Short-term eplerenone for treatment of chronic central serous chorioretinopathy; a prospective study

Hamid-Reza Moein, Lauren W Bierman, Eduardo A Novais, Carlos Moreira-Neto, Caroline R Baumal, Adam Rogers, Jay S Duker, André J Witkin, Hamid-Reza Moein, Lauren W Bierman, Eduardo A Novais, Carlos Moreira-Neto, Caroline R Baumal, Adam Rogers, Jay S Duker, André J Witkin

Abstract

Background: Increased mineralocorticoid activity is one of the plausible causes of chronic central serous chorioretinopathy (CSCR) and mineralocorticoid inhibitors such as eplerenone have been investigated as its potential therapy. This study investigates the short-term safety and efficacy of oral eplerenone in patients with chronic CSCR.

Patients and methods: Prospective study of 13 eyes of 13 patients with the diagnosis of chronic CSCR. All patients received eplerenone 50 mg/day for 4 weeks. Enhanced depth imaging optical coherence tomography (OCT) was obtained. Best corrected visual acuity (BCVA), and OCT parameters including sub retinal fluid (SRF), choroidal thickness (CT) and central macular thickness (CMT), were measured manually.

Results: The mean SRF height decreased slightly at 1-month follow-up as compared to baseline, but the change was not statistically significant (94.18 ± 17.53 vs. 113.15 ± 18.69; p = 0.08). Subfoveal CT and CMT was significantly reduced as compared to baseline (6.6% [p = 0.002] and 7.05% [p = 0.04], respectively). The BCVA did not change significantly (20/28 vs. 20/30 [p = 0.16]).

Conclusion: This study suggests that oral eplerenone may be used as a safe and potentially effective treatment in chronic CSCR, however there are minimal short-term effects on subretinal fluid or visual acuity therefore therapeutic trials longer than one month are necessary to test its benefits.Trial registration Clinicaltrials.gov identification number: NCT01822561. Registered 3/25/13, https://ichgcp.net/clinical-trials-registry/NCT01822561.

Keywords: Central serous chorioretinopathy; Eplerenone; Mineralocorticoid inhibitors.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study protocol. ETDRS Early Treatment Diabetic Retinopathy Study, OCT optical coherence tomography, LFT liver function tests, FA fluorescein angiography
Fig. 2
Fig. 2
Manual measurement of choroidal thickness and subretinal fluid in a 47 years-old man with acute central serous chorioretinopathy. Measurement tool in Cirrus HD-OCT software (Carl Zeiss Meditec, Dublin, CA) was used for this purpose. a A perpendicular line was drawn between outer edge of hyperreflective retinal pigment epithelium (RPE) and the inner sclera. Nasal and temporal choroidal thickness was calculated in a similar fashion at 500 μm intervals nasal and temporal to the fovea, respectively. b A perpendicular line was drawn between the neurosensorial retina (inner portion of outer photoreceptor segment) and the RPE, and the maximum height was recorded
Fig. 3
Fig. 3
A 58-years-old man with chronic central serous chorioretinopathy in the left eye. He had focal laser therapy 4 months before starting eplerenone therapy. Eplerenone treatment decreased subretinal fluid, choroidal thickness, and central macular thickness after 4 weeks. a–c Baseline scans before start of eplerenone. d, e Scans from 4 weeks after eplerenone treatment. a, d Infrared scans. b, e 5-line raster enhanced depth-optical coherence tomography (EDI-OCT) from the fovea. c, f Central macular thickness calculated automatically by the software

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