Eplerenone in acute CSC: fluid cleared faster, vision no better

Design

Randomised, double-masked, placebo-controlled trial

Population

44 patients with first-episode acute central serous chorioretinopathy

Primary outcome

BCVA, macular thickness, subretinal fluid and OCTA measures at 3 months

Effect

Greater SRF resolution with eplerenone (p < 0.05); BCVA similar

A double-masked randomised trial allocated 44 patients with a first episode of acute central serous chorioretinopathy to oral eplerenone 25 mg twice daily or placebo for three months.

Subretinal fluid and macular thickness fell in both groups, as expected in a condition that often resolves spontaneously. Fluid resolution was significantly greater with eplerenone at three months (p < 0.05), and choriocapillaris vessel density and flow improved more (p < 0.001). Best-corrected visual acuity improved equally in both groups.

Larger earlier trials of mineralocorticoid antagonists in chronic CSC did not show visual benefit, and this small trial in acute disease does not change that picture. Faster anatomical resolution may matter for some patients, but observation remains reasonable for most first episodes.

• Eplerenone speeded fluid resolution in first-episode acute CSC but did not improve vision.
• Most acute CSC resolves on its own; observation remains a reasonable first approach.
• Ask about corticosteroid use from any route, a common modifiable trigger.
• Check potassium and renal function if a mineralocorticoid antagonist is used.

Why it matters

Anatomical improvement without visual gain is a weak reason to add a systemic drug to a self-limiting condition.

Don't overread it

With 44 patients and three months of follow-up, the trial could not assess recurrence or long-term vision.

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