Effects of Ketoconazole On Clinical Recovery In Central Serous Chorioretinopathy

2021 ◽  
Author(s):  
Yodpong Chantarasorn ◽  
Kochapong Rasmidatta ◽  
Itsara Pokawattana ◽  
Sukhum Silpa-archa
Keyword(s):  
Treatment Group ◽  
Central Serous Chorioretinopathy ◽  
Choroidal Thickness ◽  
Rescue Therapy ◽  
Subretinal Fluid ◽  
Urinary Free Cortisol ◽  
Control Group ◽  
Time Interval ◽  
Day Range ◽  
Free Cortisol

Abstract Background: Hypercortisolism has long been correlated with choroidal vasorelaxation in central serous chorioretinopathy (CSCR). This may explain the inconsistency of therapeutic responses of the mineralocorticoid receptor (MR) antagonist since hyperaldosteronism has rarely been detected in such cases. Hence, an early treatment using ketoconazole, the first line cortisol inhibitor that also blocks the MR ligand, appears to be rational. This study aimed to evaluate the effects of ketoconazole on CSCR, and to analyze correlations between choroidal thickness and steroid hormones.Method: In this three-center retrospective cohort, forty-one naïve CSCR eyes of 41 patients were categorized into control (20 eyes) and treatment group (21 eyes). Patients in the treatment group were given oral ketoconazole at a daily dose of 400 or 600 mg for three to six weeks. At week 12, rescue laser therapy was applied to patients exhibiting persistent subretinal fluid (SRF). We performed a survival analysis to determine the time interval from presentation to clinical resolution of SRF. The secondary outcomes consisted of proportion of eyes with persistent SRF, and factors affecting therapeutic response.Results: Mean 24-hour urinary free cortisol (UFC) were elevated at 181 ± 70 and 150 ± 68 µg/day (range = 20-150) in the treatment and control group (p = 0.21). After controlling for age and gender, baseline UFC levels demonstrated a positive correlation with choroidal thickness in both eyes (p < 0.05). Ketoconazole significantly accelerated the resolution of CSCR with the median time to resolution of 7 versus 16 weeks (p < 0.01), and reduced the proportion of eyes receiving rescue therapy at 12 weeks (23.8% versus 50%, p = 0.01). Prolonged CSCR durations were likely found in elderly patients who had thick choroid in fellow eyes.Conclusions: Elevated glucocorticoids are likely responsible for the pathogenesis of CSCR. Therefore, a temporary decrease in choroidal hyperpermeability using the cortisol blocker could reduce the persistency of CSCR.

scholarly journals Oral Eplerenone Versus Observation in the Management of Acute Central Serous Chorioretinopathy: A Prospective, Randomized Comparative Study

2020 ◽  
Vol 13 (8) ◽  
pp. 170
Author(s):  
Ramesh Venkatesh ◽  
Arpitha Pereira ◽  
Chaitra Jayadev ◽  
Vishma Prabhu ◽  
Aditya Aseem ◽  
...  
Keyword(s):  
Treatment Group ◽  
Central Serous Chorioretinopathy ◽  
Subretinal Fluid ◽  
Control Group ◽  
Symptom Duration ◽  
Imaging Features ◽  
Observation Group ◽  
Fellow Eye ◽  
Beneficial Effects ◽  
Acute Central Serous Chorioretinopathy

In this prospective, interventional case-control study, 58 patients with unilateral acute central serous chorioretinopathy (CSCR) were recruited. Patients ≥ 18 years age, presenting with first episodes of acute CSCR, were included. Acute CSCR was defined by the presence of subretinal fluid (SRF) and symptoms for <12 weeks duration with no clinical or imaging features of chronicity. Patients were alternately divided into treatment (Table Eplerenone 50 mg/day for minimum 1 month) and observation groups. Vision, SRF height and subfoveal choroidal thickness (SFCT) were checked at 1-, 2- and 3-months in both eyes of each group. Each group had 29 eyes. Mean age was 40.4 ± 7.1 and 43.3 ± 8.34 years in treatment and observation group, respectively. Mean symptom duration was 6.46 ± 1.45 and 5.87 ± 2.09 weeks, respectively. Vision improvement to 6/6 was seen in 92%, 100% and 100% cases in treatment group and 74%, 86% and 100% in control group at each visit, respectively. Complete SRF resolution in the treatment group was noted in 45%, 55% and 62% cases at each respective monthly visit. In the observation group, complete SRF resolution was noted in 10%, 21% and 31% at 1-, 2- and 3-month visits, respectively. SRF (p < 0.001) and SFCT (p < 0.001) reduction was noted in the affected eye of both groups. SFCT was reduced in the fellow eye after treatment (p = 0.005) compared to the observation group (p = 0.276). In conclusion, oral eplerenone achieves faster SRF resolution and vision improvement in acute CSCR. Additionally, it shows beneficial effects on the fellow eye.

