Early Visual and Choroidal Responses to Oral Eplerenone in Acute Central Serous Chorioretinopathy: A Retrospective Comparative Cohort Study

Purpose: This study aims to evaluate the effectiveness and safety of oral eplerenone in accelerating visual and anatomical recovery in patients with acute central serous chorioretinopathy (CSCR).Design: This is a retrospective comparative cohort study.Methods: Medical records of consecutive patients with first-episode acute CSCR (<3 months symptom duration) treated at a tertiary eye care center between December 2021 and May 2026 were reviewed.Patients received either oral eplerenone (50 mg/day for three months) or observation.Best-corrected visual acuity (BCVA), subretinal fluid (SRF) height, and subfoveal choroidal thickness (SFCT) in both affected and fellow eyes were assessed using spectral-domain optical coherence tomography (SD-OCT) at baseline, one month, and three months.The primary outcome was the proportion of eyes achieving a BCVA of 6/6 at one month.Secondary outcomes included complete SRF resolution, reduction in SRF height, changes in SFCT, and treatment-related adverse events.Results: Seventy-one eyes of 71 patients were included (34 eplerenone; 37 observation).Baseline demographic, visual, and OCT characteristics were comparable between groups (all p > 0.05).At one month, significantly more eyes in the eplerenone group achieved BCVA of 6/6 than the observation group (76.5% vs. 40.5%,p = 0.002).Complete SRF resolution was also more frequent with eplerenone (32.4% vs. 10.8%,p = 0.026), with a greater reduction in SRF height (183.4 ± 50.6 µm vs. 30.4± 21.9 µm, p < 0.001).By three months, visual acuity (91.2% vs. 86.5%,p = 0.712) and complete SRF resolution (61.8% vs. 43.2%,p = 0.119) were no longer significantly different between groups.Although SFCT in the affected eye showed greater numerical reduction with eplerenone, between-group differences did not reach statistical significance.In contrast, fellow-eye SFCT was significantly lower in the eplerenone group at both one month (359.6 ± 65.2 µm vs. 406.7 ± 69.6 µm, p = 0.004) and three months (339.2 ± 70.3 µm vs. 383.1 ± 79.9 µm, p = 0.015).No serious ocular or systemic adverse events were observed.Conclusions: Oral eplerenone was associated with faster early visual recovery and SRF resolution in acute CSCR but did not alter the favorable three-month prognosis compared with observation.The significant bilateral reduction in the SFCT may be associated with a systemic pharmacological effect of mineralocorticoid receptor blockade on the choroid rather than local disease resolution alone.However, these interpretations remain hypothetical and require further evaluation in adequately powered multicenter randomized controlled trials.