Eplerenone for treatment of chronic central serous chorioretinopathy

Abstract

Purpose: To assess the morphological and functional outcome of oral eplerenone for treatment of patients with chronic central serous chorioretinopathy (CSC) in a real life experience. Patients and methods: In this retrospective study, we reviewed the clinical files of 30 patients with chronic CSC. All patients were treated with eplerenone for a period of 6 weeks or 3 months depending on the clinical response. Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and height of the subretinal fluid (SRF). Comparisons between responders and non-responders were performed to identify factors that were predictive of the treatment response. Results: All patients were treated with eplerenone 18 ± 20 weeks after onset of the first symptoms. BCVA (LogMAR) improved from 0.2 ± 0.2 to 0.13 ± 0.18 at 6 weeks ( p = 0.01) and to 0.09 ± 0.15 at 3 months ( p = 0.01). Mean CMT decreased from 409 ± 136 to 323 ± 87 µm at 6 weeks ( p = 0.001) and to 298 ± 98 µm at 3 months ( p = 0.01). Mean height of SRF decreased from 153 ± 126 to 73 ± 79 µm at 6 weeks ( p = 0.001) and to 49 ± 88 µm at 3 months ( p = 0.005). Complete resolution of SRF was achieved in 20 patients after 3 months (67%). Reported stress in the medical history was the only statistical significant predictive factor associated with a positive treatment response. Conclusion: This study showed a statistically significant improvement of the best corrected visual acuity and a significant reduction of macular thickness and subretinal fluid in patients with chronic CSC treated with oral eplerenone, especially in patients under stress.

OCT-A in chronic central serous chorioretinopathy treated with oral eplerenone and half-fluence photodynamic therapy: A comparative study

“…25 In recent years, eplerenone has also been extensively studied and discussed as a new pharmacological approach to the disease. 26 In this retrospective study, we analysed with OCTA the VD of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) in patients with CSC treated with vPDT or oral eplerenone. We demonstrated that both treatments were able to significantly improve the VD of DCP and CC after three months from baseline, whereas no difference in the VD of SCP occurred.…”

Atypical Central Serous Chorioretinopathy Masquerading as Vogt-Koyanagi-Harada Disease: A Case Report

“…While not firmly established, a few studies suggest that carbonic anhydrase inhibitors may be helpful in the treatment of active CSCR [11]. Several studies have shown signs of efficacy in treating both acute and chronic CSCR [12,13]. Also, while prospective, double-blind, randomized, placebo-controlled studies [14] have concluded that there is a lack of efficacy of eplerenone in treating CSCR, follow-up comments in the journals Fluorescein angiography of the right eye showed a reduction in macular leakage compared to baseline but also highlighted an isolated area of peripheral vascular staining in the right eye that was visible in the midphase (e, yellow arrow) and progressively leaked up to the late phase (f, yellow arrow).…”

“…Eye and Lancet [15,16] found some limitations to these studies. It is possible that in certain scenarios, particularly in the acute phase of the disease and in patients under stress [13], eplerenone may be of benefit. Given the severity of our patient's presentation and his selfdeclared high levels of stress, we opted to trial this medication.…”

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]. Additionally, it is known that elevated levels of cortisol and endogenous mineralocorticoid dysfunction [4] in patients with CSCR contribute to choroidal vasodilation, and the inhibition of this pathway may prevent aldosterone-induced choroidal thickening [5].…”