title: Oral Mineralocorticoid-Receptor Antagonists: Real-Life Experience in Clinical Subtypes of Nonresolving Central Serous Chorioretinopathy With Chronic Epitheliopathy.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of oral mineralocorticoid-receptor antagonist (MRa) therapy in three clinical presentations of nonresolving central serous chorioretinopathy (CSCR) with chronic epitheliopathy.
  
  
  METHODS
  Retrospective case series of consecutive patients with nonresolving CSCR treated with oral eplerenone or spironolactone. Treatment criteria were: persistent CSCR with subretinal fluid (SRF) lasting longer than 4 months; recurrent CSCR with SRF lasting longer than 2 months; persistent CSCR (SRF ≥ 4 months) with fundus autofluorescence gravitational tracks. Outcomes at 1, 3, and 6 months were: foveal SRF height, central macular thickness (CMT), subfoveal choroidal thickness (SFCT), best-corrected visual acuity (BCVA), and occurrence of side effects.
  
  
  RESULTS
  Among 54 eyes from 42 patients (mean age: 53 years), mean foveal SRF, CMT, and SFCT decreased significantly at 1, 3, and 6 months after treatment initiation. Mean BCVA improved significantly at 6 months. In the subgroup analysis, mean foveal SRF, CMT, and SFCT decreased significantly at 3 and 6 months in the persistent and recurrent groups. In persistent cases with tracks, a significant diminution of mean CMT and SFCT was achieved at 6 months. Treatment-related side effects were observed in 6 patients, prompting treatment discontinuation in one case.
  
  
  CONCLUSIONS
  Response to treatment was observed in the three subgroups. In persistent CSCR with tracks the response was delayed compared with persistent and recurrent cases, suggesting that longer treatment durations would be beneficial in patients with gravitational tracks of RPE alteration.
  
  
  CONCLUSIONS
  The clinical response to oral MRa is consistent with the involvement of the mineralocorticoid pathway in CSCR pathogenesis.
authors.affiliation: Department of Ophthalmology, University of Lausanne. Jules-Gonin Eye Hospital. Fondation Asile des Aveugles, Avenue de France 15, CP 133 1000 Lausanne 7, Switzerland.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Daruich
authors.affiliation: Department of Ophthalmology, University of Lausanne. Jules-Gonin Eye Hospital. Fondation Asile des Aveugles, Avenue de France 15, CP 133 1000 Lausanne 7, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Matet
authors.affiliation: Department of Ophthalmology, University of Lausanne. Jules-Gonin Eye Hospital. Fondation Asile des Aveugles, Avenue de France 15, CP 133 1000 Lausanne 7, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: Dirani
authors.affiliation: Department of Ophthalmology, University of Lausanne. Jules-Gonin Eye Hospital. Fondation Asile des Aveugles, Avenue de France 15, CP 133 1000 Lausanne 7, Switzerland.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Gallice
authors.affiliation: NIHR Moorfields Biomedical Research Centre, 162 City Road, London EC1V 2PD, United Kingdom.
authors.forename: Luke
authors.initials: L
authors.lastname: Nicholson
authors.affiliation: NIHR Moorfields Biomedical Research Centre, 162 City Road, London EC1V 2PD, United Kingdom.
authors.forename: Sobha
authors.initials: S
authors.lastname: Sivaprasad
authors.affiliation: Department of Ophthalmology, University of Lausanne. Jules-Gonin Eye Hospital. Fondation Asile des Aveugles, Avenue de France 15, CP 133 1000 Lausanne 7, Switzerland ; Sorbonne Universités, UPMC Université Paris 06, UMR 1138, Centre de Recherche des Cordeliers, team 17, 15 rue de l'Ecole de Médecine, 75006, Paris, France ; INSERM, UMR 1138, Centre de Recherche des Cordeliers, 15 rue de l'Ecole de Médecine, 75006, Paris, France ; Université Paris Descartes, Sorbonne Paris Cité, UMR 1138, Centre de Recherche des Cordeliers, 15 rue de l'Ecole de Médecine, 75006, Paris, France.
authors.forename: Francine
authors.initials: F
authors.lastname: Behar-Cohen
keywords: central serous chorioretinopathy; choroid; drug-related side effects and adverse reactions; mineralocorticoid-receptor antagonist; retinal pigment epithelium; spironolactone; treatment, epleronone