Abstract
Purpose: To present data on clinical response to eplerenone over a 1-year period in patients with central serous chorioretinopathy (CSC), and to evaluate optical coherence tomography (OCT) variables as predictors of treatment response at 3- and 12-month follow-up visits. Methods: Patients with acute or chronic CSC treated with eplerenone were retrospectively included. Clinical and imaging characteristics were recorded at baseline and at the 3-month and 12-month follow-up visits. Changes from baseline in quantitative measurements were calculated at each follow-up. Logistic regression analysis was computed to correlate clinical and OCT parameters at baseline with response to treatment at 3 and 12 months of follow-up. Results: A total of 50 eyes of 50 patients were included in the study. Mean ± SD best corrected visual acuity (BCVA) was 0.20 ± 0.14 Logarithm of the Minimum Angle of Resolution (LogMAR) at baseline and significantly improved at both the 3-month (0.12 ± 0.13 LogMAR, p < 0.0001) and 12-month (0.10 ± 0.12 LogMAR, p < 0.0001) follow-up visits. At the 3-month follow-up visit, 25 out of 50 eyes (50.0%) demonstrated macular complete subretinal fluid (SRF) resolution, while 13 eyes (26.0%) showed macular partial SRF resolution, and 12 eyes (24%) had neither partial nor complete macular SRF resolution. Among those patients with macular partial or complete SRF resolution at 3 months and thus not shifted to photodynamic therapy, 36 out of 38 cases had macular complete SRF resolution at the 12-month follow-up visit. There was a significant change from baseline at both follow-up visits in all anatomical OCT parameters (except for reduction in choroidal thickness that did not reach the statistical significance at the 12-month follow-up visit). Several OCT parameters at baseline were independently significant predictors for macular subretinal fluid complete resolution at 3 months, including (i) a thicker subfoveal choroidal thickness; (ii) a smaller subretinal fluid maximum diameter; (iii) a lower number of serous pigment epithelium detachments; and (iv) a lower number of intraretinal hyperreflective foci. Conclusion: Treatment with eplerenone in CSC patients is confirmed to be beneficial for both anatomical and functional outcomes. We identified attractive OCT metrics that could potentially be used as a tool to select patients who might mainly benefit from this treatment.
Highlights
Central serous chorioretinopathy (CSC) is a common cause of central vision loss that typically affects men in their third to fifth decades [1]
In a case-control study, our group compared eplerenone therapy with observation alone in patients with acute CSC [8]; we demonstrated that patients affected by acute CSC and treated with eplerenone achieved a greater and faster resolution of subretinal fluid (SRF) compared to the observation group
We propose that these findings are related to an advanced retinal pigment epitheliopathy at baseline in these eyes, with a consequent lower capability of the retinal pigment epithelium (RPE) cells to reabsorb SRF under eplerenone treatment
Summary
Central serous chorioretinopathy (CSC) is a common cause of central vision loss that typically affects men in their third to fifth decades [1]. This disorder is usually characterized by serous detachments of the neurosensory retina associated with retinal pigment epithelium (RPE) alterations and choroidal vessel dilation. Two MR antagonists (spironolactone and eplerenone) have been used in the treatment of acute and chronic CSC with promising results in terms of functional and anatomical outcomes [6,7,8,9,10,11,12,13]. While spironolactone may be characterized by some side effects, including reduced libido, gynecomastia, and endocrine abnormalities such as glucose and cortisol elevation, eplerenone has a more favorable side effect profile [14]
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