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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.
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.
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.
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.
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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