Efficacy of mineralocorticoid receptor antagonist for central serous chorioretinopathy: a meta-analysis

To evaluate the efficacy of mineralocorticoid receptor antagonist (MRA) for patients with central serous chorioretinopathy (CSCR).

The Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were comprehensively searched up to February 2020, to identify the studies comparing the efficacy of MRA with placebo/observation or photodynamic therapy (PDT) for CSCR. The primary outcomes were maximal subretinal fluid height and central macular thickness (CMT). The secondary outcomes included subfoveal choroidal thickness (SFCT) and best-corrected visual acuity (BCVA). Data of interest were extracted and analyzed by R version 3.6.0. The weighted mean difference and their 95% confidence intervals were used to assess the strength of the association.

Ten studies including 284 affected eyes were involved, with 168 undergoing MRA treatment, 60 taking placebo/observation, and 56 receiving PDT. The pooling results showed that MRA was significantly more effective in resolving maximal subretinal fluid height (P < 0.01) and diminishing CMT (P < 0.01) than placebo/observation, while PDT could achieve significantly better CMT reduction than MRA (P = 0.03). For BCVA improvement and SFCT reduction, no statistical difference was detected among the groups of MRA, observation, placebo, or PDT (P > 0.05).

MRA is an effective therapy for the management of CSCR, which is only slightly inferior to PDT in terms of CMT reduction. For patients who could not afford PDT, MRA could function as an alternative treatment with acceptable efficacy and safety.