Central Serous Chorioretinopathy Treated With Mineralocorticoid Antagonists

Ghadiali, Quraish; Jung, Jesse J.; Yu, Shizhu; Patel, Samir N.; Yannuzzi, Lawrence A.

doi:10.1097/iae.0000000000000748

Cited by 75 publications

(47 citation statements)

References 23 publications

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“…Our data compare favorably to the study of Chin et al [12], in which only half of the patients had a positive treatment effect with MR antagonists, but the patients who did best in their study were in the treatment-naïve subset, which represents all of the patients in our study. While Ghadiali et al [13] observed nonstatistically significant improvements in vision in their study, their sample was markedly different from ours because only 12 of 23 had subretinal fluid in their sample, whereas all of our patients had subretinal fluid. Salz et al [15] demonstrated that at 3 months, 64% of patients had complete resolution of subretinal fluid under treatment, which compares favorably to our rate of 58.3% having complete resolution at 2 months.…”

Section: Discussioncontrasting

confidence: 49%

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Mineralocorticoid Antagonists in the Treatment of Central Serous Chorioretinopathy: A Comparative Analysis

Kapoor¹,

Wagner²

2016

Ophthalmic Res

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Background and Objective: Overaction of mineralocorticoid receptor (MR) pathways has been implicated in the pathophysiology of central serous chorioretinopathy (CSCR). The purpose of this study was to evaluate MR antagonists in the treatment of CSCR. Study Design and Methods: A retrospective chart review was conducted of all CSCR patients at one center treated with spironolactone or eplerenone (50 mg p.o. b.i.d.) or observation. Patients were followed at monthly intervals with examination and optical coherence tomography. Results: 32 patients (12 eplerenone, 12 spironolactone, 8 observation) were enrolled in the study. Both MR antagonists demonstrated statistically significant visual acuity improvement and subretinal fluid reduction at 1, 2, and 3 months compared to baseline (p < 0.05). 58.3% of patients had complete resolution of subretinal fluid at 2 months on MR antagonists, compared to 12.5% under observation (p < 0.05). Photodynamic therapy was used to treat refractory subretinal fluid past 6 months in 1/24 (4.2%) on MR antagonists and 2/8 (25%) patients under observation. There was no difference in efficacy between eplerenone and spironolactone. Spironolactone exhibited increased side effects (8/12, 75%) compared to eplerenone (3/12, 25%; p < 0.05). Conclusions: This data supports the use of MR antagonists in CSCR and suggests an accelerated improvement compared to observation. Prospective randomized trials are needed to better elucidate the precise role of MR antagonists in the management of CSCR.

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Section: Discussioncontrasting

confidence: 49%

“…Other recent studies utilizing MR antagonists in CSCR have corroborated these concerns [12,13,14]. While the present study is unique in its study design comparing two different MR antagonists and an observation arm, it is useful to compare the data to other recent studies.…”

Section: Discussionmentioning

confidence: 57%

Mineralocorticoid Antagonists in the Treatment of Central Serous Chorioretinopathy: A Comparative Analysis

Kapoor¹,

Wagner²

2016

Ophthalmic Res

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“…(13) Todos os grupos avaliados apresentaram melhora significativa no volume de liquido subfoveal, espessura macular, espessura coroidea subfoveal e acuidade visual, com resposta mais lenta nos portadores de CSC apresentando sinais de "calha" e alterações gravitacionais do epitélio pigmentado.…”

Section: ) Bloqueadores Dos Receptores De Mineralocorticoides (Mra)unclassified

“…(2) Alguns critérios para contraindicação ao uso dos MRa são: gestação, insuficiência renal, hepática ou cardíaca, hiperpotassemia, usuários de inibidores da enzima de conversão da angiotensina, drogas anti-inflamatórias não esteroides, lítio e inibidores da CYO3A4. (2,13) 2) Outras Classes de Drogas:…”

