Efficacy Of Spironolactone In The Treatment Of Central Serous Chorioretinopathy

Purpose:To observe the efficacy of spironolactone in the treatment of central serous chorioretinopathy.Methods:It’s a prospective research.This study collected 36 patients(36 eyes)with central serous chorioretinopathy(CSC)diagnosed by optical coherence tomography(OCT)in the macular region and fundus fluorescence angiography(FFA)from January 2021 to January 2023 in the Second Affiliated Hospital of Nanchang University.They were divided into three groups at random: spironolactone group(12patients,12 eyes)received spironolactone tablets 20 mg twice daily until SRF is completely absorbed,and the maximum duration of medication shall not exceed 3months;retinal laser photocoagulation group(12 patients,12 eyes)were treated with retinal laser photocoagulation once;observation group(12 patients,12 eyes)were not intervened and only observed.The best corrected visual acuity(BCVA),the height of subretinal fluid(SRF),the range of neuroepithelial detachment and central macular thickness(CMT)of the three groups of patients before treatment and at 1st,2nd,3rd months after treatment were followed up and be recorded in detail,and the occurrence of adverse events was also recorded.Finally,the collected data were statistically analyzed by SPSS26.0 to observe the differences among the three groups.Results:1.There was no significant difference in age,sex,baseline BCVA,the range of neuroepithelial detachment,CMT,SRF and height between the groups before treatment.2.BCVA: Compared with the baseline values,the BCVA in the retinal laser group and spironolactone treatment group was better than the baseline values at the1 st,2nd,and 3rd months after treatment,and the difference was statistically significant(P<0.05).There was no statistically significant difference in BCVA at all time points in the observation group compared with that before treatment(P>0.05).The spironolactone treatment group and retinal laser group were significantly improved compared with the observation group at the 1st,2nd and 3rd month of treatment,and the difference was statistically significant(P<0.05),while there was no significant difference in visual acuity between the spironolactone treatment group and the retinal laser group(P>0.05).3.SRF: The SRF heights in the spironolactone treatment group and the retinal laser group were significantly lower than those before treatment at all time points after treatment,with statistically significant differences(P<0.05).In the observation group,except for the 1st month of observation,there was no significant improvement in SRF height,and the SRF height decreased in the 2nd and 3rd months compared with the baseline value,and the difference was statistically significant(P<0.05).The SRF height in the spironolactone treatment group was significantly higher than that in the retinal laser group only at the 1st month of treatment,while the difference between the two groups was not statistically significant at the 2nd and 3rd month(P<0.05),and the SRF height in the spironolactone treatment group was significantly lower than that in the observation group at the 3rd month of treatment,with a statistically significant difference(P>0.05).Compared with the observation group,the SRF height in the retinal laser group was lower at all time points,and the difference was statistically significant(P<0.05).With regard to the complete regression rate of SRF,the SRF was completely absorbed in 1 case at the 2nd month of treatment in the spironolactone treatment group,with a complete absorption rate of8%,and in 6 cases at the 3rd months of treatment,with a complete absorption rate of50%.The complete absorption of SRF at the 1st,2nd and 3rd months of treatment in the retinal laser group was 3 cases(25%),7 cases(58.33%)and 10 cases(83.33%),respectively.In the observation group,only 1 case of SRF was completely absorbed at the 2nd months of observation,with a complete absorption rate of 8%.The complete regression rate of SRF was significantly higher in the retinal laser group than in the observation group at the 2nd and 3rd months,and the difference was statistically significant(P<0.05),while there was no statistically significant difference between the spironolactone group and the observation group(P>0.05).Although the rate of complete regression of SRF was higher in the retinal laser group than in the spironolactone group at the 3rd months of treatment,the difference between the two groups was not statistically significant(P>0.05).4.CMT: CMT was reduced in the retinal laser group and spironolactone treatment group at all time points after treatment compared with that before treatment,and the difference was statistically significant(P<0.05).Except for no significant change in the 1st month of treatment,the CMT in the observation group was significantly reduced compared with the baseline value at the 2nd and 3rd months,and the difference was statistically significant(P<0.05).There was no statistically significant difference in CMT between the retinal laser group and the spironolactone treatment group at each time point after treatment(P>0.05),and the spironolactone treatment group and the laser group were significantly better than the observation group at 2nd and 3rd months of treatment,with statistically significant differences(P<0.05,P<0.05).5.The range of neuroepithelial detachment: the range of neuroepithelial detachment of spironolactone treatment group and the observation group at all time points was lower than that of baseline except the 1st month,the difference was statistically significant(P<0.05).The range of neuroepithelial detachment at each time point after treatment in the retinal laser treatment group was significantly lower than that of baseline(P<0.05).There was no statistically significant difference in the range of neuroepithelial detachment between the spironolactone treatment group and the laser treatment group at each time point after treatment(P>0.05),but the two groups were significantly better than the observation group at the 3rd month.(P<0.05,P<0.05).6.Adverse events: no adverse events were observed in each group during treatment and follow-up.Conclusion:1.Oral spironolactone therapy can effectively improve the retinal anatomical structure,accelerate the absorption of SRF,and improve their vision of patients with CSC.2.Spironolactone was used in patients with CSC without obvious adverse events,which was well tolerated,safe and reliable.For patients with CSC who cannot accept retinal laser photocoagulation,photodynamic therapy and other treatments,spironolactone oral treatment is a promising treatment option.Compared with observation,spironolactone may provide better results.