PREDNISOLONE EYE DROPS AS A POTENTIAL TREATMENT IN NONNEOVASCULAR PACHYCHOROID-RELATED DISEASES

Abstract

Purpose: To investigate the functional and structural outcomes after treatment with prednisolone eye drops in the following pachychoroid-related diseases: chronic central serous chorioretinopathy, pachychoroid pigment epitheliopathy, and peripapillary pachychoroid syndrome.

Methods: In this retrospective study, 54 eyes of 48 patients with pachychoroid-related disease were treated with prednisolone acetate 1% eye drops 3 times a day. Change in macular volume and retinal central subfield thickness on optical coherence tomography was measured. In addition, the foveal or complete resolution of fluid and the change in visual acuity were studied.

Results: The follow-up visit was at a mean of 41.2 ± 14.5 days. In the 44 eyes with chronic central serous chorioretinopathy, a significant reduction in retinal central subfield thickness ( P < 0.001) and macular volume ( P < 0.001) was observed. Foveal intra- or subretinal fluid resolved completely in 22% of the eyes. In the 8 peripapillary pachychoroid syndrome eyes, a reduction in the nasal retinal thickness was observed ( P = 0.025). One of the 2 pachychoroid pigment epitheliopathy eyes showed structural improvement. No significant change in visual acuity was observed in any of the pachychoroid spectrum diseases.

Conclusion: In patients with chronic central serous chorioretinopathy, peripapillary pachychoroid syndrome, and pachychoroid pigment epitheliopathy, anatomical improvement was observed after therapy with prednisolone eye drops. Visual acuity did not change significantly.

Fig. 1.

Multimodal imaging of a 67-year-old man with cCSC at baseline (A–D) and after treatment with prednisolone eye drops for 6 weeks (E). At baseline, hypo- and hyperautofluorescence are seen on fundus autofluorescence (A). On indocyanine green angiography (B and C), diffuse hyperpermeability is present. At baseline, subfoveal subretinal fluid is present on OCT (D), after treatment with prednisolone eye drops for 6 weeks, subfoveal SRF has resolved (E).

Fig. 2.

Optical coherence tomography in three cases with PPS before and after treatment with prednisolone eye drops (A–C). In all presented cases, a partial or a complete resolution of intraretinal fluid was observed at a follow-up of 5 to 8 weeks. In case C, only the horizontal scan through the fovea is depicted. The most prominent thickening of the nasal choroid was visible more superiorly (not shown), in accordance with the diagnosis of PPS.

Fig. 3.

Optical coherence tomography before and after treatment with prednisolone eye drops in patients with PPE (A and B). In one patient with a longstanding pigment epithelial detachment with secondary pigment epithelium atrophy and accompanying intraretinal fluid (A), no decrease in height and width of the pigment epithelial detachment was seen at follow-up. In the other patient (B), a decrease in the height and width of the pigment epithelial detachment was seen.