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Katrin Fasler, Jeanne Gunzinger, Daniel Barthelmes, Malgorzata Roos, Sandrine Zweifel; Effect of Inspra (Eplerenon) on structural and functional outcome in central serous chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3667.
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There are currently no evidence-based guidelines concerning therapy of central serous chorioretinopathy(CSC). Eplerenone (Inspra ®) has been reported to be beneficial. We report results of Eplerenone treatment on choroidal thickness, central macular thickness (CMT), subretinal fluid and visual acuity (VA) in patients with CSC.
Data of 42 patients with the diagnosis of acute or chronic CSC were retrospectively analyzed. Charts were reviewed for VA, duration and cumulative dosage of Inspra-therapy. Spectral domain enhanced depth imaging optical coherence tomographies (SD EDI-OCTs) and fluorescein-/ICG- angiograms were evaluated for choroidal thickness (CT), maximum subretinal fluid (maxSRF) and central macular thickness (CMT). Results from patients with Eplerenone treatment and patients with observation only were compared.Data were coded in Excel and analyzed in SPSS version 23. Means, standard deviations, absolute/relative frequencies were computed. Exact test by Fisher was used to investigate association between two discrete variables. Linear mixed models methodology was applied to disclose dependency of maxSRF, CMT, VA(logMAR) and choroidal thickness with respect to Inspra therapy and treatment duration. Results with p value of less than 5% were interpreted as statistically significant.
Mean age was 47 years (range 29-74), 98% male (42 pat). Mean choroidal thickness was 413 (SD=105) µm, medians for maxSRF and lnVA were 86 (IQR=129) µm and -0.22 (IQR=0.5), respectively. No statistically significant association was found between choroidal thickness or CMT and Inspra therapy. There was a dependency of maxSRF (p=0.001) on Inspra and time (p=0.013). Lower maxSRF values for patients under Inspra and a decrease of maxSRF with time were found. A higher percentage of measurements of zero subretinal fluid under Inspra (24.8%) than without Inspra (13.7%) (p=0.026) was found. There was a tendency of visual acuity improvement (lnVA) with time (p=0.095) but no impact of Inspra therapy (p=0.788).
The results suggest that Inspra therapy does not have a statistical significant structural or functional effect in patients with CSC. This finding does not encourage implementation of Inspra as gold standard treatment for CSC. There is a strong need for a prospective randomized clinical trial to make a definite statement about the effectiveness of Inspra.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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