Surv Ophthalmol. 2026 Sep-Oct;71(5):1249-1260. doi: 10.1016/j.survophthal.2026.03.008.
Summary
Acute ICSC: PDT effective; Anti-VEGF transient 1-month decreased fluid without sustained VA or anatomic benefits — Systematic review and meta-analysis
Abstract
Acute central serous chorioretinopathy (CSC) may resolve spontaneously, but risks progression to chronic disease with visual impairment. We performed a PRISMA-compliant meta-analysis evaluating photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) agents versus observation in acute CSC (<6 months), searching PubMed, EMBASE, and CENTRAL (October 2014 – May 2025) for comparative studies. Eleven studies (5 randomized, 6 non-randomized; 464 eyes) were included. PDT demonstrated robust superiority over observation, achieving significant best-corrected visual acuity gains and sustained central macular thickness reductions at 1, 3, and 12 months. Notably, PDT-treated eyes were nearly 4 times more likely to achieve complete fluid resolution at 1 month, a benefit maintained across all follow-up intervals. Conversely, anti-VEGF therapy provided only a transient anatomical reduction at 1 month, without significant visual improvement or sustained benefit. Both interventions were well tolerated. In conclusion, half-dose PDT provides durable anatomical and functional improvements for acute CSC, significantly accelerating fluid resolution and visual recovery. While observation remains a valid initial approach, early PDT is practically advantageous for patients requiring rapid visual rehabilitation or to mitigate permanent photoreceptor damage from persistent fluid. Anti-VEGF therapy offers limited, transient anatomical effects without functional benefit and should be reserved for atypical cases or when PDT is unavailable.
