© 2015 Wichtg Publishing EJO ISSN 1120-6721 Eur J Ophthalmol 2015; 26 (5): 479-484 Original article this receptor (7), leading to upregulaton of the vasodilatng KCa2.3 channels in the choroidal vasculature in case of liga- ton. All these mechanisms have the potental of vascular leak- age and choroidal thickening, demonstrated by Zhao et al (6) afer cortcosteroid or aldosterone administraton. That gives a ratonale for treatment with eplerenone, an aldosterone an- tagonist, in CSC. Other recently published smaller series and case reports of patents with CSC treated with eplerenone in- dicated promising treatment results (8-11), whereas 2 groups (12, 13) found benefcial efects in a minority of patents. Eplerenone was approved in 2003 by the Food and Drug Administraton for patents with lef ventricular systolic dys- functon and clinical evidence of congestve heart failure afer an acute myocardial infarcton and is generally well-tolerated. Because it can induce elevated potassium serum levels, a po- tentally life-threatening conditon, regular laboratory checks are mandatory during therapy with eplerenone. Compared with spironolactone, which was reported to be efectve in treatment-naive CSC (14), eplerenone has limited sex-related adverse efects (15). This retrospectve case series focused on treatment and limitatons of treatment with eplerenone in patents with chronic recurring CSC and hyperautofuorescent subretnal deposits (Figs. 2 and 3). The later are hypothesized to be CSC- related products of impaired phagocytosis of photoreceptor outer segments during retnal detachment (16, 17) and pos- sible predictors for less visual beneft afer successful treat- ment with photodynamic therapy (PDT) (18). DOI: 10.5301/ejo.5000727 Eplerenone in patents with chronic recurring central serous chorioretnopathy Christoph Leisser 1 , Nino Hirnschall 1 , Christoph Hackl 1 , Pia Plasenzot 2 , Oliver Findl 1,3 1 VIROS-Vienna Insttute for Research in Ocular Surgery, A Karl Landsteiner Insttute, Hanusch Hospital, Vienna - Austria 2 1 st Medical Department, Hanusch Hospital, Vienna - Austria 3 Moorfelds Eye Hospital NHS Foundaton Trust, London - UK Introducton Central serous chorioretnopathy (CSC) was frst described by Albrecht von Graefe in 1866 as a recurrent central retnits (1). The underlying pathogenesis is not fully understood. Angi- ographic fndings indicate the choroidal vessels being the pri- mary source of leakage (2). Typically CSC is a disease of young and middle-aged men and shows an associaton with high stress occupatons, type A personality (3), and cortcosteroid exposure (4, 5). Usually CSC has a good prognosis for sponta- neous recovery in the frst months and only a minority of pa- tents have chronic recurring episodes of CSC. Central serous chorioretnopathy typically presents as (Fig. 1) with or without pigment epithelial detachment, leading to blurred vision. The well-known fact that cortcosteroids worsen the dis- ease (4, 5) led to the hypothesis of an involvement of the mineralocortcoid receptor in the pathogenesis of CSC (6). There is a similar afnity of cortcosteroids and aldosterone to abstract Purpose: To evaluate the efect of eplerenone on patents with long-term recurring central serous chorioret- nopathy (CSC). Methods: In this retrospectve case series, 11 patents with chronic recurring CSC were included. The main focus was to include patents who had undergone photodynamic therapy (4 patents), had undergone ant–vascular endothelial growth factor treatment (3 patents), or had several episodes of CSC in the past (4 patents) (mean age 60 years; SD 9.7, range 47-76). Results: Four patents (36.4%) had full resorpton of neurosensory detachment under therapy of eplerenone with improvement of vision, while 4 more patents had improvement of vision despite residual edema. Eight patents (73%) had improved visual acuity (VA) at the end of eplerenone therapy, 2 patents had no change in VA, and 1 patent decreased VA. Mean tme of treatment was 10.6 ± 9.9 weeks (range 3-38 weeks). All patents showed subretnal deposits, with 6 of them having hyperautofuorescent subretnal deposits. Conclusions: Eplerenone represents a new treatment opton for patents with CSC. Our data indicate a good re- sponse in those patents, leading to improvement of VA in 73% of patents. Keywords: Central serous chorioretnopathy, Chronic recurring central serous chorioretnopathy, Eplerenone Accepted: November 25, 2015 Published online: December 17, 2015 Corresponding author: Oliver Findl, MD, MBA Hanusch Hospital Heinrich-Collin-Strasse 30 1140 Vienna, Austria oliver@fndl.at