scholarly journals Spironolactone versus observation in the treatment of acute central serous chorioretinopathy

2017 ◽  
Vol 102 (8) ◽  
pp. 1060-1065 ◽  
Author(s):  
Xinghong Sun ◽  
Yuanlu Shuai ◽  
Wangyi Fang ◽  
Jia Li ◽  
Weizhong Ge ◽  
...  
Keyword(s):  
Treatment Group ◽  
Central Serous Chorioretinopathy ◽  
Complete Resolution ◽  
Subretinal Fluid ◽  
Control Group ◽  
Significant Difference ◽  
Registration Number ◽  
Acute Central Serous Chorioretinopathy ◽  
The Mean ◽  
Randomised Controlled

PurposeTo evaluate the efficacy of oral spironolactone in patients with acute central serous chorioretinopathy (CSC).MethodsThis is a prospective, randomised controlled clinical study. Thirty patients with acute CSC were the participants, including 18 patients who were treated with spironolactone (40 mg orally, twice daily) for 2 months in the experimental group and 12 patients who received observation in the control group. Main outcome measures included the proportion of eyes achieving complete resolution of subretinal fluid (SRF), changes in central macular thickness (CMT), the height of SRF (SRFH), best corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT). The follow-up period was 2 months.ResultsComplete resolution of SRF was achieved in 55.6% (10/18) and 8.3% (1/12) of the eyes in the treatment group and the control group, respectively, at 2 months (p=0.018). The mean CMT and SRFH decreased significantly at each visit in both groups (p<0.05), and there was significant difference between the two groups at 2 months (p<0.05 and p<0.05, respectively). BCVA (in logarithm of the minimum angle of resolution; mean) improved in both groups at 2 months (p<0.05). In the treatment group, the mean baseline SFCT significantly decreased from 502.50±87.38 µm to 427.44±74.37 µm at 2 months (p<0.01), while the change from baseline (from 480.33±102.38 µm to 463.75±100.63 µm) was not significant in the control group (p=0.195). But the differences between the two groups in BCVA and SFCT were not significant.ConclusionsOral spironolactone is more effective with a faster absorption of SRF than observations. It is a promising treatment for acute CSC.Trial registration numberChiCTR-IPR-16008428, Results.

scholarly journals Assessment of Vitamin D Metabolism in Patients with Cushing’s Disease in Response to 150,000 IU Cholecalciferol Treatment

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4329
Author(s):  
Alexandra Povaliaeva ◽  
Viktor Bogdanov ◽  
Ekaterina Pigarova ◽  
Artem Zhukov ◽  
Larisa Dzeranova ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cushing’S Disease ◽  
Serum Vitamin ◽  
Urinary Free Cortisol ◽  
Cushing's Disease ◽  
Control Group ◽  
Vitamin D Metabolites ◽  
Vitamin D Metabolism ◽  
Serum Vitamin D ◽  
Free Cortisol

In this study we aimed to assess vitamin D metabolism in patients with Cushing’s disease (CD) compared to healthy individuals in the setting of bolus cholecalciferol treatment. The study group included 30 adults with active CD and the control group included 30 apparently healthy adults with similar age, sex and BMI. All participants received a single dose (150,000 IU) of cholecalciferol aqueous solution orally. Laboratory assessments including serum vitamin D metabolites (25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 3-epi-25(OH)D3 and 24,25(OH)2D3), free 25(OH)D, vitamin D-binding protein (DBP) and parathyroid hormone (PTH) as well as serum and urine biochemical parameters were performed before the intake and on Days 1, 3 and 7 after the administration. All data were analyzed with non-parametric statistics. Patients with CD had similar to healthy controls 25(OH)D3 levels (p > 0.05) and higher 25(OH)D3/24,25(OH)2D3 ratios (p < 0.05) throughout the study. They also had lower baseline free 25(OH)D levels (p < 0.05) despite similar DBP levels (p > 0.05) and lower albumin levels (p < 0.05); 24-h urinary free cortisol showed significant correlation with baseline 25(OH)D3/24,25(OH)2D3 ratio (r = 0.36, p < 0.05). The increase in 25(OH)D3 after cholecalciferol intake was similar in obese and non-obese states and lacked correlation with BMI (p > 0.05) among patients with CD, as opposed to the control group. Overall, patients with CD have a consistently lower 25(OH)D3/24,25(OH)2D3 ratio, which is indicative of a decrease in 24-hydroxylase activity. This altered activity of the principal vitamin D catabolism might influence the effectiveness of cholecalciferol treatment. The observed difference in baseline free 25(OH)D levels is not entirely clear and requires further study.

