*INSERM U872, University Rene Descartes Sorbonne Paris Cité, Team 17, Cordeliers Research Center, Paris, France; †University Rene Descartes Sorbonne, Paris Cité, France; and ‡Assistance Publique des Hôpitaux de Paris, Hôtel-Dieu, Paris, France.
Retina. 2013 Nov-Dec;33(10):2096-102. doi: 10.1097/IAE.0b013e318297a07a.
Based on experimental data showing that central serous chorioretinopathy could result from overactivation of mineralocorticoid receptor pathway in choroid vessels, the authors studied eplerenone, a mineralocorticoid receptor antagonist, as a potential treatment for chronic central serous chorioretinopathy.
This nonrandomized pilot study included 13 patients with central serous chorioretinopathy of at least 4-month duration, treated with 25 mg/day of oral eplerenone for a week followed by 50 mg/day for 1 or 3 months. The primary outcome measure was the changes in central macular thickness recorded by optical coherence tomography, and the secondary outcomes included changes in foveal subretinal fluid (SRF) measured by OCT, in best-corrected visual acuity (BCVA) and the percentage of eyes achieving complete resolution of subretinal fluid during the treatment period.
Central macular thickness decreased significantly from 352 ± 139 μm at baseline to 246 ± 113 μm and 189 ± 99 μm at 1 and 3 months under eplerenone treatment (P < 0.05 and P < 0.01, respectively). At 3 months, the subretinal fluid significantly decreased compared with baseline subretinal fluid (P < 0.01) and best-corrected visual acuity significantly improved compared with baseline best-corrected visual acuity (P < 0.001).
Eplerenone treatment was associated with a significant reduction in central macular thickness, subretinal fluid level, and an improvement in visual acuity. Randomized controlled trials are needed to confirm these encouraging results.
基于实验数据表明，脉络膜血管中盐皮质激素受体通路的过度激活可能导致中心性浆液性脉络膜视网膜病变，作者研究了作为潜在治疗慢性中心性浆液性脉络膜视网膜病变的药物依普利酮，一种盐皮质激素受体拮抗剂。
这是一项非随机的初步研究，纳入了至少 4 个月的中心性浆液性脉络膜视网膜病变患者 13 例，给予依普利酮 25mg/天，持续 1 周，然后给予 50mg/天，持续 1 或 3 个月。主要结局测量指标为光学相干断层扫描（OCT）记录的中心黄斑厚度变化，次要结局包括 OCT 测量的中心凹下视网膜下液（SRF）变化、最佳矫正视力（BCVA）变化以及治疗期间完全消除视网膜下液的眼数百分比。
在依普利酮治疗下，中心黄斑厚度从基线时的 352±139μm 显著降低至 1 个月时的 246±113μm（P<0.05）和 3 个月时的 189±99μm（P<0.01）。在 3 个月时，与基线时的视网膜下液相比，视网膜下液明显减少（P<0.01），与基线时的最佳矫正视力相比，最佳矫正视力明显提高（P<0.001）。
依普利酮治疗与中心黄斑厚度、视网膜下液水平的显著降低以及视力的显著改善相关。需要进行随机对照试验来证实这些令人鼓舞的结果。
