title: Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy.
abstract: OBJECTIVE
  To evaluate the effect and tolerance of oral mineralocorticoid antagonists, eplerenone and/or spironolactone, in recalcitrant central serous chorioretinopathy.
  
  
  METHODS
  Retrospective consecutive observational case series. Primary outcome measures included central macular thickness (CMT, μm), macular volume (MV, mm(3)), Snellen visual acuity, and prior treatment failures. Secondary outcomes included duration of treatment, treatment dosage, and systemic side effects.
  
  
  RESULTS
  A total of 120 patients with central serous chorioretinopathy were reviewed, of which 29 patients were treated with one or more mineralocorticoid antagonists. The average age of patients was 58.4 years. Sixteen patients (69.6%) were recalcitrant to other interventions prior to treatment with oral mineralocorticoid antagonists, with an average washout period of 15.3 months. The average duration of mineralocorticoid antagonist treatment was 3.9±2.3 months. Twelve patients (52.2%) showed decreased CMT and MV, six patients (26.1%) had increase in both, and five patients (21.7%) had negligible changes. The mean decrease in CMT of all patients was 42.4 μm (range, -136 to 255 μm): 100.7 μm among treatment-naïve patients, and 16.9 μm among recalcitrant patients. The mean decrease in MV of all patients was 0.20 mm(3) (range, -2.33 to 2.90 mm(3)): 0.6 mm(3) among treatment-naïve patients, and 0.0 mm(3) among recalcitrant patients. Median visual acuity at the start of therapy was 20/30 (range, 20/20-20/250), and at final follow-up it was 20/40 (range, 20/20-20/125). Nine patients (39.1%) experienced systemic side effects, of which three patients (13.0%) were unable to continue therapy.
  
  
  CONCLUSIONS
  Mineralocorticoid antagonist treatment had a positive treatment effect in half of our patients. The decrease in CMT and MV was much less in the recalcitrant group compared to the treatment-naïve group. An improvement in vision was seen only in the treatment-naïve group. Systemic side effects, even at low doses, may limit its usage in some patients.
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: Eric K
authors: EK
authors: Chin
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: David Rp
authors: DR
authors: Almeida
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: C Nathaniel
authors: CN
authors: Roybal
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: Philip I
authors: PI
authors: Niles
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: Karen M
authors: KM
authors: Gehrs
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: Elliott H
authors: EH
authors: Sohn
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: H Culver
authors: HC
authors: Boldt
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: Stephen R
authors: SR
authors: Russell
authors: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors: James C
authors: JC
authors: Folk
keywords: central macular thickness; central serous chorioretinopathy; corticosteroids; eplerenone; macular volume; mineralocorticoid antagonist; spironolactone