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DOI: 10.1055/a-2105-0892
Eplerenone for the Treatment of Chronic Recurrent Chorioretinopathy Centralis Serosa
Article in several languages: deutsch | English
Abstract
Background Chorioretinopathy centralis serosa (CCS) is a common disease that leads to the loss of retinal ion/fluid homeostasis due to decompensation of the retinal pigment epithelium, resulting in fluid accumulation with detachment of the neurosensory retina and/or retinal pigment epithelium. We investigated the effect of eplerenone, a mineralocorticoid receptor inhibitor, on chronic recurrent CCS (cr-CCS).
Methods A retrospective study with data analysis of 17 eyes (12 patients) between 2014 – 2021 with cr-CCS in whom other methods were not effective, not applicable, or not desired, was performed. Duration of CCS was at least 12 months with at least one recurrence. Each patient received 25 mg (1st week) and 50 mg (from the 2nd week) for at least 3 months. In each case, best-corrected visual acuity and central and peripheral retinal thickness were measured by spectral-domain optical coherence tomography. Side effects were rated by the patients as “none”, “mild” (noticeable but not affecting), “tolerable” (affecting but acceptable because of good effect), and “not tolerable” (then discontinuation of therapy).
Results There was no significant reduction in central or peripheral retinal thickness. A complete reduction of subretinal fluid was achieved in 5 of 17 eyes (29.4%). In 12 eyes, no effect of eplerenone could be detected, so other therapies were required. Visual acuity change was mainly dependent on the duration of CCS and the degree of photoreceptor damage. Side effects were reported by 11 patients as “none” and 1 patient as “mild” (arterial hypotension). No other side effects were observed.
Conclusion The response rates of therapy with eplerenone were relatively low, and no significant effect could be demonstrated. Eplerenone should not (no longer) be routinely used in the therapy of cr-CCS.
Bereits bekannt:
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Die Chorioretinopathia centralis serosa (CCS) ist ein relevantes Gesundheitsproblem, das vor allem junge Patienten betrifft.
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Der genaue Pathomechanismus bleibt nach wie vor unklar. In Studien konnte ein Zusammenhang mit der Aktivierung von Mineralokortikoid-Rezeptoren gezeigt werden.
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Es gibt bisher keine uns bekannte Studie, die explizit die Wirkung von Eplerenon auf chronisch rezidivierende Verläufe der CCS untersucht.
Neu beschrieben:
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Bei 30% der betroffenen Augen mit chronisch rezidivierendem Verlauf konnte eine komplette Resorption der subretinalen Flüssigkeit beobachtet werden.
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Eplerenon hatte in unserer Studie keinen signifikanten Efekt auf die Netzhautdicke bei chronisch rezidiverender CCS.
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Der Visus bleibt bei chronisch rezidivierender CCS unter Mineralokortikoiden unverändert.
Already known:
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Central serous chorioretinopathy (CSC) is a relevant health problem that primarily affects young patients.
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The exact pathogenic mechanism remains unclear. Studies have shown an association with the activation of mineralocorticoid receptors.
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To date, there is no study that we know of that explicitly examines the effect of eplerenone on chronic recurrent courses of CSC.
Newly described:
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Complete absorption of the subretinal fluid was observed in 30% of the affected eyes with a chronic recurrent disease course.
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In our study, eplerenone had no significant effect on retinal thickness in chronic recurrent CSC.
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Visual acuity remains unchanged in chronic recurrent CSC treated with mineralocorticoids.
Publication History
Received: 31 January 2023
Accepted: 26 May 2023
Article published online:
05 September 2023
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