Efficacy and safety of subthreshold laser in patients with acute central serous chorioretinopathy: a systematic review and meta-analysis.

Abstract

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. 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. 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. 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.