Crossover to Half-Dose Photodynamic Therapy or Eplerenone in Chronic Central Serous Chorioretinopathy Patients

Helena M A Feenstra; Elon H C van Dijk; Thomas J van Rijssen; Roula Tsonaka; Roselie M H Diederen; Reinier O Schlingemann; Carel B Hoyng; Camiel J F Boon

doi:10.1016/j.oret.2022.04.014

Crossover to Half-Dose Photodynamic Therapy or Eplerenone in Chronic Central Serous Chorioretinopathy Patients

Ophthalmol Retina. 2022 Oct;6(10):930-938. doi: 10.1016/j.oret.2022.04.014. Epub 2022 Apr 22.

Authors

Helena M A Feenstra¹, Elon H C van Dijk¹, Thomas J van Rijssen¹, Roula Tsonaka², Roselie M H Diederen³, Reinier O Schlingemann³, Carel B Hoyng⁴, Camiel J F Boon⁵

Affiliations

¹ Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
² Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
³ Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
⁴ Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands.
⁵ Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: camiel.boon@amsterdamumc.nl.

PMID: 35470085
DOI: 10.1016/j.oret.2022.04.014

Abstract

Purpose: To compare the efficacy and safety of crossover treatment to half-dose photodynamic therapy (PDT) and eplerenone treatment after the failure of primary treatment in patients with chronic central serous chorioretinopathy (cCSC).

Design: Multicenter crossover clinical trial.

Subjects: At 3 months after the baseline visit of the SPECTRA (Half-Dose Photodynamic Therapy Versus Eplerenone: Treatment Trial for Chronic Central Serous Chorioretinopathy) randomized controlled trial, either half-dose PDT or eplerenone treatment was evaluated for each patient, and patients who still demonstrated subretinal fluid (SRF) were included in the current study, the SPECS (Central Serous Chorioretinopathy Treated with Half-Dose PDT or Eplerenone Crossover Study) trial.

Methods: At the baseline visits for the current SPECS trial, crossover treatment was performed for patients who still demonstrated SRF. These patients received either half-dose PDT or oral eplerenone for 12 weeks. Both anatomic and functional parameters were evaluated 3 months after crossover treatment.

Main outcome measures: Complete resolution of SRF on OCT.

Results: Forty-nine patients were included in the SPECS trial (38 received primary eplerenone treatment; 11 received half-dose PDT). At 3 months after crossover treatment, 32 of 37 (86.5%) in the crossover to half-dose PDT group and 2 of 9 (22.2%) in the crossover to eplerenone group had complete SRF resolution (P = 0.030). The mean foveal sensitivity increased significantly more in the crossover to half-dose PDT group (mean, +3.08 dB) compared with the crossover to eplerenone group (mean, -0.27 dB; P = 0.009).

Conclusions: Patients with cCSC with the persistence of SRF after primary eplerenone treatment can benefit from half-dose PDT, which can induce a relatively fast and complete SRF resolution, along with an improvement in foveal sensitivity.

Keywords: Central serous chorioretinopathy; Eplerenone; Half-dose photodynamic therapy; Mineralocorticoid receptor agonist.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Central Serous Chorioretinopathy* / diagnosis
Central Serous Chorioretinopathy* / drug therapy
Chronic Disease
Cross-Over Studies
Eplerenone / therapeutic use
Fluorescein Angiography
Humans
Photochemotherapy*
Photosensitizing Agents / therapeutic use
Tomography, Optical Coherence
Verteporfin / therapeutic use
Visual Acuity

Substances

Photosensitizing Agents
Verteporfin
Eplerenone