Selective and nonselective mineralocorticoid receptor antagonists in central serous chorioretinopathy: systematic review and meta-analysis

BACKGROUND: Central serous chorioretinopathy (CSCR) is a common retinal disorder characterized by serous retinal detachment and choroidal abnormalities. While various treatment modalities exist, their potential adverse effects have prompted interest in alternative therapies. Although mineralocorticoid receptor antagonists (MRAs) have been explored as a potential therapy, previous studies have yielded conflicting results, and prior meta-analyses have not distinguished between the effects of selective and nonselective MRAs. Therefore, in this study, we aimed to compare the efficacy and safety of selective (eplerenone) and nonselective (spironolactone) MRAs for treating CSCR. METHODS: A systematic review was conducted using the MEDLINE, Embase, CENTRAL, Web of Science, Scopus Database, Cochrane Library and Google Scholar databases to identify randomized clinical trials (RCTs) comparing the efficacy of MRAs with placebo or between different MRAs in CSCR treatment. Efficacy was evaluated using best-corrected visual acuity (BCVA) and subretinal fluid (SRF) height, and clinical data on adverse effects were also collected. The Revised Cochrane Risk-of-Bias Tool (RoB2) was used for quality assessment. Results were synthesized through a meta-analysis to calculate the weighted mean difference (MD) using a random-effects model. Additionally, a network meta-analysis was performed to incorporate all the evidence. RESULTS: Seven RCTs, involving 283 participants, were included in the analysis. Spironolactone demonstrated a superior effect over placebo in improving BCVA (MD: − 0.14; 95% CI: − 0.25, − 0.04; P = 0.02, I2 = 68%) and reducing SRF height (MD: − 97.42; 95% CI: − 148.19, − 46.66; P = 0.94, I2 = 0%). Eplerenone exhibited a superior effect over placebo in improving BCVA (MD: − 0.0.5; 95% CI: − 0.09, − 0.01; P = 0.41, I2 = 0%) but had no significant impact on SRF height (MD: − 64.80; 95% CI: − 180.40, 50.80; P = 0.0008, I2 = 82%). Synthesizing them all indicated that spironolactone was superior to eplerenone in improving BCVA (MD: 0.13; 95% CI: 0.023, 0.23), though no significant difference was observed on SRF height (MD: − 12; 95% CI: − 170, 150). CONCLUSIONS: Spironolactone was effective in treating CSCR; superior to eplerenone especially in improving BCVA. PROTOCOL REGISTRATION: This systematic review protocol was registered in PROSPERO (ID: CRD42024601746) prior to commencement.