Ophthalmic Surg Lasers Imaging Retina. 2021 Jun;52(6):308-310. doi: 10.3928/23258160-20210528-02. Epub 2021 Jun 1.
The VICI trial reported by Lotery et al. is a recent placebo-controlled, randomized trial that examined the efficacy of eplerenone treatment for chronic central serous chorioretinopathy (CSCR) in 104 patients. The study found no significant difference in best-corrected visual acuity (BCVA) between the eplerenone-treated and placebo groups, prompting the VICI investigators to conclude that eplerenone should not be prescribed to treat CSCR. Limitations of the study include the patients' high baseline BCVA, use of a functional outcome like BCVA as the primary endpoint instead of an anatomical outcome, failure to account for rebound effect, and measuring subretinal fluid (SRF) thickness instead of the more informative SRF volume. Based on these reasons and evidence from multiple case series and prospective studies over the past 7 years, it is the opinion of the authors of this editorial that the VICI investigators' conclusion to stop prescribing eplerenone for CSCR is too severe. Future clinical trials should continue to explore the potential for eplerenone as long-term maintenance treatment in chronic CSCR. .
Lotery 等人报告的 VICI 试验是一项近期的安慰剂对照、随机试验，该试验检查了依普利酮治疗 104 例慢性中心性浆液性脉络膜视网膜病变（CSCR）的疗效。研究发现依普利酮治疗组与安慰剂组之间最佳矫正视力（BCVA）无显著差异，这促使 VICI 研究人员得出结论，依普利酮不应开处方治疗 CSCR。该研究的局限性包括患者基线 BCVA 较高，将功能结果（如 BCVA）而非解剖结果作为主要终点，未能考虑反弹效应，以及测量视网膜下液（SRF）厚度而不是更具信息量的 SRF 体积。基于这些原因和过去 7 年的多项病例系列和前瞻性研究的证据，本文编辑认为，VICI 研究人员停止为 CSCR 开具依普利酮的结论过于严厉。未来的临床试验应继续探索依普利酮作为慢性 CSCR 长期维持治疗的潜力。