scholarly journals Evaluation of acute central serous chorioretinopathy using enhanced depth imaging OCT and multifocal electroretinography

2020 ◽  
Author(s):  
In Hwan Hong ◽  
In Boem Chang ◽  
Jae Ryong Han
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Choroidal Thickness ◽  
Serous Retinal Detachment ◽  
Subretinal Fluid ◽  
Multifocal Electroretinography ◽  
Enhanced Depth Imaging ◽  
Implicit Time ◽  
Depth Imaging ◽  
Acute Central Serous Chorioretinopathy ◽  
Normal Controls

Abstract Background To evaluate the functional and structural abnormalities in patients with acute central serous chorioretinopathy (CSC) by multifocal electroretinography (mfERG) and enhanced depth imaging optical coherence tomography (EDI-OCT) Methods This prospective observational study included 57 patients with unilateral CSC. Both eyes underwent mfERG and EDI-OCT. Peak amplitudes and implicit times of the first kernel responses were analyzed and compared with those in 25 age-matched normal controls. Correlational analyses were performed between the mfERG results and EDI-OCT parameters. The thicknesses of the central retina, subretinal fluid, and choroid was measured at baseline and 3 months later. Results Compared with the normal controls, the amplitude and implicit time on mfERG were significantly impaired in the area with serous retinal detachment (SRD). The P1 amplitude and implicit time of the areas beyond the SRD were also found to be significantly impaired in the affected eyes. Eyes with a greater reduction in SRD had a less impaired mfERG response in fellow eyes than those whose retinal detachments were not spontaneously decreased by more than 90% after 3 months. Correlational analysis did not reveal any significant correlations between mfERG values and OCT parameters except for central choroidal thickness. The subfoveal choroidal thickness was negatively correlated with the mfERG parameters. Conclusion The findings of this study indicate diffuse functional impairment in acute CSC which involves both eyes and areas beyond the SRD. The retinal response of the unaffected eye was associated with regression of SRD and functional retinal abnormality is correlated with pathological changes in the choroid.

scholarly journals SUN-305 Hair Cortisol Measurement: An Innovative Method for Diagnosis and Follow-Up in Patients with Cushing’s Disease

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Natalia Gabriela Deligiannis ◽  
Soledad Sosa ◽  
Diego Gonzalez ◽  
Carolina Ibar ◽  
Dario Gustavo Jacobsen ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Reference Interval ◽  
Urinary Free Cortisol ◽  
Cushing's Disease ◽  
Control Group ◽  
Hair Cortisol ◽  
Kappa Index ◽  
Free Cortisol ◽  
Pituitary Lesion

