<p>Oral Spironolactone versus Conservative Treatment for Non-Resolving Central Serous Chorioretinopathy in Real-Life Practice</p>

Abstract

Objective: To compare the efficacy of oral spironolactone treatment versus conservative treatment for patients with persistent central serous chorioretinopathy (CSC) in real-life practice. Design: Retrospective comparative study. Patients and Methods: Medical records and retinal images of 62 patients with nonresolving CSC were reviewed. Twenty-one patients received oral spironolactone (50 mg/ day) while 41 patients received conservative treatment. Primary outcome was proportion of eyes with complete resolution of subretinal fluid (SRF) within 6 months. Secondary outcome measures included changes in SRF height, central macular thickness (CMT), lesion size and best-corrected visual acuity (BCVA). The occurrence of drug side effect was also assessed. Results: There was no significant difference in demographic data, clinical characteristics, optical coherence tomography parameters and leaking patterns in fluorescein fundus angiography between two groups. Complete resolution of SRF was significantly higher and faster in the spironolactone group than the conservative treatment group (p=0.03). Although significant anatomical improvement in SRF height, CMT and lesion size were observed in both groups (p < 0.001), final BCVA was improved significantly in only the spironolactone group (p < 0.05). The recurrence of SRF after complete resolution was observed in 4/12 eyes (33.33%) in the treatment group. None of the patients experienced any side effects of spironolactone. Conclusion: Oral spironolactone (50 mg/day) could achieve both significant anatomical and visual improvement, while the significant visual gain could not be provided with the conservative treatment. Spironolactone should be considered as an alternative treatment option in non-resolving CSC patients who cannot afford the PDT treatment.

Using oral Rifampin to treat acute central serous Chorioretinopathy: a randomized placebo-controlled clinical trial ‎

“…Rifampin is a cytochrome P450 and 3A4 inducer and thus increases the processing of endogenous steroids through the induction of hepatic metabolism [34,35]. It was considered an off-label treatment after the alleviation of chronic CSC was observed in a patient who was on multi-drug antibiotic therapy for presumed latent tuberculosis, which was an effect that persisted on rifampin monotherapy [26]. Despite these positive outcomes, the exact role of corticosteroids in CSC pathogenesis is inadequately understood.…”

“…Given that corticosteroids are involved in CSC formation, glucocorticoid inhibition has been recommended as a possible therapeutic method [16][17][18][19][20][21][22]. Small-scale case series support the role of systemic anti-corticosteroid agents, including mifepristone, ketoconazole, finasteride, and rifampin, in the treatment of CSC [6,[23][24][25][26][27]. A few studies recently examined the impacts of mineralocorticoid receptor antagonists on CSC and endorsed the use of these agents in treating the disease [28][29][30], but these medications have not been included in the treatment protocols for CSC.…”

Central serous chorioretinopathy: updates in the pathogenesis, diagnosis and therapeutic strategies

“…Most results have shown positive outcomes demonstrating a significant reduction of SRF, decreased central macular thickness (CMT), and improvement in VA [ 57 , 130 , 131 ]. Although oral spironolactone is not a first-line treatment, it is helpful for patients with non-resolving CSCR with SRD [ 132 ]. The VICI study found that oral eplerenone (25 mg/day for 1 week then increasing to 50 mg/day for up to 12 months) was not superior to placebo for improving VA in people with cCSCR at 12 months [ 133 ].…”

Sub-Threshold Micro Pulse Laser (810NM): Treatment for Chronic Central Serous Retinopathy

“…It is a unilateral condition, usually affecting young and middle-aged adults, with a male predominance. 1,2 Common risk factors include type A personality, male gender, steroid use, stress, pregnancy, alcoholism, smoking, H. pylori infection and hypermetropia. 3 Patients present with blurring of vision, metamorphopsia, micropsia and mild dyschromatopsia.…”