Exogenous Hormone Use as a Predictor of Central Serous Chorioretinopathy Recurrence: A Comparative Analysis of Observation Versus Low-Fluence Photodynamic Therapy

Purpose: Central serous chorioretinopathy (CSCR) typically resolves spontaneously within 4–6 months. Observation is the mainstay of management, but low-fluence photodynamic therapy (PDT) is a well-established treatment. This study investigates risk factors for CSCR recurrence in patients managed with observation versus PDT. Methods: This retrospective case–control study included patients with a first-time CSCR diagnosis between January 2014 and January 2018. All patients were initially managed with 4–6 months of observation and followed up for at least 1 year to monitor CSCR resolution or recurrence, defined as presence of new subretinal fluid after prior resolution. For patients who received PDT following initial observation, an additional year of follow-up post-PDT was required. Demographics, medical history, and retinal imaging findings were analyzed for recurrence associations. Results: Among 90 patients with CSCR, 56 (62.2%) were managed with observation alone, and 34 (37.8%) received PDT. The groups had comparable demographic characteristics. Exogenous hormone use was higher in the PDT group than in the observation group (17.6% vs 3.6%; P = .025). Recurrence occurred in 25 patients (27.8%): 14 (25.0%) in the observation group and 11 (32.4%) in the PDT group ( P = .57). Post-PDT recurrence was noted in 5 patients (14.7%). Baseline visual acuity was worse in the PDT group than in the observation group (mean ± SD 0.41 ± 0.33 vs 0.23 ± 0.27 logMAR; P < .001), but baseline central retinal thickness was similar between groups (mean ± SD 403 ± 169 vs 398 ± 166 µm; P = .89). Exogenous hormone use was a significant predictor of CSCR recurrence (odds ratio 5.2, 95% confidence interval 1.1–23.6; P = .034). Conclusions: Patients with exogenous hormone exposure may be at increased risk of recurrent CSCR and may be more likely to receive PDT. Reducing or avoiding exogenous hormones may lower CSCR recurrence risk.