Efficacy of Topical Non-Selective and COX-2 Selective NSAIDs in Accelerating Resolution of Acute Central Serous Chorioretinopathy: A Retrospective Analysis.

Abstract

Purpose: To evaluate whether topical nonsteroidal anti-inflammatory drugs (NSAIDs) accelerate the resolution of acute central serous chorioretinopathy (CSCR) compared with observation.

Patients and methods: This retrospective cohort study reviewed patients diagnosed with acute CSCR (2018-2023) (n = 145). Patients received either topical ketorolac (n = 26, nonselective NSAID, four times daily) or observation alone (n = 63). Historical data (2007-2013) (n = 111) comparing COX-2 selective NSAIDs (bromfenac or nepafenac, n = 38) with observation (n = 73) were analyzed for comparison. Main outcome was time to complete subretinal fluid resolution on optical coherence tomography (OCT) and visual acuity (VA) recovery to 20/20. Outcomes were analyzed using Kaplan-Meier survival curves and Cox proportional-hazards regression.

Results: Baseline demographics were similar between NSAID-treated and observed groups (mean age 45 years, ~82% male, baseline visual acuity ~20/40). In the recent cohort, NSAID treatment with ketorolac significantly accelerated fluid resolution compared with observation (median 74 vs 115 days; hazard ratio 1.70, 95% CI 1.05-2.75, p = 0.033). Historical data revealed a greater treatment effect with COX-2 selective NSAIDs (mean resolution 42 days vs 131 days with observation, p < 0.0001). When combined, NSAIDs significantly shortened CSCR duration compared to observation alone (mean 62 vs 132 days, p < 0.001), with COX-2 selective NSAIDs showing superior efficacy (p < 0.01 vs ketorolac). Visual acuity outcomes at final resolution were excellent (~20/20) and similar between groups. No significant adverse events occurred, and 12-month recurrence rates were similar between NSAID-treated and observed groups.

Conclusion: Topical NSAIDs, especially COX-2 selective agents, may accelerate resolution of acute CSCR compared to observation alone. The earlier recovery of normal vision and anatomical resolution may benefit patients clinically by reducing morbidity associated with prolonged retinal detachment. Prospective studies are warranted to confirm these findings and refine treatment protocols for acute CSCR.