Short communication
Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy
Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica
D. Ángel-Pereira
, P. Rocha-Cabrera, L. Cordovés-Dorta, M.J. Losada Castillo, A. Blasco Alberto, J.A. Abreu Reyes
Corresponding author
Servicio de Oftalmología, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
Read
108
Timeswas read the article
25
Total PDF
83
Total HTML
Share statistics
array:24 [ "pii" => "S2173579416300536" "issn" => "21735794" "doi" => "10.1016/j.oftale.2016.05.005" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "992" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2016;91:599-603" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 132 "formatos" => array:3 [ "EPUB" => 25 "HTML" => 82 "PDF" => 25 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S036566911600112X" "issn" => "03656691" "doi" => "10.1016/j.oftal.2016.02.007" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "992" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2016;91:599-603" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 274 "formatos" => array:3 [ "EPUB" => 15 "HTML" => 205 "PDF" => 54 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "599" "paginaFinal" => "603" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 276 "Ancho" => 1500 "Tamanyo" => 60678 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">OCT macular del OD obtenida mediante Spectralis<span class="elsevierStyleSup">®</span> SD-OCT, donde se observa mejoría significativa del DNS crónico, con disminución del líquido subretiniano y de los quistes intrarretinianos, 3 meses después del tratamiento (B), persistiendo hiperreflectividad intrarretiniana. Se observa engrosamiento inicial de la coroides (grosor coroideo aproximado de 360<span class="elsevierStyleHsp" style=""></span>μm) con vasos coroideos dilatados (A).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Ángel-Pereira, P. Rocha-Cabrera, L. Cordovés-Dorta, M.J. Losada Castillo, A. Blasco Alberto, J.A. Abreu Reyes" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Ángel-Pereira" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rocha-Cabrera" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Cordovés-Dorta" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Losada Castillo" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Blasco Alberto" ] 5 => array:2 [ "nombre" => "J.A." "apellidos" => "Abreu Reyes" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579416300536" "doi" => "10.1016/j.oftale.2016.05.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416300536?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566911600112X?idApp=UINPBA00004N" "url" => "/03656691/0000009100000012/v1_201612011634/S036566911600112X/v1_201612011634/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173579416301013" "issn" => "21735794" "doi" => "10.1016/j.oftale.2016.07.007" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "999" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2016;91:604-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 125 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 110 "PDF" => 12 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Bilateral polypoidal choroidal vasculopathy coexisting with exudative and atrophic age-related macular degeneration" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "604" "paginaFinal" => "607" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vasculopatía coroidea polipoidea bilateral, coexistiendo con degeneración macular asociada a la edad exudativa y atrófica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 492 "Ancho" => 1801 "Tamanyo" => 121312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Retinographs in both eyes at one year follow-up.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.R. Aronés-Santivañez, A. Dyrda, I. Alarcón Valero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.R." "apellidos" => "Aronés-Santivañez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Dyrda" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Alarcón Valero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669116001192" "doi" => "10.1016/j.oftal.2016.02.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669116001192?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416301013?idApp=UINPBA00004N" "url" => "/21735794/0000009100000012/v1_201612011629/S2173579416301013/v1_201612011629/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579416300445" "issn" => "21735794" "doi" => "10.1016/j.oftale.2016.04.027" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "989" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2016;91:596-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 132 "formatos" => array:3 [ "EPUB" => 6 "HTML" => 85 "PDF" => 41 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Subfoveal perfluorocarbon liquid. Removal after three months" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "596" "paginaFinal" => "598" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfluorocarbono líquido subfoveal. Extracción después de 3 meses" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 466 "Ancho" => 975 "Tamanyo" => 152812 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">OCT image 4 months after surgery, showing normal macular profile with some atrophy after LPFC extraction and resolution of postop CME.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. Sierra-Rodríguez, J.M. López-López, S. Jiménez-Prada de Miguel" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.A." "apellidos" => "Sierra-Rodríguez" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "López-López" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Jiménez-Prada de Miguel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S036566911600109X" "doi" => "10.1016/j.oftal.2016.02.