Spironolactone in the treatment of central serous chorioretinopathy – a case series

Background: The pathogenesis of central serous chorioretinopathy (CSC) is still poorly understood. An animal model of CSC proved that the mineralocorticoid receptor [1] of the choroid also plays a role in CSC. Since there is still no evidence-based therapy for non-self-limiting CSC, this case series evaluates the effect of oral spironolactone in CSC patients.

Methods: In this interventional, uncontrolled, prospective case series, we present 18 consecutive CSC patients. Patients were treated with spironolactone 25 mg twice daily (Spironolacton AL® 50 mg, ALIUD PHARMA) for up to 12 weeks. Follow–up examinations with BCVA, OCT, and EDI-OCT were performed at 1, 2, and 3 months after starting the treatment. Main outcome measure was a change of subretinal fluid (SRF) (in micrometers) measured by optical coherence tomography. Secondary outcome was a change in central retinal thickness (CRT) (in micrometers) measured by OCT and a change in BCVA.

Results: The subretinal fluid (SRF; mean) decreased from 219 μm (baseline) to 100 μm (visit 3) (difference 119 μm). Total central retinal thickness (CRT; mean) decreased from 405 μm before treatment (baseline) to 287 μm after treatment (difference 118 μm). The BCVA (in logMAR; mean) increased from 0.32 at baseline to 0.20 at visit 3.

Conclusion: Our case series could confirm a positive influence of spironolactone on the course CSC. Longer follow-up with a larger number of cases could provide more data about the long-term efficiency, recurrences, and safety of this well-tolerated and non-invasive treatment option of CSC.