Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy

Figures & data

Table 1 Summary of patient demographics and history

Number of patients treated with mineralocorticoid antagonists	N=23
Average age (years)	58.4±10.5
Number of males	15 (65.2%)
Bilateral disease	7 (30.4%)
Prior treatment failure(s):	16 (69.6%)
• Intravitreal anti-VEGF agents	7
• Ketoconazole	4
• Photodynamic therapy	5
• Focal thermal laser	3
• Rifampin	2
History of steroid usage (oral, intravenous, topical, inhaled)	9 (39.1%)
History of systemic hypertension	12 (52.2%)

Abbreviation: VEGF, vascular endothelial growth factor.

Table 2 Visual and anatomical outcome measures of the study eyea

Treatment	Number of patients	Median BCVA at baseline	Median BCVA at final follow-up	Mean CMT (μm) at baseline	Mean CMT (μm) at final follow-up	Mean MV (mm^3) at baseline	Mean MV (mm^3) at final follow-up
Eplerenone only	15	20/30	20/30	387.5	352.5	8.7	8.6
Spironolactone only	3	20/30	20/40	359.3	274.3	7.6	7.2
Eplerenone, followed by spironolactone	5	20/50	20/50	373.0	333.8	8.7	8.4
All patients	23	20/30	20/40	376.2	335.2	8.6	8.4

Notes:

a Study eye was the eye with most severe OCT findings when bilateral disease was present. Final follow-up is defined as time of cessation of therapy, or at the soonest follow-up if ongoing therapy.

Abbreviations: BCVA, best-corrected visual acuity (Snellen); CMT, central macular thickness; MV, macular volume; OCT, optical coherence tomography.

Figure 1 Patient with CSCR, treated with eplerenone 50 mg twice-daily.

Notes: Rapid resolution of SRF (borders highlighted with red arrows) is measured by a decrease in central macular thickness (CMT, red circle) and macular volume (MV, red rectangle) measurements from December 20, 2012 to January 17, 2013. Ongoing improvement of the eccentric SRF (inferiorly along the arcades, dashed red arrows) on March 13, 2013 can best be followed via MV.
Abbreviations: Vol, volume; min, minimum; max, maximum; ETDRS, Early Treatment Diabetic Retinopathy Study; IR, infrared radiation; OCT, optical coherence tomography; HS, high-sensitivity; CSCR, central serous chorioretinopathy; CMT, central macular thickness; MV, macular volume; SRF, subretinal fluid.

Figure 2 Patient with CSCR, treated with eplerenone 25 mg twice-daily from January to March 2013.

Notes: The dosage was increased to eplerenone 50 mg twice-daily from March to April 2013, with overall negligible change in CMT (red circle) and MV (red rectangle) throughout the course of treatment.
Abbreviations: Vol, volume; min, minimum; max, maximum; ETDRS, Early Treatment Diabetic Retinopathy Study; IR, infrared radiation; OCT, optical coherence tomography; HS, high-sensitivity; CSCR, central serous chorioretinopathy; CMT, central macular thickness; MV, macular volume.

Table 3 Decrease (Δ, initial – final) in CMT and MV for all patients treated with oral mineralocorticoid antagonists, sorted primarily by CMT, and secondarily by MV

Patient number	Treatment	Duration of treatment (months)	ΔCMT (μm)	ΔMV (mm^3)
1a	E	7	255	2.90
2	S	1.5	232	0.84
3	ES	6.5	221	1.38
4a	E	2	180	1.18
5a	E	1	164	0.43
6a	E	1	85	0.11
7	E	3.5	53	0.05
8a	ES	2	45	0.29
9	E	6	30	0.13
10	E	2.5	28	0.51
11	S	8	22	0.24
12	E	6	9	0.01
13	ES	3	9	−0.07
14	E	3	8	−0.03
15	E	1	3	0
16	S	2	1	0
17a	E	3	−2	−0.03
18a	E	4	−22	−0.17
19	E	3	−22	−0.69
20	ES	7	−36	0.02
21	ES	8.5	−43	0.23
22	E	4	−109	−2.33
23	E	3	−136	−0.35
Mean ± SD		3.9±2.3	42.4±103.3	0.20±0.91

Notes:

a Patients who had no prior treatment for CSCR (ie, treatment-naïve). Green denotes positive decrease in both CMT and MV, yellow denotes equivocal with negligible change in CMT and/or MV, red denotes increase in both CMT and MV.

Abbreviations: CMT, central macular thickness; MV, macular volume; E, eplerenone; S, spironolactone; ES, eplerenone, followed by spironolactone; SD, standard deviation; CSCR, central serous chorioretinopathy.

Table 4 Tolerable and intolerable side effects of mineralocorticoid antagonists in our cohort

Treatment	Tolerable side effects	Intolerable side effects
Eplerenone	N=3 (13.0%)	N=2 (8.7%)
	• Fatigue/malaise	• Constipation
	• Leg cramps	• Thirst/dehydration
Spironolactone	N=2 (8.7%)	N=2 (8.7%)
	• Fatigue/malaise	• Fatigue/malaise
	• Gynecomastia	• Libido
	• Orthostatic hypotension	• Cough and emesis