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566911600109X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416300445?idApp=UINPBA00004N" "url" => "/21735794/0000009100000012/v1_201612011629/S2173579416300445/v1_201612011629/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "599" "paginaFinal" => "603" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Ángel-Pereira, P. Rocha-Cabrera, L. Cordovés-Dorta, M.J. Losada Castillo, A. Blasco Alberto, J.A. Abreu Reyes" "autores" => array:6 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Ángel-Pereira" "email" => array:1 [ 0 => "dangelp300@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rocha-Cabrera" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Cordovés-Dorta" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Losada Castillo" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Blasco Alberto" ] 5 => array:2 [ "nombre" => "J.A." "apellidos" => "Abreu Reyes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1835 "Ancho" => 1500 "Tamanyo" => 379763 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retinography, FAG and autofluorescence of the first patient at diagnostic, evidencing bilateral diffuse chronic epitheliopathy, showing hyperfluorescence diffuse RPE alteration areas in both eyes.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Diffuse chronic epitheliopathy (DCE) is an atypical presentation of central serous chorioretinopathy (CSCR) characterized by recurring neurosensory retina detachments with diffuse atrophy of the retina pigment epithelium (RPE).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> DCE courses with exacerbations and remissions, leading to significant visual loss.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Multiple hematoretinal barrier rupture mechanisms are involved in the physiopathology of DCE. However, it is not known why some patients evolve towards this diffuse, chronic and recurring presentation.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">CSCR and DCE are related to the administration of exogenous corticoids and/or the production of endogenous corticoids.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Glucocorticoids have a mineralocorticoid effect due to exhibiting affinity by aldosterone receptors. This effect has been described in rodents, facilitating the accumulation of subretinal fluid.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Aldosterone receptor antagonist (ARA) drugs, i.e., spironolactone and eplerenone, have produced encouraging results in series of patients with persistent forms of CSCR.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of said medicament with positive results in 2 DCE cases is described.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic cases</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Case 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">Male, 46, member of police force without additional relevant history, who visited due to progressive visual acuity reduction in the left eye (LE).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Visual acuity (VA) in the right eye (RE) was 1.0 and in the LE 0.1. Intraocular pressure and biomicroscopy were normal, while ocular fundus was compatible with bilateral DCE. Autofluorescence suggested diffuse bilateral alteration of the pigment epithelium, and fluorescein angiography (FAG) showed hyperfluorescence areas with macular activity in the LE (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Macular optical coherence tomography (OCT) evidenced a minimum neurosensory detachment (NSD) in the RE, far from the fovea and NSD at the subfoveal, superonasal and inferotemporal level, with increased choroidal thickness in the LE (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The systemic study was negative for everything, including Mantoux, Quanti-FERON<span class="elsevierStyleSup">®</span>, infectious serology, chest X-ray and breath test.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment was initiated with spironolactone (Aldactone<span class="elsevierStyleSup">®</span>, PFIZER GEP S.L., Madrid, Spain) 25<span class="elsevierStyleHsp" style=""></span>mg/day, and after 2 months the patient exhibited improved VA of 0.15 and disappearance of subfoveal NSD in OCT (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). At present, retinal stability persists with excellent tolerance to spironolactone.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Case 2</span><p id="par0040" class="elsevierStylePara elsevierViewall">Male, 64, without relevant personal history, diagnosed with bilateral DCE. Ten years before he had been treated with photodynamic therapy in the RE and anti-VEGF (bevacizumab), without exhibiting improvement. VA in the RE was 0.6. and 0.8 in the LE, with normal tonometry and biomicroscopy. Ocular fundus revealed generalized and bilateral alteration of the RPE, with autofluorescence being compatible with DCE, demonstrating activity in FAG (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). OCT evidenced NSD areas and secondary intraretinal cysts as well as increased choroidal thickness (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A), while the LE exhibited flattened DEP with preserved foveal structure. Systemic study comprising Mantoux, Quanti-FERON<span class="elsevierStyleSup">®</span>, infectious serology, chest X-ray and breath test was negative.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Treatment was initiated with spironolactone (Aldactone<span class="elsevierStyleSup">®</span>) 25<span class="elsevierStyleHsp" style=""></span>mg/day, and after 3 months of treatment the patient presented significant reduction of NSD (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B) and visual acuity improvement of up to 0.7 in the RE and 0.9 in the LE.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Corticosteroids play an important role in the expression of CSCR and also influence the duration of episodes and number of recurrences.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–6</span></a> Glucocorticoids facilitate the accumulation of subretinal fluid and in high dosages can act on the mineralocorticoids receptor.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–8</span></a> This enhances the effects of aldosterone at the tissue level, leading to increased expression of Na<span class="elsevierStyleSup">+</span>, water channels and the Na<span class="elsevierStyleSup">+</span>/K<span class="elsevierStyleSup">+</span> ATPase pump.