Long-term results and recurrence rates after spironolactone treatment in non-resolving central serous chorio-retinopathy (CSCR)

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 255; no. 2; pp. 221 - 229
• Main Authors: Herold, Tina Rike, Rist, Kristina, Priglinger, Siegfried Georg, Ulbig, Michael Werner, Wolf, Armin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2017; Springer Nature B.V
• Subjects: Central Serous Chorioretinopathy - diagnosis; Central Serous Chorioretinopathy - drug therapy; Choroid - pathology; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mineralocorticoid Receptor Antagonists - administration & dosage; Ophthalmology; Prospective Studies; Recurrence; Retina - pathology; Retinal Disorders; Spironolactone - administration & dosage; Subretinal Fluid - drug effects; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Recurrence; Central serous retinopathy; Spironolactone; Subretinal fluid
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-016-3436-5

Purpose To evaluate the long-term results of spironolactone in non-resolving central serous chorio-retinopathy (CSCR) and recurrence rates of CSCR. Methods Interventional uncontrolled open-label prospective clinical trial of patients with non-resolving CSCR who were treated with spironolactone 50 mg daily (Spironolacton AL® 50 mg, ALIUD PHARMA) for up to 16 weeks. Follow-up visits were performed at 3, 6, 9, and 12 months. Retreatment criteria for recurrence were: gain in sub-retinal fluid (SRF) of more than 25 % plus/or increase of central retinal thickness (CRT) of more than 50 μm plus visual symptoms compared to last visit. Main outcome measures : 12-month efficacy of upload treatment with spironolactone. Secondary outcome measure was the recurrence rate at 6, 9, and 12 months. Results Of the 21 study eyes treated, 71 % ( n  = 15) showed significant improvement or complete regression on OCT examination over 12 months. Nineteen percent of the patients ( n  = 4) showed a stable course from visit 1 to visit 12. The overall reduction of sub-retinal fluid from visit 1 (156 μm ± 131 SD) to visit 12 (53 μm ± 93 SD) was statistically significant ( p  = 0.003). The change of mean visual acuity (log MAR) from 0.25 (± 0.17 SD) at baseline to 0.17 (± 0.18 SD) at visit 12 was statistically significant, with p  = 0.044. Conclusion Our results confirm a positive effect of spironolactone in non-resolving CSCR in 71 % of cases. Evaluation of recurrence rates and retreatments showed good results in patients who responded to spironolactone primarily. A prospective randomized trial may provide better data about this non-invasive treatment.