First Author: L.Ceklic BOSNIA AND HERZEGOVINA
Co Author(s): S. Latinovic
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Objective: To investigate possible effect of eplerenon 50 mg in serous pigment epithelial detachment (sPED) and subretinal fluid (SF) resolution after initial intravitreal application of 2 mg aflibercept in treatment of neovascular age-related macular degeneration (nAMD).
The over activation of the mineralocorticoid receptor (MR) pathway has been shown to cause fluid accumulation in the retina, choroidal vasodilation, and to promote retinal neovascularization in hypoxic conditions
Case presentation of three females with nAMD and occult choroidal neovascularisation with sPED treated with three consecutive intravitreal injections of 2 mg aflibercept. On control check up 6 weeks after last injection, per oral 50 mg Eplerenon (Inspra) once daily is prescribed. For follow up we used visual acuity, intraocular pressure, Amsler grid test, colour fundus (CF), optical coherence tomography (SD OCT) baseline, 6 weeks after last intravitreal injections, 6 and 8 weeks after initiation of eplerenon as well as potassium serum concentration 6 weeks after initiation of eplerenon therapy.
Morphologic improvement evident in reduction of central macular thickness and height of sPED > 20% followed with stabile visual acuity was registered in patients after 12 weeks after last intravitreal injection on eplerenenon prescription. Age of female patients was 71, 73 and 64. Baseline visual acuity 35 and 25 ETDRS letters after treatment with aflibercept and eplerenon 80 and 75 ETDRS letters after 12 weeks. Mild wave lines on Amsler grid persisted through out the follow up.
Eplerenon given as adjunctive therapy for treatment of sPED in nAMD could have beneficial effect but further more detailed and more controlled clinical investigations are recommended.