Abstract Diagnosis of endogenous Cushing’s syndrome entails corticotropic autonomy, lack of circadian rhythm and/or hypercortisolism, evaluated through 24h urinary free cortisol (UFC). Hair cortisol measurement (HCM) has been described as an alternative marker of cortisol exposure over the preceding three months. OBJECTIVES To evaluate HCM in Cushing’s disease (CD). To analyze the correlation between HCM and UFC. To compare HCM values in CD vs controls. PATIENTS AND METHODS 3 cm hair from posterior vertex in CD and in controls age- and gender-matched between May 2017 and May 2019. Controls were low level stressed individuals (Holmes-Rahe’s scale) without adrenal disease. Normal reference interval of HCM was defined (40-128 pg/mg hair). Measurement: Siemens Immulite 2000 (Gwynedd, UK) automated chemoluminiscent immunoassay (CLIA) UFC values within the 3 months previous to hair collection were considered. Controlled CD defined as UFC ≤1 upper normal limit (UNL) with or without treatment, remission as UFC ≤1 without pituitary lesion. Results are presented as median (m) and range. Kruskal-Wallis ANOVA used for median difference evaluation and Kappa index for concordance determination. Chi2 test for comparison of recategorized UFC and HCM. Statistical analysis performed with SPSS 23.0 RESULTS 23 CD patients recruited, median age 42 ± 11 years; 91% (n=21) female; 10 samples collected at diagnosis and 13 during follow-up. Control group composed of 50 individuals 45% (n=10) had controlled CD (mUFC 0.42 UNL, range 0.1-0.9) and a mHCM of 134.5 pg/mg (62-334) and 55% (n=12) did not have control (mUFC 2.2, 1.1-6) and a mHCM of 150.5 (75-459). After recategorization of UFC (&gt; o ≤ 1 UNL) and HCM (&gt; o ≤ 128 pg/mg), determinations were associated (Chi2, p= 0.18), however, the concordance was acceptable (Kappa index = 0.276). After dividing CD patients according to HCM, 35% (n=8) had normal HCM: mHCM 113.5 (62-126) and mUFC 0.45 (0.1- 4.4). Among them, 63% (n=5) had controlled CD (mHCM 110, 62-121; mUFC 0.39, 0.1-0.85); 25% (n=2) had active CD (mUFC 2.7, 1.1-4.4; mHCM 121, 75-126). 65% had high HCM (n=15): mHCM 167 (132-459) and mUFC 1.36 (0.1-6). Most of them had active CD (n=11, 73%): mHCM 160 (132-459) and mUFC 2.2 (1.1-6). Four patients with elevated HCM (m 248, 148-334) had normal UFC (m 0.61, 0.12-0.92): 2 were in remission, 1 had normal postsurgical UFC with active disease in the follow-up and 1 had normal UFC under medical treatment. Controls (n=50) had mHCM 62.5 (40-126), significantly different from CD. CONCLUSIONS We evaluated HCM in CD, proposing this method as an additional diagnostic test for hypercortisolism. The acceptable concordance between UFC and HCM is possibly due to the different duration of the evaluated periods. The difference in the HCM values observed between controlled or active CD patients and controls permits the consideration of the method as an alternative in the diagnosis and/or follow-up of CD.

Long-term outcomes of half-fluence photodynamic therapy and eplerenone in chronic central serous chorioretinopathy: A comparative study

2021 ◽  
pp. 112067212199105
Author(s):  
George Manayath ◽  
Shishir Verghese ◽  
Ratnesh Ranjan ◽  
Hitesh Agrawal ◽  
Amishi Khanna ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Comparative Study ◽  
Central Serous Chorioretinopathy ◽  
Choroidal Thickness ◽  
Subretinal Fluid ◽  
Long Term Outcomes ◽  
Chronic Central Serous Chorioretinopathy ◽  
Intergroup Comparison ◽  
Significant Difference

Aims: To compare the long-term outcomes in chronic central serous chorioretinopathy (cCSC) following half-fluence photodynamic therapy (HF-PDT) and oral eplerenone treatment. Methods: This retrospective comparative study included consecutive patients of cCSC treated with either HF-PDT or eplerenone. The treatment outcomes of the two groups were analyzed at 3-month, 6-month, and 12-month post-treatment. Results: This study included 20 eyes (20 patients) in HF-PDT group, and 18 eyes (18 patients) in eplerenone group. All baseline parameters in HF-PDT and eplerenone groups were comparable including neurosensory detachment height (217.05 ± 140.25 µm vs 178.05 ± 164.24 µm respectively, p = 0.09), best-corrected visual acuity (BCVA) (logMAR 0.24 ± 0.13 vs logMAR 0.46 ± 0.37 respectively, p = 0.1), and subfoveal choroidal thickness (SFCT) [427.4 ± 117.4 µm vs 456.38 ± 119.25 µm respectively, p = 0.45]. HF-PDT resulted in complete resolution of neurosensory detachment in higher proportion of eyes compared to eplerenone at each follow-up visits (3 months: 90% vs 27.7%, p = 0; 6 months: 100% vs 61.1%, p = 0.003; and 12 months: 100% vs 70%, p = 0.03) with a significantly shorter duration to resolution (3.3 ± 0.9 months vs 5.8 ± 3.3 months respectively, p = 0.02). Intergroup comparison showed no significant difference between mean BCVA ( p = 0.38 at 3 months, p = 0.14 at 6 months, and p = 0.19 at 12 months). Mean SFCT at 12 months of the two groups differed significantly ( p = 0.003) due to increased choroidal thickness of eplerenone group. Conclusion: HF-PDT has a superior efficacy to achieve faster, greater and long-lasting resolution of subretinal fluid in cCSC compared to eplerenone therapy.

scholarly journals Subthreshold laser therapy with a standardized macular treatment pattern in chronic central serous chorioretinopathy

