Mineralocorticoid Receptor Antagonists in Central Serous Chorioretinopathy

Wang, Sean K.; Sun, Peng; Tandias, Rachel; Seto, Brendan; Arroyo, Jorge G.

doi:10.1016/j.oret.2018.09.003

Cited by 32 publications

(30 citation statements)

References 33 publications

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“…Therapy with mineralocorticoid inhibitors (eplerenone) if effective at all, brings similar functional benefits as SMPLT and PDT. Meta-analysis of 5 randomized control trials evaluating efficacy of eplerenone treatment in CCSCR revealed just 0.1logMAR difference in BCVA between patients treated and receiving placebo at two months [34]. Most of the studies of that subject show moderate BCVA improvement, usually by less or about 0,1logMAR [35–37].…”

Section: Discussionmentioning

confidence: 99%

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Gawęcki¹,

Jaszczuk-Maciejewska²,

Jurska-Jaśko³

et al. 2019

BMC Ophthalmol

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Purpose Central serous chorioretinopathy (CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors—for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment—were also assessed. Materials and methods The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/− 10.5) with chronic central serous chorioretinopathy (mean duration 18.9 months SD +/− 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. Results Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 μm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease. Conclusion Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.

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Section: Discussionmentioning

confidence: 99%

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Gawęcki¹,

Jaszczuk-Maciejewska²,

Jurska-Jaśko³

et al. 2019

BMC Ophthalmol

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“…Meta-analysis of 5 randomized control trials evaluating efficacy of eplerenone treatment in CCSCR revealed just 0.1logMAR difference in BCVA between patients treated and receiving placebo at two months. [34].Most of the studies of that subject show moderate BCVA improvement , usually by less or about 0,1logMAR. [35,36,37] Laser photocoagulation is of limited use in chronic CSCR as it requires the leakage point to be located outside the fovea.…”

Section: Discussionmentioning

confidence: 97%

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Gawęcki¹,

Jaszczuk-Maciejewska²,

Jurska-Jaśko³

et al. 2019

Preprint

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Purpose Central serous chorioretinopathy(CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors—for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment—were also assessed. Materials and methods The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/- 10.5) with chronic central serous chorioretinopathy ( mean duration 18.9 months SD +/- 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. Results Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 µm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease. Conclusion Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.

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“…They attributed this to their low sample size and a high baseline BCVA [22], which might be true in our study as well. On the other hand, the most recent meta-analysis of randomized clinical trials with mineralocorticoid receptor antagonists shows a significant improvement in BCVA after 1 and 2 months of therapy as compared to placebo (− 0.05 logMAR; 95% CI − 0.07 and − 0.10 logMAR; 95% CI − 0.14 to − 0.06, respectively) [14]. Rahimy et al also showed a significant improvement of visual acuity in 64% of patients treated with eplerenone for 9 weeks, from 20/50 to 20/43 (p = 0.04) [13].…”

Section: Discussionmentioning

confidence: 99%

“…Eplerenone is of particular interest, as this medication does not have significant anti-testosterone side effects [12]. Recently published double-blind, randomized, placebo-controlled studies showed contradicting results on the effect of eplerenone on CSCR [12–14] and a new one is underway. This paper describes the short-term (4-week) efficacy of eplerenone in patients with chronic CSCR in a prospective interventional study.…”

Section: Introductionmentioning

confidence: 99%

Short-term eplerenone for treatment of chronic central serous chorioretinopathy; a prospective study

et al. 2019

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Background Increased mineralocorticoid activity is one of the plausible causes of chronic central serous chorioretinopathy (CSCR) and mineralocorticoid inhibitors such as eplerenone have been investigated as its potential therapy. This study investigates the short-term safety and efficacy of oral eplerenone in patients with chronic CSCR. Patients and methods Prospective study of 13 eyes of 13 patients with the diagnosis of chronic CSCR. All patients received eplerenone 50 mg/day for 4 weeks. Enhanced depth imaging optical coherence tomography (OCT) was obtained. Best corrected visual acuity (BCVA), and OCT parameters including sub retinal fluid (SRF), choroidal thickness (CT) and central macular thickness (CMT), were measured manually. Results The mean SRF height decreased slightly at 1-month follow-up as compared to baseline, but the change was not statistically significant (94.18 ± 17.53 vs. 113.15 ± 18.69; p = 0.08). Subfoveal CT and CMT was significantly reduced as compared to baseline (6.6% [p = 0.002] and 7.05% [p = 0.04], respectively). The BCVA did not change significantly (20/28 vs. 20/30 [p = 0.16]). Conclusion This study suggests that oral eplerenone may be used as a safe and potentially effective treatment in chronic CSCR, however there are minimal short-term effects on subretinal fluid or visual acuity therefore therapeutic trials longer than one month are necessary to test its benefits. Trial registration Clinicaltrials.gov identification number: NCT01822561. Registered 3/25/13, https://clinicaltrials.gov/ct2/show/study/NCT01822561

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Mineralocorticoid Receptor Antagonists in Central Serous Chorioretinopathy

Cited by 32 publications

References 33 publications

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Short-term eplerenone for treatment of chronic central serous chorioretinopathy; a prospective study

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