Abstract
To compare the macular morphology of good and poor responders to eplerenone treatment in chronic central serous chorioretinopathy (CSCR) patients. Thirty eyes of 29 patients with chronic CSCR were treated with 50 mg/day oral eplerenone and followed up for 1 year. The integrity of outer retinal layers at baseline was assessed using optical coherence tomography. Patients who showed complete resolution of subretinal fluid at 1 year were assigned to the good responder group (Group 1), whilst those who showed moderate or no resolution were classified as poor responders (Group 2). Ellipsoid zone interruption, ELM interruption and hyperreflective foci in outer segment (OS) and outer nuclear layer (ON layer) was significantly more frequent in Group 2 than in Group 1 (p < 0.05 for all parameteres). Outer segment elongation was significantly more frequently seen in Group 1 than in Group 2 (p < 0.05) Multivariable regression analysis showed that intact ellipsoid zone at baseline is an independent predictor of good therapeutic response, with an odds ratio of 26.00 (95% CI 3.69–183.45; p = 0.001) after controlling for the effect of hyperreflective foci and ELM integrity. There is higher chance of the resolution of subretinal fluid after eplerenone treatment in CSCR patients with intact outer retinal layers at baseline. Baseline morphologic evaluation of the outer retinal layers on OCT scans can be useful in predicting the response to mineralocorticoid antagonist therapy in these patients.
Highlights
To compare the macular morphology of good and poor responders to eplerenone treatment in chronic central serous chorioretinopathy (CSCR) patients
The central subfield mean thickness decreased in both groups, but the change was more significant in good responder patients (Group 1)
In our previous prospective study we found that in eplerenone treated CSCR patients baseline choroidal thickness was a positive predictive factor for subretinal fluid decrease, results which were recently supported by Bousquet et al who found that a thick choroid at baseline is associated with good treatment r esponse[13,14]
Summary
To compare the macular morphology of good and poor responders to eplerenone treatment in chronic central serous chorioretinopathy (CSCR) patients. In another study Zhao et al proved that aldosterone affects the choroidal vascular bed, but not the r etinal[7] They showed that MR activation up-regulates the KCa2.3 channel that leads to hyperpolarization of endothelial cells and the underlying smooth muscle cells, inducing choroidal vasodilatation[7]. We showed in our previous prospective clinical study that 3 month eplerenone therapy can reverse the choroidal vasodilatation and subsequently induce reabsorption of subretinal fluid[13]. Despite these promising results, we noticed that there are some patients who tend to react only modestly to treatment. Inclusion criteria Visual symptoms and clinical diagnosis of CSCR for at least 3 months RPE changes typical of CSCR Presence of SRF involving the fovea on OCT and the SRF did not dissolve during the 3-month period or did not decrease > 50 μm Exclusion criteria Under 18 years of age or limited capacity Any evidence of choroidal neovascularization or choroidal hemangioma rescue PDT, anti-VEGF or laser treatment History of other retinal abnormalities Liver or kidney disease Hyperkalemia (> 5.0 mmol/L) High serum creatinine level (> 2 mg/dL in men, > 1.8 mg/dL in woman) or creatinine clearance < 50 mL/min Concomitant therapy with drugs that increases the potassium level or are known to interact with eplerenone Pregnancy or planning to conceive
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
