Other Treatment and Management of Chronic CSCR
Transpupillary thermal therapy (TTT) is being investigated as it has a diode laser that has a wavelength of 810 nm, mainly absorbed by the choroid, allowing an effective treatment of pachychoroid disease.
Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents have also been studied because even though there is no increased levels of ocular VEGF in a patient with chronic CSCR, anti-VEGF injections theoretically should reduce hyperpermeability and congestion of choroidal vessels.
Oral mineralocorticoid receptor (MR) antagonists, such as eplerenone and spironolactone, can possibly be used due the presence of MR in the sensory retina, RPE and choroid. The mineralocorticoid pathway has been shown to cause choroidal vasodilation and leakage, due to upregulation of the vasodilator potassium channel and smooth muscle cells relaxation in the choroidal vasculature.
Oral anti-androgenic drugs, such as finasteride, which is an inhibitor of 5-alpha-reductase, prevents testosterone from changing to dihydrotestosterone, which binds the androgen receptor with greater affinity.
Methotrexate (MTX) is an antimetabolite with an immunosuppressive effect used for treating various inflammatory diseases. Beyond this action, it is also an anti-angiogenic drug, so it could have a potential therapeutic role. However, the exact mechanism is unknown, but it is thought that it could interact with steroid receptors or may improve the RPE pump, increasing the tissue adenosine levels or blocking the corticosteroid effect.
Rifampin is an antibiotic used for treatment of tuberculosis and leprosy but recently has been reported to have anti-angiogenic, anti-oxidative effect and antiglucocorticoid action.
Melatonin is not only involved in the regulations of circadian rhythm but also has a protective role in ocular diseases, lowering VEGF levels, scavenging free radicals and inhibiting glucocorticoid actions.