The use of mineralocorticoid receptor antagonists in chronic central serous chorioretinopathy

To assess the effect of eplerenone on macular structure and function in patients with chronic central serous chorioretinopathy.

17 eyes of 16 patients (aged 32-66 years) with chronic central serous chorioretinopathy treated at the Department of Ophthalmology and Ocular Oncology, Jagiellonian University in Cracow were enrolled. The duration of symptoms ranged between 4 and 24 months. The patients were dosed with eplerenone according to the scheme: first 25 mg/day for a week, then 50 mg/day for 3 months. The baseline examination and two follow-up visits (after 1-1,5 months and after 3-4 months respectively) involved best corrected visual acuity (Snellen, decimal scale), central retinal thickness in optical coherence tomography and visual disturbances in Amsler test.

The mean best corrected visual acuity improved from 0.61 (±0.25) to 0.67 (±0.28) and 0.72 (±0.28) at the first and second follow-up appointment, respectively. Central retinal thickness declined from 367 μm (±70) to 264 μm (±50) and 248 μm (±50) at the first and second follow up appointment, respectively (p<0.05). Amsler test findings improved in 10 eyes (58.8%), while the deterioration in central vision remained unchanged in 7 eyes (41.2%) at the first follow up appointment. During the second follow-up appointment, though, Amsler test improvement was reported in 7 eyes (50%), while the deterioration in central vision remained unchanged in 7 eyes (50%).

Our study suggests that eplerenone may provide an alternative treatment of chronic central serous chorioretinopathy, especially in patients with known contraindications to or ineligible for other treatments (for instance, retinal laser photocoagulation). Further randomized controlled trial is required.