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Egbert Matthe, Sylvana Ventzke, Antonia Bottesi, Olga Furashova, Dirk Sandner, Lutz E Pillunat; Systemic Eplerenone for treatment of chronic relapsing Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3720.
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© ARVO (1962-2015); The Authors (2016-present)
Central serous chorioretinopathy (CSC) is a common disease characterized by exsudation from leaking choroidal vessels resulting in detachment of the retinal pigment epithelium or neurosensory retina. We examined the effect of systemic eplerenone, an inhibitor of mineralocorticoid receptors, for the treatment of chronic relapsing CSC (crCSC).
Retrospective evaluation of data and history of 14 patients (12 male, 2 female) with crCSC who did not respond to (diuretics, aspirin, anti-VEGF intravitreally), could not receive (photocoagulation), or did not wish other treatment (photodynamic therapy, anti-VEGF intravitreally). Duration of CSC was at least 12 month with at least 1 recurrence. Each patient was treated with 25 mg (1st week) and 50 mg (starting 2nd week) for at least 3 month. Visual acuity was obtained and central foveal thickness measured with spectral domain OCT. The patients graded side effects as “none”, “mild” (notable but not irritating), “tolerable” (irritating, but willing to continue because of efficacy) and “not tolerable”, which stopped treatment.
Reduction of subretinal fluid was observed in 3 of 14 patients. Of those, 2 did not require other therapy and 1 needed continuous therapy because of relapse after stopping treatment. In 11 cases no effect of eplerenone was observed and other therapy was required. Of those, 3 had further decline of visual acuity during therapy. Change in visual acuity was strongly and mainly dependent on duration of crCSC and grade of photoreceptor damage. Side effects were graded as “none” by 12 patients and “mild” by 2 patients (hypotony, fatigue). There were no other side effects.
Therapy was well tolerated. There were no severe side effects. Systemic eplerenone is a treatment option for crCSC, especially for bilateral diseases and need for long term treatment. However, rates of response are comparatively low and duration of treatment might result in further receptor damage in cases of non-response.
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