Oral Mineralocorticoid-Receptor Antagonists: Choroidal Parameters Changes Using OCT in Central Serous Chorioretinopathy

Abstract

Background and objective: To evaluate the efficacy and safety of oral eplerenone in the treatment of acute and chronic central serous chorioretinopathy (CSCR).

Patients and methods: Treatment-naïve patients with acute (< 3 months) and chronic (≥ 3 months) CSCR were enrolled in this prospective, nonrandomized, interventional, comparative case series. Patients with acute CSCR were either treated with oral eplerenone (acute case group; n = 16) or observed only (acute control group; n = 8). All chronic patients (chronic group; n = 25) were treated with oral eplerenone. Eplerenone was prescribed 25 mg twice per day for 3 months. Best-corrected visual acuity (BCVA) and optical coherence tomography measures, including subretinal fluid (SRF) height, subfoveal choroidal thickness (CT), central CT, central choroidal volume (CV), and total CV, were assessed at baseline and 3-month follow-up (FU) visit.

Results: BCVA improvement and SRF reduction at 3-month FU relative to baseline were observed in all three study groups. SRF was completely resolved in 13 patients (81.2%) in the acute case group, four patients (50%) in the acute control group, and eight patients (32%) in the chronic group. The acute case group showed greater SRF decrease relative to baseline compared to the chronic group (P = .009), but the resolution of SRF between acute cases and an acute control group was not statistically significant (P = .076). Subfoveal CT, central CT, total CV, and central CV were significantly reduced at the 3-month FU compared to baseline in both affected and the fellow eyes in the acute case and chronic groups, whereas no change was observed in either eyes in the acute control group. At 3 months' FU, the mean logMAR visual acuity demonstrated no significant difference among the study groups (P = .08). Eplerenone was well-tolerated, and no serious side effect was detected.

Conclusions: Oral eplerenone is a safe and effective treatment option for both acute and chronic CSCR. Resolution of SRF was more significant in acute CSR cases comparative to chronic cases. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:726-733.].