Artikel
Ketoconazole in the treatment of idiopathic central serous chorioretinopathy
Suche in Medline nach
Autoren
Veröffentlicht: | 22. September 2004 |
---|
Gliederung
Text
Objective
Elevated endogenous glucocorticoid production and exogenous glucocorticoid application (systemic, inhalative, intraarticular) are said to play a role in the pathogenesis of Idiopathic Central Serous Chorioretinopathy (ICSC) and can be responsible for the disease in the absence of other factors. Ketoconazole, a fungicide of the Imidazole group, inhibits the endogenous cortisol synthesis and is therefore also used in the treatment of Cushing's disease. The aim of this study was to investigate a possible effect of Ketoconazole in the treatment of patients with ICSC.
Methods
Out of 28 patients with ICSC, 14 patients were treated with Ketoconazole 200 mg/d over a period of 4 weeks, the other 14 served as controls. Baseline examination and follow-up visit after 4 weeks included testing for visual acuity and measurement of neuroretinal or pigment epithelial detachment by optical coherence tomography (OCT). Fluorescein angiography was performed to verify the diagnosis. To evaluate the systemic effect of the Ketoconazole treatment , twenty four hour urinary free cortical secretion was measured.
Results
In the follow-up, mean visual acuity increased by an average of 0.12 in the treatment group and 0.1 in the control group. Neuroretinal or pigment epithelial detachment decreased by 145 μm in the Ketoconazole group and 92 μm in the control group, respectively. However, the differences in visual acuity and OCT results between both groups missed statistical significance.
Conclusions
A decrease in endogenous cortisol synthesis seems to be a reasonable approach in the treatment of ICSC. However, the efficacy of a 200 mg/d Ketoconazole therapy still has to be proven.