THE TREATMENT OF CENTRAL SEROUS CHOROIDOPATHY WITH A BETA-BLOCKER - METOPROLOL

Numerous theories have been proposed to explain the origin of central serous choroidopathy (CSC). However, it has been shown recently that there is a close relationship between CSC and type A-behaviour pattern (TABP) which is characterized by high adrenergic activity in the body. It is interesting to note that one of our patients who had chronic central serous choroidopathy, and metoprolol treatment for hypertension during one year, developed a recurrence of CSC three weeks after cessation of metoprolol treatment. This was one of the reasons to start this treatment modality for CSC. In this study, we present 6 cases of CSC in which the diagnosis was established by ophthalmoscopy and fluorescein angiography. In these patients, we proposed to analyse the relationship between CSC and a high adrenerigc activity by the use of a selective beta-blocker (metoprolol; 50 mg tablets, twice daily). In two of the six cases, laser photocoagulation was also performed prior to commencement of the metoprolol treatment. Visual acuity improved in two patients, stayed at 1.0 in three patients and stabilized on the pretreatment level (0.8) in one patient (case-5). However, the symptoms (metamorphopsia and micropsia) and the signs (serous retinal detachment and angiographic hyperfluorescence) decreased or disappeared in all patients after treatment. Also visual complaints in all patients improved sujectively. No recurrences were noted during the metoprolol treatment in any of the patients. New attacks, however, were documented in both eyes in one patient after cessation of treatment. In another patient (case-6), we think that the progression of a new attack was prevented with early metoprolol treatment. Our small series shows that beta-blockers may be effective in preventing recurrences and in increasing the quality of vision in CSC. It may also improve the final visual acuity in this disease.