Spironolactone for Nonresolving Central Serous Chorioretinopathy

Bousquet, Elodie; Beydoun, Talal; Rothschild, Pierre-Raphaël; Bergin, Ciara; Zhao, Min; Batista, Rui; Brandely, Marie-Laure; Couraud, Benedicte; Farman, Nicolette; Gaudric, Alain; Chast, François; Béhar-Cohen, Francine

doi:10.1097/iae.0000000000000614

Cited by 120 publications

(92 citation statements)

References 29 publications

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“…Information regarding the effects of spironolactone in the treatment of CSC derives from an uncontrolled, prospective case series [61] and a randomized, controlled crossover study [62]. In the study by Herold et al [61], 18 consecutive patients with CSC lasting for more than 3 months were treated with 25 mg of spironolactone twice daily for up to 12 weeks.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…[62] designed a prospective, randomized, double-blinded, placebo-controlled crossover study which enrolled a total of 16 patients with CSC lasting for 3 months or more. The patients were randomized to receive either spironolactone 50 mg or placebo for 1 month; following a washout period of 1 week, each patient crossed over to the other treatment arm for an additional 30 days.…”

Section: Treatment Optionsmentioning

confidence: 99%

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Central Serous Chorioretinopathy Treatments: A Mini Review

et al. 2015

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Central serous chorioretinopathy (CSC) is a retinal disorder that primarily affects young (20- to 50-year-old) white men, although it is seen occasionally in older patients and females. CSC is characterized by avascular focal leakage through the retinal pigment epithelium (RPE), resulting in serous detachment of the neurosensory retina. The course is usually self-limiting and in most cases resolves spontaneously within a 3-month period, with visual acuity usually recovering to 20/30 or better. However, chronic CSC may develop as a consequence of recurrences or persistent neurosensory detachment, and can result in progressive RPE atrophy and permanent visual loss. A primary involvement of the RPE and choroidal vascularization play a significant role in the pathogenesis of CSC and the current treatment options attempt to restore the functions of the RPE and the normal choroidal vasculature. The aim of the current review is to provide an overview of the current therapeutical approaches to CSC, including observation, laser treatment, photodynamic therapy with verteporfin, intravitreal anti-vascular endothelial growth factor therapy and the mineralocorticoid receptor antagonists.

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Section: Treatment Optionsmentioning

confidence: 99%

Section: Treatment Optionsmentioning

confidence: 99%

Central Serous Chorioretinopathy Treatments: A Mini Review

et al. 2015

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“…Because of the known association with glucocorticosteroids, the most widely studied oral agents for the treatment of CSC are anti-glucocorticoids, such as ketoconazole, 20,21 mifepristone, 22,23 and rifampin. [24][25][26] Other reports investigated anti-mineralocorticoids, such as eplerenone [43][44][45][46] and spironolactone, 47,48 as well as carbonic anhydrase inhibitors (acetazolamide). 49 We note that all these series were small (under 20 patients) with relatively short follow-up, and reported mixed results.…”

Section: Discussionmentioning

confidence: 99%

“…50 Reduction of CMT and improvement in VA was reported with the antimineralocorticoids, but it should be noted that these agents can cause low blood pressure, hyperkalemia, and other adverse effects. [43][44][45][46][47][48] Acetazolamide was shown to reduce CMT but had no effect on VA, and it too can cause low blood pressure and other adverse effects. 49 Finasteride is approved by the FDA for the treatment of benign prostatic hyperplasia (BPH) and androgenic alopecia, and is known to have an excellent safety profile, [51][52][53] and has also been shown to have fewer side effects and drug interactions than ketoconazole.…”

Section: Discussionmentioning

confidence: 99%

Finasteride is effective for the treatment of central serous chorioretinopathy

Moisseiev

Holmes

Moshiri

et al. 2016

Eye

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Purpose To evaluate the safety and efficacy of finasteride treatment in patients with central serous chorioretinopathy (CSC). Methods Retrospective review of 29 eyes of 23 patients who were treated with finasteride for CSC. Previous medical and ocular history, steroid use, length of finasteride treatment, additional treatments for CSC, visual acuity (VA), central macular thickness (CMT), and presence of subretinal fluid (SRF) throughout the follow-up period, and the occurrence of any complications were recorded. Results Initial VA was 0.29 ± 0.31 logMAR, and a trend towards improved VA was noted after 3 months (0.25 ± 0.36 logMAR; P = 0.07). VA was significantly improved at the final follow-up (0.23 ± 0.27 logMAR; P = 0.024). Initial CMT was 354 ± 160 μm, and was significantly reduced after 1 month of treatment (284 ± 77 μm; P = 0.002) and this was maintained to the end of follow-up (247 ± 85 μm; P = 0.001). A significant reduction in SRF presence was found at all time points, with an overall 75.9% rate of complete resolution. Following discontinuation, SRF recurrence was noted in 37.5% of cases. No adverse events were recorded. Conclusions Finasteride is a safe and effective treatment for CSC. It may be a possible new option for the initial management of patient with CSC, and a suggested treatment approach is presented.

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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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Spironolactone for Nonresolving Central Serous Chorioretinopathy

Cited by 120 publications

References 29 publications

Central Serous Chorioretinopathy Treatments: A Mini Review

Central Serous Chorioretinopathy Treatments: A Mini Review

Finasteride is effective for the treatment of central serous chorioretinopathy

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

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