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Efficacy of mineralocorticoid receptor antagonist for central serous chorioretinopathy: a meta-analysis

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Abstract

Purpose

To evaluate the efficacy of mineralocorticoid receptor antagonist (MRA) for patients with central serous chorioretinopathy (CSCR).

Methods

The Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were comprehensively searched up to February 2020, to identify the studies comparing the efficacy of MRA with placebo/observation or photodynamic therapy (PDT) for CSCR. The primary outcomes were maximal subretinal fluid height and central macular thickness (CMT). The secondary outcomes included subfoveal choroidal thickness (SFCT) and best-corrected visual acuity (BCVA). Data of interest were extracted and analyzed by R version 3.6.0. The weighted mean difference and their 95% confidence intervals were used to assess the strength of the association.

Results

Ten studies including 284 affected eyes were involved, with 168 undergoing MRA treatment, 60 taking placebo/observation, and 56 receiving PDT. The pooling results showed that MRA was significantly more effective in resolving maximal subretinal fluid height (P < 0.01) and diminishing CMT (P < 0.01) than placebo/observation, while PDT could achieve significantly better CMT reduction than MRA (P = 0.03). For BCVA improvement and SFCT reduction, no statistical difference was detected among the groups of MRA, observation, placebo, or PDT (P > 0.05).

Conclusion

MRA is an effective therapy for the management of CSCR, which is only slightly inferior to PDT in terms of CMT reduction. For patients who could not afford PDT, MRA could function as an alternative treatment with acceptable efficacy and safety.

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Data Availability

The pooled analysis data used to support the findings of this study are available from the corresponding author upon request.

References

  1. Kitzmann AS, Pulido JS, Diehl NN, Hodge DO, Burke JP (2008) The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980–2002. Ophthalmology 115(1):169–173

    Article  PubMed  Google Scholar 

  2. Yu J, Jiang C, Xu G (2019) Correlations between changes in photoreceptor layer and other clinical characteristics in central serous chorioretinopathy. Retina 39(6):1110–1116

    Article  PubMed  Google Scholar 

  3. Liew G, Quin G, Gillies M, Fraser-Bell S (2013) Central serous chorioretinopathy: a review of epidemiology and pathophysiology. Clin Exp Ophthalmol 41(2):201–214

    Article  PubMed  Google Scholar 

  4. Sartini F, Figus M, Nardi M, Casini G, Posarelli C (2019) Non-resolving, recurrent and chronic central serous chorioretinopathy: available treatment options. Eye (Lond) 33(7):1035–1043

    Article  Google Scholar 

  5. Nicholson BP, Atchison E, Idris AA, Bakri SJ (2018) Central serous chorioretinopathy and glucocorticoids: an update on evidence for association. Surv Ophthalmol 63(1):1–8

    Article  PubMed  Google Scholar 

  6. Prunte C, Flammer J (1996) Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol 121(1):26–34

    Article  CAS  PubMed  Google Scholar 

  7. Zhao M, Celerier I, Bousquet E, Jeanny JC, Jonet L, Savoldelli M et al (2012) Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy. J Clin Invest 122(7):2672–2679

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Daruich A, Matet A, Dirani A, Bousquet E, Zhao M, Farman N et al (2015) Central serous chorioretinopathy: recent findings and new physiopathology hypothesis. Prog Retin Eye Res 48:82–118

    Article  CAS  PubMed  Google Scholar 

  9. Rajesh B, Agrawal H, Peguda HK, Chhablani J (2018) Predictors of outcome during eplerenone therapy in chronic central serous chorioretinopathy: a prospective, Open-Label pilot clinical study. Ophthalmic Surg Lasers Imaging Retina 49(7):479–486

    Article  PubMed  Google Scholar 

  10. Sacconi R, Baldin G, Carnevali A, Querques L, Rabiolo A, Marchini G et al (2018) Response of central serous chorioretinopathy evaluated by multimodal retinal imaging. Eye (Lond) 32(4):734–742

    Article  CAS  Google Scholar 

  11. Gergely R, Kovacs I, Schneider M, Resch M, Papp A, Recsan Z et al (2017) Mineralocorticoid receptor antagonist treatment in bilateral chronic central serous chorioretinopathy: a comparative study of exudative and nonexudative fellow eyes. Retina 37(6):1084–1091

    Article  CAS  PubMed  Google Scholar 

  12. Herold TR, Rist K, Priglinger SG, Ulbig MW, Wolf A (2017) Long-term results and recurrence rates after spironolactone treatment in non-resolving central serous chorio-retinopathy (CSCR). Graefes Arch Clin Exp Ophthalmol 255(2):221–229

    Article  PubMed  Google Scholar 

  13. Cakir B, Fischer F, Ehlken C, Buhler A, Stahl A, Schlunck G et al (2016) Clinical experience with eplerenone to treat chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 254(11):2151–2157

    Article  CAS  PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012

    Article  PubMed  Google Scholar 

  15. Bousquet E, Beydoun T, Rothschild PR, Bergin C, Zhao M, Batista R et al (2015) Spironolactone for nonresolving central serous chorioretinopathy: a randomized controlled crossover study. Retina 35(12):2505–2515

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Beck RW, Moke PS, Turpin AH, Ferris FR, SanGiovanni JP, Johnson CA et al (2003) A computerized method of visual acuity testing: Adaptation of the early treatment of diabetic retinopathy study testing protocol. Am J Ophthalmol 135(2):194–205

    Article  PubMed  Google Scholar 

  17. Rahimy E, Pitcher JR, Hsu J, Adam MK, Shahlaee A, Samara WA et al (2018) A randomized double-blind placebo-control pilot study of eplerenone for the treatment of central serous chorioretinopathy (ecselsior). Retina 38(5):962–969

