Acute central serous chorioretinopathy (CSC) may resolve spontaneously, but risks progression to chronic disease with visual impairment.We performed a PRISMA-compliant meta-analysis evaluating photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) agents versus observation in acute CSC (<6 months), searching PubMed, EMBASE, and CENTRAL (October 2014 -May 2025) for comparative studies.Eleven studies (5 randomized, 6 non-randomized; 464 eyes) were included.PDT demonstrated robust superiority over observation, achieving significant best-corrected visual acuity gains and sustained central macular thickness reductions at 1, 3, and 12 months.Notably, PDT-treated eyes were nearly 4 times more likely to achieve complete fluid resolution at one month, a benefit maintained across all follow-up intervals. J o u r n a l P r e -p r o o fConversely, anti-VEGF therapy provided only a transient anatomical reduction at one month, without significant visual improvement or sustained benefit.Both interventions were well tolerated.In conclusion, half-dose PDT provides durable anatomical and functional improvements for acute CSC, significantly accelerating fluid resolution and visual recovery.While observation remains a valid initial approach, early PDT is practically advantageous for patients requiring rapid visual rehabilitation or to mitigate permanent photoreceptor damage from persistent fluid.Anti-VEGF therapy offers limited, transient anatomical effects without functional benefit and should be reserved for atypical cases or when PDT is unavailable.
Algodi et al. (Sun,) studied this question.