Department of Endocrinology, Medical University of Lodz, Lodz, Poland.
Eur Rev Med Pharmacol Sci. 2013 May;17(10):1369-73.
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).
To present a 38 year-old woman with an impressive improvement of CSCR following MR antagonist eplerenone administration.
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.
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.
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.
最近有研究表明，糖皮质激素依赖性脉络膜盐皮质激素受体 (MR) 的过度激活可能与中心性浆液性脉络膜视网膜病变 (CSCR) 的发病机制有关。
报告 1 例 MR 拮抗剂依普利酮治疗 CSCR 后明显改善的病例。
就诊时，左眼视力 (VA) 为 0.2，右眼视力为 1.0。左眼光学相干断层扫描 (OCT) 显示广泛的浆液性视网膜脱离，包括黄斑区。
依普利酮 (25mg/天) 治疗 6 周后，观察到全部视网膜下液吸收，VA 增加至 0.8。此时停用依普利酮治疗，左眼在 5 个月的随访中无复发。停用依普利酮 2 个月后，OCT 显示右眼出现视网膜下液积聚。重新开始依普利酮治疗 (25mg/天) 4 周后，右眼几乎完全吸收视网膜下液。
MR 拮抗作用在未解决的 CSCR 中的有效性支持了这样一种假设，即过度脉络膜 MR 激活可能是导致 CSCR 的潜在病理途径，MR 阻断可能是 CSCR 的有效治疗选择。需要进行对照临床试验来评估这种治疗方法。
