Photodynamic Therapy in Central Serous Chorioretinopathy: Treatment Timing, Anatomical Response, and Recurrence in a Large Real-World Cohort

INTRODUCTION: Central serous chorioretinopathy (CSC) is characterized by pathological accumulation of subretinal fluid (SRF), leading to visual impairment. Photodynamic therapy (PDT) is an established treatment for chronic or persistent CSC. This study aimed to identify predictors of treatment response in a large cohort of patients with CSC treated with PDT. METHODS: In this retrospective, single-center study, clinical characteristics and treatment outcomes of patients with CSC undergoing PDT were systematically analyzed. Central retinal thickness (CRT) and visual acuity were assessed before and after treatment. The interval between initial diagnosis and PDT was evaluated for its impact on therapeutic response. RESULTS: A total of 115 patients (90 males, 25 females; mean age 49.95 ± 10.15 years) were included. The mean interval from diagnosis to PDT was 3.79 ± 3.53 years. CRT decreased significantly following PDT (p < 0.001), with complete SRF resolution in 51.3% of eyes. Mean visual acuity improved by -0.02 ± 0.22 logMAR (p = 0.0047). Recurrence occurred in 30% of eyes after a mean of 1.1 ± 1.1 years. A significant negative correlation was observed between time to PDT and CRT reduction (r = -0.286, p = 0.001) but not with visual acuity (p = 0.76). Repeat PDT, performed in 16 eyes, resulted in further significant CRT reduction (p = 0.008). CONCLUSIONS: PDT is effective in reducing SRF in CSC. Delayed treatment was associated with diminished anatomical response. Repeat PDT may provide additional benefit in recurrent disease.