The Effectiveness of Sub-Threshold Laser Versus Spironolactone for The Treatment of Central Serous Chorioretinopathy: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.36283/ziun-pjmd14-2/058Keywords:
Central Serous Chorioretinopathy , Spironolactone , Sub-Threshold LaserAbstract
Background: The purpose of this systematic review and meta-analysis was to evaluate the efficacy of sub-threshold laser versus spironolactone for the treatment of central serous chorioretinopathy (CSCR).
Methods: A comprehensive search was conducted using PubMed, Cochrane, EMBASE, and Google Scholar for randomized controlled trials comparative and individual studies on spironolactone and sub-threshold laser in the treatment of CSCR. This search was performed according to PRISMA guidelines, covering studies published from January 2010 up to August 2024. Studies published were selected based on inclusion criteria; including patients with CSCR≥ 3 months and outcomes such as best corrected visual acuity (BCVA), sub-retinal fluid resolution (SRF), and central macular thickness (CMT). Studies other than RCTs or those without relevant outcome measures were excluded from the meta-analysis. Data synthesis was conducted using RevMan 5.4.1, effective sizes were presented as Mean difference (MD) with a 95% confidential interval. Heterogeneity was assessed using the I2statistic. The risk of Bias for each study was conducted using the revised Cochrane Risk of Bias Tool for RCTs.
Results: 8 studies, comprising 371 eyes, met the inclusion criteria. Spironolactone demonstrated a significant reduction in SRF at the 3rd and 6th month follow-up as compared to sub-threshold (MD= -27.93, 95% CI -41.61 to -14.06, P< 0.0001). The sub-threshold laser was more effective in reducing SRF at 6th month (MD= -41.61, 95% CI -69.21 to-12.90, P=0.004). No statistical difference was found between the 2 treatments for BCVA improvement. The sub-threshold laser was seen more effective in reducing CMT in the 6th month (MD= 47.99, 95% CI 31.20 to 64.77, P< 0.00001). Heterogeneity was substantial in some outcomes, indicating variability across the studies (I2> 75%).
Discussion: Spironolactone appeared more effective in reducing SRF in CSCR, while sub-threshold laser showed greater efficacy in reducing CMT. Both treatments offer benefits, but further larger-scale, multi-center trials are required to address the observed heterogeneity and long-term efficacy.
Systemic Review Registration: PROSPERO ID: (CRD42024596399)
References
Mukherji S, Soumen Karmakar, Dasgupta S. Association of Central serous chorioretinopathy with type of personality, anxiety and depression. Indian Journal of Ophthalmology. 2023 Dec 22; 72(Suppl 1):S60–5. DOI: 10.4103/IJO.IJO_1180_23
Kanda P, Gupta A, Gottlieb C, Karanjia R, Coupland SG, Bal MS. Pathophysiology of central serous chorioretinopathy: a literature review with quality assessment. Eye. 2021 Oct 15; 36(5):941–62. DOI: 10.1038/s41433-021-01808-3.
Massimiliano Borselli, Rossi C, Chisari D, Scalzo GC, Lucisano A, Randazzo G, et al. Current and emerging treatment options for central serous chorioretinopathy. Expert Review of Ophthalmology. 2024 Apr 10; 19(4):247–60. https://doi.org/10.1080/17469899.2024.2336241.
Yahalomi T, Pikkel YS, Arnon R, Kinori M, Wood K, Pikkel J. Acute Central Serous Chorioretinopathy Outbreak during the COVID-19 Pandemic: A Pilot Study. Medicina. 2024 Jan 1; 60(1):122. https://www.mdpi.com/1648-9144/60/1/122
Yu SY, Park J, Kim K, Kang M, Kim E. Central serous chorioretinopathy: Treatment. Taiwan Journal of Ophthalmology. 2022; 12(4):394. DOI:10.4103/2211-5056.362040
Nicolò M, Ferro Desideri L, Vagge A, Traverso CE. Current Pharmacological Treatment Options for Central Serous Chorioretinopathy: A Review. Pharmaceuticals. 2020 Sep 23; 13(10):264. doi:10.3390/ph13100264.
Sachdev A. Improvement in Central Serous Chorioretinopathy Following Multiwavelength Photobiomodulation Treatment – Case Report. Ophthalmology and Therapy. 2024 May 17;13(7):2055–60.doi:10.1007/s40123-024-00963-6.
Khandhadia S, Thulasidharan S, Hoang NTV, Ibrahim SA, Ouyang Y, Lotery A. Real world outcomes of photodynamic therapy for chronic central serous chorioretinopathy. Eye. 2022 Dec 26;37:2548–53.doi:10.1038/s41433-022-02370-2.
