Comparative efficacy of subthreshold micropulse laser versus conventional laser therapy in central serous chorioretinopathy

Subthreshold micropulse laser (SML) and conventional laser photocoagulation (CLP) have established efficacy in treating central serous chorioretinopathy (CSC), but systematic comparisons of their effectiveness, safety, and long-term outcomes remain lacking.We carried out this retrospective study. A total of 109 eyes from 109 CSC patients were included, with 53 eyes in the conventional laser group and 56 eyes in the SML group. The SML group was treated with a 577-nm wavelength laser, targeting areas of leakage and subretinal fluid (SRF). For patients without identifiable leakage points, the treatment area covered the SRF region. The conventional laser group received single-spot laser treatment with a laser spot reaction of <= grade 1, targeting leakage points identified by early-phase fluorescein angiography (FFA). Disease duration, leakage points on FFA, best-corrected visual acuity (BCVA) during follow-up, central macular thickness (CMT), SRF resolution, and safety were analyzed. The mean follow-up duration was 6.90 +/- 2.77 months. The conventional laser group had a shorter mean disease duration compared to the SML group (P = 0.002), and there was a significant difference in the distribution of leakage points between the two groups (P = 0.000). At 6 months post-treatment, compared to baseline, the BCVA change was 0.24 +/- 0.28 in the CL group (P = 0.02) and 0.19 +/- 0.18 in the SML group (P = 0.04). There were no significant differences in BCVA between the two groups at any follow-up time point, though. CMT changes from baseline to final follow-up demonstrated a mean reduction of 228.00 +/- 181.01 mu m in the CL group versus 176.97 +/- 143.39 mu m in the SML group (both P < 0.001). No significant differences were observed in mean CMT or final OCT changes between the two groups at any follow-up time point. The complete SRF resolution rates were 83.01% in the conventional laser group and 87.50% in the SML group (P = 0.59).Both SML and CL treatments are safe and effective for CSC. CL therapy is a safe and effective option for patients with acute disease, clearly identifiable leakage points located > 250 mu m from the foveal center, while SML is preferable for patients with longer disease duration, unclear leakage points, or leakage points located within 250 mu m of the foveal center.