Topical NSAIDs flop in management of central serous chorioretinopathy
Topical non-steroidal anti-inflammatory drugs (NSAID) have been proposed to manage central serous chorioretinopathy (CSC). According to a systematic review and meta-analysis published in Acta Ophthalmologica, reported evidence does not support the role of topical NSAID for treating CSC. This analysis identified long-term adverse effects of using topical NSAID, including persistent corneal epithelial defects, delayed corneal epithelial healing, superficial punctate keratitis, corneal infiltrations, and corneal and scleral ulcerations and melts.
CSC is a prevalent exudative maculopathy affecting males primarily aged 30-50 years. Photodynamic therapy, oral aldosterone antagonism and subthreshold multifocal laser are the recommended therapeutic approaches. The ongoing shortage of verteporfin restricts current therapeutic possibilities. Topical NSAIDs have previously been proposed as a treatment for CSC, but there needs to be more research on its exact efficacy.
Janni M. E. Larsson and colleagues investigated this background and searched 11 literature databases for a study describing topical NSAID for CSC management. The team found thirteen eligible studies (six case reports, two cohort studies and five non-randomized comparative studies), including 1001 eyes of 994 patients with CSC.
The study summary highlights the following considerations:
- There were 899 CSC patients: 381 received topical NSAID, and 518 received no treatment.
- Bromfenac 0.09%, diclofenac 0.1%, ketorolac 0.4% and 0.5%, pranoprofen 0.1%, and nepafenac 0.1% and 0.3%. were the topical NSAIDs used.
- Acute CSC cases were predominant.
- Many case studies reported treatment outcomes simultaneously with corticosteroid use discontinuation, which complicated the treatment evaluation.
- The change in best-corrected visual acuity improvement or BCVA improved slightly in NSAID-treated patients at the 1-month follow-up –0.04 logMAR. However, this change was insignificant at the 3-month follow-up –0.03 logMAR.
- The team reported no benefit in complete subretinal fluid resolution at 1-month or 3-month follow-up with OR: 1.20 and 1.17, respectively.
They said, “Based on our study findings, available evidence does not support topical NSAIDs usage for CSC management.”
Reference:
Larsson JME et al. Topical non-steroidal anti-inflammatory drugs for central serous chorioretinopathy: A systematic review and meta-analysis. Acta Ophthalmol. 2023 Aug 8. doi: 10.1111/aos.15743.
