An update on evidence for mineralocorticoid receptor antagonist in the treatment of chronic central serous retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhang Lingli , Li Hua , Wu Yufei , Song Shengfang ,  Liu Shichun

Department of Ophtalmology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China;

Corresponding author：

Liu Shichun, Email: 1256251383@qq.com

Keywords：

Central serous chorioretinopathy/drug therapy; Receptors, mineralocorticoid/antagonists & inhibitors; Review

DOI：

10.3760/cma.j.issn.1005-1015.2019.04.024

Video：

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Abstract Full text Figures/Tables Video References Cited by

As most patients of central serous retinopathy (CSC), the symptoms of acute onset will alleviate by oneself after 4-6 months. About 30%-50% of patients with CSC experience chronic or recurrent cases. Resulting in persistent neurosensory detachments and subretinal fluid, causing significant vision loss. Mineralocorticoid receptor (MR) is a kind of nuclear hormone receptors, plays a role in theregulation of water and electrolyte balance. Excessive MR signaling is associated with many diseases. Study found that MR antagonists decreased the thickness of the retina and improved in vision, there was no serious adverse reactions during the period of treatment for chronic CSC. Initial dose of MR antagonists was 25 mg per day, 1 week later, dosage was increased to 50 mg per day, and treatment for about 3 months. There is no conclusive effective treatment and the dosage are still unknown. MR antagonists may be a safe and effective way to treat chronic CSC, though evidence is scant. Prospective, multicenter, large-scale trials is required.

Citation： Zhang Lingli, Li Hua, Wu Yufei, Song Shengfang, Liu Shichun. An update on evidence for mineralocorticoid receptor antagonist in the treatment of chronic central serous retinopathy. Chinese Journal of Ocular Fundus Diseases, 2019, 35(4): 413-416. doi: 10.3760/cma.j.issn.1005-1015.2019.04.024 Copy

