Eplerenone for Central Serous Chorioretinopathy: Is There Still Room for This Treatment?

Background/Objectives: The purpose of this study was to evaluate the efficacy and safety of oral eplerenone in patients with acute and chronic central serous chorioretinopathy (CSCR). Methods: In this prospective study, 43 patients with CSCR and subretinal fluid on optical coherence tomography (OCT) at baseline were divided either to oral eplerenone (n = 23) or observation (n = 20). All subjects underwent best-corrected visual acuity (BCVA) measurement, OCT, and fluorescein angiography (FA) at baseline. The changes in BCVA and subretinal resolution (SRF) were examined at 1, 6, and 12 months after the initiation of treatment. Potential adverse events were recorded. Results: At month 6, SRF resolution was observed in 78.3% and 45% of the patients in the eplerenone and control groups, respectively (p = 0.024). However, there was a recurrence of fluid in three patients in the eplerenone group and in four patients in the control group. Therefore, at month 12, 65.2% of the patients in the eplerenone group and 25% in the control group had SRF resolution (p = 0.008). There was a statistically significant improvement in BCVA at 6 months (p < 0.001) and 12 months (p < 0.001) in the eplerenone group, while in the control group, there was an improvement in BCVA at 6 months (p = 0.079) and 12 months (p = 0.259), which did not reach statistical significance. Regarding adverse events, no ocular nor systemic adverse events were reported during the follow-up period, apart from dry mouth in 7 out of 23 patients (30.4%) taking eplerenone. Conclusions: Oral eplerenone was found to be a safe and effective treatment alternative for the management of CSCR in both acute and chronic cases, providing SRF resolution in approximately 65% of patients with significant improvement in visual acuity at the 12th month of follow-up.