Purpose <p>To investigate long-term clinical outcomes and factors associated with recurrence and visual prognosis in patients with central serous chorioretinopathy(CSC).</p> Methods <p>This retrospective study included 140 eyes diagnosed with idiopathic CSC and followed-up for ≥ 5 years(mean, 98.9 months). Baseline demographics, clinical features, and visual outcomes were reviewed. Factors associated with recurrence and final best-corrected visual acuity(BCVA) were analyzed using multivariate regression.</p> Results <p>The mean patient age was 49.2 ± 9.5 years. Resolution of the first episode occurred in all eyes, with 62.1% cases resolving within 6 months. CSC recurred in 55.7% cases at a mean of 25.7 months after resolution. The mean number of episodes was 2.1 ± 1.4. Mean logMAR(logarithm of minimum angle of resolution) BCVA was 0.18 ± 0.21 at baseline, 0.13 ± 0.19 at 1 year, 0.18 ± 0.28 at 3 years, and 0.25 ± 0.39 at the final visit. Compared to baseline values, BCVA significantly worsened at the final visit (<i>P</i> = 0.001). Visual deterioration of ≥ 0.3 logMAR occurred in 14.3% patients. Younger age was associated with a higher risk of recurrence(<i>P</i> = 0.042); on average, patients with recurrence were 3.4 years younger than those without recurrence. Longer total SRF duration(<i>P</i> = 0.018), development of CNV(<i>P</i> &lt; 0.001), and worse baseline BCVA(<i>P</i> &lt; 0.001) were all significantly associated with poorer final BCVA.</p> Conclusions <p>During the long-term follow-up, more than half of the patients with CSC experienced recurrence; a subset developed significant visual deterioration. Longer SRF duration and CNV are major determinants of poor visual prognosis. Active interventions to promote SRF resolution may help preserve long-term visual outcomes in patients with persistent SRF.</p>