Therapeutic benefit of melatonin in refractory central serous chorioretinopathy

Abstract

Purpose: To evaluate the efficacy and safety of melatonin for the treatment of chronic central serous chorioretinopathy (CSCR).

Methods: Prospective comparative case series. A total of 13 patients with chronic CSCR were treated for 1 month: 8 patients were treated orally with 3 mg melatonin t.i.d., and 5 with placebo. All patients had 20/40 or worse Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) in the affected eye or presented an incapacitating scotoma. Most of the patients had previous failed treatments for their condition. Observational procedures included ETDRS BCVA, and complete ophthalmic examination. Optical coherence tomography (OCT) was performed at day 1 and week 4. Fluorescein angiography was performed at baseline only for diagnostic purposes. Data were subjected to two-sample t-test statistical analysis. P-values of <0.05 were considered statistically significant.

Results: At 1-month follow-up, BCVA significantly improved in 87.5% of patients treated with melatonin (7 of 8 patients, P<0.05). All patients showed a mean significant reduction (P<0.01) of central macular thickness (CMT) when compared with the baseline, with 3 patients (37.5%) exhibiting complete resolution of subretinal fluid at 1-month follow-up. No significant side effects were observed. No changes in BCVA or CMT were noted in the control group.

Conclusions: These results suggest that melatonin is safe, well tolerated, and effective in the treatment of chronic CSCR, as it significantly improved BCVA and CMT in patients with this pathology. Further evaluations with longer follow-up and a larger patient population are desirable.

Figure 1

Effect of melatonin on logMAR BCVA in patients with CSCR. Melatonin (3 mg/day t.i.d.) significantly increased logMAR BCVA at 1-month follow-up, whereas no significant changes in this parameter were noted in the control group (*P<0.05 vs pretreatment values, by two-sample t-test (n=9, for melatonin group; n=5, for control group)).

Figure 2

Effect of melatonin on CMT. The treatment with melatonin (3 mg/day t.i.d.) induced a significant decrease in this parameter at 1-month follow-up, whereas no significant changes in CMT were observed in the control group (*P=0.003 vs pretreatment values, by two-sample t-test (n=9, for melatonin group; n=5, for control group)).

Figure 3

Representative OCT images of a patient (patient no. 7), before (upper panel) and after (lower panel) 1-month treatment with melatonin. Note the complete resolution of subretinal fluid after 1-month treatment. It is it is worth noting that, as stated in Table 1, the patient could not the recall last time that he was symptom free.