Half-dose PDT outperforms eplerenone in chronic central serous chorioretinopathy

In the treatment of patients with chronic central serous chorioretinopathy (cCSC), half-dose photodynamic therapy (PDT) appears to have superior short-term safety and efficacy compared with eplerenone, according to preliminary data from SPECTRA.

Conducted in three academic medical centres in the Netherlands, SPECTRA randomized 107 patients to receive either indocyanine green angiography-guided half-dose PDT (n=53) or oral eplerenone treatment (n=54) for 12 weeks. Anatomical and functional outcomes were assessed at 3 months after treatment initiation.

A total of 13 patients (three in the PDT group and 10 in the eplerenone group) failed to adhere to the study protocol. At 3 months, significantly more patients in the PDT group than in the eplerenone group achieved complete resolution of subretinal fluid (78 percent vs 17 percent; p<0.001).

On the other hand, there was no significant between-group difference in the mean best-corrected visual acuity as evaluated using Early Treatment of Diabetic Retinopathy Study letters (83.7 vs 82.8, respectively; p=0.555).

In terms of other outcomes, mean retinal sensitivity on microperimetry was 25.4 dB in the PDT group vs 23.9 dB in the eplerenone group (p=0.041). Mean vision-related quality of life scores were 87.2 and 83.8 in the respective groups (p=0.094).

Adverse events occurred less frequently with PDT, documented in three patients as opposed to 18 of those who received eplerenone (6 percent vs 33 percent).