EFFICACY AND SAFETY OF SUBTHRESHOLD LASER IN PATIENTS WITH ACUTE CENTRAL SEROUS CHORIORETINOPATHY: A Systematic Review and Meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed the efficacy and safety of subthreshold laser for acute central serous chorioretinopathy (CSC), including six randomized controlled trials with 401 participants. Compared with conventional laser, subthreshold laser probably produced similar visual-acuity improvement and less retinal pigment epithelium damage, but a lower rate of subretinal fluid resolution. Comparisons with observation and half-dose photodynamic therapy suggested similar visual outcomes, but evidence for other benefits was very uncertain. Overall, the review found subthreshold laser appears safer than conventional laser, with limited anatomical efficacy.

Key findings

• Six randomized controlled trials involving 401 participants with acute CSC were included.
• Compared with conventional laser, subthreshold laser probably yielded similar visual-acuity improvement and reduced retinal pigment epithelium damage, but had a lower rate of subretinal fluid resolution.
• Compared with observation, it may reduce persistent metamorphopsia and increase subretinal fluid resolution; certainty was very low.
• Compared with half-dose photodynamic therapy, visual outcomes may be comparable but anatomical improvement lower; certainty was very low.

Why it matters

The findings distinguish visual outcomes from anatomical response: similar visual improvement does not necessarily mean equivalent subretinal fluid resolution. Reduced retinal pigment epithelium damage may be relevant when weighing subthreshold against conventional laser, while the very low certainty of comparisons with observation or photodynamic therapy limits confidence in those potential advantages.

What to keep in mind

Evidence for comparisons with observation and half-dose photodynamic therapy was of very low certainty, limiting confidence in those findings.