Central Serous Chorioretinopathy Resolves Faster with NSAIDs, Study Finds

Topical NSAIDs are a simple, accessible and low-risk treatment option for CSCR. By targeting inflammation early, this intervention could reduce the number of patients requiring costly PDT or systemic medications. Photo: Mohammad Rafieetary, OD. Click image to enlarge. The “do nothing and wait” approach is widely used in cases of acute central serous chorioretinopathy (CSCR), which typically resolves on its own within three to six months. But though the condition is self-limited, a significant number of patients still experience recurrence or prolonged duration, which increases the risk for permanent retinal damage and vision loss. This has inspired investigation of a low-risk high-reward avenue of treatment as an alternative to observation: topical NSAID therapy. “One would not leave cystoid macular edema untreated if a safe treatment exists,” researchers state in a recent Clinical Ophthalmology review paper. They reported more positive evidence supporting this intervention.The retrospective study assessed 145 patients recently diagnosed with acute CSCR. Twenty-six patients were treated topically with the nonselective NSAID ketorolac while 63 were observed. For comparison, the researchers reviewed historical data of 38 patients treated with COX-2 selective NSAIDs (bromfenac or nepafenac) and 73 who were observed. Both NSAID-treated and observed groups had similar baseline demographics.In both cohorts, NSAIDs demonstrated superior treatment effect compared with observation, with eyes recovering within weeks rather than months like in the untreated groups. Additionally, the authors reported that combining NSAIDs significantly shortened disease duration, and that COX-2 selective NSAIDs showed greater efficacy than ketorolac. Both groups had approximately 20/20 visual acuity at disease resolution and similar one-year recurrence rates.Though all eyes recovered with excellent visual acuity regardless of treatment, the authors aver that NSAIDs have a “promising role” as an early intervention since they can shorten CSCR duration and minimize long-term complications. “Avoidance of prolonged macular detachment is clinically relevant,” they wrote in their paper.“Retina specialists might consider an off-label trial of topical NSAID therapy in acute CSCR patients, given the favorable risk profile,” they added. “Our study contributes to the evolving paradigm that acute CSCR need not simply be observed; instead, pharmacologic modulation of choroidal inflammation can expedite recovery. If confirmed, this treatment strategy could improve quality of life for patients during CSCR episodes and reduce the healthcare burden of prolonged follow-up and monitoring.”Click here for the journal source. O’Brien P, Singer MA, Bell DJ, et al. Efficacy of topical non-selective and COX-2 selective NSAIDs in accelerating resolution of acute central serous chorioretinopathy: a retrospective analysis. Clin Ophthalmol. 2025;19:3389-400.This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.