Section: ) Bloqueadores Dos Receptores De Mineralocorticoides (Mra)unclassified

Atualização em Coriorretinopatia Serosa Central

et al. 2016

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RESUMOObjetivos: Discutir os conceitos sobre coriorretinopatia serosa central e sugerir recomendações terapêuticas com o objetivo de evitar ou minimizar danos irreversíveis dos fotorreceptores pela doença. Métodos: foi realizada uma revisão da literatura com o objetivo de integrar e compilar artigos disponíveis sobre coriorretinopatia serosa central. Foi feita uma análise dos artigos e descrição das condições clinicas e mecanismos associados à doença, opções terapêuticas e recursos diagnósticos e de acompanhamento. Resultados: A associação da doença ocular com alterações nos receptores de mineralocorticoides nos capilares coroideos, perfil psicológico e uso de glicocorticoides é determinante. Opções terapêuticas são variadas e podem ser medicamentosas ou locais, estando o uso dos antagonistas de mineralocorticoides bem embasado. Outras drogas como rifampicina, finasterida, metotrexato, propafenona são discutidas e mostram vantagens limitadas. Fotocoagulação, laser micropulsado e terapia fotodinâmica modificada são as terapias locais preferenciais, com pequena diferença no resultado final. Os antiangiogênicos não tiveram sua efetividade comprovada para todas as apresentações da doença. Conclusão: Esse artigo descreve etiopatogenia, fatores associados, diagnóstico por imagens e manejo terapêutico para a coriorretinopatia serosa central nas formas aguda, crônica e recidivada. ABSTRACTPurpose: To discuss the concepts of central serous chorioretinopathy and to suggest therapeutic recommendations in order to avoid or minimize irreversible damage to the photoreceptors by the disease. Methods: A literature review was conducted with the objective to compile peer-reviewed articles available on central serous chorioretinopathy. An analysis of the peer-reviewed articles and description of clinical conditions and mechanisms associated with the disease, treatment options and diagnostic tools and monitoring was made. Results: The association of the CSC disease with damage of mineralocorticoid receptors in the choriocapillaries, psychological profile and use of glucocorticoids is critical. Treatment options vary with several drugs being used, such as the mineralocorticoid antagonists. Rifampicin, finasteride, metotreaxato and propafenone represent other drugs used for the CSC treatment. Photocoagulation, micropulse laser and modified photodynamic therapy are the preferred local therapies for CSC. Conclusion: This paper describes etiology, associated factors, diagnostic imaging and therapeutic management for acute, chronic and recurrent central serous chorioretinopathy. RESUMENPropósito: Debatir los conceptos acerca de la coriorretinopatía central serosa y ofrecer sugestiones de recomendaciones terapéuticas que puedan evitar o reducir los daños irreversibles en los fotorreceptores que son causados por la enfermedad. Métodos: Se hizo una revisión de la literatura con el objetivo de integrar y compilar artículos que se encuentren disponibles acerca del tema de la coriorretinopatía central serosa. Se realizó un análisis de los artí...

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“…Recent reports have pointed to new therapeutic applications for SPL (and its active metabolites); for example, it is being increasingly prescribed “off‐label” in ophthalmology for the treatment of central serous chorioretinopathy (Bousquet et al, ; Chin et al, ; Daruich et al, ; Ghadiali, Jung, Yu, Patel, & Yannuzzi, ; Herold, Prause, Wolf, Mayer, & Ulbig, ; Herold, Rist, Priglinger, Ulbig, & Wolf, ; Salehi, Wenick, Law, Evans, & Gehlbach, ; van Dijk et al, ), which involves the accumulation of fluid under the retina and can result in retinal detachment and vision impairment. Other studies have suggested that concomitant administration of MR antagonists might offset glucocorticoid‐induced delays in cutaneous wound healing (Farman et al, ; Maubec et al, ; Nguyen et al, ).…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a fast and sensitive UHPLC‐ESI‐MS method for the simultaneous quantification of spironolactone and its metabolites in ocular tissues

Dahmana

Gabriel²,

Gurny

2018

Biomedical Chromatography

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Glucocorticoids are a mainstay for the treatment of immune-mediated conditions and inflammatory diseases. However, their chronic use causes numerous side-effects including delays in corneal and cutaneous wound healing. This is attributed to off-target agonism of the mineralocorticoid receptor, which can be reduced by co-administration of a mineralocorticoid receptor antagonist such as spironolactone. The aim of this study was to develop a fast, selective and sensitive UHPLC-ESI-MS method for the simultaneous quantification of spironolactone, its active metabolites (7α-thiomethylspironolactone and canrenone), the latter's water-soluble prodrug potassium canrenoate and the synthetic glucocorticoid, dexamethasone, in corneal samples (17α-methyltestosterone served as an internal standard). A one-step extraction procedure using MeOH-H O (1:1) was validated and employed to recover the analytes from the corneal tissue. Extracts were centrifuged and the supernatant analyzed under isocratic conditions. Compounds were detected using selected ion recording mode. The method satisfied US Food and Drug Administration guidelines with respect to selectivity, precision and accuracy and displayed linearity from 5 to 1000 ng/mL for all of the analytes. The lower limit of quantitation of the method was 5 ng/mL, making it sufficiently sensitive for quantification of the analytes in samples from in vivo studies.

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Central Serous Chorioretinopathy Treated With Mineralocorticoid Antagonists

Cited by 75 publications

References 23 publications

Mineralocorticoid Antagonists in the Treatment of Central Serous Chorioretinopathy: A Comparative Analysis

Mineralocorticoid Antagonists in the Treatment of Central Serous Chorioretinopathy: A Comparative Analysis

Atualização em Coriorretinopatia Serosa Central

Development and validation of a fast and sensitive UHPLC‐ESI‐MS method for the simultaneous quantification of spironolactone and its metabolites in ocular tissues

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