Chantarasorn Yodpong, Rasmidatta Kochapong, Pokawattana Itsara, Silpa-Archa Sukhum
Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand.
Department of Ophthalmology, H.R.H Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, 26120, Thailand.
Clin Ophthalmol. 2022 Jun 9;16:1871-1882. doi: 10.2147/OPTH.S368427. eCollection 2022.
Patients with hypercortisolism have been associated with a higher prevalence of the pachychoroid spectrum including central serous chorioretinopathy (CSCR), which may explain the inconsistency of therapeutic responses of the mineralocorticoid receptor antagonist because hyperaldosteronism has rarely been detected in patients with CSCR. Therefore, this study aimed to evaluate the effects of ketoconazole, the first-line cortisol inhibitor, on the resolution of subretinal fluid (SRF) in CSCR and to analyze correlations between choroidal thickness and steroid hormones.
This retrospective cohort study included 41 naïve CSCR eyes of 41 patients categorized into control (20 eyes) and treatment (21 eyes) groups. Patients in the treatment group were administered oral ketoconazole at a daily dose of 400 or 600 mg for 3-6 weeks. At week 12, rescue laser therapy was applied to patients exhibiting persistent SRF. Thus, a survival analysis was performed to determine the time interval from presentation to clinical resolution of SRF. Secondary outcomes consisted of eyes with persistent SRF and factors affecting the therapeutic response.
The mean 24-hour urinary free cortisol (UFC) levels were elevated at 181 ± 70 and 150 ± 68 µg/day (range: 20-150) in the treatment and control groups, respectively (p = 0.21). After controlling for age and gender, baseline UFC levels were significantly associated with choroidal thickness in both eyes (p < 0.05). Ketoconazole significantly increased the CSCR resolution with the median time to resolution of 7 vs 16 weeks (p < 0.01) and decreased the proportion of eyes receiving rescue therapy at 12 weeks (23.8% vs 50%; p = 0.01). Prolonged CSCR durations were likely found in elderly patients with thick choroids in fellow eyes.
Patients with CSCR showed elevated glucocorticoids, which further correlated with their choroidal thickness. Using cortisol blockers may shorten the duration of existing SRF.
皮质醇增多症患者与包括中心性浆液性脉络膜视网膜病变（CSCR）在内的厚脉络膜谱系疾病的患病率较高有关，这可能解释了盐皮质激素受体拮抗剂治疗反应不一致的原因，因为CSCR患者很少检测到醛固酮增多症。因此，本研究旨在评估一线皮质醇抑制剂酮康唑对CSCR患者视网膜下液（SRF）消退的影响，并分析脉络膜厚度与类固醇激素之间的相关性。
这项回顾性队列研究纳入了41例患者的41只初发CSCR眼，分为对照组（20只眼）和治疗组（21只眼）。治疗组患者口服酮康唑，每日剂量为400或600 mg，持续3 - 6周。在第12周时，对仍有持续性SRF的患者进行挽救性激光治疗。因此，进行了生存分析以确定从出现症状到SRF临床消退的时间间隔。次要结果包括有持续性SRF的眼以及影响治疗反应的因素。
治疗组和对照组的平均24小时尿游离皮质醇（UFC）水平分别升高至181±70和150±68μg/天（范围：20 - 150）（p = 0.21）。在控制年龄和性别后，基线UFC水平与双眼脉络膜厚度显著相关（p < 0.05）。酮康唑显著提高了CSCR的消退率，消退的中位时间为7周对16周（p < 0.01），并降低了12周时接受挽救治疗的眼的比例（23.8%对50%；p = 0.01）。在对侧眼脉络膜厚的老年患者中，CSCR病程可能较长。
CSCR患者的糖皮质激素水平升高，这与他们的脉络膜厚度进一步相关。使用皮质醇阻滞剂可能会缩短现有SRF的持续时间。
