Eplerenone for Treatment of Chronic Central Serous Chorioretinopathy: A Retrospective Case Series

Abstract

Purpose: To evaluate the effect of oral eplerenone on visual acuity, subretinal fluid, and choroidal thickness in patients with chronic central serous chorioretinopathy (CSCR).

Methods: Retrospective review of all patients from a single multi-physician practice with chronic CSCR who were treated with oral eplerenone from January 2013-June 2013. All patients were followed for a minimum of three months and underwent dilated fundoscopic examination and spectral-domain ocular coherence tomography (OCT) with enhanced depth imaging (EDI) at each visit. Measurement of subfoveal fluid (SFF) height and choroidal thickness were performed. Two-tailed paired t-test was used to calculate statistical significance of pre- and post-treatment variables.

Results: Fourteen eyes of 14 patients with chronic CSCR were treated with eplerenone over a 6 month period. At 1 month follow-up, 10 out of 14 patients (71%) had decreased SFF height on OCT and 3 (21%) had complete resolution of SFF. Mean SFF height decreased from 123 µm to 61 µm (p=0.05). Mean choroidal thickness decreased from 301 µm to 263 µm (p=0.07). Mean visual acuity improved minimally from logMAR 0.41 (Snellen visual acuity 20/51) to 0.40 (Snellen visual acuity 20/50, p=0.20). At 3 months follow-up, 13 out of 14 (93%) had decreased SFF height on OCT and 9 (64%) had complete resolution of SFF. Mean SFF height decreased to 21 µm (p=0.004). Mean choroidal thickness decreased to 253 µm (p=0.1). Mean visual acuity improved to logMAR 0.28 (Snellen visual acuity 20/38, p=0.02).

Conclusions: Oral eplerenone may be an effective treatment for patients with chronic CSCR. A prospective randomized placebo-controlled trial is needed to definitively determine safety and efficacy of the drug in this setting.

Keywords: 585 macula/fovea • 688 retina