Early versus deferred treatment with Pascal short-pulse duration plus subthreshold endpoint management laser techniques for central serous chorioretinopathy

Purpose To compare anatomical and functional outcomes of combined Pascal focal short-pulse duration laser plus subthreshold diffuse laser (SDL) with Endpoint Management algorithm (SPD plus SDL-EpM) applied promptly or deferred in acute central serous chorioretinopathy (CSC). Design: Retrospective comparative study. Participants: Seventy-nine eyes with acute macular subretinal fluid (SRF) due to CSC treated between July 2022 and January 2024. Methods Group I (n = 55) received prompt SPD plus SDL-EpM laser; Group II (n = 24) received oral spironolactone (50 mg twice daily) with deferred laser after 3 months if SRF persisted. Multimodal evaluation was performed at baseline and at 1, 3, 6, and 12 months. Outcomes included subretinal fluid height (SRFH), best-corrected visual acuity (BCVA), central macular thickness (CMT) and choroid thickness measurement (CTM). Results Sixty-eight eyes (86%) completed 12-month follow-up data analysis. In the intergroup comparison, Group I demonstrated significant SRFH, CMT and BCVA better and faster results (p < 0.05) through initial 3 months. At 12 months, a tendency BCVA (p < 0.1) improvement was sustained. The CTM was not significant different between the groups I and II at all visits study. The SRF resolution was more frequent in Group I than Group II at all visits study with significant percentile from 1º, 3º and 12º months. Conclusions Prompt SPD plus SDL-EpM laser therapy in acute CSC results in faster anatomical and functional recovery compared with deferred laser following oral spironolactone therapy. Long-term outcomes were comparable between groups.