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2.	Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinopathy: an update on pathogenesis and treatment[J]. Eye (Lond), 2010, 24(12): 1743-1756. DOI: 10.1038/eye.2010.130.
3.	Bouzas EA, Karadimas P, Pournaras CJ. Central serous chorioretinopathy and glucocorticoids[J]. Surv Ophthalmol, 2002, 47(5): 431-448. DOI: 10.1016/S0039-6257(02)00338-7.
4.	Haimovici R, Rumelt S, Melby J. Endocrine abnormalities in patients with central serous chorioretinopathy[J]. Ophthalmology, 2003, 110(4): 698-703. DOI: 10.1016/S0161-6420(02)01975-9.
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6.	Kim DY, Lee JY, Lee EK, et al. Comparison of visual/anatomical outcomes and recurrence rate between oral spironolactone and photodynamic therapy for nonresolving centralserous chorioretinopathy[J/OL]. Retina, 2019, 2019: E1[2019-03-11]. http://dx.doi.org/10.1097/IAE.0000000000002507. DOI: 10.1097/IAE.0000000000002507. [published online ahead of print].
7.	Wang SK, Sun P, Tandias RM, et al. Mineralocorticoid receptor antagonists in central serous chorioretinopathy: a meta-analysis of randomized controlled trials[J]. Ophthalmol Retina, 2019, 3(2): 154-160. DOI: 10.1016/j.oret.2018.09.003.
8.	Noma H, Funatsu H, Mimura T, et al. Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology[J]. BMC Ophthalmol, 2012, 12: 39. DOI: 10.1186/1471-2415-12-39.
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14.	Liu B, Deng T, Zhang J. Risk factors for central serous chorioretinopathy: a systematic review and meta-analysis[J]. Retina, 2016, 36(1): 9-19. DOI: 10.1097/IAE.0000000000000837.
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20.	Daruich A, Matet A, Dirani A, et al. Oral mineralocorticoid-receptor antagonists: real-life experience in clinical subtypes of nonresolving central serous chorioretinopathy with chronic epitheliopathy[J]. Transl Vis Sci Technol, 2016, 5(2): 2. DOI: 10.1167/tvst.5.2.2.
21.	Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: recent findings and new physiopathology hypothesis[J]. Prog Retin Eye Res, 2015, 48: 82-118. DOI: 10.1016/j.preteyeres.2015.05.003.
22.	Zhao M, Bousquet E, Valamanesh F, et al. Differential regulations of AQP4 and Kir4.1 by triamcinolone acetonide and dexamethasone in the healthy and inflamed retina[J]. Invest Ophthalmol Vis Sci, 2011, 52(9): 6340-6347. DOI: 10.1167/iovs.11-7675.
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24.	Bousquet E, Beydoun T, Zhao M, et al. Mineralocorticoid receptor antagonism in the treatment of chronic central serous chorioretinopathy: a pilot study[J]. Retina, 2013, 33(10): 2096-2102. DOI: 10.1097/IAE.0b013e318297a07a.
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31.	Chan WM, Lam DS, Lai TY, et al. Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level[J]. Br J Ophthalmol, 2003, 87(12): 1453-1458. DOI: 10.1136/bjo.87.12.1453.
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1. Liew G, Quin G, Gillies M, et al. Central serous chorioretinopathy: a review of epidemiology and pathophysiology[J]. Clin Exp Ophthalmol, 2013, 41(2): 201-214. DOI: 10.1111/j.1442-9071.2012.02848.x.
2. Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinopathy: an update on pathogenesis and treatment[J]. Eye (Lond), 2010, 24(12): 1743-1756. DOI: 10.1038/eye.2010.130.
3. Bouzas EA, Karadimas P, Pournaras CJ. Central serous chorioretinopathy and glucocorticoids[J]. Surv Ophthalmol, 2002, 47(5): 431-448. DOI: 10.1016/S0039-6257(02)00338-7.
4. Haimovici R, Rumelt S, Melby J. Endocrine abnormalities in patients with central serous chorioretinopathy[J]. Ophthalmology, 2003, 110(4): 698-703. DOI: 10.1016/S0161-6420(02)01975-9.
5. Zhao M, Célérier I, Bousquet E, et al. Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy[J]. J Clin Invest, 2012, 122(7): 2672-2679. DOI: 10.1172/JCI61427.
6. Kim DY, Lee JY, Lee EK, et al. Comparison of visual/anatomical outcomes and recurrence rate between oral spironolactone and photodynamic therapy for nonresolving centralserous chorioretinopathy[J/OL]. Retina, 2019, 2019: E1[2019-03-11]. http://dx.doi.org/10.1097/IAE.0000000000002507. DOI: 10.1097/IAE.0000000000002507. [published online ahead of print].
7. Wang SK, Sun P, Tandias RM, et al. Mineralocorticoid receptor antagonists in central serous chorioretinopathy: a meta-analysis of randomized controlled trials[J]. Ophthalmol Retina, 2019, 3(2): 154-160. DOI: 10.1016/j.oret.2018.09.003.
