July 2018 · Vol. 49, No. 7 479 ■ CLINICAL SCIENCE ■ Predictors of Outcome During Eplerenone Therapy in Chronic Central Serous Chorioretinopathy: A Prospective, Open-Label Pilot Clinical Study Bindu Rajesh, MS; Hitesh Agrawal, DO; Hari Kumar Peguda, BSc Optom; Jay Chhablani, MS BACKGROUND AND OBJECTIVE: To assess the treat- ment response and predictive factors following eplerenone treatment in chronic central serous chorioretinopathy (CSCR). PATIENTS AND METHODS: A prospective, nonran- domized study involving fixed-dose eplerenone was conducted in 22 eyes of 11 consecutive pa- tients with bilateral chronic CSCR. The changes in subretinal fluid (SRF), central macular thickness (CMT), and best-corrected visual acuity (BCVA) were analyzed. RESULTS: A significant reduction in SRF was ob- served in 13 of 16 eyes with baseline SRF (81.25%) at 3 months (P < .04), with complete resolution in six eyes (37.5%) at 3 months and in 10 eyes (62.5%) at 6 months (P < .006). Baseline BCVA was a sig- nificant predictor of final BCVA (P < .001), whereas 3-month SRF height was a weak but significant pre- dictor of the 6-month height (r 2 = 0.53; P = .002). CONCLUSION: When treated with eplerenone, chronic CSCR shows a significant reduction in SRF, with baseline BCVA and 3-month SRF height being important predictive factors. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:479-486.] INTRODUCTION Central serous chorioretinopathy (CSCR) is a dis- order associated with collection of fluid under the neurosensory retina. 1,2 Despite the implication of sev- eral risk factors like smoking, systemic hypertension, type A personality, autoimmune disorders, sleep dis- orders, pregnancy, Helicobacter pylori infection, and psychopharmacologic medication, the underlying pathophysiologic mechanism is still unclear. 3,4 Recent reports and observations from animal stud- ies along with the occurrence of CSCR in patients with primary aldosteronism support the role of min- eralocorticoid pathways in the hyperdynamic cho- roidal circulation and thereby in the pathogenesis of CSCR. 5-8 Spironolactone and eplerenone (Eptus; Glenmark Pharmaceuticals Ltd, Maharashtra, India) were the common mineralocorticoid receptor (MR) antagonists used in various reports. 9-18 Eplerenone had the advantage of being more selective with higher affinity to MR and less sex hormone-related side ef- fects. Most of the case reports were retrospective in nature, except for a few prospective trials with vary- ing dosage regimens and follow-up protocols. 13,16 We decided to conduct a prospective pilot study using a fixed-dose protocol of eplerenone in patients with chronic CSCR to assess the response to treatment and the associated predictive factors. PATIENTS AND METHODS A prospective, nonrandomized, open-label pilot clinical study of consecutive, consenting patients diagnosed with chronic CSCR who presented to the vitreoretinal department of a tertiary care eye center From Giridhar Eye Institute, Kerala, India (BR); and Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Telangana, India (HA, HKP, JC). Originally submitted May 29, 2017. Revision received October 20, 2017. Accepted for publication February 27, 2018. The authors report no relevant fnancial disclosures. Address correspondence to Jay Chhablani, MS, Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad 500 034, India; email: jay.chhablani@gmail.com. doi: 10.3928/23258160-20180628-03