Treatment Outcomes of Simple and Complex Central Serous Chorioretinopathy

<b>Objectives</b>: To assess the association between clinical outcomes and the multimodal imaging-based classification of central serous chorioretinopathy (CSC). <b>Methods</b>: This retrospective study included 207 eyes from 155 treatment-naïve patients with CSC. The eyes were categorized into two groups, including the simple CSC group (<i>n</i> = 164) and the complex CSC group (<i>n</i> = 43), based on the presence of retinal pigment epithelial atrophy spanning two or more disc areas. All patients were initially observed without treatment for 3-6 months. For cases with persistent subretinal fluid after this observation period, treatment modalities, including continued observation, photocoagulation (PC), or photodynamic therapy (PDT), were selected. <b>Results</b>: Patients in the complex CSC group were more likely to be older (<i>p</i> = 0.01) and male (<i>p</i> = 0.01) than those in the simple group and to exhibit a higher prevalence of bilateral involvement (<i>p</i> < 0.001) and previous CSC episodes (<i>p</i> < 0.001) than those exhibited by patients in the simple group. Eyes with complex CSC exhibited a comparable incidence of spontaneous resolution within 6 months and a higher incidence of recurrence after spontaneous resolution within 6 months than eyes with simple CSC. In both the simple and complex CSC groups, the PDT subgroup exhibited a lower recurrence rate than that of the PC subgroup (simple CSC: <i>p</i> < 0.001, complex CSC: <i>p</i> = 0.03). <b>Conclusions</b>: Although CSC is typically a self-limiting disease often managed conservatively, patients with complex CSC, characterized by bilateral involvement or a history of previous episodes, are at a higher risk of subretinal fluid recurrence and may benefit from early interventions without a period of observation, such as PDT.