First Author: C.Quijano UK
Co Author(s): S. Younis A. Hamoud E. Yang
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Chronic central serous chorioretinopathy (CSR) is a localized accumulation of subretinal fluid. This can cause visual loss and permanent photoreceptor damage with Retinal Pigment Epithelial (RPE) atrophy. Researches showed that glucocorticoids bind to mineralocorticoid receptors (MR) expressed in retinal cells inducing CSR. Mineralocorticoids control water and potassium homeostasis though water/ion channel exchange. Spironolactone is a pharmacologic antagonist of aldosterone (mineralocorticoid), acting through competitive binding of MR. Currently several interventions proposed as potentially effective for treating chronic CSR but the results are inconclusive. Our research aim to assess the response and safety of spironolactone treatment in patients with chronic CSR.
Western Eye Hospital, Imperial Healthcare NHS Trust, London UK
We performed a retrospective observational review of the clinical notes of 21 patients (24 eyes) diagnosed with chronic CSR that attended the macula clinic. The patients were treated with 50 mg of Spironolactone administrated orally every day during a period of 8 weeks. Inclusion criteria was CSR suffered for minimum 6 months – naïve treatment and loss of vision and subretinal fluid secondary to chronic CSR when the treatment started. The evidence collected from the medical notes included: age, gender, laterality, duration of the CSR, duration of the treatment, best corrected visual acuity (BCVA) pre and post treatment, central macular thickness (CMT) pre and post treatment, blood pressure, blood tests and secondary side effects pre and post treatment. Cirrus HD-OCT scan, fundus autofluorescence and fundus colour photos were taken.
We included a total of 21 patients (n=24 eyes) in our study. The mean age at baseline was 44 years-old. 76% patients were males and 24 were females. The mean duration of the CSR was 10 months (range 6-24 months) before treatment. The BCVA after the treatment improved from 0.39± 0.37 LogMAR to 0.22± 0.22 LogMAR (P<0.002). With regard to the BCVA, 84% of the eyes improved, 8% did not change and 8% have reduction in the VA. The CRT measured by OCT scan improved in 75% of patients by the end of the treatment. The mean CRT changed from 389 ± 122 µm pre- treatment to 298 ± 95 µm post- treatment (P<0.00037). None of the patients presented or developed any secondary or adverse effect after the treatment. One patient was withdrawn of the spironolactone due to secondary effects. The blood pressure of all patients was found in a normal range during the treatment and the blood test results were normal in them all.
Our study showed that mineracorticoid receptor antagonist – Spironolactone is safe and effective treatment for chronic CSR by decreasing the CRT (significantly reducing subretinal fluid) and improving the BCVA, leading to a better visual prognosis and recovery, in addition to the safe profile. The identification of the retina as a mineralo-sensitive tissue raises questions of the potential of these drugs for chronic CSR treatment. Future research with larger samples and longer period of time treatment is required.