Comparing treatments for chronic central serous chorioretinopathy: a systematic review with network meta-analyses

Abstract

Purpose : Central serous chorioretinopathy (CSCR) is the fourth most common vision-threatening retinopathy encountered by ophthalmologists but no consensus on treatment exists. We aim to compare relative efficacy of treatments for chronic CSCR at 3 months and longer.

Methods : A comprehensive search of four databases was conducted for randomized controlled trials comparing treatments for chronic CSCR with each other and with controls (observation, placebo, or sham). Treatments considered included photodynamic therapy (PDT), subthreshold laser therapies (SL), mineralocorticoid receptor antagonists (MRA) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents.

Pairwise and network meta-analyses (NMA) were conducted for primary outcomes (complete resolution of subretinal fluid (SRF) and mean change in best corrected visual acuity (BCVA)) and secondary outcomes (mean change in SRF, central retinal thickness and central choroidal thickness, recurrence of SRF and adverse events) at 3 months or longer. Heterogeneity and loop and design inconsistency were assessed. Subgroup analyses including for duration of CSCR and sensitivity analyses were performed. Risk of bias and the Confidence in Network Meta-Analysis (CINeMA) informed the certainty of NMA evidence.

Results : Eleven studies of 458 eyes (450 patients) were included. NMA of the primary outcomes at 3 months showed that both PDT and SL were superior to control for resolution of SRF (OR 4.83; 95% CI 1.72 to 13.55 and 2.27; 1.14 to 4.49, respectively) and SL was superior to control for improving BCVA (MD -0.10; -0.17 to -0.04). On probability and SUCRA ranking, PDT and SL were consistently the best ranked treatments for all outcomes at 3 months. There was no evidence of heterogeneity or inconsistency and subgroup and sensitivity analyses confirmed robustness of results. However, reporting for the 6- and 12- months outcomes was limited or missing, and confidence of evidence was graded as low due to imprecision.

Conclusions : Although PDT and SL appeared to be the most highly ranked interventions, paucity of studies precludes definitive conclusions. Evidence to support superiority of PDT and SL over control was found only for our primary outcomes at 3 months. We did not find evidence to support the use of anti-VEGF or MRA. Larger high-quality comparative trials are needed to increase the strength of conclusions.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.