Mineralocorticoid Receptor Antagonist Treatment in Bilateral Chronic Central Serous Chorioretinopathy

Gergely, R; Kovács, Illés; Schneider, Miklós; Resch, Miklós; Papp, András; Récsán, Zsuzsa; Nagy, Zoltán Zsolt; Ecsedy, Mónika

doi:10.1097/iae.0000000000001303

Cited by 55 publications

(33 citation statements)

References 29 publications

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“…36,37 In the present study, we have investigated the choroid using both structural OCT (ie SFCT) and OCT-A (ie vessel density in choriocapillaris and in Sattler+Haller layer). In accordance with previous studies, 38,39 our results indicate that SFCT significantly improved after treatment overall and in both subgroups. Notably, we observed a reduction in SFCT significantly greater in eyes treated with PDT than eplerenone.…”

Section: Discussionsupporting

confidence: 93%

Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy

Rabiolo

Zucchiatti

Marchese

et al. 2017

Eye

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PurposeTo correlate function and structural optical coherence tomography (OCT) to optical coherence tomography angiography (OCT-A) measures in patients affected by central serous chorioretinopathy (CSC) and to describe their changes after treatments (ie oral eplerenone, half-fluence photodynamic therapy (PDT)).Patients and methodsTwenty eyes of 16 consecutive patients with treatment-naïve CSC undergoing either eplerenone or PDT were enrolled in this prospective, observational study. All patients underwent structural OCT and OCT-A at baseline and after therapy at months 1 and 3.ResultsEleven eyes of nine patients and nine eyes of seven patients underwent eplerenone or PDT treatment, respectively. Central macular thickness (CMT) and subretinal fluid (SRF) correlated to fovea avascular zone (FAZ) area (r=0.74 and r=0.71, P=0.01) and vessel density (r=0.77 and r=0.68, P=0.01) at deep capillary plexus (DCP). CMT (P=0.0011), SRF (P=0.0005), SFCT (P=0.0016), FAZ area at DCP (P=0.0334) improved at 3-month visit. A significant reduction of deep FAZ area was appreciated in eplerenone (P=0.0204) but not in PDT (P=0.5) group. SFCT reduction was significantly higher in PDT than eplerenone group (P=0.0347).ConclusionStructural and vascular parameters are correlated in CSC and they improve after different treatments. Both half-fluence PDT and oral eplerenone do not permanently damage choriocapillaris or other choroidal layers as evaluated by OCT-A.

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Section: Discussionsupporting

confidence: 93%

Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy

Rabiolo

Zucchiatti

Marchese

et al. 2017

Eye

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“…In our previous prospective study we found that in eplerenone treated CSCR patients baseline choroidal thickness was a positive predictive factor for subretinal uid decrease, results which were recently supported by Bousquet et al who found that a thick choroid at baseline is associated with good treatment response. 13,14 In our previous pilot study we found that outer segment elongation and baseline visual acuity also proved to be a signi cant predictor of good visual acuity. 15 Regarding neuroretinal morphological changes Cakir and coworkers reported that CSCR patients with intact RPE and intact ellipsoid zone had better BCVA after eplerenone treatment.…”

Section: 15mentioning

confidence: 88%

“…In the last ve years many papers showed that eplerenone is a safe and effective treatment option in chronic CSCR patients, mainly through reversing the choroidal vasodilatation that results in resolution of subretinal uid. 1,[7][8][9][10][11][12][13] In this study, we have chosen uid resolution as the biomarker of good response to treatment instead of the change in visual acuity, because neuroretinal re-attachement is not always accompanied by visual acuity improvement. Besides the presence of subretinal uid several other factors are in uencing the visual prognosis, such as the disruption of ellipsoid zone, disruption of the ELM, thinning of the ON layer and photoreceptor outer segment, hyperre ective foci in the retinal layers and the severity of RPE atrophy.…”

Section: Discussionmentioning

confidence: 99%

“…9,10,11,12 We also showed in our previous prospective clinical study that 3 month eplerenone therapy can reverse the choroidal vasodilatation and subsequently induce reabsorption of subretinal uid. 13 Despite these promising results, we noticed that there are some patients who tend to react only modestly to treatment. This study was intended to assess if there are any factors which can differentiate the CSCR patients who would bene t promptly from eplerenone treatment.…”

Section: Introductionmentioning

confidence: 90%

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Predictive factors of selective mineralocorticoid receptor antagonist treatment in chronic central serous chorioretinopathy

