Efficacy and safety of the mineralocorticoid receptor antagonist treatment for central serous chorioretinopathy: a systematic review and meta-analysis.

OBJECTIVES: We performed a systematic review and meta-analysis to assess the efficacy and safety of the mineralocorticoid receptor antagonist (MRA) treatment for central serous chorioretinopathy (CSC).

METHODS: We searched the PubMed, Embase, and the Cochrane Library to identify relevant clinical studies published prior to March 2020. The primary outcome was change in best-corrected visual acuity (BCVA), and the secondary outcomes included the subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT).

RESULTS: Five randomized controlled trials (RCT) and four cohort studies met the inclusion criteria with a total of 352 eyes. The MRA treatment was not superior to placebo in BCVA at 1 month (WMD = -0.06, 95% CI -0.15-0.02, P = 0.15, I2  = 86%), 3 months (WMD = -0.04, 95% CI -0.14-0.06, P = 0.44, I2  = 77%) and 6 months (WMD = -0, 95% CI -0.05-0.05, P = 0.92, I2  = 0%). The MRA treatment resulted in significant reduction than the placebo in the SRF (WMD = -60.64, 95% CI -97.91 to -23.37, P = 0.001, I2  = 49%), SFCT (WMD = -39.15, 95% CI -52.58 to -25.72, P < 0.001, I2  = 0%), and CMT (WMD = -60.75, 95% CI -97.85 to -23.65, P = 0.01, I2  = 53%).

CONCLUSIONS: Our meta-analysis shows that the MRA treatment can improve anatomical structure in CSC patients, but it is not effective for achieving BCVA gain. The applicant of the MRA is safe and have no severe effect.