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Quraish Ghadiali, Jesse J Jung, Suqin Yu, Lawrence A Yannuzzi; Central Serous Chorioretinopathy Treated with Mineralocorticoid Antagonists: a Retrospective Study Analyzing the Clinical and Multimodal Imaging Response to Therapy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6381.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect of systemic spironolactone and eplerenone on the eyes of patients with central serous chorioretinopathy (CSCR) and to better understand the role of mineralocorticoid antagonists in the treatment of this disease.
Twenty-six eyes of 16 patients (10 males, 6 females), with a mean age of 57.4 (range 41-74), diagnosed with CSCR were treated with either spironolactone, eplerenone, or a combination of both drugs and were evaluated retrospectively by chart review and multimodal imaging analysis. Spectral domain optical coherence tomography (SD-OCT) was used to measure subretinal fluid (SRF) and central macular thickness (CMT). Furthermore, enhanced depth imaging optical coherence tomography (EDI-OCT) was used to measure subfoveal choroidal thickness (CT). Visual acuity (VA), CMT, CT, and SRF measurements were taken at the initiation of treatment and at 1, 3, and 6 month follow up intervals.
The mean change and 95% confidence intervals for VA, CMT, and CT were calculated as compared to pre-treatment values in all eyes. The mean change in logMAR vision at 1, 3, and 6 month follow up intervals was 0.021 ± 0.029, -0.028 ± 0.062, and -0.066 ± 0.090, respectively. The mean change in CMT at these intervals was -4.04 ± 14.12 µm, 4.11 ± 19.73 µm, and 9.23 ± 31.17 µm, respectively. The mean change in CT at these intervals was -48.94 ± 29.53 µm, -44.00 ± 41.58 µm, and -36.80 ± 82.21 µm, respectively. Twelve eyes were found to have SRF prior to treatment. In this subset, the mean change in SRF at 1, 3, and 6 months was -28.70 ± 33.48 µm, -19.89 ± 36.58 µm, and 9.57 ± 56.74 µm, respectively. CT was significantly decreased at 1 month (P<0.01) and at 3 months (P<0.05). All other measurements showed no significant changes.
In eyes with CSCR treated with mineralocorticoid antagonists, no significant changes were found in VA or CMT; in eyes with SRF prior to treatment, there were no significant changes in SRF found at any follow up interval. There were, however, significant decreases in CT at 1 and 3 months after treatment initiation, but no significant changes at 6 months. Given these retrospective findings, mineralocorticoid antagonists do not appear to affect the natural course of CSCR based on clinical and multimodal imaging response.
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