, 2006, 22(2): 145-149. DOI: 10.1089/jop.2006.22.145.

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