Purchase this article with an account.
Niket Todi, Kapil Kapoor, Alan Wagner; Mineralocorticoid Antagonists As Adjuncts In Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1922.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Age-related macular degeneration is the leading cause of blindness in patients over the age of 65 in the developed world. While intravitreal anti-VEGF agents have become the mainstay of treatment for those with neovascular AMD (nAMD), there are many patients that are refractory to this treatment, and there are limited alternative treatment options. The goal of this study is to evaluate the use of mineralocorticoid antagonists as an adjunctive treatment for patients with nAMD, specifically those with refractory subretinal fluid (SRF).
We analyzed 23 patients with nAMD who had received at least 6 anti-VEGF injections over 6 months and still had refractory SRF. Mean age of patients was 64.6, and 52.2% were female. 13 of these patients had chronic SRF without the presence of large retinal pigment epithelium detachments (PEDs) while 10 had the presence of large PEDs. Persistent SRF was determined by optical coherence tomography. Each patient was started on oral eplerenone 25mg PO BID and titrated to higher doses according to protocol. Initial central macular thickness (CMT) was measured, as well as mean injection interval of anti-VEGF therapy before and after eplerenone treatment. The CMT at each subsequent anti-VEGF injection and any change in injection interval was checked over at least the next three months. In data analysis, patients were divided into groups with (Group A) and without (Group B) PEDs. T-test was used to determine statistical significance.
10 of 23 patients were in Group A (large PEDs), and this group did not show significant reduction in SRF or extension of injection interval. 13 of 23 patients were in group B and had predominantly chronic SRF with absence of medium-large PEDs. In Group B, mean initial CMT was 305.3 microns and mean final CMT was 240.6 microns (p<0.05). Mean initial injection interval was 40.25 days and mean final injection interval was 54.61 days (p<0.05). The mean extension of injection interval in this group was 14.36 days.
In this study, adjunctive mineralocorticoid antagonists proved a safe and efficacious treatment for nAMD patients with refractory SRF. Adjunctive mineralocorticoid antagonist treatment was associated with a decreased CMT and longer interval between anti-VEGF injections for these patients. Prospective randomized controlled trials are needed to determine the precise role of mineralocorticoid treatment in nAMD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only