Mineralocorticoid Receptor Antagonist Treatment for Steroid-Induced Central Serous Chorioretinopathy Patients with Continuous Systemic Steroid Treatment

PURPOSE: To investigate the effectiveness of mineralocorticoid receptor (MR) antagonist in patients with steroid-induced central serous chorioretinopathy (CSC). METHODS: A retrospective review was conducted of steroid-induced CSC patients who were treated with the MR antagonist spironolactone 50 mg once per day for at least 1 month. The primary outcome measure was complete resolution rate of subretinal fluid (SRF) after spironolactone treatment. Secondary outcomes included central subfield thickness (CST), subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) changes after spironolactone treatment. RESULTS: Seventeen eyes from 15 patients were included in this study. Conditions warranting chronic systemic steroid use were myasthenia gravis (6/15, 40%), glomerulonephritis (5/15, 33.3%), and organ transplantation (4/15, 26.7%). Mean symptom duration of CSC was 4.00 ± 3.04 months. After spironolactone treatment, 14 eyes (82.4%) showed complete resolution of SRF (P < 0.001) without discontinuation of systemic steroid. CST and BCVA were significantly improved after spironolactone treatment. SFCT was significantly decreased after spironolactone treatment. No patients experienced electrolyte imbalance after spironolactone treatment. CONCLUSION: MR antagonist treatment may be a therapeutic option for steroid-induced CSC patients. This treatment modality may be especially beneficial for steroid-induced CSC patients who cannot discontinue steroid medication due to systemic conditions.