Effects of Topical Fluorometholone in Chronic Central Serous Chorioretinopathy: A Proof-Of-Concept Study

Purpose To study the effects of topical fluorometholone on the activity of chronic central serous chorioretinopathy (CSCR) and the associated structural changes of the sclera.Methods Patients with chronic CSCR were included in this prospective, randomized, controlled study. All participants were randomly assigned to either observation or receiving topical fluorometholone 0.1% four times daily. Scleral thickness was measured using anterior segment optical coherence tomography. Changes in central retinal thickness (CRT), subfoveal choroidal thickness (SCT), and scleral thickness were evaluated. Correlation of fluorometholone effects with baseline characteristics was assessed.Results Forty-five eyes of 45 patients (34 males [75.5%], mean age 50.5 ± 10.9 years) were included in the treatment group, and 30 eyes of 30 patients (24 males [80.0%], mean age 52.1 ± 12.0 years) were included in the control group. After 4.7 ± 2.6 weeks of topical treatment, mean changes of CRT, SCT, and scleral thickness were −50.3 ± 136.5, −28.6 ± 40.3, and –26.9 ± 37.3 µm (p < .05). Fourteen (31.1%) eyes had complete resolution of exudation in the treatment group. No cases of complete resolution of exudation were observed in the control group (p < .001) after 3 months of follow-up. Effects of topical fluorometholone were associated with male gender, absence of choroidal neovascularization, shorter axial length, peripapillary leakage, ciliochoroidal detachment, intraretinal fluid, thicker sclera at baseline, and reduction of scleral thickness during treatment (for all, p < .05). Recurrence of activity after discontinuation of topical fluorometholone was observed in all 14 eyes with initial resolution of exudation. The median time to recurrence was 2.0 months (95% CI 2.0 to 3.5).Conclusions Topical fluorometholone may temporarily reduce exudation in chronic CSCR without choroidal neovascularization in eyes with thick sclera, short axial length, peripapillary leakage, and intraretinal fluid. Remodeling of the scleral anatomy may be responsible for the effects of topical steroids in chronic CSCR. However, the fully reversible nature of these effects does not currently allow topical steroids to be considered a long-term strategy.