Recently, we read a thought-provoking clinical trial entitled “Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months (VICI): a randomized, double-blind, placebo-controlled trial” [1]. However, the authors did not observe any significant benefit of eplerenone regarding best-corrected visual acuity (BCVA), subretinal fluid (SRF), central subfield thickness, and recurrence in patients with central serous chorioretinopathy (CSCR) compared with placebo. The study also did not explain these observations using possible mechanisms [1].

In contrast, Petkovsek et al. reported anatomical improvement, including central subfield thickness, macular cube volume, maximum SRF height and diameter achieved within the first year of eplerenone treatment [2]. In another recent study, BCVA was significantly improved and SRF and macular thickness decreased significantly in patients with CSCR treated with oral eplerenone, especially in those under stress [3]. Additionally, it is known that elevated levels of cortisol and endogenous mineralocorticoid dysfunction [4] in patients with CSCR contribute to choroidal vasodilation, and the inhibition of this pathway may prevent aldosterone-induced choroidal thickening [5].

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