Gergely

Kovács

Récsán

et al. 2020

Preprint

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Purpose: To compare the macular morphology of good and poor responders to eplerenone treatment in chronic central serous chorioretinopathy (CSCR) patients. Methods: 30 eyes of 29 patients with chronic CSCR were treated with 50 mg/day oral eplerenone and followed up for one year. The integrity of outer retinal layers at baseline was assessed using optical coherence tomography. Patients who showed complete resolution of subretinal fluid at one year were assigned to the good responder group (Group 1), whilst those who showed moderate or no resolution were classified as poor responders (Group 2). Results: Ellipsoid zone interruption, ELM interruption and hyperreflective foci in outer segment (OS) and outer nuclear layer (ONL) was significantly more frequent in Group 2 than in Group 1 (p<0.05 for all parameteres). Outer segment elongation was significantly more frequently seen in Group 1 than in Group 2 (p<0.05) Multivariable regression analysis showed that intact ellipsoid zone at baseline is an independent predictor of good therapeutic response, with an odds ratio of 26.00 (95% CI: 3.69–183.45; p=0.001) after controlling for the effect of hyperreflective foci and ELM integrity.Conclusion: There is higher chance of the resolution of subretinal fluid after eplerenone treatment in CSCR patients with intact outer retinal layers at baseline. Baseline morphologic evaluation of the outer retinal layers on OCT scans can be useful in predicting the response to mineralocorticoid receptor antagonist therapy in these patients.

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“…The detachment spontaneously resolves within 2 to 3 months in two-thirds of affected individuals, which is defined as acute CSC [3]. However, more than one-third of patients experience chronic forms of CSC with persistent sub-retinal fluid (SRF) accumulation or recurrences leading to continuous visual impairment [4].…”

Section: Introductionmentioning

confidence: 99%

Photodynamic therapy for bullous retinal detachment: a single-center experience of case series with a 6-month follow-up study

Gao

Xiao

et al. 2018

Graefes Arch Clin Exp Ophthalmol

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PurposeTo evaluate the efficacy of half-dose photodynamic therapy (PDT) for the treatment of bullous retinal detachment.MethodsInterventional prospective case series in six eyes from six consecutive patients with bullous retinal detachment. The effected eyes were treated with indocyanine green angiography (ICGA)-guided half-dose PDT with multifocal and large laser spots. Clinical evaluations included best-corrected visual acuity (BCVA), ophthalmoscopy, ophthalmic B scan, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and ICGA at each scheduled visit at baseline; at 1, 3, and 6 months after PDT; and during follow-up after 6 months.ResultsAll six eyes received half-dose verteporfin PDT with a mean number of therapeutic spots 2.83 ± 1.47 and a mean spot size of 4647 ± 996 μm in diameter. Three months after PDT, retinal reattachment was observed on B scans and resolution of sub-retinal fluid (SRF) was observed in OCT images for five eyes. There was no significant difference in the mean logMAR BCVA between the baseline and the value at 1 month after PDT (P = 0.477). At 3 months after PDT, the mean logMAR BCVA improved significantly from a baseline value of 1.02 to 0.54 (P = 0.044). At 6 months after PDT, the mean logMAR BCVA further improved to 0.46 (P = 0.025) and remained stable. One affected eye received a second half-dose PDT for SRF not reduced until the second month after PDT. Retinal reattachment and SRF resolution were observed at 1 and 3 months after the second therapy, respectively. BCVA improved from a baseline value of 20/63 to 20/20 at 1 month after the second PDT and remained stable until the sixth month after the second PDT. During follow-up after more than 6 months, recurrence occurred in no cases.ConclusionsThis study demonstrated half-dose PDT with multifocal and large laser spots was an effective treatment for bullous retinal detachment contributing to the retinal reattachment, a resolution of SRF, and an improvement of BCVA. Thus, PDT for the treatment of bullous retinal detachment is considered to be a worthwhile endeavor.

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Mineralocorticoid Receptor Antagonist Treatment in Bilateral Chronic Central Serous Chorioretinopathy

Abstract: Patients with chronic central serous chorioretinopathy can safely be treated with eplerenone as it can reverse choroidal vasodilation with an accompanying resolution of the SRF and improvement in visual acuity. These beneficial therapeutic effects are more pronounced in the exudative eyes.

Cited by 55 publications

References 29 publications

Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy

Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy

Predictive factors of selective mineralocorticoid receptor antagonist treatment in chronic central serous chorioretinopathy

Photodynamic therapy for bullous retinal detachment: a single-center experience of case series with a 6-month follow-up study

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