Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta‐analyses

Abstract

Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short‐term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta‐analyses to compare to non‐treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half‐dose or half‐fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half‐dose or half‐fluence PDT (OR: 20.6; 95% CI: 6.3–66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0–655.7; p = 0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7–6.8; p = 0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best‐corrected visual acuity was only obtained by half‐dose/‐fluence PDT (−0.13 logMAR; 95% CI: −0.20 to −0.06 logMAR; p = 0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half‐dose/‐fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long‐term data available for PDT‐based treatments finding persisting treatment results, half‐dose or half‐fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.

Risk of Central Serous Chorioretinopathy in Male Androgen Abusers

“…Interestingly, two of these patients discontinued testosterone therapy and experienced resolution of subretinal fluid [29]. In that We could not calculate a meaningful OR since incidence was 0 in both cases and controls regard, it should be noted that the natural history of CSC exhibits waxing waning [2,8], which is why a control group is necessary to fully conclude if an intervention is significantly better than observation [8].…”

“…Prolonged presence of subretinal fluid should be avoided as irreversible vision loss can occur due to photoreceptor atrophy [5,6]. A range of treatment modalities aim to provide resolution of subretinal fluid, of which the most popularly used is the half-dose photodynamic therapy (PDT) due to its efficacy and safety [7,8].…”

Topical non‐steroidal anti‐inflammatory drugs for central serous chorioretinopathy: A systematic review and meta‐analysis

“…A follow-up correspondence on the original Pecora paper also highlights the diagnostics uncertainties and differences in the definition of the diagnosis of CSC in the 1970s (Pecora, 1979). Topical NSAIDs are indeed relevant and efficacious for important differential diagnoses such as pseudophakic cystoid macular oedema/Irvine-Gass syndrome (van Dijk & Boon, 2021). Similarly, other important differential diagnoses of CSC require completely different approaches and treatment modalities that are irrelevant for CSC, for example corticosteroids for Vogt-Koyanagi-Harada disease, antibiotics for syphilitic posterior placoid chorioretinitis, or plaque radiotherapy for choroidal melanoma (van Dijk & Boon, 2021).…”

“…Although half-dose photodynamic therapy (PDT) is the mainstay of CSC treatment (van Dijk et al, 2020(van Dijk et al, , 2022, ongoing verteporfin shortage issues limit access to treatment (Sirks et al, 2020). Understanding of the efficacy of other treatment modalities beyond PDT has become more important than ever before.…”

Clinical and multimodal imaging findings in a case of serous maculopathy with absence of retinal pigment epithelium (SMARPE)

“…Further, CSC is associated with a pachychoroid feature in which hydrostatic pressure from the choroid provides serous detachment of the RPE and the neuroretina, in which treatment of the leakage point may be indicated. 9 Half-dose PDT is a relevant treatment option for CSC, 10 however, this choroidal pathophysiology of CSC is not present in SMARPE, hence, there is no current evidence to support PDT treatment in these cases. Given the relative VA stability, observation seems to be a valid approach.…”