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

Abstract

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.

Functional and morphological outcome in patients with chronic central serous chorioretinopathy treated by subthreshold micropulse laser

“…However, any results they have obtained have not been confirmed in randomized trials [ 12 – 16 ]. Just recently, mineralocorticoid pathway inhibitors have been tested in CSCR treatment with promising results [ 17 – 19 ]. Photodynamic therapy (PDT) is an important form of treatment of chronic CSCR, which is, nevertheless, costly and unavailable in some regions [ 20 – 24 ].…”

Spironolactone versus observation in the treatment of acute central serous chorioretinopathy

“…Kapoor and Wagner21 reported that there was a statistically significant increase in the incidence of side effects with spironolactone than eplerenone. Struthers et al reported that eplerenone costs between six and seven times more than spironolactone 38.…”

Effect of oral eplerenone in anatomical and functional improvement in patients with chronic central serous chorioretinopathy

“…Recently Kapoor et al did follow-up for 12 months and reported an improvement in condition but the subject size was small (n=12) 21. These studies reported variable dose dependent reversible adverse effects including but not limited to diabetes, cardiac failure, drug interactions, fatigue, dizziness, hypokalemia, bowel disturbance, weight loss, gynecomastia and altered liver enzymes.…”