Oral eplerenone in first-episode acute central serous chorioretinopathy: results of a double-masked randomized trial

Central serous chorioretinopathy (CSCR) is a pachychoroid disorder characterized by serous retinal detachment driven by choroidal vascular dysfunction and mineralocorticoid receptor (MR) overactivation. Eplerenone, a selective MR antagonist, has been proposed as a therapeutic option, although clinical evidence remains inconsistent.

In a randomized, double-blind, placebo-controlled trial, 44 patients with first-episode acute CSCR received either oral eplerenone (25 mg twice daily) or placebo for three months. Outcomes included best-corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (CT), and OCT-angiography parameters of retinal and choroidal microvasculature.

Both groups demonstrated significant reductions in CMT and SRF over time, but SRF absorption was significantly greater in the eplerenone group at 3 months (P < 0.05). Choriocapillaris vessel density and flow index improved significantly with eplerenone (P < 0.001), while superficial, deep, and radial peripapillary plexus densities did not differ between groups. BCVA improved similarly in both groups.