Crossover to Photodynamic Therapy or Micropulse Laser After Failure of Primary Treatment of Chronic Central Serous Chorioretinopathy: The REPLACE Trial

Robert E Maclaren,Carel B Hoyng,Roula Tsonaka,Myrte B Breukink,Greet Dijkman,Elon H.C Van Dijk,Thomas J Van Rijssen,Camiel J.F Boon,Sascha Fauser,Paula Scholz,Petrus J.H Peters,Susan M Downes

doi:10.1016/j.ajo.2020.04.007

Abstract

To assess whether chronic central serous chorioretinopathy (cCSC) patients without a complete resolution of subretinal fluid (SRF) after either half-dose photodynamic therapy (PDT) or high-density subthreshold micropulse laser (HSML) treatment may benefit from crossover treatment. Multicenter prospective interventional case series. cCSC patients with persistent SRF at the final visit of the PLACE trial were included. Patients received crossover treatment with either half-dose PDT or HSML. Thirty-two patients received PDT and 10 patients received HSML. At the first evaluation visit (6-8weeks after treatment), 81% of patients in the PDT group had complete resolution of SRF, while none of the HSML-treated patients had complete resolution of SRF. At final visit (1 year after baseline), 78% (P= .030) and 67% (P= .109) of the patients, respectively, had a complete resolution of SRF. The mean retinal sensitivity in the PDT group increased from 21.7 dB (standard error [SE]: 0.9) to 23.4 dB (SE: 0.8) at evaluation visit 1 (P= .003), to 24.7dB (SE: 0.8) at final visit (P < .001), while there were no significant changes in the HSML group (23.7 dB [SE: 1.6] at baseline, 23.8 dB [SE: 1.4] at evaluation 1, and 23.3 dB [SE: 1.4] at final visit). The mean visual acuity and mean visual quality-of-life questionnaire score did not change significantly in both groups. Crossover to half-dose PDT after previous unsuccessful HSML treatment for cCSC may lead to improved anatomic and functional endpoints, while crossover to HSML after half-dose PDT does not seem to significantly affect these endpoints.

Highlights

To assess whether chronic central serous chorioretinopathy patients without a complete resolution of subretinal fluid (SRF) after either halfdose photodynamic therapy (PDT) or high-density subthreshold micropulse laser (HSML) treatment may benefit from crossover treatment
CCSC patients, a statistically significant difference in treatment response was seen in favor of half-dose PDT, with 67% of PDT-treated patients achieving a complete resolution of SRF on optical coherence tomography (OCT), as compared to 29% of HSML-treated patients at 7-8 months after treatment
After second halfdose PDT in the PLACE trial, when the first half-dose PDT treatment did not result in a complete resolution of SRF, 32.4% had a complete resolution of SRF, as compared to 15.4% in the patients who needed a second HSML treatment, which was not significantly different.[14]

Summary

Introduction

To assess whether chronic central serous chorioretinopathy (cCSC) patients without a complete resolution of subretinal fluid (SRF) after either halfdose photodynamic therapy (PDT) or high-density subthreshold micropulse laser (HSML) treatment may benefit from crossover treatment. METHODS: cCSC patients with persistent SRF at the final visit of the PLACE trial were included. Patients received crossover treatment with either half-dose PDT or HSML. RESULTS: Thirty-two patients received PDT and 10 patients received HSML. At the first evaluation visit (6-8 weeks after treatment), 81% of patients in the PDT group had complete resolution of SRF, while none of the HSML-treated patients had complete resolution of SRF. At final visit (1 year after baseline), 78% (P [ .030) and 67% (P [ .109) of the patients, respectively, had a complete resolution of SRF.

Methods

Results

Conclusion