    Article  PubMed  Google Scholar 

  18. Schwartz R, Habot-Wilner Z, Martinez MR, Nutman A, Goldenberg D, Cohen S et al (2017) Eplerenone for chronic central serous chorioretinopathy-a randomized controlled prospective study. Acta Ophthalmol 95(7):e610–e618

    Article  CAS  PubMed  Google Scholar 

  19. Sun X, Shuai Y, Fang W, Li J, Ge W, Yuan S et al (2018) Spironolactone versus observation in the treatment of acute central serous chorioretinopathy. Br J Ophthalmol 102(8):1060–1065

    Article  PubMed  Google Scholar 

  20. Rabiolo A, Zucchiatti I, Marchese A, Baldin G, Sacconi R, Montorio D et al (2018) Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy. Eye (Lond) 32(1):55–66

    Article  CAS  Google Scholar 

  21. Kapoor KG, Wagner AL (2016) Mineralocorticoid antagonists in the treatment of central serous chorioretinopathy: a comparative analysis. Ophthalmic Res 56(1):17–22

    Article  CAS  PubMed  Google Scholar 

  22. Kim DY, Lee JY, Lee EK, Kim JY (2019) Comparison of visual/anatomical outcomes and recurrence rate between oral spironolactone and photodynamic therapy for nonresolving central serous chorioretinopathy. Retina. https://doi.org/10.1097/IAE.0000000000002507 e-pub ahead of print 11 Mar 2019

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zucchiatti I, Sacconi R, Parravano MC, Costanzo E, Querques L, Montorio D et al (2018) Eplerenone versus observation in the treatment of acute central serous chorioretinopathy: a retrospective controlled study. Ophthalmol Ther 7(1):109–118

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lee JH, Lee SC, Kim H, Lee CS (2019) Comparison of short-term efficacy between oral spironolactone treatment and photodynamic therapy for the treatment of nonresolving central serous chorioretinopathy. Retina 39(1):127–133

    Article  CAS  PubMed  Google Scholar 

  25. Rubsam A, Thieme CE, Schlomberg J, Winterhalter S, Muller B, Joussen AM et al (2017) Therapy rationale for mineralocorticoid-receptor antagonists, acetazolamide and a switch of therapy in nonresponders in central serous chorioretinopathy. J Ocul Pharmacol Ther 33(3):141–148

    Article  PubMed  CAS  Google Scholar 

  26. Herold TR, Prause K, Wolf A, Mayer WJ, Ulbig MW (2014) Spironolactone in the treatment of central serous chorioretinopathy—a case series. Graefes Arch Clin Exp Ophthalmol 252(12):1985–1991

    Article  CAS  PubMed  Google Scholar 

  27. Carrai P, Pichi F, Behar-Cohen FF, Ciardella A, Nucci P (2015) Comparison of two mineralocorticoid receptor antagonists in the treatment of central serous chorioretinopathy. Investig Ophthalmol Vis Sci 56(7):1284

    Google Scholar 

  28. Zhao M, Zhang F, Chen Y, Dai H, Qu J, Dong C et al (2015) A 50% versus 30% dose of verteporfin (photodynamic therapy) for acute central serous chorioretinopathy: one-year results of a randomized clinical trial. Jama Ophthalmol 133(3):333–340

    Article  PubMed  Google Scholar 

  29. Cheng CK, Chang CK, Peng CH (2017) Comparison of photodynamic therapy using half-dose of verteporfin or half-fluence of laser light for the treatment of chronic central serous chorioretinopathy. Retina 37(2):325–333

    Article  CAS  PubMed  Google Scholar 

  30. Sakurada Y, Leong B, Parikh R, Fragiotta S, Freund KB (2018) Association between choroidal caverns and choroidal vascular hyperpermeability in eyes with pachychoroid diseases. Retina 38(10):1977–1983

    Article  PubMed  Google Scholar 

  31. Wang SK, Sun P, Tandias RM, Seto BK, Arroyo JG (2019) Mineralocorticoid receptor antagonists in central serous chorioretinopathy: a meta-analysis of randomized controlled trials. Ophthalmol Retina 3(2):154–160

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Dong Yoon Kim, Giuseppe Querques, Alessandro Rabiolo, and Roy Schwartz for generously sharing their original data source. We also thank Lin Peng for the assistance of language.

Funding

No funding was associated with the design, conduct, or data analysis of this meta-analysis.

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Author notes

  1. Bilei Zhang and Yuyu Chou have contributed equally to this work

Authors and Affiliations

  1. Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Bilei Zhang, Yuyu Chou, Xinyu Zhao, Jingyuan Yang & Youxin Chen

  2. Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China

    Bilei Zhang, Yuyu Chou, Xinyu Zhao, Jingyuan Yang & Youxin Chen

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  1. Bilei Zhang
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Contributions

YXC conceived and planned the study. BLZ contributed to literature search and data extraction. YYC performed the statistical analysis and interpreted results. BLZ and YYC drafted, revised, and submitted the manuscript, together. XYZ and JYY contributed to statistical analysis and revision of the manuscript. All authors approved the final version.

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Correspondence to Youxin Chen.

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Zhang, B., Chou, Y., Zhao, X. et al. Efficacy of mineralocorticoid receptor antagonist for central serous chorioretinopathy: a meta-analysis. Int Ophthalmol 40, 2957–2967 (2020). https://doi.org/10.1007/s10792-020-01479-1

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  • DOI: https://doi.org/10.1007/s10792-020-01479-1

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