Spironolactone reduces sub retinal fluid and choroidal thickness in CSR

Abstract

Purpose: We have previously shown that mineralocorticoid receptors (MR) activation by high doses glucocorticoids induced choroid vessels dilatation and leakage in rats through endothelial SK3 channel upregulation. Specific MR antagonists prevented glucocorticoids-induced choroidal enlargement. The aim this study is test whether spironolcatone exerts significant effect of sub retinal fluid and choroidal enlargment in patients with chronic Central Serous Chorioretinopathy (CSR).

Methods: Sixteen patients with chronic CSR (> 4 months) were randomized to either oral spironolactone (50mg/d) or placebo for 30 days. After 8 days wash-out period, patients were switched to the other treatment for 30 days and followed up to 90 days. The primary endpoint was the reduction of sub-macular fluid, measured by thickness and volume from ELM to bruch, or ILM to bruch using segmentation methods. The secondary endpoint was the reduction of sub foveal macular choroidal thickness measured by EDI-OCT. Statistical analysis Crossover data were analyzed using the linear mixed effects model framework ; Since a strong and asymetric carry-over effect was present, analysis was made on the first period results only. This analysis was made on the absolute and relative difference between inclusion and day30. These differences were compared using Student's T-test or Mann-Whitney test, according to the results of the normality tests for the crossover analysis. Difference between the two groups was considered significant for p < 0.05

Results: The differences of geometrical parameters (width, volume of whole, intern or extern retina) were very strongly correlated (> 0.98). Reduction of subretinal fluid was significantly reduced in the spironolactone treated group as compared to the placebo treated group, either when measuring the ELM / bruch thickness or the CMT; and also when measuring the sub retinal volume or central macular volume. Moreover, the macular choroidal thickness was significantly reduced after spironolactone treatment but not after placebo treatment.

Conclusions: In this prospective randomized controlled study, even if the number of patients is low, the results clearly show a significant effect of spironolactone after 30 days of treatment on macular and choroidal thickness validating the hypothesis that MR is involved in CSR physiopathogenesis.

Keywords: 688 retina • 452 choroid • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials