Efficacy and safety of subthreshold laser in patients with acute central serous chorioretinopathy: a systematic review and meta-analysis
In brief
Subthreshold laser matches vision gains of conventional laser, causes less retinal damage
In six randomized trials of 401 acute CSC patients, subthreshold laser produced visual acuity improvements comparable to conventional laser while reducing retinal pigment epithelium injury. However, it resolved subretinal fluid less often, and evidence versus observation or photodynamic therapy is very low certainty, leaving its overall anatomical benefit uncertain.
- Journal
- Retina (Philadelphia, Pa.) (Q1)
- Published
- 29 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Renzo Cañote, Karina Chocce, Fernanda Millard-Serón, David R Soriano-Moreno
- PMID
- 42524860
- DOI
- 10.1097/IAE.0000000000004927
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 2 August 2026): Ranked by evidence level and journal quartile
- Picked for Ophthalmology (top studies of the week, 2 August 2026): Subthreshold laser for acute CSC meta‑analysis
Abstract
PURPOSE: Subthreshold laser has been proposed as a potentially safer and more effective alternative for patients with acute central serous chorioretinopathy (CSC). Hence, the objective of the this systematic review was to assess the efficacy and safety of subthreshold laser treatment for acute CSC. METHODS: We performed a comprehensive systematic search of PubMed/MEDLINE, EMBASE, and CENTRAL from their inception up to March 24, 2026. We included randomized controlled trials (RCTs) comparing the efficacy and/or safety of subthreshold laser against any comparator. Random-effects meta-analyses were conducted, and the certainty of evidence was rated using the minimally contextualized GRADE approach. RESULTS: Six RCTs (401 participants) in patients with acute CSC were included. Compared with conventional laser, subthreshold laser probably yields similar improvements in visual acuity and reduces retinal pigment epithelium damage but probably leads to a lower rate of subretinal fluid resolution. When compared with observation, subthreshold laser may result in similar visual acuity outcomes but may reduce persistent metamorphopsia and increase subretinal fluid resolution, although the certainty of evidence is very low. Compared with half-dose photodynamic therapy, subthreshold laser may provide comparable visual outcomes but lower anatomical improvement, with very low certainty of evidence. CONCLUSION: In acute CSC, subthreshold laser appears safer than conventional laser and produces similar visual outcomes, though its anatomical efficacy is limited. Its potential advantages over observation or photodynamic therapy remain uncertain due to low-certainty evidence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.