Spironolactone versus observation in the treatment of acute central serous chorioretinopathy

Sun, Xinghong; Shuai, Yuanlu; Fang, Wangyi; Li, Jia; Ge, Weizhong; Yuan, Songtao; Liu, Qing-Huai

doi:10.1136/bjophthalmol-2017-311096

Cited by 34 publications

(18 citation statements)

References 41 publications

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“…The percentage of patients achieving resolution of the disease varies in the literature, according to the main outcome measures considered and the different populations [ 18 , 21 , 23 , 24 , 28 ]. In the study by Ghadiali et al [ 19 ], the efficacy of both eplerenone and spironolactone was assessed in eyes with predominantly chronic disease.…”

Section: Discussionmentioning

confidence: 99%

“…In animal models, the activation of choroidal mineralocorticoid receptors was shown to cause choroidal vasodilation and leakage; this phenomenon was inhibited by mineralocorticoid receptor (MR) antagonism [ 17 ]. Based on these findings, researchers investigated the role of mineralocorticoid antagonists in the treatment of CSC, reporting positive preliminary results [ 17 – 28 ]. Spironolactone and eplerenone are both oral-specific MR antagonists approved for several systemic disorders, and are commonly used for treating hypertension and congestive heart failure.…”

Section: Introductionmentioning

confidence: 99%

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Eplerenone Versus Observation in the Treatment of Acute Central Serous Chorioretinopathy: A Retrospective Controlled Study

et al. 2018

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IntroductionTo investigate the effects of eplerenone compared to observation in the treatment of acute central serous chorioretinopathy (CSC).MethodsCharts of consecutive patients with a diagnosis of acute CSC (visual symptoms < 12 weeks) were reviewed. Included patients were divided into a treatment group (treated with eplerenone) and a control group (observation). Main outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), height of subretinal fluid (SRF) and subfoveal choroidal thickness (CT) at 1 and 3 months in the two groups.ResultsFifteen eyes of 15 patients (2 female, 13 male) and 12 eyes of 12 patients (1 female, 11 male [p = 1.000]) were included in the treatment and control groups, respectively. The mean age was 44 ± 9 (30–65) and 47 ± 11 years (28–66 years, p = 0.493), respectively. In the treatment group, BCVA improved significantly at 1 month (p = 0.018) and 3 months of follow-up (p = 0.011), while a non-significant improvement was seen in the control group. At 3 months, 12 of 15 eyes (80%) in the treatment group demonstrated complete SRF resolution, versus 3 of 12 eyes (25%) in the control group (p = 0.007). In the treatment group, SRF and CMT were significantly reduced at the 1-month follow-up (p = 0.014, p = 0.028, respectively) and the 3-month follow-up (p < 0.001 for both analyses), while in the control group the changes were not statistically significant. Eplerenone was well tolerated in all patients.ConclusionPatients affected by acute CSC treated with eplerenone achieved greater and faster resolution of the disease compared to the observation group. Eplerenone may represent an attractive new first-line treatment option for acute CSC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Eplerenone Versus Observation in the Treatment of Acute Central Serous Chorioretinopathy: A Retrospective Controlled Study

et al. 2018

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“…During the follow-up, SFCT decreased in both of the groups, but the decrease was not significant in the control group as it was in the non-treated acute CSCR group in our study. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

Choroidal thickness changes in non-treated acute and ranibizumab-treated chronic central serous chorioretinopathy

2018

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To evaluate the changes in subfoveal retinal, and choroidal thicknesses (CT) in the non-treated acute and the ranibizumab-treated chronic central serous chorioretinopathy (CSCR) patients.This retrospective study included 32 eyes of 32 consecutive patients with CSCR. There were 12 patients who presented with a spontaneous resolution of CSCR (Group 1) and 20 patients who were treated with ranibizumab for persistent subretinal fluid (SRF) (Group 2). Optical coherence tomography (OCT) imaging of subfoveal retinal thickness and enhanced depth imaging OCT of CT at subfoveal; at nasal and temporal 500 μm (T500); at nasal and temporal 1500 μm (T1500) were analyzed. The Student t test and multivariate analysis were used to compare variables within and between groups, respectively and correlations were analyzed using Pearson correlation coefficient. A P value of P < .05 was accepted as significant.The mean patient age was 38.94 ± 8.41 years (range, 20–53 years). Female/male ratio was 4/28. The mean duration of follow-up was 21.6 ± 8.2 months in the chronic CSCR group. Visual acuity improved and central foveal thickness (FT) decreased significantly in both groups. CT decreased significantly only at nasal 1500 μm (N1500) in the acute group and at all measured points in the chronic group compared with baseline, except at T500 (P = .07). No significant difference in central FT was detected between the 2 groups. Compared with the acute group, baseline subfoveal CT was significantly higher in chronic patients. There was a significant difference between the groups in baseline and final CT at T500. No significant difference was found at T1500. At nasal 500 μm and N1500, the difference between the groups was significant only for final CT values.Chronic CSCR was associated with higher baseline CT values in the subfoveal region and at T500. CT significantly decreased at most of the measured points in ranibizumab-treated chronic CSCR patients, whereas it significantly decreased only at 1 point in spontaneously resolved acute CSCR patients.

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“…A prospective, randomized study on 30 eyes with aCSC, revealed that 56% (n = 10/18) patients treated with spironolactone experienced a complete SRF resolution at two months in comparison with 8% (n = 1/12) in the control group ( p < 0.05) [ 30 ].…”

Section: Mineralocorticoid and Glucocorticoid-receptor Oral Antagomentioning

confidence: 99%

Current Pharmacological Treatment Options for Central Serous Chorioretinopathy: A Review

et al. 2020

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Central serous chorioretinopathy (CSC) is a common cause of visual impairment in patients generally aged 20 to 60 and it is characterized by acute or chronic neurosensory detachments of the retina. Although CSC resolves spontaneously in most cases, in some patients it may cause permanent visual impairment in the working population; for this reason, several approaches, including photodynamic therapy (PDT), subthreshold micropulse laser treatment and oral mineralocorticoid receptor antagonists, have been studied as first-line treatment options for CSC. To date, half-dose PDT has provided the most encouraging results in this regard, supported by large, multicenter, randomized clinical trials such as the “Prospective Randomized Controlled Treatment Trial for Chronic Central Serous Chorioretinopathy” (PLACE) trial; however, the role of novel possible non-invasive treatment options is attracting interest. This review article aims to discuss the current pharmacological treatment options investigated for the management of CSC, including aspirin, ketoconazole, beta blockers, rifampicin and many others. In particular, further evidence about oral mineralocorticoid receptor antagonists, firstly seen as promising non-invasive alternatives for treating CSC, will be provided and discussed in light of the recent “Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months” (VICI) trial results, which have largely resized their role as possible first-line oral treatment options for treating CSC.

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Spironolactone versus observation in the treatment of acute central serous chorioretinopathy

Abstract: ChiCTR-IPR-16008428, Results.

Cited by 34 publications

References 41 publications

Eplerenone Versus Observation in the Treatment of Acute Central Serous Chorioretinopathy: A Retrospective Controlled Study

Eplerenone Versus Observation in the Treatment of Acute Central Serous Chorioretinopathy: A Retrospective Controlled Study

Choroidal thickness changes in non-treated acute and ranibizumab-treated chronic central serous chorioretinopathy

Current Pharmacological Treatment Options for Central Serous Chorioretinopathy: A Review

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