8. Noma H, Funatsu H, Mimura T, et al. Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology[J]. BMC Ophthalmol, 2012, 12: 39. DOI: 10.1186/1471-2415-12-39.
9. Rueda-Rueda T, Sánchez-Vicente JL, Llerena-Manzorro L, et al. Bilateral exudative retinal detachment associated with central serous chorioretinopathy in a patient treated with corticosteroids[J]. Arch Soc Esp Oftalmol, 2017, 92(10): 481-485. DOI: 10.1016/j.oftal.2017.01.002.
10. Gobuty M, Adhi M, Duker JS. Central serous chorioretinopathy in a 91-year-old woman[J]. Br J Ophthalmol, 2013, 97(12): 1607-1616. DOI: 10.1136/bjophthalmol-2013-303707.
11. Grixti A, Kumar V. Steroid induced central serous chorioretinopathy in giant cell arteritis[J/OL]. Case Rep Ophthalmol Med, 2013, 2013: 924037[2013-06-11]. https://dx.doi.org/10.1155/2013/924037. DOI: 10.1155/2013/924037.
12. Valls PE, Martínez-Costa L, Santander F. Central serous chorioretinopathy and systemic corticosteroids in rheumatic diseases: report of three cases[J]. BMC Musculoskelet Disord, 2015, 16: 378. DOI: 10.1186/s12891-015-0843-4.
13. Prakash G, Shephali J, Tirupati N, et al. Recurrent central serous chorioretinopathy with dexamethasone eye drop used nasally for rhinitis[J]. Middle East Afr J Ophthalmol, 2013, 20(4): 363-365. DOI: 10.4103/0974-9233.120001.
14. Liu B, Deng T, Zhang J. Risk factors for central serous chorioretinopathy: a systematic review and meta-analysis[J]. Retina, 2016, 36(1): 9-19. DOI: 10.1097/IAE.0000000000000837.
15. Yoshioka H. The etiology of central serous chorioretinopathy[J]. Nippon Ganka Gakkai Zasshi, 1991, 95(12): 1181-1195.
16. Norouzpour A, Abrishami M. Central serous chorioretinopathy: from glucocorticoids to light intensity[J]. Int J Ophthalmol, 2016, 9(2): 312-314. DOI: 10.18240/ijo.2016.02.25.
17. Farman N, Rafestin-Oblin ME. Multiple aspects of mineralocorticoid selectivity[J]. Am J Physiol Renal Physiol, 2001, 280(2): 181-192. DOI: 10.1152/ajprenal.2001.280.2.F181.
18. Viengchareun S, Le MD, Martinerie L, et al. The mineralocorticoid receptor: insights into its molecular and (patho)physiological biology[J/OL]. Nucl Recept Signal, 2007, 5: 12[2007-11-30]. http://europepmc.org/abstract/MED/18174920. DOI: 10.1621/nrs.05012.
19. Wilkinson-Berka JL, Tan G, Jaworski K, et al. Identification of a retinal aldosterone system and the protective effects of mineralocorticoid receptor antagonism on retinal vascular pathology[J]. Circ Res, 2009, 104(1): 124-133. DOI: 10.1161/CIRCRESAHA.108.176008.
20. Daruich A, Matet A, Dirani A, et al. Oral mineralocorticoid-receptor antagonists: real-life experience in clinical subtypes of nonresolving central serous chorioretinopathy with chronic epitheliopathy[J]. Transl Vis Sci Technol, 2016, 5(2): 2. DOI: 10.1167/tvst.5.2.2.
21. Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: recent findings and new physiopathology hypothesis[J]. Prog Retin Eye Res, 2015, 48: 82-118. DOI: 10.1016/j.preteyeres.2015.05.003.
22. Zhao M, Bousquet E, Valamanesh F, et al. Differential regulations of AQP4 and Kir4.1 by triamcinolone acetonide and dexamethasone in the healthy and inflamed retina[J]. Invest Ophthalmol Vis Sci, 2011, 52(9): 6340-6347. DOI: 10.1167/iovs.11-7675.
23. van Dijk EHC, Schellevis RL, van Bergen MGJM, et al. Association of a haplotype in the NR3C2 gene, encoding the mineralocorticoid receptor, with chronic central serous chorioretinopathy[J]. JAMA Ophthalmol, 2017, 135(5): 446-451. DOI: 10.1001/jamaophthalmol.2017.0245.
24. Bousquet E, Beydoun T, Zhao M, et al. Mineralocorticoid receptor antagonism in the treatment of chronic central serous chorioretinopathy: a pilot study[J]. Retina, 2013, 33(10): 2096-2102. DOI: 10.1097/IAE.0b013e318297a07a.
25. Calhoun DA, White WB. Effectiveness of the selective aldosterone blocker, eplerenone, in patients with resistant hypertension[J]. J Am Soc Hypertens, 2008, 2(6): 462-468. DOI: 10.1016/j.jash.2008.05.005.
26. Chapman N, Dobson J, Wilson S, et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension[J]. Hypertension, 2007, 49(4): 839-845. DOI: 10.1161/01.HYP.0000259805.18468.8c.
27. Colussi G, Catena C, Sechi LA. Spironolactone, eplerenone and the new aldosterone blockers in endocrine and primary hypertension[J]. J Hypertens, 2013, 31(1): 3-15. DOI: 10.1097/HJH.0b013e3283599b6a.
