This systematic review aims to update current evidence on the efficacy and safety of photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) injections for acute central serous chorioretinopathy (CSC). A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane Library. Studies comparing (1) PDT versus placebo, (2) anti-VEGF versus placebo, and (3) PDT versus anti-VEGF were included and meta-analyzes were performed when appropriate. Ocular and systemic adverse effects were also summarized. Literature search yielded six comparative studies, among which five were included for this review. Meta-analysis with three studies indicated that eyes treated with PDT achieved better best-corrected visual acuity (BCVA) and central macular thickness (CMT) than the placebo group throughout a follow-up of 12 months. Meta-analysis with another two studies comparing anti-VEGF injections and placebo showed that BCVA at first month was better in anti-VEGF group than in placebo group, though the differences of BCVA and CMT no longer existed at 3 and 6 months after injection. There was no report directly comparing PDT and anti-VEGF for acute CSC. No severe complications was reported in included studies. In this review, current evidence suggested that early treatment of acute CSC by PDT is valuable in improving visual acuity, reducing subretinal fluid, and maintaining long term effectiveness. Anti-VEGF injection could shorten the duration of symptoms and accelerate visual improvement at early stage of disease. Direct comparison between these two treatment will be needed in the future.