Long-Term Follow-Up of PLACE and SPECTRA Trials: Outcomes After Successful and Unsuccessful Half-Dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

Purpose: To prospectively evaluate and compare long-term functional and structural outcomes between successful and unsuccessful first half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC). 

Design: Multicenter, prospective cohort study. 

Subjects, Participants, and/or Controls: Participants with cCSC enrolled in the PLACE and SPECTRA trials and treated with half-dose PDT in the participating Dutch medical centers, with visits at 5 to 10 years after inclusion. 

Methods, Intervention, or Testing: Participants were randomly assigned to half-dose PDT, oral eplerenone or high-density subthreshold micropulse laser and had protocol-defined retreatment and/or crossover treatment in case of persistent subretinal fluid (SRF). After 1 to 2 years of follow-up, patients were managed at clinicians’ discretion and recalled for a 5 to 10-year visit. 

Main Outcome Measures: Best-corrected visual acuity (BCVA; measured in Early Treatment of Diabetic Retinopathy Study [ETDRS] letters), retinal sensitivity on microperimetry, presence of macular neovascularization, presence of SRF at long-term follow-up, recurrence of SRF, and retreatment during follow-up. 

Results: Sixty percent (107/179) of eligible participants completed the long-term follow-up, performed at a median of 7.0 years. The first half-dose PDT was successful in 78 patients and unsuccessful in 29 patients. Due to a recurrence of SRF or persisting SRF, additional treatments were performed in 14.1% and 89.7% of patients in the successful and unsuccessful first PDT group during follow-up, respectively. BCVA at long-term follow-up was higher in the successful first PDT group (P < .001). Between baseline and long-term follow-up, BCVA increased significantly in the successful first PDT group (81.8 ± 7.8 vs 87.2 ± 8.7 ETDRS letters, P < .001), with the highest increase observed between baseline and the first control visit, followed by stabilization of BCVA thereafter. BCVA remained stable in the unsuccessful first PDT group (73.4 ± 12.1 vs 77.2 ± 16.2 ETDRS letters, P = .108). At long-term follow-up SRF was present in 16.7% and 44.8% of eyes in the successful and unsuccessful first PDT group, respectively (P = .005).

Conclusions: cCSC patients with a successful first PDT show better long-term clinical outcomes than those with an unsuccessful first PDT. Notably, BCVA remained stable in both groups from the first follow-up after half-dose PDT onward, which is a reassuring finding even for patients without initial treatment success.