Visual and anatomical outcomes of spironolactone therapy in patients with chronic central serous chorioretinopathy

Falavarjani, Khalil Ghasemi; Amirsardari, Anahita; Habibi, Abbas; Es’haghi, Acieh; Bakhti, Shohreh; Aghdam, Kaveh Abri

doi:10.4103/jovr.jovr_139_16

Cited by 10 publications

(12 citation statements)

References 33 publications

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“…This finding was similar to previous studies. 28,30 Daruich et al showed 50% of studied eyes had a complete resolution of foveal SRF at 6 months. 28 In a prospective interventional study, 30 spironolactone was prescribed 25 mg daily for the first 6 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…17,18,24 According to Preference and Trends (PAT) Survey 2016, 25 the two commonly used mineralocorticoid receptor (MR) antagonists, spironolactone and eplerenone, have been proposed as promising treatment options for non-resolving CSC. [26][27][28][29][30][31][32][33] Although eplerenone is a more selective MR antagonist, it has less potency than spironolactone in vivo, a 50-fold reduced efficacy on MR blockage. 34 Furthermore, outcome of a recent randomized, double-blind clinical trial on eplerenone versus placebo treatment in CSC revealed that there was no role for the treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Oral spironolactone significantly achieved reduced SRF and subfoveal choroidal thickness, as well as an improvement in BCVA. [27][28][29][30][31][32] From literature review, few publications studied the effect of spironolactone in non-resolving and chronic CSC, 27,29,30 and there have been only two prospective randomized controlled clinical trials that compared the efficacy between spironolactone and placebo. Although spironolactone showed a significant reduction of SRF more than placebo in persistent CSC, duration of treatment was nevertheless very short term in both studies.…”

Section: Introductionmentioning

confidence: 99%

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

Sinawat

Thongmee

Sanguansak

et al. 2020

OPTH

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Sinawat

Thongmee

Sanguansak

et al. 2020

OPTH

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“…Spironolactone or eplerenone were tested. A large amount of case series and case controlled studies outlined beneficial effects of spironolactone in CSC eyes, including improved BCVA, reduced choroidal thickness, and reduced SRF [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ]. Although eplerenone has more tolerable side effects with respect to spironolactone, it does not appear to be clinically superior in treating CSC [ 96 ].…”

Section: Multimodal Imaging Analysismentioning

confidence: 99%

The Role of Imaging in Planning Treatment for Central Serous Chorioretinopathy

Pozzo¹,

Iacono

Arrigo

et al. 2021

Pharmaceuticals

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Central serous chorioretinopathy (CSC) is a controversial disease both in terms of clinical classification and choice of therapeutic strategy. Choroidal layers, retinal pigment epithelium (RPE), photoreceptors, and retina are involved to varying degrees. Beyond well-known symptoms raising the clinical suspect of CSC and slit-lamp fundus examination, multimodal imaging plays a key role in assessing the extent of chorioretinal structural involvement. Subretinal fluid (SRF) originating from the choroid leaks through one or multiple RPE defects and spreads into the subretinal space. Spontaneous fluid reabsorption is quite common, but in some eyes, resolution can be obtained only after treatment. Multiple therapeutic strategies are available, and extensive research identified the most effective procedures. Imaging has carved a significant role in guiding the choice of the most appropriate strategy for each single CSC eye. Multiple biomarkers have been identified, and all of them represent a diagnostic and prognostic reference point. This review aims to provide an updated and comprehensive analysis of the current scientific knowledge about the role of imaging in planning the treatment in eyes affected by CSC.

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“…The efficacy of spironolactone and eplerenone in the treatment of CSCR has already been well established. However, many of these studies have been done for the treatment of chronic CSCR [ 18 , 19 ]. A recently published multicentric clinical trial (VICI trial) from the United Kingdom studied the effects of oral eplerenone in patients with treatment-naïve CSCR of >4-month duration.…”

Section: Introductionmentioning

confidence: 99%

Oral Eplerenone Versus Observation in the Management of Acute Central Serous Chorioretinopathy: A Prospective, Randomized Comparative Study

et al. 2020

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In this prospective, interventional case-control study, 58 patients with unilateral acute central serous chorioretinopathy (CSCR) were recruited. Patients ≥ 18 years age, presenting with first episodes of acute CSCR, were included. Acute CSCR was defined by the presence of subretinal fluid (SRF) and symptoms for <12 weeks duration with no clinical or imaging features of chronicity. Patients were alternately divided into treatment (Table Eplerenone 50 mg/day for minimum 1 month) and observation groups. Vision, SRF height and subfoveal choroidal thickness (SFCT) were checked at 1-, 2- and 3-months in both eyes of each group. Each group had 29 eyes. Mean age was 40.4 ± 7.1 and 43.3 ± 8.34 years in treatment and observation group, respectively. Mean symptom duration was 6.46 ± 1.45 and 5.87 ± 2.09 weeks, respectively. Vision improvement to 6/6 was seen in 92%, 100% and 100% cases in treatment group and 74%, 86% and 100% in control group at each visit, respectively. Complete SRF resolution in the treatment group was noted in 45%, 55% and 62% cases at each respective monthly visit. In the observation group, complete SRF resolution was noted in 10%, 21% and 31% at 1-, 2- and 3-month visits, respectively. SRF (p < 0.001) and SFCT (p < 0.001) reduction was noted in the affected eye of both groups. SFCT was reduced in the fellow eye after treatment (p = 0.005) compared to the observation group (p = 0.276). In conclusion, oral eplerenone achieves faster SRF resolution and vision improvement in acute CSCR. Additionally, it shows beneficial effects on the fellow eye.

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Visual and anatomical outcomes of spironolactone therapy in patients with chronic central serous chorioretinopathy

Cited by 10 publications

References 33 publications

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

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

The Role of Imaging in Planning Treatment for Central Serous Chorioretinopathy

Oral Eplerenone Versus Observation in the Management of Acute Central Serous Chorioretinopathy: A Prospective, Randomized Comparative Study

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