Oral Medications for Central Serous Chorioretinopathy: A Literature Review

The document reviewed the evidence for oral medications in treating central serous chorioretinopathy (CSCR), with a focus on mineralocorticoid receptor antagonists (MRAs) like eplerenone and spironolactone. The literature search covered articles from 1980 to July 2018, resulting in 73 articles. Eplerenone showed mixed results in randomized controlled trials (RCTs), with one RCT of 15 patients indicating significant improvements, while another showed no difference except at the 3-month mark. Spironolactone also showed promise in reducing subretinal fluid (SRF) and improving best-corrected visual acuity (BCVA), but most evidence comes from small or retrospective studies. Other medications reviewed included beta blockers, Helicobacter pylori eradication therapy, rifampicin, methotrexate, aspirin, carbonic anhydrase inhibitors, mifepristone, melatonin, finasteride, ketoconazole, antioxidants, and curcumin-phospholipids. However, the evidence for these treatments was not robust, with some showing potential benefits that require further investigation. The review concluded that MRAs, particularly eplerenone, have the highest quality evidence for use in CSCR but emphasized the need for larger RCTs to establish a solid evidence base. Side effects of MRAs such as hyperkalemia, hypotension, and endocrine disturbances were also noted, with eplerenone potentially causing fewer side effects due to its selectivity.