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SPIRONOLACTONE FOR NONRESOLVING CENTRAL SEROUS CHORIORETINOPATHY: A RANDOMIZED CONTROLLED CROSSOVER STUDY.

Bousquet E, Beydoun T, Rothschild PR, Bergin C, Zhao M, Batista R, Brandely ML, Couraud B, Farman N, Gaudric A, Chast F, Behar-Cohen F - Retina (Philadelphia, Pa.) (2015)

Bottom Line: Crossover data analysis showed a statistically significant reduction in SRF in spironolactone treated eyes as compared with the same eyes under placebo (P = 0.04).Secondary analysis on the first period (Day 0-Day 30) showed a significant reduction in subfoveal choroidal thickness in treated eyes as compared with placebo (P = 0.02).In eyes with persistent SRF due to central serous chorioretinopathy, spironolactone significantly reduced both the SRF and the subfoveal choroidal thickness as compared with placebo.

View Article: PubMed Central - PubMed

Affiliation: *Department of Ophthalmology, Hôtel-Dieu of Paris, Assistance Publique Hôpitaux de Paris, Paris, France, Université Sorbonne Paris Cité; †Inserm U1138, Team 17, Université Sorbonne Paris Cité, Université Pierre et Marie Curie, Centre de Recherche des Cordeliers, Paris, France; ‡Department of Ophthalmology, University of Lausanne, Jules Gonin Ophthalmic Hospital, Fondation Asile des aveugles, Switzerland; §Department of Pharmacy Hôtel-Dieu of Paris, Assistance Publique Hôpitaux de Paris, Université Sorbonne Paris Cité, Paris, France; ¶INSERM, U1138, Team 1, Université René Descartes Sorbonne Paris Cité, Université Pierre et Marie Curie Paris, Centre de Recherche des Cordeliers, Paris, France; and **Department of Ophthalmology, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France.

ABSTRACT

Purpose: To evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, for nonresolving central serous chorioretinopathy.

Methods: This is a prospective, randomized, double-blinded, placebo-controlled crossover study. Sixteen eyes of 16 patients with central serous chorioretinopathy and persistent subretinal fluid (SRF) for at least 3 months were enrolled. Patients were randomized to receive either spironolactone 50 mg or placebo once a day for 30 days, followed by a washout period of 1 week and then crossed over to either placebo or spironolactone for another 30 days. The primary outcome measure was the changes from baseline in SRF thickness at the apex of the serous retinal detachment. Secondary outcomes included subfoveal choroidal thickness and the ETDRS best-corrected visual acuity.

Results: The mean duration of central serous chorioretinopathy before enrollment in study eyes was 10 ± 16.9 months. Crossover data analysis showed a statistically significant reduction in SRF in spironolactone treated eyes as compared with the same eyes under placebo (P = 0.04). Secondary analysis on the first period (Day 0-Day 30) showed a significant reduction in subfoveal choroidal thickness in treated eyes as compared with placebo (P = 0.02). No significant changes were observed in the best-corrected visual acuity. There were no complications related to treatment observed.

Conclusion: In eyes with persistent SRF due to central serous chorioretinopathy, spironolactone significantly reduced both the SRF and the subfoveal choroidal thickness as compared with placebo.

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Related in: MedlinePlus

Follow-up of Patient 6 treated with spironolactone on the first period. Autofluorescent images of both eyes show bilateral disease (A). After 1 month of spironolactone, the SRF almost completely resolved and decreased intensity of focal leaks was observed on fluorescein angiography (B and C). Under placebo for a month, retinal detachment completely resolved (D). For each time point, fluorescein angiography images taken at late stage (5 minutes) (left panel) are shown, together with the ETDRS grid (middle panel) and an enhanced depth imaging scan (right panel).
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Figure 4: Follow-up of Patient 6 treated with spironolactone on the first period. Autofluorescent images of both eyes show bilateral disease (A). After 1 month of spironolactone, the SRF almost completely resolved and decreased intensity of focal leaks was observed on fluorescein angiography (B and C). Under placebo for a month, retinal detachment completely resolved (D). For each time point, fluorescein angiography images taken at late stage (5 minutes) (left panel) are shown, together with the ETDRS grid (middle panel) and an enhanced depth imaging scan (right panel).

Mentions: The immediate on–off effect of the treatment was observed in four of the eight patients in this sequence. An example of this was Patient 1, this patient presented with CSC 6 months after their primary episode, this second episode showed no resolution of SRF for 4 months (Figure 3A). After 30 days of spironolactone (M1), SRF had completely resolved (Figure 3B), however, after switching to placebo for 30 days, the SRF had reformed presenting with increased fluorescein leakage at the initial RPE leak site (Figure 3C). The off effect can be disguised by a carryover effect; this was observed in three patients. For example Patient 6 presented with bilateral disease as shown on autofluorescent images (Figure 4A) and 2 active RPE leaks were observed (Figure 4B). Central serous chorioretinopathy persisted for 3.5 months before enrollment here after 30 days of spironolactone, SFCT decreased from 610 μm to 548 μm and SRF had largely resolved with some segments remaining elongated (Figure 4, B and C). The following while under placebo, the anatomical structure of the fovea continued to normalize although SFCT returned to 608 μm (Figure 4D).


