Optical density of subretinal fluid in patients with chronic central serous chorioretinopathy treated with eplerenone: a potential imaging biomarker

Abstract

Purpose : Optical density (OD) of subretinal fluid (SRF) assessed by optical coherence tomography (OCT) in eyes with central serous retinopathy (CSR) has been shown to be a potentially unique biomarker to distinguish it from other macular pathology. We investigated whether optical density of SRF in patients with chronic CSR treated with eplerenone correlates with presenting visual acuity (VA) and treatment response.

Methods : A retrospective, observational study of patients with chronic CSR who were treated with eplerenone between January 2014 and March 2016 with at minimum 1.4 months of follow up (range 1.4 - 11.0) and had spectral domain OCT was conducted. OD measurements of the vitreous and SRF were obtained using ImageJ (National Institutes of Health) and a SRF to vitreous OD ratio (ODR) was calculated. Patients with OCTs that did not have enough SRF for analysis were excluded. VA, central macular thickness (CMT), peak SRF height, and foveal SRF height were measured. The Mann-Whitney U was used to compare continuous variables and the Pearson’s correlation coefficient was used to determine statistical significance for linear regressions.

Results : Twenty-seven eyes of 21 patients with a mean age of 56 years (range 32-75) met the inclusion criteria. Seven eyes (28%) responded to eplerenone treatment with complete resolution of SRF. Mean logMAR VA at baseline was unchanged 2 months following initiation of treatment (0.39 ±0.31 versus 0.36 ±0.34; P=0.89). There was no significant difference between the ODR of eyes that had SRF resolution with eplerenone versus eyes that did not respond to eplerenone and had persistent SRF (1.32 ±1.04 versus 2.09 ±2.52; P=0.58). A linear correlation was not found between ODR and changes in CMT (P=0.26), peak SRF (P=0.19), and foveal SRF (P=0.29). There was an inverse correlation between ODR and presenting logMAR VA with linear regression (P=0.02).

Conclusions : Presenting OD of SRF on OCT in eyes with chronic CSR treated with eplerenone did not correlate with degree of macular SRF change . There was also no difference in ODR between eyes that had complete anatomic resolution with eplerenone compared to eyes that did not respond. Presenting visual acuity was correlated with ODR, however, this relationship is potentially confounded by the degree of foveal involvement.

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