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Rishi P Singh, Jonathan Sears, Rumneek Bedi, Andrew Schachat, Peter K Kaiser, Justis Ehlers; Oral Eplerenone For The Management Of Chronic Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1927.
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The proposed pathogenesis for central serous chorioretinopathy (CSCR) is excessive glucocorticoid-dependent mineralocorticoid receptor (MR) activation in the choroidal vasculature. In this study, we examine eplerenone (Inspra, Pfizer), an MR antagonist, as a treatment option for patients with CSCR.
A retrospective consecutive case series was conducted for patients who received oral eplerenone for the treatment of chronic CSCR with a minimum follow-up of 90 days. At baseline and each follow-up visit, spectral domain OCT (SDOCT) imaging was performed, including macular cube and 5-line raster scans (both horizontal and vertical) were performed with a Zeiss Cirrus HD-OCT (Cirrus version 6.1 software). SDOCT analysis included manual measurements of the height and diameter size of subretinal fluid. The primary outcome measure was reduction in subretinal fluid following initiation of therapy. Secondary outcome measures included logMar visual acuity and central subfield retinal thickness.
A total of 17 eyes of 13 patients with a history of chronic CSCR treated with 25 and 50 mg of oral eplerenone per day were identified. Subretinal fluid decreased over time following eplerenone therapy (p = 0.007 and p = 0.002, diameter and height respectively). Maximum subretinal fluid diameter decreased from a mean of 131.5 μm at baseline to 15.3 μm at day 181+. Subretinal fluid height decreased from an average of 2174.4 μm at baseline to 46.9 μm at day 181+. LogMar visual acuity improved from 0.42 (Snellen equivalent: 20/53) at baseline to 0.29 (Snellen equivalent: 20/39) at day 181+ (p = 0.013). CST decreased from 339.5 μm at baseline to 270.3 μm at day 181+ (p = 0.029).
Following eplerenone oral therapy, there was a significant reduction in subretinal fluid in eyes with chronic CSCR. Additionally, a reduction in CST and improved visual acuity were noted. Additional research, including larger prospective randomized trials, is needed to validate these findings.
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