This is the first prospective, randomized, placebo-controlled study to assess the anatomic and functional effects of oral eplerenone therapy in patients with chronic central serous chorioretinopathy (CSR).

Study design

Chronic CSR was defined as patients with persistent symptoms, subfoveal fluid on OCT, and less than 50% reduction in fluid thickness 3 months after the initial diagnosis. Patients were randomized 2:1 into a treatment or placebo group. The treatment arm received 25 mg/day of eplerenone for 1 week followed by 50 mg/day for 8 weeks, while placebo was taken once daily. Fifteen patients completed the study, of which 10 patients (15 eyes) were in the eplerenone group, and 5 (6 eyes) were in the placebo group.

Outcomes

After 9 weeks of eplerenone, vision improved from 0.394 to 0.330 logMAR (P=0.04). The eplerenone group also showed improvements in average maximal subretinal fluid height (139.3 μm vs 51.8 μm), subfoveal fluid height (121.4 μm vs 29.4 μm), and central subfield thickness (366.2 μm vs 283.7 μm).

In the placebo group, vision remain unchanged from baseline (0.313 to 0.342 logMAR; P=0.21) and all anatomic changes, on average, worsened. There were no serious adverse events in either group.

Limitations

Due to the small number of patients, there is an increased chance of bias and random effects. The investigators did not know the optimal eplerenone dosage for this cohort and administered the drug for a relatively short interval.

Clinical significance

Chronic CSR is a difficult disease to treat. These early findings suggest eplerenone might be a safe and effective treatment for this condition. Future studies in larger populations are necessary to determine appropriate doses and treatment intervals.