Oral Spironolactone Treatment in Chronic Central Serous Chorioretinopathy

Sae Rom Chung; Jin Gu Jeong; Tae Eun Lee; In Cheon You; Min Ahn; Nam Chun Cho

doi:10.3341/jkos.2020.61.3.250

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Chung, Jeong, Lee, You, Ahn, and Cho: Oral Spironolactone Treatment in Chronic Central Serous Chorioretinopathy

Original Article

J Korean Ophthalmol Soc 2020;61(3):250-257.

Published online: 25 September 2020

DOI: https://doi.org/10.3341/jkos.2020.61.3.250

Oral Spironolactone Treatment in Chronic Central Serous Chorioretinopathy

Sae Rom Chung, MD¹, Jin Gu Jeong, MD¹, Tae Eun Lee, MD^1,^2,³, In Cheon You, MD, PhD^1,^2,³, Min Ahn, MD, PhD^1,^2,³, Nam Chun Cho, MD, PhD^1,^2,³

¹Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Korea

²Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea

³Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea

Address reprint requests to Nam Chun Cho, MD, PhD Department of Ophthalmology, Jeonbuk National University Hospital, #20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea Tel: 82-63-250-1960, Fax: 82-63-250-1960 E-mail: cnauo@jbnu.ac.kr

Received 22 May 2019 Revised 11 September 2019 Accepted 21 February 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effect of oral spironolactone for nonresolving chronic central serous chorioretinopathy after intravitreal bevacizumab injection.

Methods

Seventeen eyes of 17 patients with nonresolving chronic central serous chorioretinopathy after intravitreal bevacizumab injection from September 2017 to December 2018 were treated with oral spironolactone for 6 months, and changes in central macular thickness, subretinal fluid height, and best-corrected visual acuity (BCVA) were analyzed retrospectively.

Results

The central macular thickness decreased from 309.94 ± 105.20 µm at baseline to 259.76 ± 81.83 µm at 3 months, and 243.11 ± 61.98 µm at 6 months, which were both statistically significant (Wilcoxon signed-rank test, p = 0.016 and p = 0.001, respectively). The subretinal fluid height decreased from 138.05 ± 95.69 µm at baseline to 70.88 ± 83.13 µm at 3 months, and 54.00 ± 56.25 µm at 6 months, which were both statistically significant (Wilcoxon signed-rank test, p = 0.002 and p = 0.000, respectively). The BCVA (LogMAR) changed from 0.30 ± 0.38 at baseline to 0.35 ± 0.43 at 1 month, 0.29 ± 0.43 at 3 months, and 0.26 ± 0.40 at 6 months. The results at 6 months were statistically significant (Wilcoxon signed-rank test, p = 0.033). There were no side effects in patients treated with oral spironolactone.

Conclusions

In chronic central serous chorioretinopathy, treatment with oral spironolactone significantly reduced the central macular thickness, subretinal fluid height, and the BCVA, without side effects.

Keywords: Bevacizumab, Central serous chorioretinopathy, Spironolactone

References

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Figure 1.

Changes of macular thickness map and optical coherence tomography scan of a patient with central serous chorioretinopathy at baseline (A), at 1 month (B) and 3 months (C). The best corrected visual acuity was 0.8 at baseline and improved to 1.2 by 3 months. ILM-RPE = inner limiting membrane-retinal pigment epithelium.

Figure 2.

SRF, CMT, BCVA changes in each spironolactone-treated eye. Individual values are presented from baseline to 6 months. CMT = central macular thickness; SRF = subretinal fluid; BCVA = best collected visual acuity; logMAR = logarithm of the minimum angle of resolution.

Figure 3.

Subretinal fluid height at baseline, 1 month, 3 months and 6 months after starting the treatment. The spironolactone effect was statistically significant by 3 months and 6 months (Wilcoxon signed-rank test p = 0.002, p = 0.000). SRFH = subretinal fluid height.

Figure 4.

Central macular thickness at baseline, 1 month, 3 months and 6 months after starting the treatment. The spironolactone effect was statistically significant by 3 months and 6 months (Wilcoxon signed-rank test p = 0.016, p = 0.001). CMT = central macular thickness.

Figure 5.

Best corrected visual acuity (logMAR) at baseline, 1 month, 3 months and 6 months after starting the treatment. The spironolactone effect was statistically significant by 6 months (Wilcoxon signed-rank test, p = 0.033). BCVA = best corrected visual acuity; logMAR = logarithm of minimal angle of resolution.

Table 1.

Characteristics of the patients

Factor	Value (n = 17)
Number of patients (M:F)	17 (12:5)
Age (years)	56.50 ± 8.54
Diabetes	2 (0.12)
Hypertension	4 (0.23)
Steroid use	2 (0.12)

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

M:F = male:female.

Table 2.

Statistical overview of median, mean, and standard deviation of SRF, CMT, BCVA from baseline, 1 month, 3 months, and 6 months

Variable	Baseline	1 month	3 months	6 months
SRF (μ m)	108.00 (138.05 ± 95.69)	86.00 (105.23 ± 92.43)	64.00 (70.88 ± 83.13)	32.00 (54.00 ± 56.25)
CMT (μ m)	284.00 (309.94 ± 105.20)	263.00 (292.52 ± 100.12)	255.00 (259.76 ± 81.83)	221.00 (243.11 ± 61.98)
BCVA (logMAR)	0.34 (0.30 ± 0.38)	0.30 (0.35 ± 0.43)	0.15 (0.29 ± 0.43)	0.09 (0.26 ± 0.40)

Values are presented as median (mean ± standard deviation).

SRF = subretinal fluid; CMT = central macular thickness; BCVA = best collected visual acuity; logMAR = logarithm of the minimum angle of resolution.

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