28. Eguchi K, Kabutoya T, Hoshide S, et al. Add-on use of eplerenone is effective for lowering home and ambulatory blood pressure in drug-resistant hypertension[J]. J Clin Hypertens (Greenwich), 2016, 18(12): 1250-1257. DOI: 10.1111/jch.12860.
29. Salehi M, Wenick AS, Law HA, et al. Interventions for central serous chorioretinopathy: a network meta-analysis[J]. Cochrane Database Syst Rev, 2015(12): CD011841. DOI: 10.1002/14651858.CD011841.pub2.
30. Mehta PH, Meyerle C, Sivaprasad S, et al. Preferred practice pattern in central serous chorioretinopathy[J]. Br J Ophthalmol, 2017, 101(5): 587-590. DOI: 10.1136/bjophthalmol-2016-309247.
31. Chan WM, Lam DS, Lai TY, et al. Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level[J]. Br J Ophthalmol, 2003, 87(12): 1453-1458. DOI: 10.1136/bjo.87.12.1453.
32. Lim JI, Glassman AR, Aiello LP, et al. Collaborative retrospective macula society study of photodynamic therapy for chronic central serous chorioretinopathy[J]. Ophthalmology, 2014, 121(5): 1073-1078. DOI: 10.1016/j.ophtha.2013.11.040.
33. Reibaldi M, Cardascia N, Longo A, et al. Standard-fluence versus low-fluence photodynamic therapy in chronic central serous chorioretinopathy: a nonrandomized clinical trial[J]. Am J Ophthalmol, 2010, 149(2): 307-315. DOI: 10.1016/j.ajo.2009.08.026.
34. Atik A, Hu Y, Yu H, et al. Changes in macular sensitivity after half-dose photodynamic therapy for chronic central serous chorioretinopathy[J]. BMC Ophthalmol, 2017, 17(1): 140. DOI: 10.1186/s12886-017-0535-y.
35. Haga F, Maruko R, Sato C, et al. Long-term prognostic factors of chronic central serous chorioretinopathy after half-dose photodynamic therapy: a 3-year follow-up study[J/OL]. PLoS One, 2017, 12(7): 0181479[2017-07-24]. http://dx.plos.org/10.1371/journal.pone.0181479. DOI: 10.1371/journal.pone.0181479.
36. Rabiolo A, Zucchiatti I, Marchese A, et al. Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy[J]. Eye (Lond), 2018, 32(1): 55-66. DOI: 10.1038/eye.2017.290.
37. Herold TR, Prause K, Wolf A, et al. Spironolactone in the treatment of central serous chorioretinopathy--a case series[J]. Graefe’s Arch Clin Exp Ophthalmol, 2014, 252(12): 1985-1991. DOI: 10.1007/s00417-014-2780-6.
38. Herold TR, Rist K, Priglinger SG, et al. Long-term results and recurrence rates after spironolactone treatment in non-resolving central serous chorio-retinopathy (CSCR)[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(2): 221-229. DOI: 10.1007/s00417-016-3436-5.
39. Ghadiali Q, Jung JJ, Yu S, et al. Central serous chorioretinopathy treated with mineralocorticoid antagonists: a one-year pilot study[J]. Retina, 2016, 36(3): 611-618. DOI: 10.1097/IAE.0000000000000748.
40. Falavarjani KG, Amirsardari A, Habibi A, et al. Visual and anatomical outcomes of spironolactone therapy in patients with chronic central serous chorioretinopathy[J]. J Ophthalmic Vis Res, 2017, 12(3): 281-289. DOI: 10.4103/jovr.jovr_139_16.
41. Singh RP, Sears JE, Bedi R, et al. Oral eplerenone for the management of chronic central serous chorioretinopathy[J]. Int J Ophthalmol, 2015, 8(2): 310-314. DOI: 10.3980/j.issn.2222-3959.2015.02.17.
42. Salz DA, Pitcher JD, Hsu J, et al. Oral eplerenone for treatment of chronic central serous chorioretinopathy: a case series[J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(4): 439-444. DOI: 10.3928/23258160-20150422-06.
43. Cakir B, Fischer F, Ehlken C, et al. Clinical experience with eplerenone to treat chronic central serous chorioretinopathy[J]. Graefe’s Arch Clin Exp Ophthalmol, 2016, 254(11): 2151-2157. DOI: 10.1007/s00417-016-3373-3.
44. Leisser C, Hirnschall N, Hackl C, et al. Eplerenone in patients with chronic recurring central serous chorioretinopathy[J]. Eur J Ophthalmol, 2016, 26(5): 479-484. DOI: 10.5301/ejo.5000727.
45. Gergely R, Kovács I, Schneider M, et al. Mineralocorticoid receptor antagonist treatment in bilateral chronic central serous chorioretinopathy: a comparative study of exudative and nonexudative fellow eyes[J]. Retina, 2017, 37(6): 1084-1091. DOI: 10.1097/IAE.0000000000001303.
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An update on evidence for mineralocorticoid receptor antagonist in the treatment of chronic central serous retinopathy

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