Department of Ophthalmology, Hôpital Cochin, OphtalmoPôle, Assistance Publique-Hôpitaux de Paris, Paris, France.
Department of Ophthalmology, Hôpital Cochin, OphtalmoPôle, Assistance Publique-Hôpitaux de Paris, Paris, France.
Am J Ophthalmol. 2019 Feb;198:80-87. doi: 10.1016/j.ajo.2018.09.034. Epub 2018 Oct 9.
To assess the efficacy and safety of mineralocorticoid receptor antagonists (MRAs) in the treatment of nonresolving central serous chorioretinopathy (CSC) and to identify factors that are predictive of treatment response.
Retrospective, multicenter, noncomparative, interventional case series.
Clinical and imaging data from consecutive patients with nonresolving CSC treated with eplerenone or spironolactone for 3 to 6 months between 2012 and 2016 were reviewed. Outcome measures included the resolution of foveal subretinal detachment (SRD), changes in SRD height, central macular thickness, subfoveal choroidal thickness, best corrected visual acuity, and the occurrence of adverse events assessed at 3 and 6 months. The response to treatment was defined by a decrease by >50% in SRD height under treatment. Comparisons between responder and nonresponder groups were performed using univariate and multivariate regression analyses to identify factors that were predictive of treatment response.
Fifty-nine patients (64 eyes) were included. The mean SRD height and central macular thickness significantly decreased while the mean best corrected visual acuity significantly improved at 3 and 6 months. The mean subfoveal choroidal thickness significantly decreased at 3 months. Among the 64 eyes included, 67.2% responded to treatment, among which 38.3% and 40.5% had a complete resolution of the foveal SRD at 3 and 6 months, respectively. Baseline subfoveal choroidal thickness was the only factor associated with a treatment response in the multivariate analysis.
Our study suggests that MRA could be a safe and effective treatment in patients with nonresolving CSC. MRA treatment is more effective in cases with a thicker baseline choroid.
评估盐皮质激素受体拮抗剂 (MRA) 在治疗未消退性中心性浆液性脉络膜视网膜病变 (CSC) 中的疗效和安全性，并确定预测治疗反应的因素。
回顾性、多中心、非对照、干预性病例系列研究。
对 2012 年至 2016 年间连续接受依普利酮或螺内酯治疗 3 至 6 个月的未消退性 CSC 患者的临床和影像学数据进行回顾性分析。主要观察指标包括中心凹下视网膜下积液 (SRD) 消退、SRD 高度变化、中央视网膜厚度、中心凹下脉络膜厚度、最佳矫正视力以及 3 个月和 6 个月时不良事件的发生情况。治疗反应定义为治疗后 SRD 高度降低>50%。采用单变量和多变量回归分析比较反应组和非反应组，以确定预测治疗反应的因素。
共纳入 59 例（64 只眼）患者。3 个月和 6 个月时，SRD 高度和中央视网膜厚度显著降低，最佳矫正视力显著提高；3 个月时中心凹下脉络膜厚度显著降低。64 只眼中，67.2%对治疗有反应，其中 38.3%和 40.5%在 3 个月和 6 个月时分别完全消退中心凹下 SRD。多变量分析显示，基线时中心凹下脉络膜厚度是唯一与治疗反应相关的因素。
本研究表明，MRA 可能是治疗未消退性 CSC 的一种安全有效的方法。MRA 治疗在基线时脉络膜较厚的情况下更有效。
