title: Mineralocorticoid Antagonists in the Treatment of Central Serous Chorioretinopathy: A Comparative Analysis.
abstract: OBJECTIVE
  Overaction of mineralocorticoid receptor (MR) pathways has been implicated in the pathophysiology of central serous chorioretinopathy (CSCR). The purpose of this study was to evaluate MR antagonists in the treatment of CSCR.
  
  
  METHODS
  A retrospective chart review was conducted of all CSCR patients at one center treated with spironolactone or eplerenone (50 mg p.o. b.i.d.) or observation. Patients were followed at monthly intervals with examination and optical coherence tomography.
  
  
  RESULTS
  32 patients (12 eplerenone, 12 spironolactone, 8 observation) were enrolled in the study. Both MR antagonists demonstrated statistically significant visual acuity improvement and subretinal fluid reduction at 1, 2, and 3 months compared to baseline (p < 0.05). 58.3% of patients had complete resolution of subretinal fluid at 2 months on MR antagonists, compared to 12.5% under observation (p < 0.05). Photodynamic therapy was used to treat refractory subretinal fluid past 6 months in 1/24 (4.2%) on MR antagonists and 2/8 (25%) patients under observation. There was no difference in efficacy between eplerenone and spironolactone. Spironolactone exhibited increased side effects (8/12, 75%) compared to eplerenone (3/12, 25%; p < 0.05).
  
  
  CONCLUSIONS
  This data supports the use of MR antagonists in CSCR and suggests an accelerated improvement compared to observation. Prospective randomized trials are needed to better elucidate the precise role of MR antagonists in the management of CSCR.
authors.affiliation: Wagner Macula and Retina Center, Virginia Beach, Va., and Eastern Virginia Medical School, Norfolk, Va., USA.
authors.forename: Kapil G
authors.initials: KG
authors.lastname: Kapoor
authors.forename: Alan L
authors.initials: AL
authors.lastname: Wagner
mesh_terms: D000284:Administration, Oral; D000328:Adult; D056833:Central Serous Chorioretinopathy / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D000077545:Eplerenone; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012189:Retrospective Studies; D013148:Spironolactone / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone