Oral eplerenone in first-episode acute central serous chorioretinopathy: results of a double-masked randomized trial.

BACKGROUND

Central serous chorioretinopathy (CSCR) is a pachychoroid disorder characterized by serous retinal detachment driven by choroidal vascular dysfunction and mineralocorticoid receptor (MR) overactivation. Eplerenone, a selective MR antagonist, has been proposed as a therapeutic option, although clinical evidence remains inconsistent.

METHODS

In a randomized, double-blind, placebo-controlled trial, 44 patients with first-episode acute CSCR received either oral eplerenone (25 mg twice daily) or placebo for three months. Outcomes included best-corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (CT), and OCT-angiography parameters of retinal and choroidal microvasculature.

RESULTS

Both groups demonstrated significant reductions in CMT and SRF over time, but SRF absorption was significantly greater in the eplerenone group at 3 months (P < 0.05). Choriocapillaris vessel density and flow index improved significantly with eplerenone (P < 0.001), while superficial, deep, and radial peripapillary plexus densities did not differ between groups. BCVA improved similarly in both groups.

CONCLUSION

Eplerenone accelerates SRF resolution and enhances choriocapillaris perfusion in acute CSCR, although visual outcomes remain comparable to placebo. Early MR antagonism may offer anatomical and microvascular benefits in CSCR management.