Central serous chorioretinopathy (CSCR) is an idiopathic disease most commonly seen in young men, with a prevalence of 5.8 per 100,000. It is characterized by one or more cases of detachment serosa in the retinal neurosensory layer and may be associated with retinal pigment epithelial (RPE) detachment.
The disease has a wide range of clinical manifestations. The most common clinical manifestation is central scotoma, which may be associated with metamofopsia. Other clinical manifestations include dyschromatosis, micropsy, hyperopia, and decreased sensitivity to contrast.
Most cases of acute CSCR resolve spontaneously within 3 months and patients' visual acuity returns to normal. But during CSCR recovery there are often areas of RPE atrophy and pigmented changes that can be seen in more than 90% of patients.
In these patients, the anatomical depression of the fovea returns to normal, but studies show that after the absorption of serous fluid, some of the density of the foveal cone cells is reduced, and this may indicate a slight decrease in the visual acuity of patients compared to before. Be sick. In chronic cases (more than three months), the disease can be associated with complications such as geographic atrophy, chronic retinal cystic changes, subretinal fibrinosis accumulations, subretinal fibrosis, and secondary choroidal neovascularization, followed by permanent vision loss.. The pathogenesis of CSCR is not fully understood but is thought to be associated with impaired choroid circulation, which is confirmed by endocyanin angiographic findings (ICGA).
Choroidal vas deferens and dilatation, choroid staining and hyperfluorescence are seen in the intermediate and delayed phases of ICGA in CSCR patients. Aldosterone causes vasodilation and leakage of the choroidal arteries, which may be exerted by up-regulation of the potassium channels of the choroidal vascular endothelial cells. Another pathogenesis reported in this disease is dysfunction of the mineralocorticoid system. Risk factors for this condition include stressful personality type (personality type A), corticosteroid use, and hypertension.
In animal models, activation of choroidal mineralocorticoid receptors caused vasodilation and leakage. This is inhibited by mineralocorticoid antagonists. It is estimated that 15–50% of patients with acute CSCR will experience a recurrence of the disease after spontaneous recovery, which seems to be a high statistic and reflects the approach of physicians in making the right decision to follow patients or perform appropriate interventions. Has been disrupted.
The most common way to treat this problem is to wait for spontaneous recovery after about three months, but other treatments such as laser, photodynamic therapies and mineralocorticoid antagonists have been proposed for it.
Therefore, due to the high prevalence of this disease, it seems necessary to adopt a method of treatment that, while having good performance, has the least possible side effects. Since in many cases no treatment is prescribed for this problem, so the improvement of vision and complications of patients receiving the drug can be compared with patients for whom no treatment has been prescribed.
Due to the lack of detailed studies comparing the effectiveness of corticosteroid mineral antagonist drugs such as eplerenone compared to untreated follow-up, researchers are interested in evaluating the effectiveness of this drug on CSCR.
In two separate studies in 2013 and 2002, Levy and Lowe reported that the disease was more common in young men (1), and in our study, 70% of patients were men with a mean age of about 39 years.
According to Berkinck's study, most acute CSCR cases resolve spontaneously over a period of 3 months, and patients' visual acuity returns to normal (3).
In our study, more than 30% of patients had a visual acuity above 0.5 on the LogMar scale at the end of the first month without receiving eplerenone. However, all patients referred to the hospital had less than 0.5 visual acuity upon arrival. In his study, Otto cited a decrease in the density of Fuah cone cells after serous fluid uptake as a possible reason for this inadequate repair (5).
Bojarborra also states in her study that during CSCR recovery, most areas of RPE atrophy and pigmentation changes are seen in more than 90% of patients (4).
In Zhao's study, 5-week treatment with eplerenone reduced retinal detachment and increased disease severity in 2 patients. This effect continued for up to 5 months after eplerenone was discontinued (12).
But in our study, the effects were measured only clinically and also the change in choroid thickness of its patients after one month. In a review article on the effect of eplerenone on CSCR in 2018, Chatzirali et al. Stated that oral eplerenone at a dose of 25–50 mg per day is effective and tolerable for the treatment of chronic CSCR disease.
This study is in line with the recent study and Zhao's study to conclude that treatment with eplerenone has a significant effect on the treatment of the disease (13).
This finding was confirmed not only by improving patients' visual acuity, but also by accurate measurements of choroid thickness in the macula, as well as the 500- and 1000-micron temporal-nasal superior and inferior areas.
This study presented quite acceptable results by analyzing the mean changes in choroid thickness before and after treatment with eplerenone. On the other hand, the number of patients in the study (40 in the control group and 40 in the treatment group) in the field of data analysis is highly reliable.
The researcher also did not find a significant relationship between gender and age successfully in the study population. In 2015, Singh and colleagues treated a total of 17 eyes of 13 patients treated with 25 and 50 mg of oral apleronone per day. LogMAR visual acuity improved from 0.42 (Snelln equivalent: 20/53) initially to 0.29 (Snenl equivalent: 20/39) on day 181 (P = 0.0024) (14).
In the present study, the severity of patients improved from 0.28 to 0.61. In a 2019 study of short-term aplerone therapy in the treatment of chronic CSCR in 13 affected eyes, Moin et al. Showed that oral aplerone may be used as a safe and potentially effective treatment. But it has minimal short-term effects on subcutaneous fluid or visual acuity, so follow-ups longer than one month are necessary to demonstrate its benefits (15). However, the present study on more patients and more confidently stated that treatment with eplerenone can clearly improve visual acuity and choroid thickness. In a study of 114 patients (57 in each group), Professor Andrew Latry and colleagues found that Eplerenone was not superior to placebo for improving BCVA in patients with chronic CSCR after 12 months of treatment (16). But the present study did not confirm this view.