Predictive factors of selective mineralocorticoid antagonist treatment in chronic central serous chorioretinopathy

Abstract

Purpose: To compare the macular morphology of good and poor responders to eplerenone treatment in chronic central serous chorioretinopathy (CSCR) patients. Methods: 30 eyes of 29 patients with chronic CSCR were treated with 50 mg/day oral eplerenone and followed up for one year. The integrity of outer retinal layers at baseline was assessed using optical coherence tomography. Patients who showed complete resolution of subretinal fluid at one year were assigned to the good responder group (Group 1), whilst those who showed moderate or no resolution were classified as poor responders (Group 2). Results: In Group 2 hyperreflective foci in outer segment and outer nuclear layer were significantly more frequent, while ellipsoid zone interruption was significantly more frequent than in Group 1 (p=0.006 and p<0.001 respectively). The multivariable regression analysis showed that intact ellipsoid zone at baseline is an independent predictor of good therapeutic response, with an odds ratio of 26.00 (95% CI: 3.69–183.45; p=0.001). Conclusion: The resolution of subretinal fluid after eplerenone treatment is associated with the integrity of outer retinal layers in CSCR patients. Baseline morphologic evaluation of these layers can be useful in predicting the response to mineralocorticoid antagonist therapy.