July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Combination therapy with oral mineralocorticoid antagonist and ophthalmic glucocorticoid for non-resolving central serous chorioretinopathy.
Author Affiliations & Notes
  • Der-Chong Tsai
    Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan
    School of Medicine, National Yang-Ming University, Taipei, Taiwan
  • De-Kuang Hwang
    Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
  • Shih Jen Chen
    Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
  • Footnotes
    Commercial Relationships   Der-Chong Tsai, None; De-Kuang Hwang, None; Shih Jen Chen, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5039. doi:https://doi.org/
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      Der-Chong Tsai, De-Kuang Hwang, Shih Jen Chen; Combination therapy with oral mineralocorticoid antagonist and ophthalmic glucocorticoid for non-resolving central serous chorioretinopathy.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5039. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Emerging evidence has revealed the mineralocorticoid receptor (MR) antagonist as an effective treatment of central serous chorioretinopathy (CSC) with non-resolving subretinal fluid (SRF). Besides, the MR pathway may partially explain the paradoxical pro-edematous effect of glucocorticoids in CSC. After MR blockage, it is hypothesized that glucocorticoids may further reduce, rather than aggravate, the persistent SRF in CSC. This study aims to investigate the short-term effectiveness and safety of combination therapy with spironolactone and ophthalmic glucocorticoids among the patients with non-resolving CSC.

Methods : This retrospective case series included fifteen eyes of fifteen consecutive patients (12 [80%] male) with non-resolving CSC after oral MR antagonist treatment. Once enrolled, patients were treated with the combination of oral spironolactone (25 mg twice a day) and ophthalmic glucocorticoids (betamethasone eye drop four times a day and dexamethasone gel once a day). Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and spectral-domain optical coherence tomography examinations were performed at each visit. The primary outcome measure was the change of SRF height at fovea during the 3-month interval between the initiation of combination therapy (baseline) and the last visit. The secondary outcome measures were the changes of central foveal thickness (CFT), subfoveal choroidal thickness (SFCT) and BCVA during this 3-month period.

Results : The mean (± standard deviation [SD]) foveal SRF height at baseline, 1-month and 3-month visits were 205.2 (± 101.3) μm, 125.1 (± 83.2) μm, and 45.6 (± 65.9) μm, respectively. During the 3-month follow up, there were significant reduction of SRF height (p= 0.001), CFT (p= 0.002) and SFCT (p=0.017). Six (40%) patients experienced complete resolution of SRF. The mean BCVA improved from 0.51 (± 0.36) to 0.37 (± 0.37) logMAR (p= 0.008). No patient had more than 10 % increase in CFT and any decrease in BCVA from baseline. One patient developed a significant rise in IOP (>30 mmHg).

Conclusions : With favorable short-term visual and anatomical outcomes in this study, combination therapy of MR antagonist and ophthalmic glucocorticoids appears to be a safe option for non-resolving CSC. The long-term outcome of this therapy warrants further investigation.

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

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