Long-term follow-up of chronic central serous chorioretinopathy patients receiving oral eplerenone and half-dose photodynamic therapy in the SPECTRA trial: SPECTRA trial report No. 4.

Assessing the 24-month treatment outcome of half-dose photodynamic therapy (PDT) or oral eplerenone in chronic central serous chorioretinopathy (cCSC). Multicentre randomized clinical trial included cCSC patients from the SPECTRA trial who were randomized to receive half-dose PDT or oral eplerenone. Outcomes were evaluated at 24 months, including the primary outcome measure of complete resolution of subretinal fluid (SRF) on optical coherence tomography (OCT) and the secondary outcome measures best-corrected visual acuity (BCVA), retinal and foveal sensitivity on microperimetry and the National Eye Institute Visual Functioning Questionnaire 25 (NEI-VFQ25) score. At baseline, 107 patients were included, of which 80 patients attended the final visit at 24 months: 40 had been randomized to primary treatment with half-dose PDT and 40 to eplerenone. In the eplerenone group, as many as 36/40 (90%) needed crossover treatment at 3 months with half-dose PDT due to persistent SRF, compared to 8/40 (20%) in the half-dose PDT group. At the final visit, complete SRF resolution was observed in 32/40 (80%) who were primarily treated with half-dose PDT and in 35/40 (88%) who received primary eplerenone treatment (p = 0.609). There were no significant differences in terms of BCVA, foveal sensitivity, retinal sensitivity and NEI-VFQ25 score. This study provides evidence for the long-term efficacy of half-dose PDT in resolving SRF and improving functional outcomes in cCSC. Even when patients initially received eplerenone treatment that did not result in complete SRF resolution, crossover treatment with half-dose PDT led to similar (long-term) group outcomes compared to half-dose PDT as initial treatment.