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Eric K Chin, David Almeida, Stephen R Russell, James C Folk; Oral Mineralocorticoid Antagonists for the Treatment of Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1923.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect and tolerance of oral mineralocorticoid antagonists, eplerenone and/or spironolactone, in central serous chorioretinopathy (CSCR).
We performed a retrospective observational case series. The medical records of one-hundred twenty patients diagnosed with CSCR between January 1, 2012 and September 1, 2013 were reviewed. Twenty-nine patients were treated with one or more mineralocorticoid antagonists. Six patients were excluded from final analysis. Primary outcome measures included best corrected visual acuity (BCVA, Snellen), central macular thickness (CMT, μm), and macular volume (MV, mm^3) via Spectralis® Heidelberg OCT. Secondary outcomes included duration of treatment, treatment dose, tolerable and intolerable side effects, and prior treatment failures.
The average age was 58.4 ± 10.5 years (range, 36.9-72.6 years) and 15 patients (65.2%) were male. Nine patients (39.1%) had a history of prior steroid use. Sixteen patients (69.6%) had been previously treated with other interventions (e.g. ketoconazole, rifampin, anti-vascular endothelial growth factor agents, or photodynamic therapy) before trying oral mineralocorticoid antagonists. Fifteen patients were treated with eplerenone only, three patients were treated with spironolactone only, and five patients were treated with spironolactone following a trial of eplerenone. Medication dose varied from 25 mg to 50 mg twice daily. The average entire duration of treatment (eplerenone and/or spironolactone), or time to nearest follow-up while on treatment, was 3.9 ± 2.3 months (range, 1-8.5 months). Twelve patients (52.2%) showed decreased CMT and MV, six patients (26.1%) had increased in both, and five patients (21.7%) had negligible changes. For all patients, the mean decrease in CMT from start of therapy to final follow-up was 42.4 μm (range, -136 to 255 μm), and the mean decrease in MV was 0.20 mm^3 (range -2.33 to 2.90 mm^3). Median BCVA at start of therapy was 20/30 (range, 20/20-20/250), and at final follow-up 20/40 (range, 20/20-20/125). Nine patients (39.1%) experienced systemic side effects, of which three patients (13.0%) were unable to tolerate continuation of therapy.
Mineralocorticoid-antagonist treatment had a positive treatment effect in half of our patients who may have not responded to other therapies. Systemic side effects, even at low doses, may limit its usage in some patients.
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