2021 ◽  
Author(s):  
Benedikt Schworm ◽  
Jakob Siedlecki ◽  
Leonie F. Keidel ◽  
Tina R. Herold ◽  
Nikolaus Luft ◽  
...  
Keyword(s):  
Laser Treatment ◽  
Central Serous Chorioretinopathy ◽  
Choroidal Thickness ◽  
Subretinal Fluid ◽  
Symptom Duration ◽  
Macular Function ◽  
Chronic Central Serous Chorioretinopathy ◽  
Subfoveal Choroidal Thickness ◽  
Laser Treatments ◽  
Subthreshold Laser

Abstract Purpose There is an ongoing controversial debate about the effectiveness of laser treatments in chronic central serous chorioretinopathy (cCSC). We performed a prospective non-randomized interventional study to learn about the effects of a subthreshold laser treatment (Topcon Endpoint Management™, Topcon Healthcare Inc., Tokyo, Japan) in patients with cCSC. Methods Patients with cCSC and a minimum symptom duration of 4 months were included and treated with a standardized laser pattern covering the macular area. Retreatment was performed every 3 months if persistent subretinal fluid was observed. The primary endpoint was resolution of subretinal fluid at 6 months. Further outcome parameters included best corrected visual acuity, microperimetry, central macular and subfoveal choroidal thickness. Results A total of 42 eyes of 39 patients were included. Mean patient age was 48 ± 10.6 years (range 25–67). Mean symptomatic time before inclusion into the study was 134 ± 133.4 weeks (16–518). Before inclusion, 78.6% of the patients had failed to resolve subretinal fluid under mineralocorticoid receptor antagonists and 14.3% had a recurrence after half-dose photodynamic therapy. Complete resolution of subretinal fluid was observed in 42.9% at 6 months and in 53.8% at 12 months after baseline. Central retinal thickness decreased from 398 ± 135 µm to 291 ± 68 µm (p < 0.001), subfoveal choroidal thickness changed slightly (430 ± 116 µm to 419 ± 113 µm, p = 0.026), microperimetry-derived macular function improved by 19.1 ± 4.7 dB to 21.3 ± 4.8 dB (p = 0.008) and mean BCVA improved by 4.9 ± 8.6 ETDRS letters (p < 0.001). Conclusion The results show that the investigated laser treatment is effective in reducing subretinal fluid and leads to an improvement of functional parameters.

scholarly journals The Effect of Selective Retina Therapy with Automatic Real-Time Feedback-Controlled Dosimetry for Chronic Central Serous Chorioretinopathy: A Randomized, Open-Label, Controlled Clinical Trial

2021 ◽  
Vol 10 (19) ◽  
pp. 4295
Author(s):  
Ji-young Lee ◽  
Min-hee Kim ◽  
Seung-hee Jeon ◽  
Seung-hoon Lee ◽  
Young-jung Roh
Keyword(s):  
Real Time ◽  
Central Serous Chorioretinopathy ◽  
Controlled Trial ◽  
Subretinal Fluid ◽  
Post Treatment ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Chronic Central Serous Chorioretinopathy ◽  
Selective Retina Therapy

This prospective randomized controlled trial evaluated the safety and efficacy of real-time feedback-controlled dosimetry (RFD)-guided selective retina therapy (SRT) in chronic central serous chorioretinopathy (CSC). Forty-four participants with chronic CSC were included and randomly assigned to the control group or SRT group. The SRT laser system with RFD-guidance was applied to cover the entire leakage area. If SRF remained at the 6-week follow-up visit, re-treatment and rescue SRT was performed for the SRT group and crossover group, respectively. The rate of complete resolution of subretinal fluid (SRF), mean SRF height, and mean retinal sensitivity were compared between the two groups at 6-weeks post-treatment. The complete SRF resolution rate in all SRT-treated eyes was evaluated at 12-weeks post-treatment. The rate of complete SRF resolution was significantly higher in the SRT group (63.6%) than in the control group (23.8%) at 6-weeks post-treatment (p = 0.020). The mean SRF height at 6 weeks after SRT was significantly lower in the SRT group (p = 0.041). Overall, SRT-treated eyes showed complete SRF resolution in 70.3% of eyes at 12-weeks post-treatment. RFD-guided SRT was safe and effective to remove SRF in chronic CSC patients during the 3-month follow-up period.