Kumawat D, Ravi AK, Sahay P, Alam T, Desai A, Kumar A. Systemic evaluation of patients with central serous chorioretinopathy: A case-control study. European Journal of Ophthalmology. 2020 Nov 25;31(6):3223–30. doi: 10.1177/1120672120975698
Venkatesh R, Prabhu V, Joshi A, Mangla R, Singh R, Wu L, et al. Real-world practice patterns of eplerenone use for central serous chorioretinopathy. International Journal of Retina and Vitreous [Internet]. 2023 Oct 2 [cited 2024 Apr 13];9(1). Available from: https://escholarship.org/uc/item/2546j3dk
K Sandeep, Venugopal KC, Javagal AP, Acharya P, Sreelekshmi SR, N Narendra, et al. Comparison of oral propranolol, oral rifampicin, and intravitreal anti-VEGF in central serous chorioretinopathy. Indian Journal of Ophthalmology. 2023 Sep 21;71(10):3381–5.
Zhao YY, Wang H, Chen W, Wang Q, Liu Y. Comparative evaluation of central serous retinopathy in pilots and non-pilot patients. Photodiagnosis and Photodynamic Therapy. 2024 Dec; 50: 104376. https://doi.org/10.1016/j.pdpdt.2024.104376
Chhablani J, Chhablani J, Ong J, Rajendran A, Zhang X, Parolini B, et al. Subthreshold laser therapy guidelines for retinal diseases. Eye. 2022 Jun 23;36(12):2234–5. https://doi.org/10.1038/s41433-022-02136-w
Cozzupoli GM, Sacconi R, Tombolini B, Fantaguzzi F, Servillo A, Menean M, et al. Long-term predictors of anti-VEGF treatment response in patients with neovascularization secondary to CSCR: a longitudinal study. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2023 Sep 29;262(1):73–80. https://doi.org/10.1007/s00417-023-06255-2
Maciej Gawęcki, Grzybowski A, Święch A. Biometric Risk Factors for Central Serous Chorioretinopathy. Ophthalmology and therapy. 2023 Feb 25;12(2):1327–38. doi:10.1007/s40123-023-00687-z.
PRISMA [Internet]. Prisma-statement.org. 2022 [cited August 31, 2022]. Available at: https://prisma-statement.org/
PROSPERO: International prospective register of systematic reviews. Available at: https://www.crd.york.ac.uk/prospero/
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a Web and Mobile App for Systematic Reviews. Systematic Reviews [Internet]. 2016 Dec; 5(1). Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0384-4
Cochrane. Cochrane Database of Systematic Reviews [Internet]. 2023 [cited 2024 oct 5]. Available from: https://www.cochranelibrary.com/
Ravman [Internet]. Version 5.4.1. ABC Software Inc.; 2024. Available from: https://www.ravman.com
Gao S, Ge G, Zhang Y, Zhang M. Subthreshold Micropulse Laser Versus Oral Spironolactone in Chronic Central Serous Chorioretinopathy: A Quasi-Randomized Controlled Trial. Translational Vision Science & Technology. 2024 Aug 12; 13(8):19 . https://doi.org/10.1167/tvst.13.8.19
Mercuri S, D’Alterio FM, Gallo B, Walid Raslan, Gupta A, Khairat N, et al. Subthreshold laser compared to oral spironolactone for the treatment of chronic central serous chorioretinopathy: a retrospective study. International Ophthalmology. 2024 Mar 13; 44(1).https://doi.org/10.1007/s10792-024-03063-3
Altınel MG, Acikalin B, Gunes H, Demir G. Optical coherence tomography parameters as predictors of treatment response to a 577-nm subthreshold micropulse laser in chronic central serous chorioretinopathy. Lasers in Medical Science. 2021 Jan 7;36(7):1505–14. https://doi.org/10.1007/s10103-020-03225-6
Işık MU. Efficacy of the subthreshold micropulse yellow wavelength laser photostimulation in the treatment of chronic central serous chorioretinopathy. International Journal of Ophthalmology. 2020 Sep 18;13(9):1404–10. doi:10.18240/ijo.2020.09.11
Uzlu D, Erdöl H, Kola M, Özbay AD. The efficacy of subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy. Lasers in Medical Science. 2020 Aug 19;36(5):981–8.https://doi.org/10.1007/s10103-020-03129-5
Herold TR, Rist K, Siegfried Georg Priglinger, Ulbig MW, Wolf A. Long-term results and recurrence rates after spironolactone treatment in non-resolving central serous chorio-retinopathy (CSCR). Graefe s Archive for Clinical and Experimental Ophthalmology. 2016 Jul 30;255(2):221–9. DOI: 10.1007/s00417-016-3436-5
