SPIRONOLACTONE FOR NONRESOLVING CENTRAL SEROUS CHORIORETINOPATHY

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Abstract

This study is a randomized controlled crossover study evaluating the effect of spironolactone, a mineralocorticoid receptor antagonist for the treatment of nonresolving central serous chorioretinopathy. Spironolactone significantly reduced both serous retinal detachment and choroidal thickness as compared with placebo. Larger clinical trials are needed to confirm these promising results.

Purpose:

To evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, for nonresolving central serous chorioretinopathy.

Methods:

This is a prospective, randomized, double-blinded, placebo-controlled crossover study. Sixteen eyes of 16 patients with central serous chorioretinopathy and persistent subretinal fluid (SRF) for at least 3 months were enrolled. Patients were randomized to receive either spironolactone 50 mg or placebo once a day for 30 days, followed by a washout period of 1 week and then crossed over to either placebo or spironolactone for another 30 days. The primary outcome measure was the changes from baseline in SRF thickness at the apex of the serous retinal detachment. Secondary outcomes included subfoveal choroidal thickness and the ETDRS best-corrected visual acuity.

Results:

The mean duration of central serous chorioretinopathy before enrollment in study eyes was 10 ± 16.9 months. Crossover data analysis showed a statistically significant reduction in SRF in spironolactone treated eyes as compared with the same eyes under placebo ( P = 0.04). Secondary analysis on the first period (Day 0–Day 30) showed a significant reduction in subfoveal choroidal thickness in treated eyes as compared with placebo ( P = 0.02). No significant changes were observed in the best-corrected visual acuity. There were no complications related to treatment observed.

Conclusion:

In eyes with persistent SRF due to central serous chorioretinopathy, spironolactone significantly reduced both the SRF and the subfoveal choroidal thickness as compared with placebo.

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Most cited references 27

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A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes.

Ron Margolis, Richard Spaide (2009)

To measure macular choroidal thickness in normal eyes at different points using enhanced depth imaging (EDI) optical coherence tomography (OCT) and to evaluate the association of choroidal thickness and age. Retrospective, observational case series. EDI OCT images were obtained in patients without significant retinal or choroidal pathologic features. The images were obtained by positioning a spectral-domain OCT device close enough to the eye to acquire an inverted image. Seven sections were obtained within a 5 x 30-degree area centered at the fovea, with 100 scans averaged for each section. The choroid was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 500-microm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Statistical analysis was performed to evaluate variations of choroidal thickness at each location and to correlate choroidal thickness and patient age. The mean age of the 30 patients (54 eyes) was 50.4 years (range, 19 to 85 years), and 14 patients (46.7%) were female. The choroid was thickest underneath the fovea (mean, 287 microm; standard deviation, +/- 76 microm). Choroidal thickness decreased rapidly in the nasal direction and averaged 145 microm (+/- 57 microm) at 3 mm nasal to the fovea. Increasing age was correlated significantly with decreasing choroidal thickness at all points measured. Regression analysis suggested that the subfoveal choroidal thickness decreased by 15.6 microm for each decade of life. Choroidal thickness seems to vary topographically within the posterior pole. The thickness of the choroid showed a negative correlation with age. The decrease in the thickness of the choroid may play a role in the pathophysiologic features of various age-related ocular conditions.

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Pachychoroid pigment epitheliopathy.

David Warrow, Quan Hoang, K. Bailey Freund (2013)

To report nine cases of pachychoroid pigment epitheliopathy. An observational case series of nine patients who underwent comprehensive ophthalmic examination, fundus photography, fundus autofluorescence, spectral-domain optical coherence tomography, and enhanced depth imaging optical coherence tomography. Eighteen eyes of 9 patients, aged 27 years to 89 years, were diagnosed with pachychoroid pigment epitheliopathy based on the characteristic funduscopic appearance of reduced fundus tessellation with overlying retinal pigment epithelial changes in one or both eyes, fundus autofluorescence abnormalities, and increased subfoveal choroidal thickness confirmed by enhanced depth imaging optical coherence tomography (mean, 460.2 μm). The five older patients had been previously diagnosed with age-related macular degeneration, while the four younger subjects were referred for possible inflammatory chorioretinitis, pattern dystrophy, or nonspecific drusen. No subjects had a history of or subsequently developed subretinal fluid. Pachychoroid pigment epitheliopathy falls within a spectrum of diseases associated with choroidal thickening that includes central serous chorioretinopathy and polypoidal choroidal vasculopathy, and it should be suspected in eyes with a characteristic fundus appearance related to choroidal thickening and associated retinal pigment epithelial abnormalities but no history of subretinal fluid. Enhanced depth imaging optical coherence tomography confirming an abnormally thick choroid and characteristic retinal pigment epithelial changes on fundus autofluorescence support the diagnosis. Because these patients are frequently misdiagnosed, the recognition of pachychoroid pigment epitheliopathy may avoid unnecessary diagnostic testing and interventions.

