Eplerenone for the treatment of chronic central serous chorioretinopathy: 3-year clinical experience

Abstract

Background/aimsThe efficacy of mineralocorticoid receptor antagonist eplerenone to treat chronic central serous chorioretinopathy (CSCR) has been established. However, previous studies have been limited by small cohort size and short follow-up duration. This study aims to report 3-year clinical outcomes of patients treated with eplerenone for chronic CSCR.MethodsInstitutional review board-approved retrospective chart analysis at a single institution from 2012 to 2018. Baseline best-corrected visual acuity and anatomical measurements related to degree of subretinal fluid (SRF) were collected at eplerenone initiation. Follow-up data were collected at the closest date to 12, 24 and 36 months.ResultsData were obtained for 100 eyes of 83 patients at 1-year (mean 11.18 ± 4.00 months), 49 eyes at 2-year (24.01 ± 3.33 months) and 33 eyes at 3-year (mean 35.5 ± 7.89 months) follow-up visits. The rate of complete SRF resolution was 31%, 28% and 33%, respectively. At final follow-up, logarithm of the minimum angle of resolution visual acuity change from baseline was +0.10 ± 0.24 (p = 0.130). Average change from baseline at final follow-up for central subfield thickness was −97 ± 140.6 µm (p < 0.001), cube volume was –1.07 ± 1.71 mm3 (p < 0.001), macular thickness –28. 5 ± 47.5 µm (p < 0.001), maximum SRF height was −95.6 ± 160.5 µm (p < 0.001) and maximum SRF diameter was −1169.0 ± 1638.7 µm (p = 0.008).ConclusionAnatomical improvement occurs primarily within the first year of eplerenone treatment for chronic CSCR.

Optical Coherence Tomography Parameters as Predictors of Treatment Response to Eplerenone in Central Serous Chorioretinopathy

“…The OCT images were reviewed for qualitative features and analyzed for quantitative measures using the Spectralis built-in analysis software (Heidelberg Eye Explorer Version 6.0, Heidelberg Engineering GmbH, Heidelberg, Germany). The following measurements were performed at baseline and at each follow-up visit, as previously shown [18,19]: (i) subfoveal choroidal thickness; (ii) foveal SRF height; (iii) macular maximum SRF height; (iv) macular maximum SRF diameter; (v) number of pigment epithelium detachments (PEDs); and (vi) number of intraretinal hyperreflective foci (Figure 1). In detail, the (i) and (ii) measurements were performed on the horizontal scan passing through the fovea (the EDI scan for the choroidal thickness), while the other assessments were performed considering all the OCT B-scans throughout the macula.…”

Eplerenone for chronic central serous chorioretinopathy

“…17 (30%) of 57 patients received eplerenone for less than 3 months. However, in previous studies, 2,3 treatment with eplerenone of between 6 and 12 months resulted in resolution of subretinal fluid and improvement of vision in 60-80% of patients. In these same studies, 2,3 CSCR recurred when treatment ceased.…”

“…First, seven (13%) of the 54 patients in the placebo group analysed for the primary endpoint received photodynamic therapy or subthreshold laser therapy compared with three (5%) of the 57 patients in the eplerenone group analysed for the primary endpoint. Because further treatments were offered only if bestcorrected visual acuity deteriorated by 15 or more letters from baseline, 2 the greater proportion of patients treated in the placebo group than in the eplerenone group could reflect the greater proportion of patients without resolution in the placebo group. However, by treating these patients with photodynamic therapy or subthreshold laser therapy, bestcorrected visual acuity at 1 year followup was modified.…”

Current perspectives on the use of eplerenone for chronic central serous chorioretinopathy

“…In contrast, Petkovsek et al reported anatomical improvement, including central subfield thickness, macular cube volume, maximum SRF height and diameter achieved within the first year of eplerenone treatment [2]. In another recent study, BCVA was significantly improved and SRF and macular thickness decreased significantly in patients with CSCR treated with oral eplerenone, especially in those under stress [3].…”