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Clinical experience with eplerenone to treat chronic central serous chorioretinopathy

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Chronic central serous chorioretinopathy (CSC) is a vision-threatening eye disease for which there is still no approved treatment. Recent studies suggest that the corticosteroid pathway in the choroid is implicated in CSC pathogenesis, and that therapy with the aldosterone antagonist eplerenone improves clinical outcomes. However, there is still little clinical data to support this hypothesis. We performed a retrospective chart review to further investigate the clinical value of eplerenone treatment in patients with chronic CSC and to identify possible response predictors.

Methods

Twenty-four patients with chronic CSC resistant to conventional therapy over at least 4 months were included in this retrospective study. Patients were initially treated with 25 mg/day of eplerenone administered orally for 1 week, followed by a sustained daily dose of 50 mg. The primary outcome measure was percentage of eyes achieving complete resolution of subretinal fluid (SRF), recorded by spectral domain optical coherence tomography (SD-OCT). Secondary outcomes included changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA). Baseline SD-OCT images were also evaluated as possible predictors of treatment response.

Results

Twenty-nine percent of patients experienced complete resolution of SRF after a median of 106 days of treatment, while 33 % of patients showed a transient initial decrease in SRF, and 25 % failed to respond to treatment. Treatment had to be stopped in 13 % of patients because of adverse effects of the eplerenone treatment. In the study population, CMT decreased from 342 to 275 μm after treatment, which was associated with a modest improvement in mean BCVA from 0.35 to 0.3 logMar. The integrity of the ellipsoid zone and the retinal pigment epithelium (RPE) at baseline were associated with a tendency towards a favourable visual outcome.

Conclusion

This study confirms the proposed clinical value of eplerenone for treating patients with therapy-resistant CSC. However, patients presenting widespread RPE changes are less likely to benefit from eplerenone treatment, which may argue for an earlier intervention. Larger studies are needed to characterise patient subgroups that may benefit the most from eplerenone treatment.

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Authors and Affiliations

  1. Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Bertan Cakir, Franziska Fischer, Christoph Ehlken, Anima Bühler, Andreas Stahl, Günther Schlunck, Daniel Böhringer, Hansjürgen Agostini & Clemens Lange

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  1. Bertan Cakir
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  2. Franziska Fischer
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  3. Christoph Ehlken
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  4. Anima Bühler
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  5. Andreas Stahl
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  6. Günther Schlunck
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  7. Daniel Böhringer
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  8. Hansjürgen Agostini
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  9. Clemens Lange
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Corresponding author

Correspondence to Clemens Lange.

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No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; or expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cakir, B., Fischer, F., Ehlken, C. et al. Clinical experience with eplerenone to treat chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 254, 2151–2157 (2016). https://doi.org/10.1007/s00417-016-3373-3

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  • DOI: https://doi.org/10.1007/s00417-016-3373-3

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