Long-term outcomes of half-fluence photodynamic therapy and eplerenone in chronic central serous chorioretinopathy: A comparative study

Abstract

Aims: To compare the long-term outcomes in chronic central serous chorioretinopathy (cCSC) following half-fluence photodynamic therapy (HF-PDT) and oral eplerenone treatment. Methods: This retrospective comparative study included consecutive patients of cCSC treated with either HF-PDT or eplerenone. The treatment outcomes of the two groups were analyzed at 3-month, 6-month, and 12-month post-treatment. Results: This study included 20 eyes (20 patients) in HF-PDT group, and 18 eyes (18 patients) in eplerenone group. All baseline parameters in HF-PDT and eplerenone groups were comparable including neurosensory detachment height (217.05 ± 140.25 µm vs 178.05 ± 164.24 µm respectively, p = 0.09), best-corrected visual acuity (BCVA) (logMAR 0.24 ± 0.13 vs logMAR 0.46 ± 0.37 respectively, p = 0.1), and subfoveal choroidal thickness (SFCT) [427.4 ± 117.4 µm vs 456.38 ± 119.25 µm respectively, p = 0.45]. HF-PDT resulted in complete resolution of neurosensory detachment in higher proportion of eyes compared to eplerenone at each follow-up visits (3 months: 90% vs 27.7%, p = 0; 6 months: 100% vs 61.1%, p = 0.003; and 12 months: 100% vs 70%, p = 0.03) with a significantly shorter duration to resolution (3.3 ± 0.9 months vs 5.8 ± 3.3 months respectively, p = 0.02). Intergroup comparison showed no significant difference between mean BCVA ( p = 0.38 at 3 months, p = 0.14 at 6 months, and p = 0.19 at 12 months). Mean SFCT at 12 months of the two groups differed significantly ( p = 0.003) due to increased choroidal thickness of eplerenone group. Conclusion: HF-PDT has a superior efficacy to achieve faster, greater and long-lasting resolution of subretinal fluid in cCSC compared to eplerenone therapy.

Comparison of Retinochoroidal Vascular and Structural Changes after Half-Dose Photodynamic Therapy versus Half-Fluence Photodynamic Therapy Based on Optical Coherence Tomography Angiography in Eyes with Chronic Central Serous Chorioretinopathy

“…The present study compared the efficacy of half-fluence and half-dose PDT based on OCTA and anatomical changes in the retinal and choroidal vasculature. To date, findings related to whether SRF resolution or relapse is dose-dependent or fluence-dependent are inconsistent [26][27][28][29][30]. In the present study, group 1 (half-fluence) had a larger area of increased vascular density in the choriocapillaris and deep capillary plexus than group 2 (halfdose).…”

Acute Exacerbation of Chronic Central Serous Chorioretinopathy at the Site of a Retinal Pigment Epithelium Aperture

“…Considering treatment, a recent study comparing long-term outcomes between half-fluence PDT and oral eplerenone in chronic CSCR patients found that half-fluence PDT had better efficacy in achieving faster and longer-term resolution of subretinal fluid. 8 Moreover, in a study comparing the outcomes of half-dose PDT for CSCR with or without subfoveal The leakage focus is located at the site of the previously described RPE aperture. Some RPE alterations are also visible in the papillomacular region.…”

Prevalence and Morphologic Biomarkers of Metamorphopsia in eyes with “Resolved” Chronic Central Serous Chorioretinopathy

“…4,5 Beside the CSC features, complete resolution of SRF represents the primary treatment outcome in both clinical practice and clinical trials. [6][7][8][9] After resolution of SRF, cases are categorized in the "resolved" stage. In detail, the term chronic "resolved" CSC is usually used to define individuals without SRF and with history/signs of previous accumulation of fluid in the subretinal space.…”