Oral Mineralocorticoid-Receptor Antagonists: Real-Life Experience in Clinical Subtypes of Nonresolving Central Serous Chorioretinopathy With Chronic Epitheliopathy

Daruich, Alejandra; Matet, Alexandre; Dirani, Ali; Gallice, Mathilde; Nicholson, Luke; Sivaprasad, Sobha; Béhar-Cohen, Francine

doi:10.1167/tvst.5.2.2

Cited by 88 publications

(71 citation statements)

References 23 publications

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“…(), who found a significant difference in choroidal thickness between the treated group and the placebo group (treatment effect vs. period effect), and the retrospective study by Daruich et al. (), which showed such difference at 1, 3 and 5 months after starting treatment with mineralocorticoid receptor antagonists.…”

Section: Discussionmentioning

confidence: 96%

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Eplerenone for chronic central serous chorioretinopathy–a randomized controlled prospective study

Schwartz

Habot‐Wilner

Martinez

et al. 2017

Acta Ophthalmologica

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Purpose: To evaluate the efficacy and safety of eplerenone for chronic nonresolving central serous chorioretinopathy (CSC). Methods: Prospective, double-blind, randomized placebo-controlled study. Nineteen eyes of 17 patients with persistent subretinal fluid (SRF) due to CSC were enrolled and randomized to receive eplerenone 50 mg/day or placebo for 3 months, followed by a 3-month follow-up. The main outcome measure was change in SRF from baseline to 3 months of treatment. Secondary outcomes included change in SRF at any time-point, complete resolution of SRF, improvement in choroidal thickness and change in best-corrected visual acuity (BCVA). Results: Thirteen eyes were treated with eplerenone and six with placebo. Both groups showed reduction in SRF throughout the treatment period, with a significant reduction at months 1, 3 and 5 only in the treatment group. Twentythree per cent in the treatment group and 30.8% per cent in the placebo group experienced complete resolution of SRF. A significant improvement in BCVA was noted in the placebo group at 4 months, as well as a significant difference in BCVA between groups at 3 months in favour of the placebo group (p = 0.005). There was no significant difference in choroidal thickness in either group throughout the study period. No adverse events related to eplerenone were noted in the treatment group. Conclusion: In this study, eplerenone was not found to be superior to placebo in eyes with chronic CSC.

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Section: Discussionmentioning

confidence: 96%

“…In a retrospective study by Daruich et al. () describing the use of oral mineralocorticoids in patients with nonresolving CSC, 18 of 54 eyes (33.3%) did not show a change in SRF from baseline during 6 months of treatment and thus were termed nonresponders.…”

Section: Discussionmentioning

confidence: 99%

Eplerenone for chronic central serous chorioretinopathy–a randomized controlled prospective study

Schwartz

Habot‐Wilner

Martinez

et al. 2017

Acta Ophthalmologica

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“…2, 6). On the other hand, MR antagonists have shown beneficial effects in patients with non-spontaneously resolving central serous chorioretinopathy [48][49][50][51]. However, the exact role of MR in retinal physiopathology still remains poorly understood.…”

Section: Towards a Differentiation Of Ocular Corticosteroidsmentioning

confidence: 99%

Towards an Optimized Use of Ocular Corticosteroids: EURETINA Award Lecture 2017

Behar-Cohen

2018

Ophthalmologica

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Since their discovery, glucocorticoids (GCs) have been extensively used for the treatment of ocular diseases because of their anti-inflammatory, anti-edematous and angiostatic properties. Various GCs have been synthetized to optimize their beneficial anti-inflammatory effects and reduce their effects on sodium retention, identified as a mineralocorticoid effect, leading to a potency and specificity grading of the different GCs. However, the side effects, specificity and potency of GCs are highly tissue specific. Because the eye is a confined organ, local GC administration can reduce the systemic undesirable and severe side effects but does not protect from potential local toxicity and side effects, which are dose-dependent, influenced by the disease stage and by genetic and epigenetic susceptibility. GCs can potentially induce retinal cell death through non-classical pathways such as paraptosis and non-caspase-dependent apoptosis that could be undetectable when using classical toxicology tests. To reduce the risks of toxicity, therapeutic lower doses of GCs are desirable and can be achieved using optimized methods of administration such as transscleral iontophoresis or polymeric implants. In the retina, glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) expression is regulated by disease conditions such as ocular inflammation. Activation of the MR pathway by its specific ligand, aldosterone, or by illicit GC occupation can cause retinal edema, subretinal fluid accumulation, and choroidal vasodilation and leakage, suggesting that central serous chorioretinopathy could benefit from MR antagonist. A better understanding of the MR/GR balance in the ocular tissue and the differential effects of their activation in the different ocular cells is still required to envisage an optimized use of GCs for the treatment of different ocular disease conditions.

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“…Não foi observada diferença terapêutica entre os bloqueadores espironolactona e eplerenone. (2,3) Os efeitos colaterais foram mínimos, como ginecomastia, disfunção erétil, hiperpotassemia e alterações nos níveis de pressão arterial e tiveram resolução após a suspensão da medicação. Foram menos frequentes com o eplerenone.…”

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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Oral Mineralocorticoid-Receptor Antagonists: Real-Life Experience in Clinical Subtypes of Nonresolving Central Serous Chorioretinopathy With Chronic Epitheliopathy

Cited by 88 publications

References 23 publications

Eplerenone for chronic central serous chorioretinopathy–a randomized controlled prospective study

Eplerenone for chronic central serous chorioretinopathy–a randomized controlled prospective study

Towards an Optimized Use of Ocular Corticosteroids: EURETINA Award Lecture 2017

Atualização em Coriorretinopatia Serosa Central

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