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Eplerenone for the treatment of chronic central serous chorioretinopathy: 3-year clinical experience
  1. Daniel S Petkovsek1,
  2. Daniel G Cherfan1,
  3. Felipe F Conti1,2,
  4. Grant L Hom2,
  5. Justin P Ehlers1,
  6. Amy S Babiuch1,
  7. Aleksandra V Rachitskaya1,
  8. Peter K Kaiser1,
  9. Andrew P Schachat1,
  10. Sunil K Srivastava1,
  11. Sumit Sharma3,
  12. Rishi P Singh1
  1. 1Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, USA
  3. 3Department of Retina and Uveitis, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, USA
  1. Correspondence to Dr Rishi P Singh, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio 44195, USA; drrishisingh{at}gmail.com

Abstract

Background/aims The efficacy of mineralocorticoid receptor antagonist eplerenone to treat chronic central serous chorioretinopathy (CSCR) has been established. However, previous studies have been limited by small cohort size and short follow-up duration. This study aims to report 3-year clinical outcomes of patients treated with eplerenone for chronic CSCR.

Methods Institutional review board-approved retrospective chart analysis at a single institution from 2012 to 2018. Baseline best-corrected visual acuity and anatomical measurements related to degree of subretinal fluid (SRF) were collected at eplerenone initiation. Follow-up data were collected at the closest date to 12, 24 and 36 months.

Results Data were obtained for 100 eyes of 83 patients at 1-year (mean 11.18 ± 4.00 months), 49 eyes at 2-year (24.01 ± 3.33 months) and 33 eyes at 3-year (mean 35.5 ± 7.89 months) follow-up visits. The rate of complete SRF resolution was 31%, 28% and 33%, respectively. At final follow-up, logarithm of the minimum angle of resolution visual acuity change from baseline was +0.10 ± 0.24 (p = 0.130). Average change from baseline at final follow-up for central subfield thickness was −97 ± 140.6 µm (p < 0.001), cube volume was –1.07 ± 1.71 mm3 (p < 0.001), macular thickness –28. 5 ± 47.5 µm (p < 0.001), maximum SRF height was −95.6 ± 160.5 µm (p < 0.001) and maximum SRF diameter was −1169.0 ± 1638.7 µm (p = 0.008).

Conclusion Anatomical improvement occurs primarily within the first year of eplerenone treatment for chronic CSCR.

  • retina
  • central serous chorioretinopathy
  • Macular edema
  • Eplerenone
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Footnotes

  • Contributors All authors contributed to intellectual development of study. Design and conduct of the study: DP, DG and RS; collection and management of the data: DP, DG and FC; analysis and interpretation of the data: DP, DG, FC and RS; preparation of the manuscript: DP, GH and RS; and review of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DP, DG, FC and GH: None to Declare. AB reports grants from Regeneron, personal fees from VINDICO, MCME Global, outside the submitted work; AR reports personal fees from Allergan, Alcon, Zeiss, outside the submitted work; AS reports personal fees and other from American Academy of Ophthalmology, outside the submitted work; In addition, AS has a patent Elsevier with royalties paid and may receive possible future payments (none to-date) from Easton Capital. JE reports personal fees from Bioptigen, Leica, Zeiss, Alcon, Santen, grants and personal fees from Thrombogenics, Genentech, grants from Regeneron, outside the submitted work; JE has a patent Bioptigen issued. PK personal fees from Bausch and Lomb, Novartis, Carl Zeiss Meditec, Topcon, Allergan, outside the submitted work. RS reports grants and personal fees from Genentech/Roche, Alcon/Novartis, grants from Apellis, personal fees from Optos, Zeiss, from Biogen, grants and personal fees from Regeneron Pharmaceuticals, Inc., outside the submitted work; SKS reports grants and personal fees from Bausch and Lomb, Leica, Santen, grants and personal fees from Carl Zeiss Meditec, grants from Allergan, outside the submitted work; SKS has a patent Bioptigen and Synergetics issued. SS reports personal fees from Allergan, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The protocol was approved by the Cleveland Clinic Foundation Institutional Review Board and adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on request from the corresponding author.

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