Eplerenone in acute central serous chorioretinopathy: faster fluid resolution, same visual acuity

Design

Randomised, double-blind, placebo-controlled trial

Population

44 patients with first-episode acute central serous chorioretinopathy

Primary outcome

Best-corrected visual acuity, central macular thickness, subretinal fluid and choroidal perfusion over 3 months

Effect

Greater subretinal fluid absorption with eplerenone (P < 0.05); acuity similar in both groups

This double-blind, placebo-controlled trial randomised 44 patients with first-episode acute central serous chorioretinopathy to oral eplerenone 25 mg twice daily or placebo for three months. Outcomes included visual acuity, central macular thickness, subretinal fluid height, choroidal thickness and OCT-angiography measures.

Both groups showed falls in central macular thickness and subretinal fluid over time, but fluid absorption was significantly greater with eplerenone at three months (P < 0.05). Choriocapillaris vessel density and flow index improved with eplerenone (P < 0.001), while superficial and deep plexus densities did not differ. Best-corrected visual acuity improved similarly in both arms.

Acute episodes often resolve by themselves, and this trial shows an anatomical edge without a functional one. The abstract gives no effect sizes or intervals for fluid height. Eplerenone raises potassium and needs monitoring, and the trial was small. It does not establish a role beyond observation for a first episode.

• Most first episodes settle with observation; a drug that speeds fluid clearance but not vision is not an obvious reason to treat.
• Check for steroid use, including topical and inhaled, and for stress and sleep factors, in every patient with this condition.
• If an aldosterone antagonist is considered, check potassium and renal function and review interacting drugs.
• Follow with OCT and document fluid height rather than relying on acuity alone.
• Reserve discussion of treatment for persistent or recurrent fluid, where evidence is separate.

Why it matters

It tests whether blocking the mineralocorticoid receptor helps early in the disease, and it separates anatomical from visual benefit.

Don't overread it

A small trial with equal visual outcomes does not show that treating a first episode benefits patients.

The statistics, in plain English

A P value just under 0.05 in 44 patients is a fragile result, and the abstract does not give the size of the fluid difference or an interval. Anatomical improvements do not always translate into better sight, and here acuity improved equally with placebo.

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