Sildenafil may be a safe and effective therapy for people with central serous chorioretinopathy (CSCR), according to the preliminary results of a study published in Ophthalmology Retina.
Researchers sought to examine the potential benefit of sildenafil citrate in treating CSCR. Patients with chronic illness, either with or without refractory CSCR, were eligible to enroll in the PISCES Trial (ClinicalTrials.gov identifier NCT04356716).
Participants (n=4; 100% male; mean age, 43 years ± 5 years) received sildenafil therapy; those weighing less than 150 lbs received 40 mg twice daily, and those weighing more than 150 lbs received 80 mg twice daily. Best corrected visual acuity (BCVA) and swept-source optical coherence tomography angiography (OCT-A) evaluations were conducted at baseline, 4 weeks, and 8 weeks.
Each participant had 1 symptomatic eye followed for approximately 5 years. Half (2) of the participants had undergone previous treatment (oral eplerenone and half-fluence photodynamic therapy) and 1 participant received high-dose oral prednisone.
All participants continued sildenafil treatment for approximately 4 months, with no adverse events or side effects reported. Sildenafil was discontinued in 1 participant after 2 months due to a lack of improvement and abnormal OCT-A flow signal. In total, 3 participants demonstrated 2 or more lines of BCVA improvement; 1 patient experienced this improvement after discontinuing sildenafil and initiating aflibercept. All 4 participants experienced subretinal fluid.
In all 4 eyes, subfoveal choroidal thickness increased from 368 µm to 403 µm (P =.02). Eyes in patients who demonstrated subretinal fluid resolution showed an average subfoveal choroidal thickness decrease from 429 µm to 397 µm, without significance (P =.13).
Study limitations include the small number of patients.
“Although small, our data demonstrate that select patients with chronic/refractor CSCR may benefit from sildenafil,” the research shows. “Larger samples are necessary to characterize and predict response, potentially in comparison with those meeting [photodynamic therapy] criteria.”
Breazzano MP, Coleman DJ, Chen RWS, Chang S, Daly S, Tsang SH. Prospective impact of sildenafil on chronic central serous chorioretinopathy: PISCES trial. Ophthalmol Retina. 2020;4(11):1119-1123.