The pathophysiology of central serous chorioretinopathy (CSC) is complex and has not been fully elucidated. Suggested theories include hyperpermeability and increased hydrostatic pressure in the choroidal vasculature, which creates RPE detachments overwhelming the RPE barrier function, leading to accumulation of subretinal fluid (SRF). Elevated glucocorticoid and androgen levels have also been implicated in the pathogenesis of CSC. Finesterade is an antiandrogenic agent that inhibits enzyme 5 alpha reductase that converts testosterone to dihydrotestosterone (which has a greater affinity for the androgen receptor). In this study the authors retrospectively evaluated a series of 29 eyes of 23 patients who were treated with finasteride 5mg/day orally for CSC. There were 20 (86.9%) males and three females (13.1%) included in the study. The evaluation record included previous medical and ocular history, steroid use, length of finasteride and additional treatments for CSC, visual acuity central macular thickness and presence of SRF at follow-up and the occurrence of any complications. Initial VA was 0.29±0.31 logMAR, and a trend towards improved VA was noted after three months (0.25±0.36 logMAR; P=0.07). VA was significantly improved at the final follow-up (0.23±0.27 logMAR; P=0.024). Initial CMT was 354±160μm, and was significantly reduced after one month of treatment (284±77μm; P=0.002) which was maintained to the end of follow-up (247±85μm; P=0.001). A significant reduction in SRF was found at all time points, with an overall 75.9% rate of complete resolution. Following discontinuation, recurrence of SRF was noted in six (37.5%) of cases. No adverse events were recorded after a mean follow-up period of 16.1 months. The authors concluded that finasteride is a safe and effective treatment for CSC. It may be a possible new option for the initial management of patients with CSC. Limitations of the study: retrospective nature, small sample size, short follow-up period, lack of control group, inclusion of eyes that had received other, treatments pre and post finesterade therapy. 

Finasteride is effective for the treatment of central serous chorioretinopathy.
Moisseiev E, Holmes AJ, Moshiri A, Morse LS.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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