Anterior scleral thickness in eyes with central serous chorioretinopathy: A systematic review and meta-analysis.

PURPOSE: To investigate anterior scleral thickness (AST) as a potential anatomical biomarker for central serous chorioretinopathy (CSC) by synthesizing the evidence on differences in AST between eyes with CSC and healthy controls through a systematic review and meta-analysis. METHODS: A systematic literature search was conducted across multiple databases in January 2026. Observational studies comparing AST measured using optical coherence tomography in eyes with CSC and healthy controls were included. Data were extracted independently by two reviewers. Random-effects meta-analyses were performed using standardized mean differences (SMD, Cohen's d). Risk of bias was assessed using the Agency for Healthcare Research and Quality checklist. RESULTS: Eight studies comprising 805 individuals (454 CSC, 351 controls) were included in the qualitative synthesis, seven of which were eligible for meta-analysis. AST was significantly higher in eyes with CSC compared with controls in all quadrants: temporal (SMD 0.57, 95% CI 0.40-0.75), nasal (SMD 0.48, 95% CI 0.25-0.71), superior (SMD 0.28, 95% CI 0.04-0.53), and inferior (SMD 0.32, 95% CI 0.08-0.57). Analysis for the temporal quadrant showed low heterogeneity. Findings were robust in sensitivity analyses, and funnel plot assessment did not reveal substantial asymmetry. CONCLUSION: Eyes with CSC exhibited increased AST compared with healthy controls. These findings support a potential role for scleral morphology in CSC pathophysiology.