Purpose:

To evaluate the efficacy of treatment of chronic central serous retinopathy (CSR) with the mineralocorticoid receptor antagonist eplerenone.

Methods:

IRB approval was obtained through the University of Minnesota. Subjects with CSR based on symptoms, biomicroscopy, fluorescein angiography (FA) and optical coherence tomography (OCT) were enrolled. Subjects must have had symptoms and subretinal fluid on OCT for at least three months prior to study enrollment. Previous treatment was not exclusionary however concomitant therapy was. Exclusion criteria included co-existing macular disease, pre-existing electrolyte anomalies, or previous sensitivity to eplerenone. Baseline best corrected visual acuity (BCVA), OCT, and FA was obtained on each subject. Each subject was given 25mg eplerenone daily for 1 week, subsequently increased to 50mg daily. Baseline, 1 month, and 3 month electrolyte studies were obtained. The primary outcome was change in central macular thickness (CMT) based on OCT. Secondary outcomes included change in BCVA and subjective response. Treatment failure was defined as either subretinal fluid increase or worsening BCVA. Statistical analysis was done using a paired student’s t test.

Results:

A total of eleven eyes of ten subjects were enrolled. All achieved the primary endpoint at 3 months. The mean follow up duration was 10 months and the mean treatment duration was 6.3 months. Ten of eleven eyes had decreased SRF at month 3 and six maintained this decrease through the last follow visit. (initial mean CMT 379.1 at month 0; 287.3 at month 3 (p=0.0381); 336.0 at last follow up (p=0.247)) Three eyes had improvement of BCVA by at least one line at month 3 and six showed a one line improvement at the final follow up visit (initial mean logMAR 0.21 at month 0; 0.227 at month 3 (p=0.752); 0.217 at last follow up (p=0.934)). Four eyes were classified as treatment failures with either worse than baseline BCVA or increased SRF from baseline at the final follow up visit. There were no complications to the therapy.

Conclusion:

Eplerenone shows moderate efficacy in the treatment of chronic CSCR, however the effect seems to be more on subretinal fluid resolution rather than visual acuity improvement.

Contact Details:

Email: richardhjohnston@yahoo.com

Richard Johnston