A Novel Panmacular Strategy for Subthreshold Micropulse Laser in CSC: Two-Year Functional and Morphological Outcomes

Background/Objectives: Central serous chorioretinopathy (CSC) is the fourth most common retinal disorder. Subthreshold micropulse laser therapy (MPLT) is a promising option. The study aimed to evaluate whether a novel panmacular MPLT strategy leads to significant long-term functional and structural improvement in acute (aCSC), chronic (cCSC), and recurrent (rCSC). Methods: This retrospective, non-comparative study included CSC patients (n = 41) and healthy controls (n = 14). Participants underwent panmacular subthreshold MPLT. Best-corrected visual acuity (BCVA), retinal sensitivity (RetSens), central choroidal thickness (CCT), and pachyvessel diameter were measured at baseline and at 24 months post first treatment. The mean post-intervention observation time (from the last treatment to the final follow-up) was 24.0 months for the aCSC group and 18.6 months for the cCSC and rCSC groups. Treatment required a mean of 1 session in the aCSC group (range 1–3) and a mean of 2.8 sessions in the cCSC and rCSC groups (range 1–8). Results: Complete subretinal fluid (SRF) resolution was achieved in 100% of aCSC cases, 86.66% of cCSC, and 63.63% of rCSC. Non-resolution/recurrence occurred in 13.33% of cCSC (2/15), and 36.37% of rCSC (4/11). After two years BCVA significantly improved across all groups (e.g., aCSC: improved from 0.74 ± 0.05 to 0.98 ± 0.02, p = 0.005). RetSens significantly improved in aCSC (increased by 5 dB, p = 0.001) and cCSC (increased by 3.8 dB, p = 0.046) CCT, CRT and pachyvessel diameter significantly decreased post-treatment in all CSC groups (p < 0.05). Conclusions: Panmacular MPLT is a safe and effective therapy for CSC, providing significant long-term functional and structural improvement, particularly in acute and chronic cases. The therapeutic effects were weakest in the rCSC group, which showed the poorest functional outcomes and a higher burden, suggesting that a recurrent disease course may be a primary negative prognostic factor.