Efficacy of intravitreal injection of aflibercept 2 mg compared to oral spironolactone in acute central serous chorioretinopathy patients

Purpose The aim of this study was to compare the efficacy of intravitreal injection of aflibercept 2 mg to oral spironolactone in acute central serous chorioretinopathy cases with subretinal fluid (SRF) of less than a 3-month duration. Patients and methods This is a prospective randomized study which included 40 eyes of 40 treatment naïve patients with acute central serous chorioretinopathy who were divided into two groups: group 1 which included 20 eyes of 20 patients who received intravitreal injection of aflibercept 2 mg based on pro-re-nata protocol and group 2 that included 20 eyes of 20 patients who received oral spironolactone 50 mg daily up to 12 months. Optical coherence tomography was performed for all cases at baseline and after 1, 3, 6, 9, and 12 months. Results In group 1, the central macular thickness (CMT) diminished significantly from 446±120.5 µm at baseline to 207.2±11.1 µm after 12 months ( P <0.001), while in group 2, the CMT showed a statistically significant decline from 449±115.1 µm at baseline to 238.2±31.8 µm after 12 months ( P <0.001). There was a more significant decline in the CMT in group 1 compared to group 2 throughout the whole duration of the study ( P =0.001, 0.02, 0.003, 0.02, and 0.002 at 1, 3, 6, 9, and 12 months, respectively). Complete resolution of the SRF was achieved in all cases of group 1 and in 55% of the cases of group 2, with a statistically significant difference ( P =0.001). There was a statistically significant improvement in best-corrected visual acuity (BCVA) (LogMAR) after 12 months in both groups (group 1 from 0.4±0.1 at baseline to 0.1±0.0 after 12 months, P <0.001 and group 2 from 0.4±0.1 to 0.16±0.06, respectively, P <0.001). Group 1 showed a more significant BCVA improvement compared to group 2 throughout the follow-up visits at 1, 6, 9, and 12 months ( P =0.001, 0.006, 0.01, and 0.006, respectively). Both groups showed a significant positive correlation between the number of injections (in group 1), baseline CMT, baseline SRF height, and baseline BCVA with the CMT, SRF height, and BCVA changes after 12 months ( P <0.001). Conclusion Intravitreal aflibercept 2 mg injections resulted in a faster and a more resolution of the SRF with better BCVA gain compared to oral spironolactone.