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Aldosterone receptors have been described at the level of the central nervous system and recently almost all components of the renine-angiotensin-aldosterone system have been isolated in the human eye, mainly in uvea and RPE cells.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The administration of high glucocorticoid doses produces dilatation of choroidal vessels, facilitating fluid extravasation. This effect can be reversible with the use of ARA<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> which diminish the expression of the potassium channel (KCa2.3) involved in choroidal vasodilatation, which represents an important therapeutic target.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">At present, available therapeutic alternatives for this disease are delivering controversial results. Photodynamic therapy, laser photocoagulation, micropulsed diode laser and transpupilar thermotherapy are described in the treatment of chronic forms of CSCR.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,9,10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In addition, acetylsalicylic acid, carbonic anhydrase inhibitors, adrenergic blockers, ketoconazol and anti-VEGF medicaments have also been described.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">At present, despite the difficulties for assessing the therapeutic efficacy of ARA in chronic and recurring forms of CSCR, their use has become widespread. In the 2 presented cases, spironolactone performed as an efficient and tolerable therapeutic tool, although its efficacy must be assessed with caution. The authors consider that long-term controlled trials including higher numbers of patients are necessary to adequately assess the efficacy of said medicaments both in persistent forms of CSCR as well as in DCE.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare not having received any funding for this paper.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interests</span><p id="par0080" class="elsevierStylePara elsevierViewall">No conflict of interests or commercial interest was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres764852" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec766281" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres764851" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Casos clínicos" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec766282" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Clinic cases" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 2" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-12-15" "fechaAceptado" => "2016-02-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec766281" "palabras" => array:7 [ 0 => "Epitheliopathy" 1 => "Diffuse" 2 => "Chronic" 3 => "Spironolactone" 4 => "Antagonists" 5 => "Receptor" 6 => "Aldosterone" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec766282" "palabras" => array:7 [ 0 => "Epiteliopatía" 1 => "Difusa" 2 => "Crónica" 3 => "Espironolactona" 4 => "Antagonistas" 5 => "Receptores" 6 => "Aldosterona" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Two cases are presented of patients with chronic diffuse epitheliopathy (CDE) that showed a favourable response when treated with spironolactone. The first patient had regions of neurosensory detachment (DNS) and the second, multiple DNS, secondary intra-retinal cysts and retinal pigment epithelium detachment.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">After treatment with spironolactone, both patients showed a visual acuity improvement and structural changes (reduced neurosensory retinal detachment and cystoid degeneration).</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Aldosterone receptor agonists (ARA) used for persistent forms of chronic central serous chorioretinopathy show encouraging results and could represent a therapeutic alternative for CDE.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Casos clínicos</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se presentan 2 casos clínicos de epiteliopatía difusa crónica (EDC) con respuesta favourable a espironolactona. En el primer paciente se visualizan regiones de desprendimiento neurosensorial (DNS), y en el segundo múltiples DNS, quistes intrarretinianos secundarios y desprendimiento del epitelio pigmentario de la retina.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tras el tratamiento con espironolactona, se observa mejoría de la agudeza visual y de las alteraciones estructurales en ambos pacientes (disminución del DNS y quistes intrarretinianos).</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los fármacos antagonistas de los receptores de aldosterona usados para formas persistentes de coriorretinopatía central serosa (CRCS) tienen resultados alentadores, y podrían ser una alternativa terapéutica en la EDC.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Casos clínicos" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ángel-Pereira D, Rocha-Cabrera P, Cordovés-Dorta L, Losada Castillo MJ, Blasco Alberto A, Abreu Reyes JA. Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica. Arch Soc Esp Oftalmol. 2016;91:592–596.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1835 "Ancho" => 1500 "Tamanyo" => 379763 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retinography, FAG and autofluorescence of the first patient at diagnostic, evidencing bilateral diffuse chronic epitheliopathy, showing hyperfluorescence diffuse RPE alteration areas in both eyes.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 588 "Ancho" => 1781 "Tamanyo" => 200901 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">macular OCT obtained with Cirrus<span class="elsevierStyleSup">®</span> (Aldactone, PFIZER, GEP S.L., Madrid, Spain) HD-OCT of the first patient, showing neurosensory retina detachment at the macular level in the LE before (A) and 2 months after treatment with spironolactone (B). Choroidal thickness: approximately 345<span class="elsevierStyleHsp" style=""></span>μm.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2010 "Ancho" => 1500 "Tamanyo" => 417029 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Retinography, FAG and autofluorescence of the second patient, showing diffuse RPE alteration compatible with bilateral diffuse chronic epitheliopathy.