Long-Term Anatomical Response to Navigated Micropulse Laser in Chronic Central Serous Chorioretinopathy: A 24-Month Longitudinal Study

INTRODUCTION: Chronic central serous chorioretinopathy (cCSC) is characterized by persistent subretinal fluid (SRF), and long-term anatomical response to navigated subthreshold micropulse laser (NSML) varies among patients. This study evaluated 24-month anatomical and functional outcomes after NSML and investigated baseline optical coherence tomography (OCT) parameters associated with treatment response. METHODS: This retrospective longitudinal study included 61 eyes with treatment-naïve cCSC treated with NSML and followed for 24 months. Eyes were classified as responders or nonresponders according to complete resolution or persistence of subretinal fluid (SRF) at month 24. Baseline and 24-month OCT parameters, including SRF height, subretinal hyperreflective material (SHRM) height and width, choroidal thickness, Haller layer thickness, and Sattler/choriocapillaris complex thickness, were compared within and between groups. Pearson correlation analysis assessed associations between longitudinal OCT changes and best-corrected visual acuity (BCVA). Multivariable logistic regression was performed to identify independent baseline predictors of anatomical response. RESULTS: At 24 months, 33 eyes (54.1%) achieved complete SRF resolution, whereas 28 eyes (45.9%) showed persistent SRF. Baseline SRF height was significantly greater in responders than in nonresponders (205.2 ± 143.3 μm versus 129.9 ± 80.1 μm; p = 0.0127), while other baseline OCT parameters and BCVA were comparable between groups. Responders showed significant reductions in SRF height and SHRM width and a significant improvement in BCVA, whereas nonresponders showed no significant structural improvement and significant BCVA worsening. In multivariable analysis, baseline SRF height was the only independent predictor of complete anatomical response at 24 months (adjusted odds ratio [OR] 2.46; 95% confidence interval [CI] 1.13-5.35; p = 0.023). CONCLUSIONS: Long-term anatomical response to NSML in cCSC is heterogeneous. Greater baseline SRF height was independently associated with complete SRF resolution at 24 months, suggesting that more active but potentially reversible disease may be more likely to benefit from treatment.