Topical non‐steroidal anti‐inflammatory drugs for central serous chorioretinopathy: A systematic review and meta‐analysis

Abstract

Central serous chorioretinopathy (CSC) is a prevalent exudative maculopathy and the ongoing verteporfin shortage restricts current treatment possibilities. Topical non‐steroidal anti‐inflammatory drugs (NSAID) have previously been proposed as a treatment for CSC, although its exact efficacy remains unclear. In this systematic review and meta‐analysis, we outlined the efficacy of topical NSAIDs for the treatment of CSC. We searched 11 literature databases on 13 December 2022, for any study describing topical NSAID treatment for CSC. Thirteen eligible studies were included with a total of 1001 eyes of 994 patients with CSC. Six studies were case reports, two were cohort studies and five were non‐randomized comparative studies. Where specified, topical NSAIDs used were bromfenac 0.09%, diclofenac 0.1%, ketorolac 0.4% and 0.5%, pranoprofen 0.1%, and nepafenac 0.1% and 0.3%. Studies were predominantly of cases with acute CSC and several case studies reported treatment outcomes simultaneously with discontinuation of corticosteroid use, which complicated treatment evaluation. Meta‐analyses of comparative studies revealed a statistically significant but clinically irrelevant best‐corrected visual acuity improvement of −0.04 logMAR (95% CI: −0.07 to −0.01 logMAR; p = 0.01) at 1‐month follow‐up, which became statistically insignificant at 3‐month follow‐up (−0.03 logMAR; 95% CI: −0.06 to 0.003 logMAR; p = 0.08). Further, we found no benefit in complete subretinal fluid resolution at 1‐month follow‐up (OR: 1.20; 95% CI: 0.81–1.76; p = 0.37) or 3‐month follow‐up (OR: 1.17; 95% CI: 0.86 to 1.59; p = 0.33). Taken together, available evidence does not support the use of topical NSAIDs for the treatment of CSC.

Perspectives and Update on the Global Shortage of Verteporfin (Visudyne®)

“…Due to its complexity and the lack of pharmaceutical-grade active pharmaceutical ingredients, pharmacy compounding was deemed unattainable by hospital pharmacists [31]. As a result, ophthalmologists are seeking alternative medicinal products [15,32], but no strongly evidencebased alternative treatments with similar efficacy as PDT are currently known. To our knowledge, no other photosensitizers have become available for performing PDT in the eye since our last paper on the verteporfin shortage has been published [23].…”

Blinded by Stress: A Patient and Physician Perspective on Central Serous Chorioretinopathy

“…One complicating factor in this topic is that even peer-reviewed literature may be harmful when not seen in relevant context or not viewed critically considering its evidence level. For example, case reports or advice can be found on the use of topical NSAIDs for CSC, although best evidence does not recommend their use [ 32 ]. Thus, accurate and relevant patient information needs to be accessible, and different strategies may be required in different settings.…”