Long-term Eplerenone treatment in chronic central serous chorioretinopathy: effects on affected and fellow eye

Purpose: Purpose of this study is to assess long-term morpho-functional retinal and choroidal changes both in affected and in fellow eyes with chronic central serous chorioretinopathy (cCSC) in response to continuous oral EPL treatment by means of structural OCT and OCTA. Methods: This study was conducted on patients with monolateral subretinal fluid (SRF) secondary to cCSC. We enrolled a total of 34 eyes, 17 eyes with SRF and 17 fellow eyes with pachychoroid disease spectrum. Baseline best-corrected visual acuity (BCVA) and anatomical (OCT and OCTA) parameters of both eyes were collected at eplerenone initiation, and at 6,12, and 48 months. The imaging assessment was performed with a swept-source-OCTA (SS-OCTA) (DRI OCT, Triton, Topcon Corp., Tokyo, Japan). All patients received 50 mg daily of eplerenone after approval by the patient’s primary care provider. Potassium levels were monitored throughout the study period. Choriocapillaris en face OCTA images were exported and analyzed with Fiji ImageJ. Results: All the patients completed the 48-month continuous therapy with EPL. (i) cCSC affected eyes; Compared with baseline (0.34 ± 0.13 LogMAR), the BCVA significantly improved at follow-up visits (6 months logMAR 0.28 ± 0.13, p=0.039; 12 months logMAR 0.22± 0.11, p=0.025; 48 months logMAR 0.21± 0.08, p=0.028). Moreover, there was a significant reduction from baseline at 6,12 and 48-months follow-up in all structural OCT parameters (SRF and SFCT; p<0.05). (ii) cCSC fellow eyes; SFCT showed a significant reduction from baseline (594 ± 234.4 μm) at follow-up visits (6 months 533 ± 203.2 μm, p=0.001; 12 months 506 ± 184.2 μm, p=0.011; 48 months 491.3 ± 179.5 μm, p=0.001). Choriocapillaris flow deficit percentage (FD%) analysis showed a statistically significant reduction after continuous EPL treatment. Compared with the baseline, the SS-OCTA analysis showed a significant FD% decrease from 28.9 ± 1.96 % at baseline to 26.8 ± 1.61 at 6 months (p= 0.022), to 26.6 ± 1.42 at 12 months (p=0.001) and, to 26.4 ± 1.44 at 48 months (p<0.001). However, we did not find statistical significance at follow-up visits to regard BCVA (p>0.05). Conclusions: Our results showed long-term morpho-functional improvement in response to continuous oral EPL therapy in both eyes of patients with cCSC. We demonstrated that the beneficial effect of EPL for cCSC occurs within the first 6 months, with continuous improvement over one year and with a maintenance at 48 months.