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Robert Beardsley, Sandra Montezuma, Richard Johnston; Treatment of Central Serous Retinopathy with the Mineralocorticoid Receptor Antagonist Eplerenone. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1925.
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To evaluate the efficacy of treatment of chronic central serous retinopathy (CSR) with the mineralocorticoid receptor antagonist eplerenone.
IRB approval was obtained through the University of Minnesota. Subjects with CSR based on symptoms, biomicroscopy, fluorescein angiography (FA) and optical coherence tomography (OCT) were enrolled. Subjects must have had symptoms and subretinal fluid on OCT for at least three months prior to study enrollment. Previous treatment was not exclusionary however concomitant therapy was. Exclusion criteria included co-existing macular disease, pre-existing electrolyte anomalies, or previous sensitivity to eplerenone. Baseline best corrected visual acuity (BCVA), OCT, and FA was obtained on each subject prior to study drug initiation. Each subject was given 25mg eplerenone twice daily for 1 week, subsequently increased to 50mg twice daily. Subjects were monitored for response to therapy over 3 months. Baseline electrolyte studies were obtained as well as at 1 month and 3 months. The primary outcome was change in central macular thickness (CMT) based on OCT. Secondary outcomes included change in best corrected visual acuity and subjective visual response.
A total of at least ten subjects were enrolled. At least eight were enrolled for the study duration of three months. Six patients showed statistically significant OCT improvement of CMT. In terms of secondary endpoints, four subjects showed improvement of BCVA by at least one line and eight said that their vision was subjectively improved. There were no complications to the therapy and no electrolyte anomalies.
Eplerenone shows efficacy in the treatment of chronic CSR with a low side effect profile. Larger, randomized trials are needed to further refine its utility in clinical settings.
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