RPE Tear and Chronic CSC-like Subretinal Fluid After Subthreshold Micropulse Laser for Serous PED

Subthreshold micropulse laser (SML) is a phototherapeutic alternative strategy for central serous chorioretinopathy (CSC) and has been reported for selected serous pigment epithelial detachments (PEDs), especially when the verteporfin in photodynamic therapy (PDT) is unavailable. However, retinal pigment epithelium (RPE) tear following SML has not been well documented. This case report describes an RPE tear and chronic CSC-like subretinal fluid after SML treatment for serous PED in a 44-year-old male. The patient developed an RPE tear after primary SML treatment, followed by chronic recurrent CSC-like subretinal fluid and extrafoveal leakage foci. Staged SML and focal laser photocoagulation guided by sequential multimodal imaging completely resolved the refractory subretinal fluid, with stable visual function and no recurrence during long-term follow-up. This report highlights a potential safety risk of SML for serous PED, underscoring the value of multimodal imaging in guiding treatment with sequential SML or focal photocoagulation for chronic CSC-like fluid.