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Sabrina FALAH, Thomas Pugliese, Jonathan Benesty, Marie-Helene Errera, José-Alain Sahel, Michel Paques; Antagonists of mineralocorticoid receptors in the treatment of chronic central serous chorioretinopathy: a case series.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1928.
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The optimal management of CSC remains controversial. Recent clinical and experimental studies suggest that chronic central serous chorioretinopathy (CSR) may result from an overactivation of mineralocorticoid receptor pathway and therefore may provide the rationale for the use of eplerenone (Zhao and al. Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy; J Clin Invest. 2012 Jul 2;122(7):2672-9). Herein, we report our experience about the use of eplerenone in these patients.
Thirteen patients (14 eyes) with a minimum of 6 months duration of chronic CSR were enrolled in the study. They had no previous treatment for CSR. They all received eplerenone (50mg/d orally) during 1 to 3 months. The median duration of follow-up was 6 months. Outcome measures were: best corrected visual acuity (BCVA), central macular thickness, subretinal fluid amount, and choroidal thickness measured by enhanced depth imaging (EDI)- spectral domain optical coherence tomography (EDI-OCT). For each subject, OCT image sets were obtained using a Spectralis OCT (Heidelberg Engineering, Germany).
The mean age of patients included was 47 y. Ten were male (77%) and mean duration of chronic CSR was 36 months. No statistical significant difference for BCVA [p=0.40], central macular thickness [p=0.15] and retrofoveal choroidal thickness [p=0.11] was found at 1 and 3 months following the start of eplerenon treatment. However, a statistically significant reduction of subretinal fluid was found under treatment [p<0.05] with complete resolution in 4 eyes during the first month of treatment.
Eplerenone may represent an effective approach to decrease the amount of subretinal fluid in eyes with chronic CSR. However, our study failed to show a significant benefit on visual outcome, maybe due to preexistent damage to photoreceptors and RPE. Randomized controlled trials are needed to confirm these results before formulating recommendations on the use of antagonists of mineralocorticoid receptors in the treatment of chronic CSR.
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