Interventions for central serous chorioretinopathy: a network meta-analysis

Area of Science:

• Ophthalmology
• Retinal Diseases
• Choroidopathy

Background:

• Central serous chorioretinopathy (CSC) involves retinal detachment and dysfunction of the choroid and retinal pigment epithelium (RPE).
• While often self-limiting, CSC can lead to irreversible vision loss.
• Current management strategies, including observation, laser treatment, photodynamic therapy (PDT), and anti-VEGF injections, lack an evidence-based consensus.

Purpose of the Study:

• To compare the relative effectiveness of various interventions for central serous chorioretinopathy (CSC).

Main Methods:

• Systematic search of multiple electronic databases (CENTRAL, MEDLINE, EMBASE, ISRCTN, ClinicalTrials.gov, WHO ICTRP) up to October 2015.
• Inclusion of randomized controlled trials (RCTs) comparing any CSC intervention against another intervention or control.
• Independent study selection and data extraction by two reviewers, with data pooled using fixed-effect models and network meta-analysis for intraocular interventions.

Main Results:

• Twenty-five small, often poorly reported RCTs with 1098 participants were included.
• Low-quality evidence suggests little difference between anti-VEGF agents, observation, or sham treatment for visual acuity in acute CSC.
• Half-dose PDT may offer slight visual improvement and reduced recurrence in acute CSC; micropulse laser shows potential for better visual acuity in both acute and chronic CSC.
• Anti-VEGF treatment in chronic CSC showed little difference in visual acuity compared to low-fluence PDT but was associated with higher rates of persistent CSC.

Conclusions:

• CSC's enigmatic nature and spontaneous resolution rates complicate treatment efficacy assessment.
• The quality and size of existing RCTs limit definitive conclusions on CSC interventions.
• Photodynamic therapy (PDT) and micropulse laser treatments appear most promising for future head-to-head comparative trials against natural history or other interventions.