Sneha Padidam MD
Vitreoretinal surgical fellow
Retina Group of Washington, Washington, D.C.
Dr. Helena Feenstra of the of Leiden University Medical Center presented the results of the SPECTRA trial. The SPECTRA trial is an open-label, multi-center, randomized controlled trial comparing the efficacy of half-dose photodynamic therapy (PDT) versus oral eplerenone treatment in patients with chronic central serous chorioretinopathy (CSC).
Inclusion criteria were patients with chronic CSC defined as fovea-involving subretinal fluid (SRF) lasting at least 6 weeks, best-corrected visual acuity (BCVA) better than 20/200, leakage on fluorescein angiography with atrophic retinal pigment epithelium changes, and hyperfluorescent areas on indocyanine green angiography (ICGA). Exclusion criteria were the presence of SRF for greater than 18 months, corticosteroid use within 3 months of inclusion, and the presence of other causes of SRF such as choroidal neovascularization.
One hundred seven patients were randomized in a 1:1 fashion for inclusion in the trial from three participating centers in Europe. The patients underwent either ICGA-guided half-dose PDT (50 J/cm2, 83 seconds, 689 nm) with treatment starting 15 minutes after verteporfin infusion or oral eplerenone treatment for a total of 12 weeks. Eplerenone was started at 25mg/day for the first week and then increased to 50mg/day for the following weeks. At the 3-month evaluation crossover treatment was considered if there was persistent SRF on optical coherence tomography (OCT). The primary endpoint was absence of SRF on OCT. Secondary outcome measures included BCVA, a visual function questionnaire (NEI-VFQ-25), and foveal and retinal sensitivity on microperimetry.
Of the 96 patients evaluated at the 3-month visit, 38/46 (83%) patients in the eplerenone group and 11/50 (22%) patients in the half-dose PDT group had persistent SRF on OCT. Of 90 patients evaluated at the final 12-month visit, 38/39 (97%) in the group with primary resolution after half dose PDT, 7/7 (100%) in the group with primary resolution after eplerenone, 30/35 (85.7%) in the group who received crossover from eplerenone to half-dose PDT, and 5/9 (55.5%) in the group who received crossover from half-dose PDT to eplerenone group, had a complete resolution of SRF on OCT. Most of the patients treated with half dose PDT in either the primary group or crossover treatment group had complete resolution of SRF at 12 months. Out of patients that crossed over from PDT to eplerenone, 5/9 (56%) had complete resolution of SRF at 12 months. At 12 months, the half dose PDT group had a significantly greater improvement in BCVA. There was no difference in the visual function questionnaire or retinal sensitivity between the two groups at 12 months.
The study concluded that half dose PDT is the treatment of choice for achieving complete resolution of SRF in chronic CSCR even after initial treatment with eplerenone.