Serum Visfatin does not seem to be a Useful Marker to Guide Glucocorticoid Substitution in Adrenal Insufficiency

2020 ◽  
Vol 52 (05) ◽  
pp. 322-328
Author(s):  
Marta Fichna ◽  
Agata Czarnywojtek ◽  
Anna Sowińska ◽  
Maria Gryczyńska ◽  
Paweł Gut ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Elevated Serum ◽  
Urinary Free Cortisol ◽  
Control Group ◽  
Fasting Insulin ◽  
Nicotinamide Phosphoribosyltransferase ◽  
Free Cortisol ◽  
Biochemical Analyses ◽  
Visfatin Level ◽  
Factor Α

AbstractPrimary adrenal insufficiency (Addison’s disease, AD) requires lifelong steroid substitution. Excess exogenous glucocorticoids promote abdominal obesity, insulin-glucose imbalance, and hypertension. Reliable markers of the adequate glucocorticoid replacement are lacking. Visfatin is a pro-inflammatory adipokine, with enzymatic activity of nicotinamide phosphoribosyltransferase. It enhances leukocyte function and synthesis of tumour necrosis factor α (TNFα) and interleukin-6 (IL-6). Serum visfatin is elevated in autoimmunity, but also in obesity, insulin resistance, and metabolic syndrome. This study was aimed to investigate whether serum visfatin could guide the glucocorticoid substitution in AD. Biochemical analyses were performed in 96 patients with AD (mean age 43.3±14.9 years) and 91 controls (43.5±12.5 years). Visfatin level was significantly elevated in patients with AD compared to controls (p<0.0001). Higher circulating IL-6 was also detected among subjects with AD (p=0.006). In AD, visfatin level was positively correlated with IL-6 (p=0.014), TNFα (p=0.001), body mass (p=0.015), fasting insulin (p=0.001) and HOMA-IR (p=0.001). No relationship was noticed with daily hydrocortisone (p=0.096) and urinary free cortisol excretion (p=0.499). Only the correlations with IL-6 and fasting insulin survived multiple regression analysis (p=0.049 and p=0.005, respectively). Additionally, positive correlation between visfatin and autoantibodies to 21-hydroxylase was noted (p=0.005). In the control group serum visfatin was correlated with IL-6 (p=0.009) and TNFα (p=0.0002). The current study reveals elevated serum visfatin in autoimmune AD. Visfatin does not seem a useful marker of the glucocorticoid replacement, although it correlates with fasting insulin and pro-inflammatory molecules. Further functional analyses are warranted to elucidate the role of visfatin in autoimmunity.

Two-year follow-up of mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy

2018 ◽  
Vol 103 (8) ◽  
pp. 1184-1189 ◽  
Author(s):  
Marta Zola ◽  
Alejandra Daruich ◽  
Alexandre Matet ◽  
Irmela Mantel ◽  
Francine Behar-Cohen
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Mineralocorticoid Receptor ◽  
Choroidal Thickness ◽  
Treatment Initiation ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Chronic Central Serous Chorioretinopathy ◽  
Mineralocorticoid Receptor Antagonist ◽  
Subfoveal Choroidal Thickness ◽  
Imaging Characteristics

AimsTo evaluate the long-term oral mineralocorticoid receptor antagonist (MRa) treatment in chronic central serous chorioretinopathy (CSC).MethodsPatients with chronic non-resolving CSC (defined as foveal subretinal fluid (SRF) lasting >4 months with retinal pigment epithelium (RPE) alterations) treated with MRa only (eplerenone or spironolactone) for at least 6 months were retrospectively included. Clinical and imaging characteristics were recorded during visits at baseline, 6, 12, 18 and 24 months.ResultsSixteen eyes of 16 patients were included (mean age 53±11 years; 14 men, 2 women). Mean duration of SRF before treatment initiation was 11.2±19.7 months. MRa treatment was administered during 21.0±5.1 months (range, 10–24 months). There was a progressive improvement of visual acuity (p=0.05), a decrease of foveal SRF height (p=0.011), central macular thickness (p=0.004) and subfoveal choroidal thickness (p=0.002) over 24 months. Changes in SRF were correlated with subfoveal choroidal thickness at 24 months (p=0.006, Spearman r=065). The mean time to complete foveal SRF resolution was 10.5±8.0 months after treatment initiation. At 24 months, foveal SRF resolution was achieved in 13 eyes (81%). Minor side effects occurred in five patients (31%) and resolved after switching between MRa.ConclusionThe visual and anatomical benefit of MRa treatment prolonged for 6 months or more in chronic, non-resolving CSC appeared to be maintained over a 24-month period. These results suggest that MRa can be proposed as an alternative therapy in severe CSC with advanced RPE alterations.

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