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Table 3 Summary of findings

From: Mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy: systematic review and meta-analyses

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect (95% CI)

№ of participants (studies)

Certainty of the evidence

(GRADE)

Comments

Risk with Placebo

Risk with

Mineralocorticoids

(Spironolactone or Eplerenone)

Best-corrected visual acuity (BCVA)

assessed with: Early

Treatment Diabetic

Retinopathy Study

(ETDRS) chart (more = better)

follow up: range 1 month to 12 months

The mean bestcorrected visual acuity was 79.5 letters

MD 0.99 letters more (0.18 fewer to 2.16 more)

–

218

(5 RCTs)

⨁⨁⨁◯

MODERATE a

Mineralocorticoid receptor antagonists likely results in little to no difference in bestcorrected visual acuity

Absolute percent difference = 1.0% absolute improvement (95% CI 0.2% worsening to 2.2% improvement)

Relative percent difference = 1.27% relative improvement (95% CI 0.23% worsening to 2.77% improvement)

SMD = -0.22 (95% CI -0.04 to 0.48)

MCID = 5 letters

Subretinal fluid height assessed with: Optical

Coherence

Tomography (fewer = better)

follow up: range 1 month to 12 months

TThe mean subretinal fluid thickness was 72.5 micrometers

MD 2.17 micrometers fewer (5.89 fewer to 1.61 more)

–

243

(5 RCTs)

⨁⨁⨁◯

MODERATE a,b

Mineralocorticoid receptor antagonists likely results in little to no difference in subretinal fluid height

Absolute percent difference = not applicable

Relative percent difference = 1.82% relative improvement (95% CI 1.35% worsening to 4.95% improvement)

SMD = -0.35 (95% CI -0.95 to 0.26)

MCID = 10%

Subfoveal choroidal thickness assessed with: Optical

Coherence

Tomography (fewer = better)

follow up: range 1 month to 12 months

The mean subfoveal choroidal thickness ranged from 379.5-527 micrometers

MD 21.23 micrometers fewer (64.69 fewer to 22.24 more)

–

228

(4 RCTs)

⨁⨁◯◯

LOW a,c,d

Mineralocorticoid receptor antagonists may result in little to no difference in subfoveal choroidal thickness

Absolute percent difference = not applicable

Relative percent difference = 4.6% relative improvement (95% CI 4.8% worsening to 14% improvement)

MCID = 10%

Central macular thickness assessed with: Optical

Coherence

Tomography (fewer = better)

follow up: range 2 months to 12 months

3The mean central macular thickness ranged from 270- 380 micrometers

MD 18.1 micrometers fewer (113.04 fewer to 76.84 more)

–

145

(3 RCTs)

⨁◯◯◯

VERY LOW e,f,g

The evidence is very uncertain about the effect of mineralocorticoids on central macular thickness

Absolute percent difference = not applicable

Relative percent difference = 4.9% relative improvement (95% CI 20.8% worsening to 30.6% improvement)

MCID = 10%

  1. GRADE Working Group grades of evidence
  2. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
  3. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
  4. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
  5. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
  6. Mineralocorticoid receptor antagonists (Spironolactone or Eplerenone) compared to placebo for chronic central serous chorioretinopathy
  7. Patient or population: Chronic central serous chorioretinopathy
  8. Setting: Outpatient
  9. Intervention: Mineralocorticoid receptor antagonists (Spironolactone or Eplerenone)
  10. CI Confidence interval, MD Mean difference, RCT Randomised controlled trial, SMD Standardised mean difference, MCID Minimal clinically important difference
  11. Downgraded one level by imprecision. Less than 400 participants were included in the meta-analysis.
  12. We found high heterogeneity (I2 = 79%) but we explained the inconsistency by subgroup analysis.
  13. Downgraded one level by study limitations (risk of bias). We performed a sensitivity analysis for high overall risk of bias (due to selection of the reported) result caused by Pichi et al. (three-arm trial). We found an important change on pooled result.
  14. We found high heterogeneity (I2 = 85%) but we explained the inconsistency by subgroup analysis.
  15. Downgraded one level by study limitations (risk of bias). We performed a sensitivity analysis for high overall risk of bias (due to missing outcome data) caused by Rahimy et al. We found an important change on pooled result.
  16. We found high heterogeneity (I2 = 68%) but we explained the inconsistency by subgroup analysis.
  17. Downgraded two levels by imprecision. Less than 400 participants were included in the meta-analysis, and the absolute effect varied from an important clinically benefit to an important clinically harm.
  18. *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
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International Journal of Retina and Vitreous

ISSN: 2056-9920

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