Oral Spironolactone versus Conservative Treatment for Non-Resolving Central Serous Chorioretinopathy in Real-Life Practice

Figures & data

Figure 1 Measurement of subretinal fluid height (upper left), lesion size (upper right) and central macular thickness (lower).

Table 1 Demographic Data and Clinical Characteristics

Variables	Treatment Group	Control Group	p-value
	(n=21)	(n=41)
Age (years)	46.33 ± 8.62	44.27 ± 8.65	0.38
Male N (%)	12 (57.14%)	26 (63.41%)	0.63
Occupation N (%)			0.52
Agriculture	4 (19.05%)	11 (26.83%)
Worker	4 (19.05%)	8 (19.51%)
Officer	6 (28.57%)	15 (36.59%)
Not identified	7 (33.33%)	7 (17.07%)
Duration of disease (months)
Mean (SD)	5.28 ± 1.10	4.24 ± 1.92	0.44
Median (Range)	6 (4–8)	3 (3–12)
Baseline BCVA (logMAR)	0.47 ± 0.46	0.27 ± 0.35	0.06
Subretinal fluid height (µm)	222.38 ± 107.16	255.24 ± 125.69	0.29
Central macular thickness (µm)	380.28 ± 129.99	416.04 ± 148.90	0.69
Lesion size (µm)	2977.62 ± 1479.39	3481.61 ± 1161.72	0.14
Pigment epithelial detachment N (%)	9 (42.85%)	10 (24.39%)	0.15
FFA patterns			0.36
Expansile dot	9 (42.86%)	19 (46.34%)
Smokestack	1 (4.76%)	2 (4.88%)
Non-specific	11 (52.38%)	20 (48.78%)

Abbreviations: CSC, central serous chorioretinopathy; BCVA, best-corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; PED, pigment epithelial detachment; FFA, fundus fluorescein angiography.

Table 2 Comparison of Eyes with Complete Resolution of SRF in Both Groups

Variables	Treatment Group (n=21)	Control Group (n=41)	P-value
Complete resolution of SRF	12 (57.14%)	13 (31.71%)	0.03*
1 month	9 (42.85%)	2 (4.87%)
3 months	2 (9.52%)	9 (21.95%)
6 months	1 (4.76%)	2 (4.87%)
No complete resolution of SRF	9 (42.86%)	28 (68.29%)

Notes: Complete resolution, no residual subretinal fluid. *Cox regression test: p = 0.032, hazard ratio = 2.38, 95% CI (1.07, 5.26). Bold data indicates Cox regression analysis compares “Complete resolution” and “No complete resolution in both groups, p-value is 0.032 which is statistically significant. 

Abbreviation: SRF, subretinal fluid.

Figure 2 Kaplan–Meier survival estimates over 6-month follow up of patients in both groups. Cox regression test: p = 0.032, HR = 0.42, 95% CI (0.19, 0.93).

Table 3 Secondary Outcomes Measured at Baseline, 1 Month, 3 Months and 6 Months

Variables	Baseline	1 Month	3 Months	6 Months	P-value*
SRF height (µm)
Treatment	222.4 ± 107.2	90.0 ± 101.7	115.3 ± 113.3	103.2 ± 96.5	<0.001
Control	255.2 ± 125.7	186.4 ± 115.8	127.2 ± 106.6	140.5 ± 119.1	<0.001
CMT (µm)
Treatment	380.3 ± 129.9	234.7 ± 113.6	270.4 ± 119.1	257.3 ± 94.3	<0.001
Control	416.1 ± 148.9	346.5 ± 244.9	268.1 ± 137.2	309.4 ± 132.2	<0.001
Lesion size (µm)
Treatment	2977.6 ± 1479.4	1798.6 ± 1370.1	2076.1 ± 1028.7	1966.2 ± 1131.4	0.02
Control	3481.6 ± 1161.7	3001.4 ± 1668.1	2257.6 ± 1627.2	2220.6 ± 1583.1	<0.001
BCVA (logMAR)
Treatment	0.47 ± 0.46	0.36 ± 0.48	0.37 ± 0.42	0.38 ± 0.41	<0.05
Control	0.27 ± 0.35	0.27 ± 0.35	0.24 ± 0.34	0.24 ± 0.35	0.23

Note: *Compared between baseline and 6 months.

Abbreviations: BCVA, best-corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; SRF, subretinal fluid; CMT, central macular thickness.

Table 4 Secondary Outcome Changes from Baseline to 6 Months in Both Groups

Variables	Treatment Group (n=21)	Control Group (n=41)	P-value
SRF Height Change N (%)			0.06
<50% reduction	9 (38.10%)	18 (43.90%)
50–99% reduction	1 (4.76%)	10 (24.39%)
100% reduction	12 (57.14%)	13 (31.71%)
CMT Change N (%)			0.72
<10% reduction	4 (19.05%)	12 (29.27%)
10–20% reduction	3 (14.28%)	4 (9.76%)
>20% reduction	14 (66.67%)	25 (60.97%)
Lesion Size N (%)			0.27
<50% reduction	5 (23.81%)	25 (60.97%)
50–99% reduction	4 (19.05%)	3 (7.32%)
100% reduction	12 (57.14%)	13 (31.71%)
BCVA Change N (%)			0.39
Improved
1-line BCVA gain	1 (4.76%)	3 (7.32%)
2-line BCVA gain	5 (23.81%)	5 (12.19%)
3-line BCVA gain	4 (19.05%)	4 (9.76%)
Stable	9 (42.86%)	24 (58.54%)
Worse	2 (9.52%)	5 (12.19%)

Abbreviations: SRF, subretinal fluid; CMT, central macular thickness; BCVA, best-corrected visual acuity.

Figure 3 Changes in subretinal fluid height (upper left), central macular thickness (upper right), lesion size (lower left) and best-corrected visual acuity (lower right) over 6-month follow-up period.

Table 5 Multivariate Analysis of Factors Associated with the Complete Resolution of SRF

Variables	HR	95% CI	p-value
Age (years): <45/≥45	2.38	0.75, 7.69	0.145
Previous steroid use: no use/use	1.8	0.24, 14.29	0.564
Duration of disease (months): <6/≥6	3.7	1.23, 12.5	0.021*
Baseline SRF (um): <300/≥300	7.14	0.85, 100	0.070
Baseline CMT (um): ≥450/<450	1.14	0.23, 5.53	0.867
Baseline lesion size (um): <2500/≥2500	1.3	0.43. 3.95	0.638
Present of serous PED: PED/no PED	1.72	0.52, 5.88	0.374
SRF at 3 months: resolved/not resolved	32.88	5.58, 193.75	<0.001*
FFA pattern: expansile dot/others	9.19	2.35, 35.87	0.001*
Baseline BCVA (logMAR): ≥0.2/<0.2	1.01	0.35, 2.92	0.980

Note: *Statistical significance when p<0.05.

Abbreviations: HR, hazard ratio; CI, confidence intervals; SRF, subretinal fluid; CMT, central macular thickness; PED, pigment epithelial detachment; FFA, fundus fluorescein angiography; BCVA, best-corrected visual acuity; logMAR, logarithm of the minimum angle of resolution.