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Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa

Mineralocorticoid receptor antagonists as treatment option for acute and chronic central serous chorioretinopathy

  • Das therapeutische Prinzip
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Zusammenfassung

Hintergrund

Die Ätiologie der Chorioretinopathia centralis serosa (CCS) ist nicht abschließend geklärt. Der Zusammenhang zwischen endogenen und exogenen Glukokortikoidkonzentrationen und dem Auftreten einer CCS ist hinreichend bekannt, allerdings wird erst seit Kurzem ein möglicher neuer zugrunde liegender Pathomechanismus diskutiert.

Methoden und Ergebnisse

Untersuchungen zeigten, dass die Überaktivierung mineralokortikoider Rezeptoren der Choroidea bei der Pathogenese der CCS eine Rolle spielt. Diese Überaktivierung führt über eine intrazelluläre Signalkaskade in der vaskulären Endothelzelle zur Erhöhung der Permeabilität. Die spezifische medikamentöse Blockade mineralokortikoider Rezeptoren war in einer Pilotstudie erfolgreich. Erste Studien und eine eigene Fallserie ergaben einen funktionellen und morphologischen Therapieerfolg mit Mineralokotikoidrezeptorantagonisten. Allerdings handelt es sich bislang um unkontrollierte Beobachtungsstudien, und Spontanbesserungen sind gerade bei akuter CCS nicht auszuschließen.

Schlussfolgerung

Es sollten daher dringend kontrollierte prospektive klinische Studien erfolgen, da Spironolacton® oder Eplerenon als Therapieansatz insbesondere für Patienten mit einer chronischen CCS ohne Besserungstendenz ein hilfreicher Baustein in der Behandlung sein könnte.

Abstract

Background

It is well known that central serous chorioretinopathy (CSCR) is triggered by endogenous and exogenous glucocorticoids but the exact pathomechanism is not completely understood. According to the results of previous studies overactivation of mineralocorticoid receptors may play a decisive role in the pathogenesis of CSCR.

Methods and results

Experimental studies have shown that overactivation of mineralocorticoid receptors in endothelial cells of the choroid induces increased permeability. In a pilot study inhibition of mineralocorticoid receptors was successful in treating CSCR. This article reports about the use of spironolactone in the treatment of CSCR. In this observational case series spectral-domain optical coherence tomographv (SD-OCT) showed either reduction or complete reabsorption of subretinal fluid. In pilot studies and in this case series inhibition of mineralocorticoid receptors as a therapeutic option was effective and safe; however, the efficacy is difficult to distinguish from spontaneous recovery, especially in acute CSCR.

Conclusion

For further assessment of this treatment controlled clinical trials are urgently required as this therapy would offer a new approach for patients with chronic CSCR and no tendency towards recovery.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Maier, S. Stumpfe, N. Feucht, P. Strobl, V. Rath und C.P. Lohmann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Augenklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    M. Maier, S. Stumpfe, N. Feucht, P. Strobl, V. Rath & C.P. Lohmann

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  1. M. Maier
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  2. S. Stumpfe
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  3. N. Feucht
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  4. P. Strobl
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  6. C.P. Lohmann
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Correspondence to M. Maier.

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Maier, M., Stumpfe, S., Feucht, N. et al. Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa. Ophthalmologe 111, 173–180 (2014). https://doi.org/10.1007/s00347-013-3001-0

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