Title Spironolactone for chronic central serous chorioretinopathy - a pilot study

To estimate the efficacy of oral spironolactone in patients with chronic central serous chorioretinopathy (CSC). METHODS This was a pilot study consisting of patients who were diagnosed with chronic central serous chorioretinopathy for at least a 6-month duration. This study included 75 eyes of 74 patients who were treated with spironolactone (20 mg orally, twice daily) for 8 weeks. The best corrected visual acuity (BCVA), subretinal fluid (SRF), central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were each measured at baseline, 4 weeks and 8 weeks. of and The BCVA the baseline BCVA 0.654).

In recent reports, CSC patients who were treated with mineralocorticoid antagonists (spironolactone and eplerenone) achieved the same high rates of antiandrogen effects 5 , even when spironolactone was administered in a lower and therefore well tolerable dose, which can then lead to a lower rate of common side effects. In this study, we treated Chinese patients who were diagnosed as having chronic CSC with spironolactone.

Ethical Approval
This study was conducted in accordance with the Declaration of Helsinki and was 4 approved by the ethics committee of Shanghai General Hospital. Informed consent was obtained from each patient. All patients underwent a thorough ophthalmic examination and agreed to receive trabeculectomy to reduce IOP. For the EDI-OCT evaluation, the CMT decreased significantly from 397 ± 132 µm at baseline to 310 ± 103 µm and 254 ± 103 µm at 4 weeks and 8 weeks, respectively (Table 1 and Figure 3). The differences between baseline and 4 weeks and 8 weeks were statistically significant (p = 0.000). Fifteen patients had no significant changes in the CMT at 8 weeks, with these patients exhibiting a CMT decrease of <20%.

Subjects and methods
The mean SFCT measurements at baseline and during the follow-up period are summarized in Table 1 and Kapoor KG9 created a retrospective chart review of 32 CSC patients who were treated with spironolactone or eplerenone (50 mg p.o. bid.) or observation, and it was observed that both MR antagonists demonstrated statistically significant visual acuity improvement and subretinal fluid reduction at 1, 2 and 3 months compared to the baseline (p < 0.05). A total of 58.3% of patients had a complete resolution of the subretinal fluid at 2 months of MR antagonist treatment, compared to 12.5% of patients who were under observation (p < 0.05). There was no difference in the efficacy between eplerenone and spironolactone treatments. Spironolactone treatment exhibited increased side effects (8/12 patients, 75%) compared to eplerenone treatment (3/12 patients, 25%; p < 0.05). There is also a study from Herold TR10 that reported that 18 patients with chronic CSC who were treated with 25 mg spironolactone twice daily for 12 weeks exhibited decreases in SRF and CMT as well as improvements in BCVA. These results are similar to our results. However, these research subjects were all foreigners, and our subjects are Chinese. Through our study, we observed that spironolactone treatment is also effective for Chinese people. Additionally, the dose used in our study was 20 mg twice daily, whereas the other study used a dosage of 25 mg twice daily10, which indicates that the low dose is also effective. However, the OCT parameters for subfoveal choroidal thickness did not show significant changes with treatment, although, as previously reported, patients with exudative CSC and subretinal fluids did exhibit significant anatomical improvements. We inferred that perhaps because of the signal loss before the scleral-choroidal edge in some cases, it was difficult to establish clear data on the possible differences in the subfoveal choroidal thickness in intractable chronic CSC patients at baseline and during the follow-up period.
By reviewing the studies of recent years3, 8  Meanwhile, Bousquet E3 reported that a complete reabsorption of SRF was achieved in 3/12 patients (25%), with those patients being European. Additionally, our study had a larger sample of patients than the previous studies. Although the causes have not yet been thoroughly studied, the differences may be due to changes in hormone levels in stress and the environments; therefore, more clinical studies of multicenter big data are necessary. The limitation of our study was that the followup period only consisted of 2 months, which was too short to assess the long-term    Figure 1 shows the BCVA (in logMAR) at baseline, 4 weeks and 8 weeks. **P<0.01; Compared with bas 13 Figure 2 shows the SRF (in μm) at baseline, 4 weeks and 8 weeks. **P<0.01; Compared with baseline. Figure 3 shows the CMT (in μm) at baseline, 4 weeks and 8 weeks. **P<0.01; Compared with baseline 14 Figure 4 shows the SFCT (in μm) at baseline, 4 weeks and 8 weeks.
15 Figure 5 shows the enhanced depth imaging optical coherence tomography (EDI-OCT) pictures of two 16 Figure 6 shows the fundus photography and fundus autofluorescence for a 43-year-old male patient. a

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