title: Clinical experience with eplerenone to treat chronic central serous chorioretinopathy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Bertan
authors.initials: B
authors.lastname: Cakir
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Fischer
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ehlken
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Anima
authors.initials: A
authors.lastname: Bühler
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stahl
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Schlunck
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Böhringer
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Hansjürgen
authors.initials: H
authors.lastname: Agostini
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany. clemens.lange@uniklinik-freiburg.de.
authors.forename: Clemens
authors.initials: C
authors.lastname: Lange
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056833:Central Serous Chorioretinopathy / Q000175:diagnosis / Q000188:drug therapy*; D002908:Chronic Disease; 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; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D013148:Spironolactone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone
keywords: Central macular thickness; Central serous chorioretinopathy; Eplerenone; Mineralocorticoid antagonist; Subretinal fluid