Int Ophthalmol. 2026 Oct 12;46(1):417. doi: 10.1007/s10792-026-04287-1.
Summary
1st-episode ICSC: Oral eplerenone (vs placebo) enhanced fluid resolution but no change in VA at 3 months — Prospective, double-masked RCT, 44 patients
Abstract
Background: Central serous chorioretinopathy (CSCR) is a pachychoroid disorder characterized by serous retinal detachment driven by choroidal vascular dysfunction and mineralocorticoid receptor (MR) overactivation. Eplerenone, a selective MR antagonist, has been proposed as a therapeutic option, although clinical evidence remains inconsistent.
Methods: In a randomized, double-blind, placebo-controlled trial, 44 patients with first-episode acute CSCR received either oral eplerenone (25 mg twice daily) or placebo for three months. Outcomes included best-corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (CT), and OCT-angiography parameters of retinal and choroidal microvasculature.
Results: Both groups demonstrated significant reductions in CMT and SRF over time, but SRF absorption was significantly greater in the eplerenone group at 3 months (P < 0.05). Choriocapillaris vessel density and flow index improved significantly with eplerenone (P < 0.001), while superficial, deep, and radial peripapillary plexus densities did not differ between groups. BCVA improved similarly in both groups.
Conclusion: Eplerenone accelerates SRF resolution and enhances choriocapillaris perfusion in acute CSCR, although visual outcomes remain comparable to placebo. Early MR antagonism may offer anatomical and microvascular benefits in CSCR management.