SPIRONOLACTONE FOR NONRESOLVING CENTRAL SEROUS CHORIORETINOPATHY: A RANDOMIZED CONTROLLED CROSSOVER STUDY.

Bousquet E, Beydoun T, Rothschild PR, Bergin C, Zhao M, Batista R, Brandely ML, Couraud B, Farman N, Gaudric A, Chast F, Behar-Cohen F - Retina (Philadelphia, Pa.) (2015)

Follow-up of Patient 6 treated with spironolactone on the first period. Autofluorescent images of both eyes show bilateral disease (A). After 1 month of spironolactone, the SRF almost completely resolved and decreased intensity of focal leaks was observed on fluorescein angiography (B and C). Under placebo for a month, retinal detachment completely resolved (D). For each time point, fluorescein angiography images taken at late stage (5 minutes) (left panel) are shown, together with the ETDRS grid (middle panel) and an enhanced depth imaging scan (right panel).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697359&req=5

Figure 4: Follow-up of Patient 6 treated with spironolactone on the first period. Autofluorescent images of both eyes show bilateral disease (A). After 1 month of spironolactone, the SRF almost completely resolved and decreased intensity of focal leaks was observed on fluorescein angiography (B and C). Under placebo for a month, retinal detachment completely resolved (D). For each time point, fluorescein angiography images taken at late stage (5 minutes) (left panel) are shown, together with the ETDRS grid (middle panel) and an enhanced depth imaging scan (right panel).
Mentions: The immediate on–off effect of the treatment was observed in four of the eight patients in this sequence. An example of this was Patient 1, this patient presented with CSC 6 months after their primary episode, this second episode showed no resolution of SRF for 4 months (Figure 3A). After 30 days of spironolactone (M1), SRF had completely resolved (Figure 3B), however, after switching to placebo for 30 days, the SRF had reformed presenting with increased fluorescein leakage at the initial RPE leak site (Figure 3C). The off effect can be disguised by a carryover effect; this was observed in three patients. For example Patient 6 presented with bilateral disease as shown on autofluorescent images (Figure 4A) and 2 active RPE leaks were observed (Figure 4B). Central serous chorioretinopathy persisted for 3.5 months before enrollment here after 30 days of spironolactone, SFCT decreased from 610 μm to 548 μm and SRF had largely resolved with some segments remaining elongated (Figure 4, B and C). The following while under placebo, the anatomical structure of the fovea continued to normalize although SFCT returned to 608 μm (Figure 4D).

Bottom Line: Crossover data analysis showed a statistically significant reduction in SRF in spironolactone treated eyes as compared with the same eyes under placebo (P = 0.04).Secondary analysis on the first period (Day 0-Day 30) showed a significant reduction in subfoveal choroidal thickness in treated eyes as compared with placebo (P = 0.02).In eyes with persistent SRF due to central serous chorioretinopathy, spironolactone significantly reduced both the SRF and the subfoveal choroidal thickness as compared with placebo.

View Article: PubMed Central - PubMed

Affiliation: *Department of Ophthalmology, Hôtel-Dieu of Paris, Assistance Publique Hôpitaux de Paris, Paris, France, Université Sorbonne Paris Cité; †Inserm U1138, Team 17, Université Sorbonne Paris Cité, Université Pierre et Marie Curie, Centre de Recherche des Cordeliers, Paris, France; ‡Department of Ophthalmology, University of Lausanne, Jules Gonin Ophthalmic Hospital, Fondation Asile des aveugles, Switzerland; §Department of Pharmacy Hôtel-Dieu of Paris, Assistance Publique Hôpitaux de Paris, Université Sorbonne Paris Cité, Paris, France; ¶INSERM, U1138, Team 1, Université René Descartes Sorbonne Paris Cité, Université Pierre et Marie Curie Paris, Centre de Recherche des Cordeliers, Paris, France; and **Department of Ophthalmology, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France.

ABSTRACT

Purpose: To evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, for nonresolving central serous chorioretinopathy.

Methods: This is a prospective, randomized, double-blinded, placebo-controlled crossover study. Sixteen eyes of 16 patients with central serous chorioretinopathy and persistent subretinal fluid (SRF) for at least 3 months were enrolled. Patients were randomized to receive either spironolactone 50 mg or placebo once a day for 30 days, followed by a washout period of 1 week and then crossed over to either placebo or spironolactone for another 30 days. The primary outcome measure was the changes from baseline in SRF thickness at the apex of the serous retinal detachment. Secondary outcomes included subfoveal choroidal thickness and the ETDRS best-corrected visual acuity.

Results: The mean duration of central serous chorioretinopathy before enrollment in study eyes was 10 ± 16.9 months. Crossover data analysis showed a statistically significant reduction in SRF in spironolactone treated eyes as compared with the same eyes under placebo (P = 0.04). Secondary analysis on the first period (Day 0-Day 30) showed a significant reduction in subfoveal choroidal thickness in treated eyes as compared with placebo (P = 0.02). No significant changes were observed in the best-corrected visual acuity. There were no complications related to treatment observed.

Conclusion: In eyes with persistent SRF due to central serous chorioretinopathy, spironolactone significantly reduced both the SRF and the subfoveal choroidal thickness as compared with placebo.

Show MeSH
Related in: MedlinePlus