Eplerenone for the treatment of central serous chorioretinopathy: 3 year clinical experience

Abstract

Purpose : Central serous chorioretinopathy (CSCR) is a condition that presents with sub-retinal fluid and can be sight-threatening in its chronic form. As understanding of the pathophysiology behind CSCR continues to evolve, the use of oral therapies, including the anti-mineralocorticoid oral agent eplerenone, has been increasingly reported. Though the efficacy of this agent has been established, prior studies have been limited by small cohort size and short follow up duration. The aim of this report is to present data on the anatomical and clinical response to oral eplerenone over a three year period in eyes of patients with CSCR.

Methods : An IRB approved retrospective chart analysis from 2012-2018 was performed. Eyes with a diagnosis of chronic CSCR, treated with 25 or 50mg/day oral eplerenone were included. Baseline best-corrected visual acuity and anatomical measurements measured by spectral domain optical coherence tomography (SD-OCT) were collected at eplerenone initiation. Follow up data was collected at the closest date to 12, 24, and 36 months follow up, with minimum follow up of 6 months. Eyes with a pre-existing retinal disorder that was likely to limit visual acuity or confound OCT measurements were excluded. The primary outcome was reduction in central subfield thickness at the final follow up visit. Secondary outcomes included mean change in visual acuity (logMAR equivalent of Snellen best corrected visual acuity), macular cube volume, macular cube average thickness, and maximum sub-retinal fluid diameter and height.

Results : Follow up data was obtained for 100 eyes of 83 patients at 1 year (mean 11.18 ± 4.00 months), 49 eyes at 2 year (24.01 ± 3.33 months), and 33 eyes at three year (mean 35.5 ± 7.89 months) follow up visits. For these samples, the rate of complete sub-retinal fluid resolution was 31%, 28%, and 33%, respectively. At final follow up, logMAR visual acuity change from baseline was +0.10 ± 0.24 (p=0.130). Average change from baseline at final follow up for CST was -97 ± 140.6 µm (p < 0.001), cube volume was – 1.07 ± 1.71 mm³ (p < 0.001), macular thickness – 28. 5 ± 47.5 µm (p < 0.001), maximum sub-retinal fluid height was -95.6 ± 160.5 µm (p < 0.001), maximum sub retinal fluid diameter was -1169.0 ± 1638.7 µm (p = 0.008).

Conclusions : Anatomic improvement occurs primarily within the first year of eplerenone treatment for chronic central serous chorioretinopathy.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.