Wait-and-see and other factors associated with recurrence risk in central serous chorioretinopathy patients: A systematic review and meta-analysis of cohort studies

Background: : Central serous chorioretinopathy (CSC) is a common macular disease characterized by serous retinal detachment and leakage spots at the level of the retinal pigment epithelium. While acute CSC is often self-limiting, chronic and recurrent CSC can lead to permanent vision loss. The identification of risk factors associated with recurrent CSC is crucial for preventive measures and appropriate management. This systematic review aims to determine the various risk factors for the recurrence of central serous chorioretinopathy, with a particular focus on the "wait and see" approach and other contributing factors. Methods: : The review protocol was registered in PROSPERO (ID: CRD42023413852). A systematic literature search was conducted across four databases (PubMed, Cochrane, Embase, and ScienceDirect) using the keywords "((Central serous chorioretinopathy) AND (Recurrence) AND (Risk))". Meta-analyses were performed using Review Manager 5.4. Results: : A total of five studies met the inclusion criteria for all factors, while three studies were selected for meta-analyses regarding the "wait and see" approach. The analysis revealed four significant risk factors for CSC recurrence: patient's clinical condition, therapy administration, age and gender, and patient history. Additionally, a meta-analysis based on three studies involving 1025 eyes demonstrated a statistically significant difference between CSC patients who received no therapy (wait and see) and those who underwent specific therapeutic interventions, with a relative risk of 1.82 (95% CI 1.49–2.22, I2 95%, P <0.00001). Conclusions: : Early identification of risk factors, including the ‘wait and see’ approach and other factors, is crucial in preventing the recurrence of central serous chorioretinopathy. Patients at high risk of recurrence should receive vigilant treatment and routine monitoring to avoid permanent vision loss. This systematic review provides valuable insights for clinical decision-making and emphasizes the importance of individualized management strategies for CSC patients.