Oral spironolactone offers an alternative for chronic CSR

Investigators retrospectively compared visual and anatomical outcomes among chronic central serous chorioretinopathy (CSR) patients treated with oral spironolactone or half-dose photodynamic therapy (PDT).

Study design

The analysis comprised 50 patients with nonresolving CSR; 26 were treated with oral spironolactone (25 mg, twice daily) and 24 underwent half-dose PDT. Spironolactone was discontinued once subretinal fluid was resolved. Baseline characteristics, including age, duration of symptoms, visual acuity, central subfield thickness, subretinal fluid height and subfoveal choroidal thickness were similar between groups.

Outcomes

Over 12 months of follow-up, both groups showed significant and comparable improvements in mean visual acuity and subretinal fluid height. Central subfield thickness was significantly lower in the PDT group, however. Recurrence rate over 12 months was higher in spironolactone group compared with the PDT group.

Limitations

This was a retrospective chart review, which could have led to selection bias though baseline characteristics were well-matched between groups. The small sample size is an important limitation. While there were no major side effects from oral spironolactone, some patients may have discontinued the drug and were subsequently excluded from this review.

Clinical significance

Through 1 year of follow-up, oral spironolactone appears to be comparable to half-dose PDT. This study supports aldosterone antagonist use (similar to eplerenone) for chronic CSR. For patients with this condition who want to avoid PDT, this may be a reasonable option. However, patients using oral spironolactone may need close monitoring for recurrence.