The first full day of the American Society of Retina Specialists Annual Meeting has just ended here in Vancouver. It’s been a productive meeting so far, with a few clinical pearls that will change the way I practice. Yesterday’s case conference session had a memorable patient presented by Kirk Packo’s group in Chicago that will change the way I approach central serous retinopathy (CSR).
They presented a patient who had widespread chorioretinal lesions and a serous macular detachment. The thinking was that it could be due either to tuberculosis or to chronic CSR. The patient was placed on standard multi-drug therapy for tuberculosis and while on the therapy, the macular edema resolved. However, when the drugs were stopped, the fluid recurred. The patient was placed again on the TB drugs, the fluid again resolved, and when the drugs were stopped, the fluid again re-accumulated. At this point, they began to consider that the patient may not have TB, but may rather have chronic CSR and that one of the TB medications was having a positive independent effect on the serous retinopathy.
The reviewed the list of TB drugs and realized that rifampin has the ability to decrease endogenous steroid production, and that perhaps this was resulting in resolution of the patients serous retinopathy. They gave the patient a trial of rifampin alone (600 mg per day) and voila, the fluid resolved again.
Since that time, they had used rifampin in several other patients with CSR and have seen resolution of the fluid within 1-4 weeks. The case presentation doesn’t prove anything, and further study is required, but it does raise the possibility that rifampin may help CSR, particularly chronic cases, and I will now consider it as an option to offer select patients with central serous chorioretinopathy.