Comparison of the efficacy and safety of subthreshold micropulse laser with photodynamic therapy for the treatment of chronic central serous chorioretinopathy: A meta-analysis

Abstract

Background: This meta-analysis was conducted to compare the therapeutic effect and safety of subthreshold micropulse laser (SML) vs photodynamic therapy (PDT) in treatment of chronic central serous chorioretinopathy (cCSC).

Methods: PubMed, EMBASE, and the Cochrane Library were searched for all relevant studies published up to August 17, 2020. Data of interest were analyzed by STATA (version 14.0) software.

Results: Four randomized clinical trials (RCTs) and 5 retrospective studies with 790 eyes were included in this meta-analysis after study selection. The results showed that SML significantly improved the best-corrected visual acuity (BCVA) compared with PDT at 6 to 8 weeks, 6 months, and 7 to 8 months in patients with cCSC (weighted mean difference (WMD) = -0.15, 95% confidence intervals (CI): -0.23 to -0.07, P < .01; WMD = -2.83, 95% CI: -4.79 to -0.87, P < .01; and WMD = -2.61, 95% CI: -4.23 to -1.24, P = .026, respectively). There was also a statistically significant difference between SML and PDT groups in the differences in the complete resolution of subretinal fluid (SRF) (risk radios = 0.388, 95% CI: 0.307 to 0.491, P < .01). There were no significant differences between the SML and PDT in the overall effect with central macular thickness (CMT), adverse events, complete resolution of SRF and treatment response.

Conclusions: Based on the available evidence, this meta-analysis demonstrated that SML may be considered as a competitive alternative to PDT for treating cCSC, and as the first-line treatment of cCSC.

Figure 1

Flow diagram of the study selection process.

Figure 2

Forest plot of mean change from baseline in best-corrected visual acuity (logMAR BCVA) in eyes with chronic central serous chorioretinopathy (cCSC) treated with subthreshold micropulse laser (SML) and photodynamic therapy (PDT). Follow-up examinations occurred 1 month, 3 months, and 6 months after initiating therapy. Dots show the estimated mean difference and error bars indicated 95% confidence intervals (CI). Values to the left of the vertical line indicate a BCVA advantage for the SML group and values to the right indicate a BCVA advantage for the PDT group.

Figure 3

Forest plot of mean change from baseline in best-corrected visual acuity (BCVA, ETDRS letters) in eyes with chronic central serous chorioretinopathy (cCSC) treated with subthreshold micropulse laser (SML) and photodynamic therapy (PDT). Follow-up examinations occurred during the first 6 to 8 weeks and 7 to 8 months after treatment. Dots show the estimated mean difference and error bars indicated 95% confidence intervals (CI). Values to the left of the vertical line indicate a BCVA advantage for the SML group and values to the right indicate a BCVA advantage for the PDT group.

Figure 4

Forest plot of mean change from baseline in central macular thickness (CMT) in eyes with chronic central serous chorioretinopathy (cCSC) treated with subthreshold micropulse laser (SML) and photodynamic therapy (PDT). Follow-up examinations occurred during the first 1 to 2 months, 3 to 4 months, 6 months and 12 months after initiating therapy. Dots show the estimated mean difference and error bars indicated 95% confidence intervals (CI). Values to the left of the vertical line indicate a central macular thickness (CMT) advantage for the SML group and values to the right indicate a central macular thickness (CMT) advantage for the PDT group.

Figure 5

Forest plot of mean change from baseline in subfoveal choroidal thickness (SFCT) in eyes with chronic central serous chorioretinopathy (cCSC) treated with subthreshold micropulse laser (SML) and photodynamic therapy (PDT). Follow-up examinations occurred during the first 1 to 2 months, 3 months, 6 months, and over 6 months after initiating therapy. Dots show the estimated mean difference and error bars indicated 95% confidence intervals (CI). Values to the left of the vertical line indicate a subfoveal choroidal thickness (SFCT) advantage for the SML group and values to the right indicate a subfoveal choroidal thickness (SFCT) advantage for the PDT group.

Figure 6

Forest plot of the incidence of complete resolution of SRF in eyes with chronic central serous chorioretinopathy (cCSC) treated with subthreshold micropulse laser (SML) and photodynamic therapy (PDT). Follow-up examinations occurred during the 2 time periods less than or equal to 6 months and over 6 months after treatment. Dots show the estimated mean difference and error bars indicated 95% confidence intervals (CI). Values to the left of the vertical line indicate a lower incidence of complete resolution of SRF for the SML group and values to the right indicate a lower incidence of complete resolution of SRF for the PDT group.

Figure 7

Forest plot of the treatment response in eyes with chronic central serous chorioretinopathy (cCSC) treated with subthreshold micropulse laser (SML) and photodynamic therapy (PDT). Dots show the estimated mean difference and error bars indicated 95% confidence intervals (CI). Values to the left of the vertical line indicate a higher treatment response for the SML group and values to the right indicate a higher treatment response for the PDT group.

Figure 8

Forest plot of the incidence of adverse events in eyes with chronic central serous chorioretinopathy (cCSC) treated with subthreshold micropulse laser (SML) and photodynamic therapy (PDT). Dots show the estimated mean difference and error bars indicated 95% confidence intervals (CI). Values to the left of the vertical line indicate a lower incidence of adverse events for the SML group and values to the right indicate a lower incidence of adverse events for the PDT group.