Finasteride for chronic central serous chorioretinopathy

Abstract

Purpose: To evaluate the safety and efficacy of finasteride, an inhibitor of dihydrotestosterone synthesis, in the treatment of chronic central serous chorioretinopathy.

Methods: Five patients with chronic central serous chorioretinopathy were prospectively enrolled in this pilot study. Patients were administered finasteride (5 mg) daily for 3 months, after which study medication was withheld and patients were observed for 3 months. Main outcome measures included best-corrected visual acuity, central subfield macular thickness, and subretinal fluid volume as assessed by optical coherence tomography. Serum dihydrotestosterone, serum testosterone, and urinary cortisol were also measured.

Results: There was no change in mean best-corrected visual acuity. Mean center-subfield macular thickness and subretinal fluid volume reached a nadir at 3 months and rose to levels that were below baseline by 6 months. The changes in both optical coherence tomography parameters paralleled those in serum dihydrotestosterone level. In four patients, center-subfield macular thickness and/or subretinal fluid volume increased after discontinuation of finasteride. In the remaining patient, both optical coherence tomography parameters normalized with finasteride and remained stable when the study medication was discontinued.

Conclusion: Finasteride may represent a novel medical treatment for chronic central serous chorioretinopathy. Larger controlled clinical trials are needed to further assess the efficacy of finasteride for the treatment of central serous chorioretinopathy.

Figure 1

Alterations in optical coherence tomography-derived center-subfield thickness and subretinal fluid volume in relationship to serum dihydroxytestosterone (DHT). Mean center-subfield macular thickness (first panel), mean subretinal fluid volume (second panel), and mean serum DHT (third panel) declined to a nadir at 3 months, and then rose slightly by 6 months. The changes in center-subfield macular thickness and subretinal fluid volume paralleled serum DHT concentrations.

Figure 2

Treatment response to finasteride in a 54 year old patient with subretinal fluid persisting for 24 months prior to study enrollment. In this patient with subretinal fluid under the fovea at baseline with a subretinal fluid volume of 0.70 μl (top panel), near complete resolution of subretinal fluid to a subretinal fluid volume of 0.10 μl was seen after 3 months of treatment with finasteride (middle panel). The subretinal fluid re-accumulated once finasteride was discontinued; however, at 3 months following discontinuation of study drug the subretinal fluid volume was still below baseline at a subretinal fluid volume of 0.30 μl (bottom panel).

Figure 3

Resolution of subretinal fluid and angiographic leakage following treatment with finasteride in a 37 year old patient with subretinal fluid persisting for 1 year prior to study enrollment. In this patient with subretinal fluid tracking inferior to the fovea (subretinal fluid volume of 2.00 μl) and fluorescein angiographic leakage nasal to the fovea at baseline (first column), complete resolution of subretinal fluid and leakage was seen after 2 months of treatment with finasteride (second column). This effect was maintained during the study period after the drug was discontinued from month-3 through month-6 (third column).