Micropulse laser therapy at 532, 577, and 810 nm for chronic central serous chorioretinopathy: a systematic review and Meta-analysis

To evaluate the effectiveness of 532, 577, and 810 nm lasers as an initial treatment for non-resolving central serous chorioretinopathy (CSC).

Following the Cochrane Collaboration Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, randomized clinical trials (RCTs), non-randomized cohorts, observational studies, and case series (>10 cases) assessing these lasers for non-resolving CSC with ≥3mo of follow-up were included. Non-resolving CSC was defined as persistent subretinal fluid (SRF) for >3-6mo. Searches were conducted in PubMed, the Cochrane Library, and Embase (January 17, 2025). Two authors independently performed data extraction and assessed the risk of bias. The primary outcome was SRF resolution on optic cherence tomography (OCT) at 3-6mo. Central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were secondary outcomes. A random-effects model was employed to calculate pooled proportions with 95% confidence intervals (CIs), and heterogeneity was assessed using I² and Q statistics.

Twenty-four studies (3 RCTs, 21 non-RCTs) involving 829 non-resolving CSC eyes (77.6% male, mean age 45.36y) were included. SRF resolution was 59% (95%CI: 0.51-0.67; I²=72.6%), showing no significant difference between lasers. Trim-and-fill adjustment raised SRF resolution to 65% (95%CI: 0.44-0.81). CRT significantly decreased by 126.32 µm (95%CI: 95.99-156.65; P<0.0001; I²=95.7%), with the largest reduction noted for the 810 nm laser. BCVA change was 0.10 logMAR (95%CI: -0.03 to 0.22; P=0.13; I²=96.6%), indicating no significant visual improvement.

This Meta-analysis supports the use of 532, 577, and 810 nm subthreshold micropulse lasers as equally effective in resolving SRF in non-resolving CSC.