Micropulse Laser versus Eplerenone for Chronic Central Serous Chorioretinopathy: A 12-Month Comparison

Abstract

Introduction: To compare the long-term efficacy of navigated subthreshold micropulse laser (NSML) and continuous oral eplerenone (EPL) in chronic central serous chorioretinopathy (cCSC).

Methods: This retrospective observational study included 44 eyes with cCSC (EPL: n = 26; NSML: n = 18). Best-corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF) height, and subfoveal choroidal thickness (SFCT) were evaluated over 12 months.

Results: Both groups showed significant improvements in BCVA and CMT (p < 0.05). Complete SRF resolution was achieved in both groups by 12 months, with NSML showing faster resolution (2.77 ± 1.43 vs. 6.34 ± 2.17 months, p < 0.001). The EPL group demonstrated significant SFCT reduction at 6 and 12 months (p = 0.001), while the NSML group showed no significant SFCT changes (p > 0.05).

Conclusions: Both NSML and EPL improved retinal morphology and visual function in patients with cCSC. NSML achieved faster SRF resolution, while EPL resulted in more significant choroidal thickness reduction. These findings suggest distinct mechanisms of action: NSML primarily affects the retinal pigment epithelium, while EPL modulates choroidal vasculature. Treatment choice may depend on individual patient characteristics and treatment goals.

Keywords: Central serous chorioretinopathy; OCT; Optical coherence tomography; Pachychoroid; Subfoveal choroidal thickness.

Fig. 1

The changes in subfoveal choroidal thickness (SFCT) in both groups. In the case of patients with chronic central serous chorioretinopathy (cCSC) treated with navigated subthreshold microsecond pulse laser (NSML), no significant reduction in SFCT was observed at the 6-month or 1-year follow-up (A). On the other hand, patients with cCSC treated with continuous EPL (50 mg/daily) showed a significant decrease in SFCT at 6 months, and this reduction continued even further at 12 months (B)