Oral Spironolactone versus Conservative Treatment for Non-Resolving Central Serous Chorioretinopathy in Real-Life Practice

OBJECTIVE: To compare the efficacy of oral spironolactone treatment versus conservative treatment for patients with persistent central serous chorioretinopathy (CSC) in real-life practice. DESIGN: Retrospective comparative study. PATIENTS AND METHODS: Medical records and retinal images of 62 patients with non-resolving CSC were reviewed. Twenty-one patients received oral spironolactone (50 mg/day) while 41 patients received conservative treatment. Primary outcome was proportion of eyes with complete resolution of subretinal fluid (SRF) within 6 months. Secondary outcome measures included changes in SRF height, central macular thickness (CMT), lesion size and best-corrected visual acuity (BCVA). The occurrence of drug side effect was also assessed. RESULTS: There was no significant difference in demographic data, clinical characteristics, optical coherence tomography parameters and leaking patterns in fluorescein fundus angiography between two groups. Complete resolution of SRF was significantly higher and faster in the spironolactone group than the conservative treatment group (p=0.03). Although significant anatomical improvement in SRF height, CMT and lesion size were observed in both groups (p < 0.001), final BCVA was improved significantly in only the spironolactone group (p < 0.05). The recurrence of SRF after complete resolution was observed in 4/12 eyes (33.33%) in the treatment group. None of the patients experienced any side effects of spironolactone. CONCLUSION: Oral spironolactone (50 mg/day) could achieve both significant anatomical and visual improvement, while the significant visual gain could not be provided with the conservative treatment. Spironolactone should be considered as an alternative treatment option in non-resolving CSC patients who cannot afford the PDT treatment.