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

Abstract

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.

Keywords: acute; central serous chorioretinopathy; contralateral eye; eplerenone.

Figure 1

Changes in subretinal fluid (SRF) height and sub foveal choroidal thickness (SFCT) in both treatment and observation groups. (A–C): Box and whisker plots showing the change in the SRF height and SFCT in the treatment group at baseline, 1-,2- and 3-month visits. (D–F): Box and whisker plots showing the change in the SRF height and SFCT in the observation group at baseline, 1-,2- and 3-month visits.

Figure 2

Changes in the subretinal fluid (SRF) height and sub foveal choroidal thickness (SFCT) of both eyes on optical coherence tomography in the observation group. (A,B): Multicolor and OCT image of the fellow eye at presentation. The SFCT at presentation was 284 µm. (C,D): Multicolor and OCT image of the study eye at presentation showing the SRF. The SFCT at presentation was 374 µm. (E,F): Multicolor and OCT image of the fellow eye at the 3-months final follow-up visit. The SFCT was 277 µm. (G,H): Multicolor and OCT image of the study eye at 3-months final visit showing the complete resolution of the SRF. The SFCT was 253 µm.

Figure 3

Changes in the subretinal fluid (SRF) height and sub foveal choroidal thickness (SFCT) of both eyes on optical coherence tomography in the treatment group. (A,B): Multicolor and OCT image of the study eye at presentation showing the SRF. The SFCT at presentation was 520 µm. (C,D): Multicolor and OCT image of the study eye at 2-month visit showing the complete resolution of the SRF. The SFCT was 349 µm. (E): OCT image of the fellow eye at presentation. The SFCT at presentation was 475 µm. (F): OCT image of the fellow eye at the 2-month final follow-up visit. The SFCT was 333 µm.