Multimodal retinal imaging evaluation may predict the response to eplerenone therapy in central serous chorioretinopathy

Abstract

Purpose : To evaluate the effects of oral eplerenone in treatment-naïve patients affected by central serous chorioretinopathy (CSC), and to identify predictive factors associated with a better response to eplerenone by multimodal retinal imaging.

Methods : Interventional non-randomized clinical study. Twenty-eight treatment-naïve CSC eyes were prospectively enrolled and treated with oral eplerenone for 1 to 3 months. Primary outcomes included the percentage of eyes achieving complete resolution of subretinal fluid (SRF) on structural optical coherence tomography (OCT) after treatment, and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcomes included the presence of pathological findings on indocyaine green angiography (ICGA) and OCT-angiography (OCT-A) at baseline associated with different response to eplerenone treatment.

Results : Seventeen eyes (61%) demonstrated total reabsorption of SRF on structural OCT, 5 eyes (18%) presented a partial response to eplerenone therapy and 6 eyes (21%) showed no response. Eplerenone treatment has also proven efficacy in reducing CMT and improving BCVA (p<0.001). The complete response to eplerenone treatment was associated with absence of CNV at OCT-A and the presence of hotspot at ICGA (p<0.001 and p=0.002, respectively). None of 7 eyes with CNV in OCT-A imaging had a complete response to eplerenone and none of 3 eyes without hotspot at ICGA showed a complete response to the treatment.

Conclusions : Our results confirmed the effectiveness of eplerenone therapy in treatment-naïve CSC. Multimodal retinal imaging allowed us to propose predictive factors (i.e. absence of CNV on OCT-A and presence hotspot on ICGA) for better response to eplerenone.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.