Wang Sean K, Sun Peng, Tandias Rachel M, Seto Brendan K, Arroyo Jorge G
Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, First Hospital of China Medical University, Shenyang, People's Republic of China.
Ophthalmol Retina. 2019 Feb;3(2):154-160. doi: 10.1016/j.oret.2018.09.003. Epub 2018 Sep 15.
A meta-analysis comparing mineralocorticoid receptor (MR) antagonists (eplerenone or spironolactone) versus observation or placebo in the treatment of central serous chorioretinopathy (CSCR) based on best-corrected visual acuity (BCVA) and subretinal fluid (SRF) level data from randomized controlled trials (RCTs).
Central serous chorioretinopathy patients may demonstrate decreased visual acuity, reduced contrast sensitivity, scotomas, and metamorphopsia. Although multiple treatment options for CSCR have been proposed, compelling evidence for any particular method is still lacking.
Three databases (PubMed, EMBASE, and BIOSIS) were searched for potentially relevant records as of March 2018. Of 114 unique studies identified, 5 RCTs comparing BCVA with either eplerenone or spironolactone versus observation or placebo were included. The quality of articles was assessed according to the Cochrane Risk of Bias Tool, with any discrepancies resolved by author consensus.
A total of 145 eyes of patients with CSCR were included in the meta-analysis. Compared with placebo or observation, MR antagonist treatment showed a significant positive effect on BCVA after both 1 month (weighted mean difference [WMD], -0.05 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], -0.07 to -0.02 logMAR; Z = 3.94; P < 0.0001) and 2 months (WMD, -0.10 logMAR; 95% CI, -0.14 to -0.06 logMAR; Z = 4.69; P < 0.00001). Mineralocorticoid receptor antagonist treatment also significantly reduced SRF height in CSCR at 1 month (WMD, -81.15 μm; 95% CI, -148.25 to -14.05 μm; Z = 2.37; P = 0.02). However, this effect was no longer significant at 2 months (WMD, -58.63 μm; 95% CI, -155.40 to 38.13 μm; Z = 1.19; P = 0.23). None of the patients in the 5 trials withdrew because of adverse effects, and blood electrolyte levels, including potassium, remained normal in all cases.
Our findings suggest a modest benefit with MR antagonist therapy for CSCR patients in improving BCVA. We anticipate that MR antagonists will be well tolerated by most CSCR patients and that barriers to starting a trial of these medications in nonresolving CSCR should be low.
一项基于随机对照试验（RCT）的最佳矫正视力（BCVA）和视网膜下液（SRF）水平数据，比较盐皮质激素受体（MR）拮抗剂（依普利酮或螺内酯）与观察或安慰剂治疗中心性浆液性脉络膜视网膜病变（CSCR）的荟萃分析。
中心性浆液性脉络膜视网膜病变患者可能会出现视力下降、对比敏感度降低、暗点和视物变形。虽然已经提出了多种治疗CSCR的方法，但仍缺乏任何特定方法的令人信服的证据。
截至2018年3月，在三个数据库（PubMed、EMBASE和BIOSIS）中搜索潜在相关记录。在114项独特研究中，纳入了5项比较依普利酮或螺内酯与观察或安慰剂的BCVA的RCT。根据Cochrane偏倚风险工具评估文章质量，任何差异通过作者共识解决。
荟萃分析共纳入145只CSCR患者的眼睛。与安慰剂或观察相比，MR拮抗剂治疗在1个月（加权平均差[WMD]，最小分辨角对数[logMAR]为-0.05；95%置信区间[CI]，-0.07至-0.02 logMAR；Z = 3.94；P < 0.0001）和2个月（WMD，-0.10 logMAR；95% CI，-0.14至-0.06 logMAR；Z = 4.69；P < 0.00001）时对BCVA均显示出显著的积极影响。盐皮质激素受体拮抗剂治疗在1个月时也显著降低了CSCR中的SRF高度（WMD，-81.15μm；95% CI，-148.25至-14.05μm；Z = 2.37；P = 0.02）。然而，这种效果在2个月时不再显著（WMD，-58.63μm；95% CI，-155.40至38.13μm；Z = 1.19；P = 0.23）。5项试验中没有患者因不良反应退出，所有病例中的血液电解质水平，包括钾，均保持正常。
我们的研究结果表明，MR拮抗剂治疗对CSCR患者改善BCVA有适度益处。我们预计大多数CSCR患者对MR拮抗剂耐受性良好，并且在非缓解性CSCR中开展这些药物试验的障碍应该较低。