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Central serous chorioretinopathy.

Maria Wang, Inger Munch, Pascal Hasler … (2008)

Central serous chorioretinopathy (CSC) is a disease of the retina characterized by serous detachment of the neurosensory retina secondary to one or more focal lesions of the retinal pigment epithelium (RPE). CSC occurs most frequently in mid-life and more often in men than in women. Major symptoms are blurred vision, usually in one eye only and perceived typically by the patient as a dark spot in the centre of the visual field with associated micropsia and metamorphopsia. Normal vision often recurs spontaneously within a few months. The condition can be precipitated by psychosocial stress and hypercortisolism. Ophthalmoscopic signs of CSC range from mono- or paucifocal RPE lesions with prominent elevation of the neurosensory retina by clear fluid - typical of cases of recent onset - to shallow detachments overlying large patches of irregularly depigmented RPE. The spectrum of lesions includes RPE detachments. Granular or fibrinous material may accumulate in the subretinal cavity. Serous detachment often resolves spontaneously. From first contact, counselling about the potential relation to stress and glucocorticoid medication is warranted. After 3 months without resolution of acute CSC or in chronic CSC, treatment should be considered. Resolution of detachment can usually be achieved in acute CSC by focal photocoagulation of leaking RPE lesions or, in chronic CSC, by photodynamic therapy. The effect of therapy on long-term visual outcome is insufficiently documented. Reattachment within 4 months of onset is considered a relevant therapeutic target because prolonged detachment is associated with photoreceptor atrophy. This suggests that the value of treatment depends upon proper selection of cases that will not resolve without therapy. Chronic CSC may be difficult to differentiate from occult choroidal neovascularization secondary to CSC. Patients with chronic CSC who receive glucocorticoid treatment for systemic disease can often be managed without having to discontinue this medication.

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Author and article information

Journal

Journal ID (nlm-ta): Retina

Journal ID (iso-abbrev): Retina (Philadelphia, Pa.)

Journal ID (publisher-id): retina

Title: Retina (Philadelphia, Pa.)

Publisher: Retina

ISSN (Print): 0275-004X

ISSN (Electronic): 1539-2864

Publication date (Print): December 2015

Publication date (Electronic): 04 December 2015

Volume: 35

Issue: 12

Pages: 2505-2515

Affiliations

[* ]Department of Ophthalmology, Hôtel-Dieu of Paris, Assistance Publique Hôpitaux de Paris, Paris, France, Université Sorbonne Paris Cité;

[† ]Inserm U1138, Team 17, Université Sorbonne Paris Cité, Université Pierre et Marie Curie, Centre de Recherche des Cordeliers, Paris, France;

[‡ ]Department of Ophthalmology, University of Lausanne, Jules Gonin Ophthalmic Hospital, Fondation Asile des aveugles, Switzerland;

[§ ]Department of Pharmacy Hôtel-Dieu of Paris, Assistance Publique Hôpitaux de Paris, Université Sorbonne Paris Cité, Paris, France;

[¶ ]INSERM, U1138, Team 1, Université René Descartes Sorbonne Paris Cité, Université Pierre et Marie Curie Paris, Centre de Recherche des Cordeliers, Paris, France; and

[** ]Department of Ophthalmology, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France.

Author notes

Reprint requests: Francine Behar-Cohen, MD, PhD, INSERM U1138 eq. 17, Centre de Recherche des Cordeliers, 15, rue de l'Ecole de Médecine, 75006 Paris, France; e-mail: francine.behar@ 123456gmail.com

Article

Publisher ID: RETINA214-0731 Accession ID: 00009

DOI: 10.1097/IAE.0000000000000614

PMC ID: 4697359

PubMed ID: 26017871

SO-VID: f69a8e56-7933-4048-a92e-592863e75083

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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Keywords: central serous chorioretinopathy,choroidal thickness,choroidal vessels,mineralocorticoid receptor,spironolactone,treatment

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Keywords: central serous chorioretinopathy, choroidal thickness, choroidal vessels, mineralocorticoid receptor, spironolactone, treatment

SPIRONOLACTONE FOR NONRESOLVING CENTRAL SEROUS CHORIORETINOPATHY : A Randomized Controlled Crossover Study

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Most cited references 27

A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes.

Pachychoroid pigment epitheliopathy.

Central serous chorioretinopathy.

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