Oral Treatment of Central Serous Chorioretinopathy Patients Using Propranolol Tablets

Abstract

Purpose: To evaluate the pharmacological effects of propranolol treatment of patients with central serous chorioretinopathy (CSCR) over 4 months.

Results: Among the 89 male and 31 female patients, the mean BCVA decreased to 0.42 ± 0.08 logMAR during CSCR attacks. Oral propranolol showed good effectiveness in reducing CSCR signs after at least 4 months of treatment. The final BCVA of the patients in groups 1 and 2 was 0.09 ± 0.01 and 0.19 ± 0.03 logMAR, respectively (p < 0.05). Moreover, the mean complete remission time in groups 1 and 2 was 1.9 and 3.5 months, respectively (p < 0.05), while the "success" rate in groups 1 and 2 was 95.0% (57/60) and 78.3% (47/60), respectively (p < 0.05). The recurrence rate in groups 1 and 2 was 5.3% (3/57) and 25.5% (12/47) after a further 5 months of follow-up, respectively (p < 0.05).

Materials and methods: One hundred and twenty patients were enrolled and randomly divided into two groups that both underwent a visual acuity test and optical coherence tomography (OCT) scanning, between April and December 2017. The 60 patients in group 1 were requested to take propranolol for 4 months, while the other 60 subjects (group 2) received placebo therapy during the same period. The best-corrected visual acuity (BCVA) of every volunteer and an OCT image of each patient were checked and recorded at the beginning of the study and each week thereafter. If the signs of CSCR disappeared completely from the OCT scans, the case was considered a "success" and treatment stopped at once. However, the "success" subjects were further evaluated in follow-ups throughout the next 5 months to determine the rate of recurrence in groups 1 and 2. The time of total complete remission of CSCR from the OCT scans was also measured in groups 1 and 2.

Conclusion: CSCR patients revealed an excellent prognosis and success rate of 95.0% after taking propranolol. The treatment was able to enhance subretinal fluid (SRF) absorption, shorten the time to total complete remission, and significantly decrease CSCR recurrence. As such, we suggest that taking propranolol may be an alternative and viable choice for CSCR patients, given that the new method was shown to be safe, cheap, effective, well tolerated and convenient.

Keywords: best-corrected visual acuity (BCVA); central serous chorioretinopathy (CSCR); propranolol.

Figure 1

The flow chart shows the designed protocols and final results, divided into groups 1 and 2, during the whole 9 months of our study. * denoted a significant difference between the propranolol and placebo groups.

Figure 2

Optical coherence tomography (OCT) images generated using the OPKO (E-Vision Instrument Company, Taiwan) in a 42-year-old male with CSCR. The topographic maps show highly bulged swelling from macular retinal edema and loss of the fovea at day 1.

Figure 3

After oral propranolol for 70 days (Day 70), the vertical and horizontal scans from the 42-year-old male with CSCR show that the retinal pigment epithelium (RPE) had detached with significantly reduced macular edema. Therefore, the patient was considered as a “success” case for propranolol treatment in group 1.