Gao Sheng, Zhang Yun, Zhang Meixia
Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.
Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China.
J Ophthalmol. 2024 Mar 18;2024:7197249. doi: 10.1155/2024/7197249. eCollection 2024.
To evaluate the efficacy of spironolactone in the treatment of chronic central serous chorioretinopathy (CSC) and identify imaging characteristics that can predict the benefit of spironolactone treatment.
Patients with chronic CSC were treated with spironolactone (20 mg/tid) and followed for 6 months. The primary outcome measure was complete resolution of the subretinal fluid (SRF), and the best-corrected visual acuity (BCVA), the SRF area, the central macular thickness (CMT), the subfoveal choroidal thickness (SFCT), and the density of the choriocapillaris vessel and adverse events were secondary outcome measures. Patients who presented complete resolution of SRF were included in the responder group and the other patients who had moderate or no resolution were included in the nonresponder group. Imaging characteristic comparisons between the responder and nonresponder groups were performed with regression analyses to identify factors that are predictive of a good response to treatment.
Forty-two eyes of 42 patients with a mean age of 46.06 ± 6.66 years were included. A total of 57.1% of the patients achieved a complete resolution of SRF. The mean SRF area, CMT, and SFCT decreased significantly (all < 0.05) throughout the follow-up period and BCVA improved slightly ( > 0.05). The vascular density of the choriocapillaris of the fellow eyes did not vary significantly during treatment. Logistic regression analysis revealed that SFCT (=0.002) and the intact ellipsoid zone (=0.001) were correlated with disease resolution. A relatively higher baseline SFCT was a predictive factor associated with a good response to treatment according to multivariate analysis.
This study suggested that oral spironolactone could be an effective and safe therapy for chronic CSC patients. Eyes with a higher baseline SFCT and intact ellipsoid zone could have a good response. These parameters are an important prognostic marker.
评估螺内酯治疗慢性中心性浆液性脉络膜视网膜病变（CSC）的疗效，并确定可预测螺内酯治疗获益的影像学特征。
慢性CSC患者接受螺内酯治疗（20毫克/每日三次），并随访6个月。主要结局指标是视网膜下液（SRF）完全消退，最佳矫正视力（BCVA）、SRF面积、中心黄斑厚度（CMT）、黄斑中心凹下脉络膜厚度（SFCT）、脉络膜毛细血管密度以及不良事件为次要结局指标。SRF完全消退的患者纳入反应者组，其他消退程度中等或未消退的患者纳入无反应者组。通过回归分析对反应者组和无反应者组之间的影像学特征进行比较，以确定预测治疗良好反应的因素。
纳入42例患者的42只眼，平均年龄46.06±6.66岁。共有57.1%的患者SRF完全消退。在整个随访期间，平均SRF面积、CMT和SFCT显著下降（均P<0.05），BCVA略有改善（P>0.05）。治疗期间对侧眼脉络膜毛细血管的血管密度无显著变化。逻辑回归分析显示，SFCT（P=0.002）和完整椭圆体带（P=0.001）与疾病消退相关。根据多变量分析，相对较高的基线SFCT是与治疗良好反应相关的预测因素。
本研究表明，口服螺内酯对慢性CSC患者可能是一种有效且安全的治疗方法。基线SFCT较高且椭圆体带完整的眼可能有良好反应。这些参数是重要的预后标志物。
