Mineralocorticoid receptor antagonists offer an alternative for nonresolving CSC

This retrospective interventional case series examines the benefit of mineralocorticoid receptor antagonists (MRA) in patients with persistent central serous chorioretinopathy (CSC).

Study design

The authors obtained clinical and imaging data from 59 consecutive patients (64 eyes) with nonresolving CSC who were treated with eplerenone or spironolactone for 3 to 6 months.

Outcomes

Forty-three eyes (67%) responded to MRA treatment, among which 38% and 41% had a complete resolution of the foveal subretinal detachment at 3 and 6 months, respectively. No treatment response was observed in 21 eyes (33%). A baseline subfoveal choroidal thickness of greater than 515 microns was the only factor associated with a treatment response in the multivariate analysis.

Limitations

The study's retrospective design and overall small sample size, albeit for a rare and heterogenous disease, limit its applicability. A lack of a placebo control is a major weakness.

Clinical significance

Mineralocorticoid receptor antagonists represent an increasingly useful and fairly well-tolerated option for patients with persistent subretinal fluid in the setting of CSC. Patients with thicker subfoveal choroids at baseline are more likely to experience a treatment response.