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Mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy: systematic review and

Camila Q Felipe1, Ana Luiza Biancardi2, Vinicius T Civile3

  • 1Postgraduate Program in Health Sciences, Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), São Paulo, Brazil.

International Journal of Retina and Vitreous
|June 7, 2022
PubMed
Abstract

Insights

Mineralocorticoid receptor antagonists (MRAs) show minimal impact on vision and anatomical measures in chronic central serous chorioretinopathy (cCSCR). Evidence regarding adverse events and central subfield thickness remains uncertain, suggesting limited clinical benefit.

Area of Science:

  • Ophthalmology
  • Retinal Diseases
  • Pharmacology

Background:

  • Mineralocorticoid receptor antagonists (MRAs) are frequently prescribed for chronic central serous chorioretinopathy (cCSCR).
  • The clinical effectiveness of MRAs in managing cCSCR is not well-established.
  • This study aimed to systematically evaluate the efficacy of MRAs for cCSCR.

Purpose of the Study:

  • To assess the impact of MRAs on visual acuity and anatomical parameters in patients with cCSCR.
  • To evaluate the safety profile of MRAs in this patient population.
  • To provide evidence-based insights for the clinical use of MRAs in cCSCR management.

Main Methods:

  • A systematic review and meta-analysis of randomized clinical trials (RCTs) comparing MRAs to placebo in adult cCSCR patients.
  • Primary outcomes included best-corrected visual acuity (BCVA) and adverse events.
  • Secondary outcomes assessed central subfield thickness (CST), subretinal fluid height (SFH), and central choroidal thickness (CCT).
  • Searches were conducted across multiple databases up to May 2021, with risk of bias assessed using the Cochrane tool (version 2).

Main Results:

  • Five RCTs involving 225 patients were included, treated with spironolactone or eplerenone versus placebo.
  • Moderate-certainty evidence indicates MRAs have little to no effect on BCVA (SMD 0.22; 95% CI -0.04 to 0.48).
  • MRAs demonstrated little to no effect on SFH (SMD -0.35; 95% CI -0.95 to 0.26) and CCT (MD -21.23; 95% CI -64.69 to 22.24).
  • Evidence regarding adverse events and CST was of very low certainty, with uncertain impact on CST (MD 18.1; 95% CI -113.04 to 76.84).

Conclusions:

  • MRAs demonstrate minimal to no significant effect on visual acuity in patients with cCSCR.
  • The impact of MRAs on anatomical parameters like SFH and CCT is also negligible.
  • The evidence concerning adverse events and CST is highly uncertain, warranting caution in prescribing MRAs for cCSCR.
Keywords:
Central Serous ChorioretinopathyEplerenoneMineralocorticoid Receptor AntagonistsSpironolactone

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