Dados do Trabalho

Título

Subthreshold Micropulse Laser Therapy versus Photodynamic Therapy for Chronic Central Serous Chorioretinopathy: A Meta-Analysis of Randomized Controlled Trials

Objetivo

Chronic central serous chorioretinopathy (CSCR) can lead to permanent vision loss if untreated. Herein we perform a meta-analysis comparing the long-term efficacy of Subthreshold Micropulse Laser Therapy (SMLT) versus Photodynamic Therapy (PDT) in treating chronic CSCR.

Recent data presents conflicting results regarding the long-term efficacy of PDT versus SMLT in treating CSCR. This meta-analysis aims to resolve these dispute by systematically evaluating Randomized Clinical Trials comparing these treatments

Método

A systematic search of PubMed, Embase, and Cochrane databases up to May 2024 identified RCTs comparing SMLT with PDT in chronic CSCR. Data extraction and quality assessment were performed using the Cochrane Risk of Bias tool (RoB-2), and a Mantel-Haenszel random-effects model was used for data synthesis. Sensitivity analyses tested the robustness of findings. This study was registered in the PROSPERO database (CRD42024549135).

Resultados

Four RCTs comprising 305 eyes were included. SMLT was inferior to PDT in leading to disease remission in the short-term (risk ratio [RR] 0.47, 95% CI [0.34, 0.65]), but not in the long-term (RR 0.72, 95% CI [0.45, 1.15]). There was no significant difference between SMLT and PDT in terms of best corrected visual acuity (BCVA) in the short (mean difference [MD] -1.28 letters, 95% confidence interval [CI] [-4.90, 2.34]) or long-term (MD -1.20 letters, 95% CI [-2.70, 0.29]). For short-term central macular thickness (CMT), no differences were observed (MD 34.03 micrometers, 95% CI [-33.64, 101.71]), but PDT was superior after removing the Kretz et al. study on the leave one out sensitivity analysis (MD 64.51, 95% CI [5.63, 123.40].Long-term central macular thickness differences were insignificant (MD -1.43 micrometers, 95% CI [-29.45, 26.62]).

Conclusões

In this meta-analysis of RCTs comparing SMLT with PDT for CSCR, SMLT was as effective as PDT in the long-term in terms of BCVA, CMT, and disease remission. Although PDT was superior in the short-term regarding CMT and leading to disease remission, SMLT led to comparable benefits in the long-term. SMLT presents a viable and effective long-term treatment option. Further large-scale RCTs are needed to confirm these findings.

Palavras Chave

chronic central serous chorioretinopathy, subthreshold micropulse laser therapy, photodynamic therapy, meta-analysis, randomized controlled trials.