Oral eplerenone for the management of chronic central serous chorioretinopathy

AIM: To examine eplerenone(Inspra, Pfizer), a mineralocorticoid receptor antagonist, as a treatment option for chronic central serous chorioretinopathy(CSCR).METHODS: A retrospective consecutive case series was conducted for patients receiving oral eplerenone for chronic CSCR. At baseline and each follow-up visit,spectral domain optical coherence tomography(SD-OCT)imaging was performed, including manual measurements of the height and diameter size of subretinal fluid. The primary outcome measure was the reduction in subretinal fluid following initiation of therapy.RESULTS: A total of 17 eyes of 13 patients treated with25 and 50 mg of oral eplerenone per day were identified.Subretinal fluid(SRF) decreased over time following eplerenone therapy(P = 0.007 and P =0.002, diameter and height respectively). Maximum SRF height decreased from a mean of 131.5 μm at baseline to 15.3 μm at day181+. SRF diameter decreased from an average of 2174.4μm at baseline to 46.9 μm at day 181 +. Log MAR visual acuity improved from 0.42(Snellen equivalent: 20/53) at baseline to 0.29(Snellen equivalent: 20/39) at day 181 +(P = 0.024). Central subfield thickness(CST) decreased from 339.5 μm at baseline to 270.3 μm at day 181+(P = 0.029).CONCLUSION: Eplerenone therapy resulted in significant anatomic and visual improvements in eyes with chronic CSCR.

Comparing imaging capabilities of spectral domain and swept source optical coherence tomography angiography in healthy subjects and central serous retinopathy

Background:There are two forms of system implementation of optical coherence tomography angiography(OCTA)in ophthalmic imaging,i.e.,spectral domain(SD-)and swept source OCTA(SS-OCTA).The purpose of this paper is to compare the SD-OCTA and SS-OCTA for elucidating structural and vascular features associated with central serous retinopathy(CSR),and to evaluate the effects of CSR on SD-and SS-OCTA’s imaging capabilities.Methods:Normal subjects and CSR patients were imaged by SD-and SS-OCTA using 3×3 mm and 6×6 mm scan patterns.OCT signal strengths at the superficial retina,deep retina,Sattler’s layer and Haller’s layer were used to compare the ability of SD-and SS-OCTA to image structural features.In addition,the ability to acquire angiograms were discussed by evaluating retinal vessel density.Central serous volume(CSV)was measured and it was correlated with difference in signal strengths(ΔS)between two OCTA devices.Results:Seven normal eyes and seven diseased eyes were recruited.Results showed no significant differences between SD-and SS-OCT in detecting structural features of the retinal layer according to the paired t-test.However,when imaging the Sattler’s layer for normal eyes,a significant difference is found between SD-and SS-OCT(p<0.0001 for 3×3 mm scan,and p=0.0002 for 6×6 mm);while for CSR eyes,the corresponding values were p<0.0001 and p=0.0003,respectively.At Haller’s layer for normal eyes,the corresponding values were p=0.0004 and p=0.0014;and for CSR eyes,p=0.0004 and p<0.0001,respectively.A strong correlation betweenΔS and CSV was observed in the Sattler’s layer(3×3 mm–p=0.0031 and R^(2)=0.951;6×6 mm–p=0.0075 and R^(2)=0.911)and Haller’s layer(3×3 mm–p=0.0026 and R^(2)=0.955;6×6 mm–p=0.0013 and R^(2)=0.972).Conclusions:The results suggest no differences between SD-and SS-OCTA for imaging the retinal layers however,when imaging beyond retinal layers,SS-OCTA appears advantageous in detecting returning signals.In CSR cases,the CSV may have an impact on sub-CSR tissue imaging and appears to have more impact on SD-than SS-OCTA.