Comparison of the efficacy of subthreshold micropulse laser versus intravitreal anti-VEGF therapy for chronic central serous chorioretinopathy

Objective To compare the therapeutic ability between 577-nm subthreshold micropulse laser (SML) and intravitreal anti-VEGF injection (IVA) in the treatment of chronic central serous chorioretinopathy (cCSCR). Methods The medical records of 50 cCSCR patients (50 eyes) who underwent SML (30 eyes) or IVA injection (20 eyes) were reviewed in this retrospective cohort study. Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), subretinal fluid (SRF), and subfoveal choroidal thickness (SFCT) measured by optical coherence tomography (OCT) at baseline, 1, 3, and 6 months post-treatment were extracted and compared between the two groups. Results Baseline demographic and clinical characteristics, including age, sex, leakage pattern on fluorescein angiography (FA), BCVA, CRT, SRF, and SFCT, were comparable between the two groups (all p > 0.05). The mean ± SD of SML sessions and IVA injection were 1.67 ± 0.80 and 1.75 ± 0.97, respectively ( p > 0.05). In comparison to the baseline values, BCVA showed statistically significant improvement at 6 months after treatment in both groups ( p < 0.05), while the CRT, SRF and SFCT values prominently decreased at the final evaluation (all p < 0.05). No statistically significant difference was revealed in the BCVA and CRT data of all time points between the two groups (all p > 0.05). At baseline, 1 month, and the 3 months, there was no statistically significant difference for the SRF and SFCT values between groups ( p > 0.05). However, at the 6th month, the SML group demonstrated significantly lower SRF, whereas the IVA group showed significantly lower SFCT (both p < 0.05). Conclusion Both SML and anti-VEGF has been confirmed effective in improving visual acuity and achieving anatomical recovery in patients with cCSCR. At 6 months, IVA was associated with greater reduction in SFCT, whereas SML achieved superior SRF resolution. These findings support individualized treatment selection based on disease characteristics and underlying pathophysiology.