Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Ophthalmology, Haga Hospital, The Hague, The Netherlands.
Acta Ophthalmol. 2023 Mar;101(2):140-159. doi: 10.1111/aos.15263. Epub 2022 Sep 30.
Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short-term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta-analyses to compare to non-treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half-dose or half-fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half-dose or half-fluence PDT (OR: 20.6; 95% CI: 6.3-66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0-655.7; p = 0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7-6.8; p = 0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best-corrected visual acuity was only obtained by half-dose/-fluence PDT (-0.13 logMAR; 95% CI: -0.20 to -0.06 logMAR; p = 0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half-dose/-fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long-term data available for PDT-based treatments finding persisting treatment results, half-dose or half-fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.
治疗慢性中心性浆液性脉络膜视网膜病变（cCSC）仍然存在争议。由于 cCSC 是一种病情时好时坏的疾病，因此治疗效果很难评估，尤其是在试验比较没有安慰剂/对照组的活性治疗时。在这项研究中，我们系统地回顾了随机对照试验（RCT）中测试的任何 cCSC 治疗的短期疗效，并采用网络荟萃分析将其与非治疗对照组进行比较。我们于 2022 年 3 月 20 日在 11 个文献数据库中检索了 cCSC 治疗的 RCT。我们共确定了 17 项 RCT，共纳入 1172 只眼。治疗包括传统激光（44 只眼）、半剂量或半强度光动力疗法（PDT）（298 只眼）、雷珠单抗（16 只眼）、抗氧化剂（50 只眼）、盐皮质激素受体拮抗剂（187 只眼）、利福平（91 只眼）、选择性视网膜光凝（SRT）（67 只眼）和亚阈值微脉冲激光（192 只眼）。与对照组相比，只有半剂量或半强度 PDT（OR：20.6；95%CI：6.3-66.7；p<0.0001）和传统激光（OR：36.4；95%CI：2.0-655.7；p=0.015）治疗可显著提高完全视网膜下液吸收，SRT 治疗的程度低一个数量级（OR：3.4；95%CI：1.7-6.8；p=0.00075）。与对照组相比，且经过敏感性分析后，只有半剂量/-强度 PDT 治疗可显著改善最佳矫正视力的变化（-0.13 对数 MAR；95%CI：-0.20 至-0.06 对数 MAR；p=0.00021）。总之，三种治疗方案与不治疗相比均有显著改善：半剂量/-强度 PDT、传统激光，而 SRT 的改善程度要小得多。考虑到传统激光仅适用于中心外渗漏，且基于 PDT 的治疗的长期数据显示治疗效果持续存在，半剂量或半强度 PDT 是 cCSC 患者唯一可行的治疗选择。维替泊芬短缺不应导致无效治疗方法的使用，因为它们会使患者面临不必要的不良事件风险。
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