PURPOSE: To evaluate the results of indocyanine green angiography-guided verteporfin (Visudyne; Novartis Pharma AG, Switzerland) photodynamic therapy with half-fluence rate in the treatment of acute symptomatic central serous chorioretinopathy. METHODS: A retrospective review over 12 months was performed of 19 consecutive patients with subfoveal fluid because of acute symptomatic central serous chorioretinopathy proved by spectral-domain optical coherence tomography and fluorescein angiography, treated with indocyanine green angiography-guided verteporfin (6 mg/m) photodynamic therapy with half-fluence rate (25 J/cm). Acute symptomatic central serous chorioretinopathy was defined as first episode of symptoms and duration of symptoms before treatment of ≤12 weeks. RESULTS: Best-corrected visual acuity at baseline was 47 letters (±10; n = 19) according to the Early Treatment Diabetic Retinopathy Study chart. At 12 months after photodynamic therapy, the mean best-corrected visual acuity improved to 56 letters (P = 0.003).Pretreatment central foveal thickness was 406 μm and decreased by a mean of 163 μm at Month 12 control (P < 0.001). At Month 1 after photodynamic therapy, subretinal fluid in spectral-domain optical coherence tomography was completely resolved in all 19 patients. None of the patients developed any recurrence of symptoms over 12 months. No ocular or systemic side effects were observed during 12 months follow-up. CONCLUSION: Indocyanine green angiography-guided half-fluence photodynamic therapy with verteporfin is effective in treating acute symptomatic central serous chorioretinopathy, resulting in visual improvement and complete resolution of exudative macular detachment.