Long-Term Eplerenone Treatment in Peripapillary Pachychoroid Syndrome: A Case Series.

Introduction: The aim of the study was to evaluate the long-term efficacy of eplerenone in patients with peripapillary pachychoroid syndrome (PPS), a recently described entity characterized by vascular congestion of Haller's layer vessels near the optic nerve. Case Presentations: Three male patients (mean age: 70.3 years) with PPS received oral eplerenone 50 mg daily for 12 months. Baseline and post-treatment choroidal thickness, visual acuity, and retinal fluid status were assessed. At baseline, mean choroidal thickness was 420 µm, and mean visual acuity was 70 letters. After 12 months of treatment, all patients showed a significant reduction in choroidal thickness (mean: 48 µm, p < 0.05) and near-complete resolution of intraretinal and subretinal fluid. No adverse events were reported. Conclusions: Long-term eplerenone treatment appears effective in reducing choroidal thickness and improving visual outcomes in PPS patients. These findings suggest mineralocorticoid receptor antagonists may be valuable in managing pachychoroid spectrum disorders.