Choriocapillaris Reperfusion in Resolved Chronic Central Serous Chorioretinopathy Treated with Eplerenone: Long-Term Effects on the Fellow Eye

Abstract

Introduction The aim of this work is to utilize swept-source optical coherence tomography angiography (SS-OCTA) to assess the long-term changes in the choroidal and choriocapillaris (CC) layers of the fellow unaffected eye of patients with unilateral resolved chronic central serous chorioretinopathy (cCSC) following treatment with continuous oral eplerenone (EPL). Methods The study included 35 patients with cCSC and subretinal fluid (SRF) in one eye. SS-OCTA imaging was performed on the fellow cCSC eyes at baseline, 6 months, and 12 months during eplerenone therapy. CC OCT angiography was analyzed to determine the percentage of choriocapillaris flow deficits (FD%), the number of flow deficits (FDn), and the average area of flow deficits (FDa). Results The results demonstrated significant changes in CC flow deficits from baseline to follow-up visits. Specifically, there was a significant decrease in FD% from 28.9 ± 2.2% at baseline to 26.4 ± 1.9% at 6 months ( p = 0.023), and further to 24.9 ± 1.7% at 12 months ( p = 0.001). Additionally, the FD area gradually contracted over the follow-up period ( p < 0.05). Conversely, there was a significant increase in the number of flow deficits compared to baseline ( p < 0.05). No statistically significant changes were observed in best-corrected visual acuity (BCVA) at the follow-up visits ( p > 0.05). Conclusions The findings of this study demonstrated long-term reperfusion of the choriocapillaris in unaffected fellow cCSC eyes during continuous oral eplerenone therapy. The beneficial effects of eplerenone therapy were observed after 6 months and maintained at 1 year. These results suggest that specific mineralocorticoid receptor (MR) antagonists may be effective in promoting choriocapillaris recovery in the unaffected eyes of patients with cCSC.

Efficacy and Predictive Factors of Oral Spironolactone Treatment in Chronic Central Serous Chorioretinopathy

“…Importantly, the MR antagonist was well-tolerated by patients, with minimal occurrence of adverse events [ 22 ]. Furthermore, oral administration may be effective in promoting the recovery of choriocapillaris in the affected and unaffected eyes of patients with chronic CSC [ 23 , 24 ].…”

“…Synchronous changes in choroidal vessel hyperpermeability and vasodilation may not change volumetric blood flow. Notably, oral administration of MR antagonists may be effective at promoting choriocapillaris recovery and reperfusion in the unaffected eyes of patients with chronic CSC [ 23 ].…”