Zhang B, He Z, Zhao H, Gao H, Zhang Z, Gao Z, et al. Evaluating the efficacy of recombinant human growth factors in scar remodelling for patients with facial soft tissue injuries. International Wound Journal. 2024 Jan; 21(1) .https://doi.org/10.1155/2024/7197249
Sinawat S, Thongmee W, Sanguansak T, Laovirojjanakul W, Sinawat S, Yospaiboon Y. Oral Spironolactone versus Conservative Treatment for Non-Resolving Central Serous Chorioretinopathy in Real-Life Practice. Clinical Ophthalmology. 2020 Jun;14: 1725–34. https://doi.org/10.2147/OPTH.S260998
Oribio-Quinto C, Antonio Domingo Alarcón-Garcia, Jacobo Enriquez-Fuentes, Bárbara Burgos-Blasco, Jose Ignacio Fernandez-Vigo. Functional and anatomical results of subthreshold micropulse laser as rescue treatment for central serous chorioretinopathy after verteporfin shortage. Photodiagnosis and Photodynamic Therapy. 2024 Jul 1;49: 104295–5. https://doi.org/10.1016/j.pdpdt.2024.104295
Zhang X, Lim C, Chhablani J, Yew Meng Wong. Central serous chorioretinopathy: updates in the pathogenesis, diagnosis and therapeutic strategies. Eye and vision [Internet]. 2023 Jul 11;10(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334588/
Zarnegar A, Ong J, Matsyaraja T, Arora S, Chhablani J. Pathomechanisms in central serous chorioretinopathy: A recent update. International Journal of Retina and Vitreous. 2023 Jan 20;9(1). doi: 10.1186/s40942-023-00443-2.
Karimi S, Nastaran Payandeh, Sahar, Nouri H, Abtahi SH. Central Serous Chorioretinopathy Risk Factors in An Iranian Cohort: A Case-control Study. Journal of Ophthalmic and Vision Research. 2023 Nov 30;18(4):410-416. doi: 10.18502/jovr.v18i4.14553.
Schworm B, Siedlecki J, Keidel LF, Herold TR, Luft N, Priglinger SG. Subthreshold laser therapy with a standardized macular treatment pattern in chronic central serous chorioretinopathy. Graefe’s archive for clinical and experimental ophthalmology. 2021 Jun 10; 259(11):3271–81. doi: 10.1007/s00417-021-05256-3.
Jae Yong Han, Yong Joon Kim, Eun Young Choi, Lee J, Ji Hwan Lee, Kim M, et al. Therapeutic Efficacy of Spironolactone for Central Serous Chorioretinopathy. Yonsei Medical Journal [Internet]. 2022 Jan 1 [cited 2024 Aug 28];63(4):365–5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965434/
Sahoo NK, Ong J, Selvam A, Maltsev D, Sacconi R, Venkatesh R, et al. Longitudinal follow-up and outcome analysis in central serous chorioretinopathy. Eye [Internet]. 2023 Mar 1 [cited 2024 Jun 1];37(4):732–8. Available from: https://www.nature.com/articles/s41433-022-02044-z
Reddy K, Sumit Randhir Singh, Niroj Kumar Sahoo, Sai Bhakti Mishra, Riccardo Sacconi, Iovino C, et al. Optical coherence tomography angiography findings in fellow eyes of choroidal neovascularisation associated with central serous chorioretinopathy. british journal of ophthalmology. 2019 Feb 23;105(9):1280–5.
Docherty G, Sidiqi A, Martens R, Akil H, Navajas EV. Conversion of focal choroidal excavation with the onset of central serous chorioretinopathy: report of 2 cases and review of the literature. Retinal Cases & Brief Reports. 2021 Jul;15(4):376–85.
Aktan G, Mandelkorn RM. Irreversible visual loss after an attack of central serous retinopathy. Annals of Ophthalmology. 2001 Dec;33(4):323–5.
Kaye R, Chandra S, Sheth J, Boon CJF, Sivaprasad S, Lotery A. Central serous chorioretinopathy: An update on risk factors, pathophysiology and imaging modalities. Progress in Retinal and Eye Research [Internet]. 2020 Nov 1 [cited 2021 Jan 10]; 79:100865. Available from:https://www.sciencedirect.com/science/article/abs/pii/S1350946220300379
Helena M.A. Feenstra, Dijk van, Gemmy M, Ohno-Matsui K, Timothy Y.Y. Lai, Koizumi H, et al. Central serous chorioretinopathy: An evidence-based treatment guideline. Progress in Retinal and Eye Research. 2024 Feb 1;101236–6.
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