J Retin.  2024 May;9(1):41-51. 10.21561/jor.2024.9.1.41.

Time-dependent Efficacy and Safety of Eplerenone for Central Serous Chorioretinopathy: Meta-analysis of Randomized Controlled Clinical Trials

• Hwang G
• Lee JY
• Cho WK
• Kim DS
• Kim DI
• Shin JA

• KMID: 2556466
• DOI: http://doi.org/10.21561/jor.2024.9.1.41

Abstract

Purpose
We sought to evaluate the time-dependent efficacy and safety of eplerenone for central serous chorioretinopathy.
Methods
A systematic search was performed from inception to May 2023 in the Medline, EMBASE, and Cochrane literature databases to find randomized controlled trials that have administered oral eplerenone therapy to central serous chorioretinopathy patients.
Results
Five randomized controlled trials were included in the final analysis. Among a total of 252 central serous chorioretinopathy patients, 134 were included in the eplerenone group and 118 were included in the control group. The best-corrected visual acuity was statistically significantly improved in the eplerenone group compared to the control group (95% confidence interval [CI], -0.08 to -0.02; p = 0.001). After meta-analysis was performed at each follow-up point, it was found that eplerenone statistically significantly improved the best-corrected visual acuity compared to the control group at 2 and 3 months after starting oral eplerenone therapy, but there was no statistically significant difference at 6 months. Subretinal fluid, chorioretinal thickness, central macular thickness, and complications showed no statistically significant differences between the eplerenone and control groups (p = 0.43, 0.67, 0.64, and 0.12, respectively). The difference in the risk of complications occurring between the eplerenone and control groups also didn’t show statistical significance (p = 0.12).
Conclusions
Although eplerenone is not superior to a control protocol when considering anatomical improvements, the best-corrected visual acuity seems to improve up to 3 months superiorly compared to in the control group when oral eplerenone therapy is administered for central serous chorioretinopathy. In addition, the complications of eplerenone are tolerable. Therefore, clinically short-term use of eplerenone up to 3 months in central serous chorioretinopathy patients can be considered.

Keyword

Central serous chorioretinopathy; Eplerenone; Mineralocorticoid receptor antagonist