Potential involvement of mineralocorticoid receptor activation in the pathogenesis of central serous chorioretinopathy: case report.

BACKGROUND

Recently it has been suggested that excessive glucocorticoid-dependent choroidal mineralocorticoid receptor (MR) activation may be involved in the pathogenesis of central serous chorioretinopathy (CSCR).

AIM

To present a 38 year-old woman with an impressive improvement of CSCR following MR antagonist eplerenone administration.

CASE REPORT

At presentation, visual acuity (VA) was 0.2 in the left eye and 1.0 in the right eye. Optical coherence tomography (OCT) of the left eye showed extended serous retinal detachment including the macular area.

RESULTS

After six weeks of treatment with eplerenone (25 mg/day) total resorption of subretinal fluid with an increase in VA to 0.8 was observed. At that point the therapy with eplerenone was discontinued, with no recurrence in the left eye during five months follow-up. Two months after the discontinuation of eplerenone, subretinal fluid accumulation in the right eye was revealed by OCT. Four weeks after reintroducing the treatment with eplerenone (25 mg/day) almost total resorption of subretinal fluid in the right eye was observed.

CONCLUSIONS

The effectiveness of MR antagonism in unresolved CSCR supports the hypothesis that excessive choroidal MR activation may be a potential pathological pathway leading to CSCR, and MR blockage may be an effective treatment option for CSCR. Controlled clinical trials are necessary to evaluate this therapeutic approach.