Sinawat Suthasinee, Thongmee Watcharaporn, Sanguansak Thuss, Laovirojjanakul Wipada, Sinawat Supat, Yospaiboon Yosanan
KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Clin Ophthalmol. 2020 Jun 24;14:1725-1734. doi: 10.2147/OPTH.S260998. eCollection 2020.
To compare the efficacy of oral spironolactone treatment versus conservative treatment for patients with persistent central serous chorioretinopathy (CSC) in real-life practice.
Retrospective comparative study.
Medical records and retinal images of 62 patients with non-resolving CSC were reviewed. Twenty-one patients received oral spironolactone (50 mg/day) while 41 patients received conservative treatment. Primary outcome was proportion of eyes with complete resolution of subretinal fluid (SRF) within 6 months. Secondary outcome measures included changes in SRF height, central macular thickness (CMT), lesion size and best-corrected visual acuity (BCVA). The occurrence of drug side effect was also assessed.
There was no significant difference in demographic data, clinical characteristics, optical coherence tomography parameters and leaking patterns in fluorescein fundus angiography between two groups. Complete resolution of SRF was significantly higher and faster in the spironolactone group than the conservative treatment group (=0.03). Although significant anatomical improvement in SRF height, CMT and lesion size were observed in both groups ( < 0.001), final BCVA was improved significantly in only the spironolactone group ( < 0.05). The recurrence of SRF after complete resolution was observed in 4/12 eyes (33.33%) in the treatment group. None of the patients experienced any side effects of spironolactone.
Oral spironolactone (50 mg/day) could achieve both significant anatomical and visual improvement, while the significant visual gain could not be provided with the conservative treatment. Spironolactone should be considered as an alternative treatment option in non-resolving CSC patients who cannot afford the PDT treatment.
在实际临床实践中比较口服螺内酯治疗与保守治疗对持续性中心性浆液性脉络膜视网膜病变（CSC）患者的疗效。
回顾性对照研究。
回顾62例未愈CSC患者的病历及视网膜图像。21例患者接受口服螺内酯（50毫克/天）治疗，41例患者接受保守治疗。主要结局指标为6个月内视网膜下液（SRF）完全消退的眼比例。次要结局指标包括SRF高度、中心黄斑厚度（CMT）、病变大小及最佳矫正视力（BCVA）的变化。同时评估药物副作用的发生情况。
两组间人口统计学数据、临床特征、光学相干断层扫描参数及荧光素眼底血管造影渗漏模式无显著差异。螺内酯组SRF完全消退的比例显著高于且速度快于保守治疗组（P = 0.03）。尽管两组SRF高度、CMT及病变大小均有显著解剖学改善（P < 0.001），但仅螺内酯组最终BCVA有显著改善（P < 0.05）。治疗组12眼中有4眼（33.33%）在SRF完全消退后复发。所有患者均未出现螺内酯的任何副作用。
口服螺内酯（50毫克/天）可实现显著的解剖学及视力改善，而保守治疗无法提供显著的视力提高。对于无法承担光动力疗法（PDT）治疗费用的未愈CSC患者，螺内酯应被视为一种替代治疗选择。
