Interventions for central serous chorioretinopathy: a network meta-analysis

A BSTRACT Conventionally, rennin–angiotensin–aldosterone system (RAAS) inhibition has focused on angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers and angiotensin receptor-neprilysin inhibitors (ARNI) are the latest addition to this armamentarium. However, mineralocorticoid receptor antagonists (MRAs) also constitute an integral part of this anti-RAAS brigade, which are perceived more often as diuretics and are often under prescribed in heart failure (HF) despite being universally advocated by all major guidelines. Apart from HF, they have also shown promise in the management of hypertension, post-myocardial infarction, and hyperaldosteronism. Eplerenone, Food and Drug Administration (FDA) approved in 2002, is an acceptable alternative to spironolactone due to its sparing androgenic effects. In two big pivotal trials in heart failure (EMPHASIS -HF) and post-myocardial infarction (EPHESUS), the drug has firmly shown a reduction in adverse cardiovascular events. It has an established place in the management of resistant hypertension too. In this article, we will discuss the role of RAAS and its pathophysiology, pitfalls of spironolactone, which led to success of its congener, eplerenone, major studies conducted on eplerenone, current role of eplerenone, and comparison of the two MRAs.

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“…Separate trials are underway to determine if there are beneficial effects of eplerenone for acute and chronic CSR. [ 24 ]…”

Section: Linical R Ole Of Ementioning

confidence: 99%

Eplerenone: The multifaceted drug in cardiovascular pharmacology

2020

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“… DIFFERENCES BETWEEN PROTOCOL AND REVIEW We made the following amendments to our protocol (Salehi 2015).

We excluded trials of traditional Chinese medicine.

…”

mentioning

confidence: 99%

Interventions for central serous chorioretinopathy: a network meta-analysis

Salehi

Wenick

Law

et al. 2015

Cochrane Database of Systematic Reviews

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Background Central serous chorioretinopathy (CSC) is characterized by serous detachment of the neural retina with dysfunction of the choroid and retinal pigment epithelium (RPE). The effects on the retina are usually self limited, although some people are left with irreversible vision loss due to progressive and permanent photoreceptor damage or RPE atrophy. There have been a variety of interventions used in CSC, including, but not limited to, laser treatment, photodynamic therapy (PDT), and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents. However, it is not known whether these or other treatments offer significant advantages over observation or other interventions. At present there is no evidence-based consensus on the management of CSC. Due in large part to the propensity for CSC to resolve spontaneously or to follow a waxing and waning course, the most common initial approach to treatment is observation. It remains unclear whether this is the best approach with regard to safety and efficacy. Objectives To compare the relative effectiveness of interventions for central serous chorioretinopathy. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2015, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2014), EMBASE (January 1980 to October 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 5 October 2015. Selection criteria Randomized controlled trials (RCTs) that compared any intervention for CSC with any other intervention for CSC or control. Data collection and analysis Two review authors independently selected studies and extracted data. We pooled data from all studies using a fixed-effect model. For interventions applied to the eye (i.e. not systemic interventions), we synthesized direct and indirect evidence in a network meta-analysis model. Main results We included 25 studies with 1098 participants (1098 eyes) and follow-up from 16 weeks to 12 years. Studies were conducted in Europe, North and South America, Middle East, and Asia. The trials were small (most trials enrolled fewer than 50 participants) and poorly reported; often it was unclear whether key aspects of the trial, such as allocation concealment, had been done. A substantial proportion of the trials were not masked. The studies considered a variety of treatments: anti-VEGF (ranibizumab, bevacizumab), PDT (full-dose, half-dose, 30%, low-fluence), laser treatment (argon, krypton and micropulse laser), beta-blockers, carbonic anhydrase inhibitors, Helicobactor pylori treatment, and nutritional supplements (Icaps, lutein); there were only one or two tri...

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“…A recent meta-analysis has stated that there is no agreement on the best treatment strategy in CSC. 24 Thus, SS-OCT imaging might be of special importance. 25…”

Section: Discussionmentioning

confidence: 99%

Swept-Source Optical Coherence Tomography Angiography in Central Serous Chorioretinopathy

Michalewska¹,

Nawrocki²

2018

Journal of VitreoRetinal Diseases

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This article aims to evaluate the appearance of central serous chorioretinopathy (CSC) with swept-source optical coherence tomography angiography (SS-OCTA), to discuss whether localization of the leakage spot seen on fluorescein angiography (FA) corresponds to any recognizable spot on SS-OCTA, and to provide subsequent diagnosis of choroidal neovascularization (CNV) in the course of CSC. Methods: A prospective interventional case series was conducted in a private outpatient office on 30 eyes of 27 patients. In addition to ophthalmic examination, FA, spectral-domain OCT, SS-OCT and SS-OCTA were performed at least once. If laser photocoagulation or anti-vascular endothelial growth factor (anti-VEGF) injection was administered, then all examinations were repeated afterward. Following SS-OCTA, morphology features of CSC were analyzed: localization of the leakage spot, presence of feeder vessels, and presence of CNV. Changes after treatment were recorded. Results: In 26 of 30 cases the leakage site on FA corresponded to a highly hyporeflective site on SS-OCTA. In 7 of these cases laser was successfully administered. In 20/30 eyes we additionally observed thickened vessels at the level of choriocapillaris in close proximity to the most hyporeflective spot. CNV was observed in 4 cases. The leakage spot is the most hyporeflective spot on SS-OCTA localized at the level of choriocapillaris. Additionally, choroidal feeder vessels might be visualized at the level of choriocapillaris in 66% of cases. In 4 eyes, CNV in the course of CSC was noted. Conclusions: In CSC, SS-OCTA is a valuable diagnostic tool and its results complement FA. It might add to the treatment process, especially regarding the need to start and to monitor anti-VEGF injections. Anti-VEGF treatment results in fading but not in complete disappearance of CNV in the course of CSC.

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Interventions for central serous chorioretinopathy: a network meta-analysis

Cited by 46 publications

References 48 publications

Eplerenone: The multifaceted drug in cardiovascular pharmacology

Eplerenone: The multifaceted drug in cardiovascular pharmacology

Interventions for central serous chorioretinopathy: a network meta-analysis

Swept-Source Optical Coherence Tomography Angiography in Central Serous Chorioretinopathy

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