Efficacy of mineralocorticoid receptor antagonist for central serous chorioretinopathy: a meta-analysis
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ORIGINAL PAPER
Efficacy of mineralocorticoid receptor antagonist for central serous chorioretinopathy: a meta-analysis Bilei Zhang . Yuyu Chou . Xinyu Zhao . Jingyuan Yang . Youxin Chen
Received: 7 April 2020 / Accepted: 20 June 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To evaluate the efficacy of mineralocorticoid receptor antagonist (MRA) for patients with central serous chorioretinopathy (CSCR). Methods The Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were comprehensively searched up to February 2020, to identify the studies comparing the efficacy of MRA with placebo/ observation or photodynamic therapy (PDT) for CSCR. The primary outcomes were maximal subretinal fluid height and central macular thickness (CMT). The secondary outcomes included subfoveal choroidal thickness (SFCT) and best-corrected visual acuity (BCVA). Data of interest were extracted and analyzed by R version 3.6.0. The weighted mean difference and their 95% confidence intervals were used to assess the strength of the association.
Bilei Zhang and Yuyu Chou have contributed equally to this work B. Zhang Y. Chou X. Zhao J. Yang Y. Chen (&) Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing 100730, China e-mail: [email protected] B. Zhang Y. Chou X. Zhao J. Yang Y. Chen Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing 100730, China
Results Ten studies including 284 affected eyes were involved, with 168 undergoing MRA treatment, 60 taking placebo/observation, and 56 receiving PDT. The pooling results showed that MRA was significantly more effective in resolving maximal subretinal fluid height (P \ 0.01) and diminishing CMT (P \ 0.01) than placebo/observation, while PDT could achieve significantly better CMT reduction than MRA (P = 0.03). For BCVA improvement and SFCT reduction, no statistical difference was detected among the groups of MRA, observation, placebo, or PDT (P [ 0.05). Conclusion MRA is an effective therapy for the management of CSCR, which is only slightly inferior to PDT in terms of CMT reduction. For patients who could not afford PDT, MRA could function as an alternative treatment with acceptable efficacy and safety. Keywords Central serous chorioretinopathy Mineralocorticoid receptor antagonist Photodynamic therapy Meta-analysis
Introduction Central serous chorioretinopathy (CSCR) is a common cause of visual loss of working-age population and predominantly affects males [1]. It is characterized by
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serous retinal detachment with a variety of symptoms, such as metamorphopsia, micropsia, and dyschromatopsia [2]. Generally, these lesions regress spontaneously in almost 80% of patients within 3 months as its natural course [3]. However, chronic or nonresolving CSCR that lasts over 3 months might lead to
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