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Agustina Palacio, Niloofar Piri, Ahmet Ozkok, Shlomit Schaal, Tongalp H Tezel; QUANTITATVE EVALUATION OF EPLERENONE TREATMENT FOR CENTRAL SEROUS CHORIORETINOPATHY (CSCR). Invest. Ophthalmol. Vis. Sci. 2014;55(13):6377.
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To determine the effect of mineralocorticod receptor antagonist eplerenone (Inspra®; Pfizer, NY) in the treatment for CSCR.
Pre- and serial post treatment HD-OCT scans with EDI cuts were obtained from five CSCR patients treated with 50 mg/day of eplerenone. OCT scans were analyzed morphometrically to determine the change in the amount of the subretinal serous fluid. Clinical and morphometric data was compared with a control group of five untreated CSCR patients having similar age (55±12 vs. 49±20, p=0.84), gender (p=1.0), initial logMAR visual acuity (0.29±0.16 vs. 0.21±0.16, p=0.42), duration of symptoms (113±111 vs. 80±156 days, p=0.55) and central macular thickness (415±81 vs. 387±84 microns, p=0.55). Also, the impact of eplerenone on choroidal vasculature was estimated by calculating “Choroidal Perfusion Index” (CPI) which is defined as the ratio of the choroidal vascular area to the total choroidal area underneath the serous elevation.
Eplerenone treatment caused significant regression of the subretinal fluid which reflected itself by a decrease in the central macular thickness (415±80 vs. 271±28 microns, p=0.02) and total serous fluid area (0.77±0.88 vs. 0.14±0.22, p=0.03), in contrast to observation group which remained the same (central macular thickness = 388±84 mm2 vs.339±84 microns, p=0.35; total serous fluid area = 0.60±0.39 vs. 40±0.74 mm2, p=0.7). The resolution rate of the subretinal fluid was three time higher in the eplerenone group (33±16% vs. 10±25%). Resolution of the subretinal fluid was accompanied with a an increase in CPI (1.7±1.3). Despite better anatomical outcome, the impact of eplerenone treatment on logMAR visual acuity was similar in both groups (3 improved and 2 stable vs. 2 improved, 2 stable, 1 worsened, p=0.55). Treatment with eplerenone was well tolerated in all patients without serious adverse effects.
Eplerenone speeds up the resolution of the subretinal fluid in CSCR. However, it is not effective to relieve the choroidal congestion, nor has an impact on final visual acuity.
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