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 276 "Ancho" => 1500 "Tamanyo" => 64797 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">RE macular OCT obtained with Spectralis<span class="elsevierStyleSup">®</span> SD-OCT, showing significant improvement of chronic NSD, with subretinal fluid and intraretinal cysts reduction, 3 months after treatment (B), with persistence of intraretinal hyper-reflectiveness. Initial thickening of the choroids can be appreciated (choroidal thickness of approximately 360<span class="elsevierStyleHsp" style=""></span>μm) with dilated choroidal vessels (A).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epitelopatía en Reguero" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Gismero" 1 => "M.J. Morillo" 2 => "F. Minaya" 3 => "J.C. León" 4 => "J.M. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2003" "volumen" => "78" "paginaInicial" => "35" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12571772" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central serous chorioretinopathy: recent findings and new physiopathology hypothesis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Daruich" 1 => "A. Matet" 2 => "A. Dirani" 3 => "E. Bousquet" 4 => "M. Zhao" 5 => "N. Farman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.preteyeres.2015.05.003" "Revista" => array:6 [ "tituloSerie" => "Prog Retin Eye Res" "fecha" => "2015" "volumen" => "48" "paginaInicial" => "82" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26026923" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral mineralocorticoid antagonists for recalcitrant central serous chorioretinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.K. Chin" 1 => "D.R. Almeida" 2 => "C.N. Roybal" 3 => "P.I. Niles" 4 => "K.M. Gehrs" 5 => "E.H. Sohn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/OPTH.S86778" "Revista" => array:6 [ "tituloSerie" => "Clin Ophthalmol" "fecha" => "2015" "volumen" => "9" "paginaInicial" => "1449" "paginaFinal" => "1456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26316684" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Zhao" 1 => "I. Célérier" 2 => "E. Bousquet" 3 => "J.C. Jeanny" 4 => "L. Jonet" 5 => "M. Savoldelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1172/JCI61427" "Revista" => array:6 [ "tituloSerie" => "J Clin Invest" "fecha" => "2012" "volumen" => "122" "paginaInicial" => "2672" "paginaFinal" => "2679" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22684104" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spironolactone in the treatment of central serous chorioretinopathy – a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.R. Herold" 1 => "K. Prause" 2 => "A. Wolf" 3 => "W.J. Mayer" 4 => "M.W. Ulbig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00417-014-2780-6" "Revista" => array:6 [ "tituloSerie" => "Graefes Arch Clin Exp Ophthalmol" "fecha" => "2014" "volumen" => "252" "paginaInicial" => "1985" "paginaFinal" => "1991" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25138605" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of eplerenone in therapy-resistant chronic central serous chorioretinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.B. Breukink" 1 => "A.I. Den Hollander" 2 => "J.E. Keunen" 3 => "C.J. Boon" 4 => "C.B. Hoyng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/aos.12311" "Revista" => array:6 [ "tituloSerie" => "Acta Ophthalmol" "fecha" => "2014" "volumen" => "92" "paginaInicial" => "488" "paginaFinal" => "490" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25043789" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spironolactone for nonresolving central serous chorioretinopathy a randomized controlled crossover study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Bousquet" 1 => "T. Beydoun" 2 => "P. Rothschild" 3 => "C. Bergin" 4 => "M. Zhao" 5 => "R. Batista" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Retina" "fecha" => "2015" "volumen" => "35" "paginaInicial" => "1515" "paginaFinal" => "2505" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expression of classical components of the renin-angiotensin system in the human eye" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. White" 1 => "S.C. Cheruvu" 2 => "M. Sarris" 3 => "S.S. Liyanage" 4 => "E. Lumbers" 5 => "J. Chui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1470320314549791" "Revista" => array:6 [ "tituloSerie" => "J Renin Angiotensin Aldosterone Syst" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "59" "paginaFinal" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25287897" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "System review and meta-analysis on photodynamic therapy in central serous chorioretinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Ma" 1 => "N. Meng" 2 => "X. Xu" 3 => "F. Zhou" 4 => "Y. Qu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Ophthalmol" "fecha" => "2014" "volumen" => "92" "paginaInicial" => "594" "paginaFinal" => "601" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in the treatment of central serous chorioretinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.A. Abouammoh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.sjopt.2015.01.007" "Revista" => array:6 [ "tituloSerie" => "Saudi J Ophthalmol" "fecha" => "2015" "volumen" => "29" "paginaInicial" => "278" "paginaFinal" => "286" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26586979" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009100000012/v1_201612011629/S2173579416300536/v1_201612011629/en/main.assets" "Apartado" => array:4 [ "identificador" => "5812" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009100000012/v1_201612011629/S2173579416300536/v1_201612011629/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416300536?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2018 February | 8 | 2 | 10 |
| 2018 January | 11 | 1 | 12 |
| 2017 December | 6 | 4 | 10 |
| 2017 November | 18 | 5 | 23 |
| 2017 October | 7 | 3 | 10 |
| 2017 September | 5 | 2 | 7 |
| 2017 August | 8 | 2 | 10 |
| 2017 July | 7 | 5 | 12 |
| 2017 June | 11 | 1 | 12 |
| 2017 May | 0 | 0 | 0 |
| 2016 December | 1 | 0 | 1 |
