Abstract
Purpose :
The mineralocorticoid-receptor (MR) is involved in the pathogenesis of central serous chorioretinopathy (CSCR). Oral MR antagonists have demonstrated their efficacy in non-resolving acute CSCR, but little is known regarding their effect on long-standing cases with chronic epitheliopathy. This study aimed to evaluate the efficacy and safety of oral MR antagonists in 3 clinical presentations of non-resolving CSCR with chronic epitheliopathy.
Methods :
Retrospective case series of consecutive patients with non-resolving CSCR and chronic epitheliopathy treated with oral eplerenone or spironolactone. Treatment criteria were: “persistent CSCR” with subretinal fluid (SRF) ≥4 months; “recurrent CSCR” with SRF ≥2 months; “persistent CSCR with tracks” defined as SRF ≥4 months with gravitational tracks on fundus autofluorescence. Outcomes at 1, 3 and 6 months were: foveal SRF height, central macular thickness (CMT), subfoveal choroidal thickness (SFCT), best-corrected visual acuity (BCVA) and occurrence of side effects.
Results :
Among 54 eyes from 42 patients (mean age: 53 years; mean duration since CSCR diagnosis: 5.4 years), mean foveal SRF, CMT and SFCT decreased significantly at 1, 3 and 6 months after treatment initiation (6 months: p<0.0001, p=0.0003 and p<0.0001, respectively). Mean BCVA improved significantly at 6 months (p=0.041). In the persistent group, mean foveal SRF, CMT and SFCT decreased significantly at 3 and 6 months (6 months: p=0.006, p=0.017 and p=0.008, respectively). Similarly, in the recurrent group mean foveal SRF, CMT and SFCT decreased significantly at 3 and 6 months (6 months: p=0.012, p=0.026 and p=0.002, respectively). In persistent cases with tracks, a near-significant diminution of SRF and a significant diminution of mean CMT and SFCT were observed at 6 months only (p=0.058, p=0.044 and p=0.041, respectively). Overall, treatment-related side effects were observed in 6 patients, prompting discontinuation in 1 subject.
Conclusions :
Response to oral MR antagonists was observed in the 3 presentations of CSCR and chronic epitheliopathy, with favorable tolerance. The SFCT decrease was consistent with the MR pathway implication in CSCR pathogenesis. In persistent CSCR with tracks the response was delayed, suggesting that longer treatment duration would be beneficial in chronic cases with severe RPE alteration.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.