Oral Eplerenone Versus Observation in the Management of Acute Central Serous Chorioretinopathy: A Prospective, Randomized Comparative Study

Abstract

In this prospective, interventional case-control study, 58 patients with unilateral acute central serous chorioretinopathy (CSCR) were recruited. Patients ≥ 18 years age, presenting with first episodes of acute CSCR, were included. Acute CSCR was defined by the presence of subretinal fluid (SRF) and symptoms for <12 weeks duration with no clinical or imaging features of chronicity. Patients were alternately divided into treatment (Table Eplerenone 50 mg/day for minimum 1 month) and observation groups. Vision, SRF height and subfoveal choroidal thickness (SFCT) were checked at 1-, 2- and 3-months in both eyes of each group. Each group had 29 eyes. Mean age was 40.4 ± 7.1 and 43.3 ± 8.34 years in treatment and observation group, respectively. Mean symptom duration was 6.46 ± 1.45 and 5.87 ± 2.09 weeks, respectively. Vision improvement to 6/6 was seen in 92%, 100% and 100% cases in treatment group and 74%, 86% and 100% in control group at each visit, respectively. Complete SRF resolution in the treatment group was noted in 45%, 55% and 62% cases at each respective monthly visit. In the observation group, complete SRF resolution was noted in 10%, 21% and 31% at 1-, 2- and 3-month visits, respectively. SRF (p < 0.001) and SFCT (p < 0.001) reduction was noted in the affected eye of both groups. SFCT was reduced in the fellow eye after treatment (p = 0.005) compared to the observation group (p = 0.276). In conclusion, oral eplerenone achieves faster SRF resolution and vision improvement in acute CSCR. Additionally, it shows beneficial effects on the fellow eye.

Central serous chorioretinopathy: A review

“…Commonly, CSC is categorised into acute, chronic, and recurrent subtypes based on the duration of presence of SRF, whether the SRF resolves between episodes, and fundus findings (Figure 5). 64–66 However, due to overlap between subtypes there is ongoing debate and no universally accepted classification system 7,67,68 …”

“…In one U.S. study, 31% of CSC patients went on to have recurrences over 22 years of follow up, with a median time of recurrence at 1.3 years (range 0.4–18.2 years), and mean number of recurrences of 1.5 (range 1–2) 4 . Other studies have found rates of recurrence to vary between 30% and 50% of patients over long term follow up 7,64,77 . Risk factors for recurrences include high subfoveal choroidal thickness, less intense patterns of fluorescein leakage (either fluorescence increase or spatial diffusion), and shift work 77 …”

“…A 2020 prospective, case control study of 58 eyes with acute CSC (presence of symptoms and SRF for <12 weeks duration) by Venkatesh et al 64 randomised patients to eplerenone (50 mg/day for a minimum of 1 month) or observation. They found that over 3 months of follow up, visual acuity improvement to 6/6 occurred faster, and complete resolution of SRF occurred more frequently in those treated in eplerenone.…”

Stellungnahme von BVA, DOG und RG zur Chorioretinopathia centralis serosa (CCS)

“…Eine Therapie der akuten CCS mittels Mineralokortikoidantagonisten [117] oder mittels photodynamischer Therapie wurde berichtet [88], soll aber aufgrund der unzureichenden Evidenzlage und der guten Spontanresorption der Flüssigkeit im akuten Stadium nicht angewandt werden.…”

Commentary: Retinal pigment epithelial leak identification in central serous chorioretinopathy: Is fundus fluorescein angiography a must?

“…These include subthreshold micropulse laser (green/yellow), half-fluence/half-dose photodynamic therapy, and mineralocorticoid antagonists. [ 7 ]…”