September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Is Eplerenone an alternative in the treatment of inflammatory macular edema resistant to acetazolamide?
Author Affiliations & Notes
  • Nicole Stuebiger
    Ophthalmology, Charite, University Medicine Berlin, Berlin, Germany
  • Ann-Sophie Zeisberg
    Ophthalmology, Charite, University Medicine Berlin, Berlin, Germany
  • Sibylle Winterhalter
    Ophthalmology, Charite, University Medicine Berlin, Berlin, Germany
  • Footnotes
    Commercial Relationships   Nicole Stuebiger, None; Ann-Sophie Zeisberg, None; Sibylle Winterhalter, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1869. doi:
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      Nicole Stuebiger, Ann-Sophie Zeisberg, Sibylle Winterhalter; Is Eplerenone an alternative in the treatment of inflammatory macular edema resistant to acetazolamide?. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1869.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : Uveitis patients with an acetazolamide resistant intraretinal cystoid macular edema (CME) are a therapeutic challenge, esp. when other treatment options, like systemically or intravitreally applied corticosteroids are contraindicated because of secondary glaucoma or systemic side effects.

Methods : In a pilot study we included 5 patients (=5 eyes) with acetazolamide resistant CME. In 4 patients (n=4) an otherwise non-active intermediate uveitis was the underlying etiology of CME and one patient had CME of unknown origin (n=1). In all patient eyes corticosteroids were contraindicated and systemically applied acetazolamide had been ineffective. Thus our patients received Eplerenone (Inspra®) in a dosage of 25mg/d during the first week, with an increase to 50mg/d after one week therapy. Eplerenone, a diuretic aldosterone antagonist, downregulates the fluid content of the retina via blocking the mineralocorticoid receptors of the retinal Mueller cells. Ophthalmological examinations in these patients were done one month - and then every 3 months - after initiating therapy.

Results : The patients mean age was 47±17 years and the male:female ratio was 2:3. Treatment of CME with higher doses of systemic corticosteroids or applying a Dexamethasone Intravitreal Implant were contraindicated due to corticosteroid dependend secondary glaucoma (n=2), systemic side effects (n=2), or former non-response (n=1).
During a mean follow up of 7 months all affected eyes demonstrated reduction of central retinal thickness. Before Eplerenone treatment mean central retinal thickness was 461±164µm, at the end of follow up macular thickness decreased significantly to 215±84µm [p=0,04]. Also visual acuity improved from 20/60 to 20/40. None of the patients suffered from systemic side effects.

Conclusions : These results demonstrate, that Eplerenone, which already has shown effectiveness in reduction of subretinal fluid in patients with central serous chorioretinopathy, is also beneficial in inflammatory CME. A prospective clinical trial should be initiated to confirm these results.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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