Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy

Eric K Chin, David RP Almeida, C Nathaniel Roybal, Philip I Niles, Karen M Gehrs, Elliott H Sohn, H Culver Boldt, Stephen R Russell, James C FolkDepartment of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USAPurpose: To evaluate the effect and tolerance of oral mineralocortic...

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Autores principales:	Chin EK, Almeida DRP, Roybal CN, Niles PI, Gehrs KM, Sohn EH, Boldt HC, Russell SR, Folk JC
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/355b2c0c1c464815846bbeeb8c857349
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spelling	oai:doaj.org-article:355b2c0c1c464815846bbeeb8c8573492021-12-02T05:50:51ZOral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy1177-5483https://doaj.org/article/355b2c0c1c464815846bbeeb8c8573492015-08-01T00:00:00Zhttp://www.dovepress.com/oral-mineralocorticoid-antagonists-for-recalcitrant-central-serous-cho-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Eric K Chin, David RP Almeida, C Nathaniel Roybal, Philip I Niles, Karen M Gehrs, Elliott H Sohn, H Culver Boldt, Stephen R Russell, James C FolkDepartment of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USAPurpose: To evaluate the effect and tolerance of oral mineralocorticoid antagonists, eplerenone and/or spironolactone, in recalcitrant central serous chorioretinopathy.Methods: Retrospective consecutive observational case series. Primary outcome measures included central macular thickness (CMT, µm), macular volume (MV, mm3), Snellen visual acuity, and prior treatment failures. Secondary outcomes included duration of treatment, treatment dosage, and systemic side effects.Results: A total of 120 patients with central serous chorioretinopathy were reviewed, of which 29 patients were treated with one or more mineralocorticoid antagonists. The average age of patients was 58.4 years. Sixteen patients (69.6%) were recalcitrant to other interventions prior to treatment with oral mineralocorticoid antagonists, with an average washout period of 15.3 months. The average duration of mineralocorticoid antagonist treatment was 3.9±2.3 months. Twelve patients (52.2%) showed decreased CMT and MV, six patients (26.1%) had increase in both, and five patients (21.7%) had negligible changes. The mean decrease in CMT of all patients was 42.4 µm (range, -136 to 255 µm): 100.7 µm among treatment-naïve patients, and 16.9 µm among recalcitrant patients. The mean decrease in MV of all patients was 0.20 mm3 (range, -2.33 to 2.90 mm3): 0.6 mm3 among treatment-naïve patients, and 0.0 mm3 among recalcitrant patients. Median visual acuity at the start of therapy was 20/30 (range, 20/20–20/250), and at final follow-up it was 20/40 (range, 20/20–20/125). Nine patients (39.1%) experienced systemic side effects, of which three patients (13.0%) were unable to continue therapy.Conclusion: Mineralocorticoid antagonist treatment had a positive treatment effect in half of our patients. The decrease in CMT and MV was much less in the recalcitrant group compared to the treatment-naïve group. An improvement in vision was seen only in the treatment-naïve group. Systemic side effects, even at low doses, may limit its usage in some patients.Keywords: central serous chorioretinopathy, mineralocorticoid antagonist, eplerenone, spironolactone, corticosteroids, central macular thickness, macular volumeChin EKAlmeida DRPRoybal CNNiles PIGehrs KMSohn EHBoldt HCRussell SRFolk JCDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2015, Iss default, Pp 1449-1456 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Chin EK Almeida DRP Roybal CN Niles PI Gehrs KM Sohn EH Boldt HC Russell SR Folk JC Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy
description	Eric K Chin, David RP Almeida, C Nathaniel Roybal, Philip I Niles, Karen M Gehrs, Elliott H Sohn, H Culver Boldt, Stephen R Russell, James C FolkDepartment of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USAPurpose: To evaluate the effect and tolerance of oral mineralocorticoid antagonists, eplerenone and/or spironolactone, in recalcitrant central serous chorioretinopathy.Methods: Retrospective consecutive observational case series. Primary outcome measures included central macular thickness (CMT, µm), macular volume (MV, mm3), Snellen visual acuity, and prior treatment failures. Secondary outcomes included duration of treatment, treatment dosage, and systemic side effects.Results: A total of 120 patients with central serous chorioretinopathy were reviewed, of which 29 patients were treated with one or more mineralocorticoid antagonists. The average age of patients was 58.4 years. Sixteen patients (69.6%) were recalcitrant to other interventions prior to treatment with oral mineralocorticoid antagonists, with an average washout period of 15.3 months. The average duration of mineralocorticoid antagonist treatment was 3.9±2.3 months. Twelve patients (52.2%) showed decreased CMT and MV, six patients (26.1%) had increase in both, and five patients (21.7%) had negligible changes. The mean decrease in CMT of all patients was 42.4 µm (range, -136 to 255 µm): 100.7 µm among treatment-naïve patients, and 16.9 µm among recalcitrant patients. The mean decrease in MV of all patients was 0.20 mm3 (range, -2.33 to 2.90 mm3): 0.6 mm3 among treatment-naïve patients, and 0.0 mm3 among recalcitrant patients. Median visual acuity at the start of therapy was 20/30 (range, 20/20–20/250), and at final follow-up it was 20/40 (range, 20/20–20/125). Nine patients (39.1%) experienced systemic side effects, of which three patients (13.0%) were unable to continue therapy.Conclusion: Mineralocorticoid antagonist treatment had a positive treatment effect in half of our patients. The decrease in CMT and MV was much less in the recalcitrant group compared to the treatment-naïve group. An improvement in vision was seen only in the treatment-naïve group. Systemic side effects, even at low doses, may limit its usage in some patients.Keywords: central serous chorioretinopathy, mineralocorticoid antagonist, eplerenone, spironolactone, corticosteroids, central macular thickness, macular volume
format	article
author	Chin EK Almeida DRP Roybal CN Niles PI Gehrs KM Sohn EH Boldt HC Russell SR Folk JC
author_facet	Chin EK Almeida DRP Roybal CN Niles PI Gehrs KM Sohn EH Boldt HC Russell SR Folk JC
author_sort	Chin EK
title	Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy
title_short	Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy
title_full	Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy
title_fullStr	Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy
title_full_unstemmed	Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy
title_sort	oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/355b2c0c1c464815846bbeeb8c857349
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Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy

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