Ketoconazole in the Treatment of Central Serous Chorioretinopathy

Purpose: The aim of this study is to measure the endogenous cortisol levels in the patients with central serous chorioretinopathy (CSCR) and also, evaluate the short-term effect of oral ketoconazole in the treatment of both acute and chronic CSCR. Methods: In this prospective interventional case series 12 patients with acute CSCR and 7 patients with chronic CSCR (Including one patient with bilateral chronic disease) were treated with oral ketoconazole 200 mg two times per day. Measurement of best corrected visual acuity (BCVA), macular thickness [Using optical coherence tomography (OCT)], and 24-hour urinary cortisol levels were done before and after one month of treatment. Results: Abnormal elevated levels of 24-hour urinary cortisol were identified in 50% of cases at presentation and it reduced after treatment (P=0.03). In acute CSCR patients, pretreatment mean logMAR BCVA was 0.3±0.2 and improved to 0.1±0.1 after treatment (P=0.005). Also central macular thickness was significantly reduced after treatment (P=0.001). Complete or partial improvement in central macular thickness and BCVA were happened in four from eight eyes with chronic CSCR. Conclusion: Oral ketoconazole (400 mg/day) may be a noninvasive and safe therapeutic option for patients with acute CSCR and may alter the clinical course of some patients with chronic disease.