Efficacy and Safety of Carbonic Anhydrase Inhibitors in the Management of Central Serous Chorioretinopathy

<b>Purpose:</b> To evaluate the efficacy and safety of carbonic anhydrase inhibitors for central serous chorioretinopathy (CSCR). <b>Methods:</b> The study protocol (PROSPERO registry no. CRD42024589621) involved a search of major databases (Cochrane CENTRAL, PubMed/MEDLINE, and Google Scholar) for studies comparing carbonic anhydrase inhibitors with placebo for the treatment of CSCR. Data were pooled using a random-effects model. Effect measures were risk ratios (RRs) for dichotomous outcomes, and mean differences with 95% CIs for continuous outcomes. <b>Results:</b> The analysis included 225 patients from 7 observational studies, with 133 in the carbonic anhydrase inhibitor group and 92 in the placebo group. No significant change in best-corrected visual acuity was observed in the carbonic anhydrase inhibitor group compared with placebo (mean difference, 0.01 logMAR, 95% CI, -0.08 to 0.11; <i>P</i> = .76). Carbonic anhydrase inhibitors significantly reduced subfoveal choroidal thickness (mean difference, -12.80 µm, 95% CI, -24.66 to -0.94; <i>P</i> = .03) and central macular thickness (mean difference, -52.18 µm, 95% CI, -98.20 to -6.15; <i>P</i> = .03), but no significant differences between groups were observed in incidence of complete resolution of subretinal fluid (RR, 1.45, 95% CI, 0.90-2.36; <i>P</i> = .13) or CSCR recurrence (RR, 0.67, 95% CI, 0.20-2.22; <i>P</i> = .51). Incidence of adverse events was significantly higher in the carbonic anhydrase inhibitor group compared with placebo (RR, 8.75, 95% CI, 1.24-61.79; <i>P</i> = .03). <b>Conclusions:</b> Carbonic anhydrase inhibitors reduce subfoveal choroidal thickness and central macular thickness in CSCR but do not improve visual acuity or achieve complete fluid resolution. In addition, carbonic anhydrase inhibitors pose a higher risk of adverse events, indicating the need for cautious use and further research on their long-term efficacy and safety.