Photodynamic therapy provides superior visual gains and faster fluid resolution in acute central serous chorioretinopathyPhotodynamic therapy shows better results for central serous chorioretinopathy

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 (anti-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 1 month, a benefit maintained across all follow-up intervals. Conversely, anti-VEGF therapy provided only a transient anatomical reduction at 1 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.