Ketoconazole in the treatment of central serous chorioretinopathy: a pilot study

Purpose: The aim of this study was to evaluate a possible effect of systemic ketoconazole on visual acuity (VA) and retinal thickness in patients with acute central serous chorioretinopathy (CSCR). Methods: Fifteen consecutive patients were treated with ketoconazole 200 mg/day for a period of 4 weeks. Another 15 patients served as a control group. Baseline examination and review after 4 weeks included VA testing and measurement of neuroretinal or pigment epithelial detachment by optical coherence tomography (OCT). Fluorescein angiography was performed to verify the diagnosis. Results: At baseline, mean VA in Snellen units was 0.6 +/- 0.2 (logMAR 0.2 +/- 0.7) in the treatment group and 0.7 +/- 0.3 (logMAR 0.2 +/- 0.5) in the control group. On OCT, mean neuroretinal or pigment epithelial detachment measured 288 +/- 163 mu m in the ketoconazole group and 225 +/- 51 mu m in the control group, respectively. Four weeks later, mean VA improved in both groups. On OCT, neuroretinal or pigment epithelial detachment decreased in both the treatment and control groups. The differences were not statistically significant. Conclusions: Although a pharmacological decrease in endogenous cortisol synthesis appears to be a rational approach in the treatment of CSCR, systemic ketoconazole at 200 mg/day was not associated with a significantly better outcome in this preliminary study.