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A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROL PILOT STUDY OF EPLERENONE FOR THE TREATMENT OF CENTRAL SEROUS CHORIORETINOPATHY (ECSELSIOR)

Purpose: To evaluate the safety and effects of oral eplerenone in chronic central serous chorioretinopathy. Methods: Prospective, randomized, double-blind, placebo-control study at a tertiary referral academic private practice. For a diagnosis of chronic central serous chorioretinopathy, patients must have had at least 3 months clinical follow-up demonstrating persistent symptoms, subfoveal fluid on spectral-domain optical coherence tomography, and <50% reduction in fluid thickness. Patients were randomized 2:1 (treatment:placebo) to receive eplerenone (25 mg daily for 1 week, then up to 50 mg daily for 8 weeks) or placebo once daily. Results: Fifteen patients completed the study. Ten patients (15 eyes) were randomized into the eplerenone treatment arm, while the remaining 5 patients (6 eyes) received placebo. After 9 weeks of eplerenone therapy, mean logarithm of the minimal angle of resolution visual acuity improved from 0.394 (Snellen equivalent: 20/50) to 0.330 (20/43, P = 0.04). In the placebo group, the mean logarithm of the minimal angle of resolution visual acuity slightly decreased from 0.313 (20/41) to 0.342 (20/44) during the same period (P = 0.21). With respect to anatomic changes, mean maximal subretinal fluid height in the eplerenone group improved from 139.3 &mgr;m at baseline to 51.8 &mgr;m (P = 0.02), mean subfoveal fluid height improved from 121.4 &mgr;m to 29.4 &mgr;m (P = 0.01), and mean central subfield thickness improved from 366.2 &mgr;m to 283.7 &mgr;m (P = 0.02). In comparison with the placebo group, mean maximal subretinal fluid height worsened from 135.9 &mgr;m to 172.3 &mgr;m (P = 0.32), mean subfoveal fluid height worsened from 92.1 &mgr;m to 134.0 &mgr;m (P = 0.54), and mean central subfield thickness worsened from 345.0 &mgr;m to 380.0 &mgr;m (P = 0.37). No patients in either group experienced serious adverse events to result in treatment discontinuation. Conclusion: These findings suggest that oral eplerenone therapy is safe and potentially effective in the treatment of chronic central serous chorioretinopathy with persistent subretinal fluid.