Ultrawide-field indocyanine angiography changes post 12 weeks of eplerenone in central serous chorioretinopathy.

Central serous chorioretinopathy (CSCR) is a pachychoroid-spectrum disease driven by choroidal hyperpermeability. Mineralocorticoid receptor (MR) dysregulation is implicated, and eplerenone, a selective MR antagonist, may reduce leakage. Ultrawide-field indocyanine green angiography (UWF-ICGA) enables panoramic assessment of choroidal vasculature. We evaluated UWF-ICGA changes after 12 weeks of eplerenone and correlated them with functional and anatomical outcomes. In this prospective, single-center observational study (January 2024 to June 2025), 58 adults with CSCR received Eplerenone (50 mg daily for 1 month, then 25 mg daily for 2 months). Baseline workup included best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography enhanced depth imaging (OCT-EDI), fundus fluorescein angiography (FFA), and UWF-ICGA (OPTOS California). The primary outcome was mean change in the total area of choroidal hyperpermeability (measured in mm2) from baseline to 12 weeks in the mid phase to late phase of ICGA (indocyanine green angiography). Secondary outcome measures included changes in the widest diameters of the ampullas of the supero temporal, supero nasal, infero temporal, and infero nasal vortex veins (in mm) in the early mid phase of ICGA on optos california using built in optos advance software's planimetry tool, changes in subfoveal choroidal thickness (SFCT) (in microns) on OCT-EDI and measured using its inbuilt planimetry tools, BCVA in logMAR, and presence of sub retinal fluid (SRF) on OCT from baseline to 12 weeks. Paired t-tests and Chi-square tests were applied (α = 0.05). Participants (86.2% male; mean age 39.9 ± 2.6 years) presented acutely (mean 8.8 ± 1.3 days). BCVA improved from 0.24 ± 0.10 to 0.08 ± 0.06 LogMAR (Δ = -0.16 ± 0.09; P < 0.001), with elimination of the poorest visual acuity category (0.28-0.48). The central macular thickness decreased from 540.3 ± 146.5 to 271.3 ± 23.3 µm (Δ = -269.0 ± 145.2; P < 0.001); SRF resolved in 86.2% (P < 0.001). The UWF-ICGA hyperpermeability area fell from 9.62 ± 5.70 to 6.47 ± 4.32 mm² (Δ = -3.15 ± 4.28; P < 0.001). SFCT decreased from 476.8 ± 102.5 to 391.6 ± 24.8 µm (Δ = -85.2 ± 103.4; P < 0.001). Quadrant vortex vein diameters showed small, nonsignificant reductions; the overall mean changed from 1.39 ± 0.17 to 1.35 ± 0.16 mm (P > 0.05). Twelve weeks of eplerenone was associated with significant functional gains and structural recovery in acute CSCR, alongside a measurable reduction in UWF-ICGA hyperpermeability and SFCT. UWF-ICGA offers a sensitive, mechanism-aligned biomarker for monitoring MR-targeted therapy.