Therapeutic interventions for chronic central serous chorioretinopathy: a comprehensive assessment of systematic reviews.

Abstract

Background: A variety of different treatments have been proposed to effectively treat chronic central serous chorioretinopathy but there remains uncertainty regarding the efficacy of a number of treatment options. We aim to evaluate the efficacy of several therapeutic options for chronic central serous chorioretinopathy including photodynamic therapy, conventional laser photocoagulation, subthreshold micropulse laser, selective retina therapy, vascular endothelial growth factor (VEGF) antagonists, and mineralocorticoid receptor antagonists.

Methods: Pubmed, Embase, and Cochrane databases were searched for systematic reviews and meta-analyses evaluating treatment modalities for chronic central serous chorioretinopathy. Primary outcome measures included improvement in best corrected visual acuity (BCVA) and resolution of subretinal fluid (SRF). Conclusions regarding the efficacy of each modality were summarized and compared to findings of several key randomized controlled trials.

Results: Ten systematic reviews and meta-analyses that incorporated 58 unique randomized controlled trials and observational studies were identified. Treatments that were shown to improve BCVA and promote SRF resolution included half-fluence and half-dose photodynamic therapy, conventional laser therapy, and subthreshold micropulse laser therapy. Evidence regarding selective retina therapy was limited and inconclusive. VEGF antagonists were not effective in the absence of choroidal neovascularization and mineralocorticoid receptor antagonists were not effective.

Conclusion: The most effective therapeutic option for chronic central serous chorioretinopathy is half-dose or half-fluence photodynamic therapy, however, conventional laser therapy is an acceptable alternative in cases when photodynamic therapy is unavailable and when fluid leakage sites are not subfoveal or juxtafoveal. Subthreshold micropulse laser is less effective but can be considered when other options are unavailable.