Laser Photocoagulation May Prevent Detachment in Acute Retinal Necrosis

Laser photocoagulation can effectively prevent retinal detachment (RD) from occurring in patients with acute retinal necrosis (ARN), according to research published in Retina. The researchers report that the treatment can help avoid the common but serious complication, especially when combined with antiviral therapy and steroids.

The researchers searched the PubMed, Embase and Cochrane databases for relevant terms (“Retinal Necrosis Syndrome, Acute” or “acute retinal necrosis”) and (laser or photocoagulation) and retrieved records for studies with well-defined laser-treated and control groups or studies with enough data for manual grouping. They also required the results of RD to be reported in the articles.

They identified 14 studies with a total of 532 eyes. The quality of the included studies was moderate and there was only 1 prospective study. The combined results of the meta-analysis yielded a pooled odds ratio (OR) of 0.61 (95% confidence interval [CI], 0.41-0.90; P<.05; I²=27%). A sensitivity analysis demonstrated that the ORs were similar when excluding any study. 

With a subgroup analysis, the researchers found that the 3 subgroups (antiviral therapy, n=4 studies; antiviral therapy + steroid, n=8 studies; and antiviral therapy + steroid + aspirin, n=2 studies) showed moderate heterogeneity (I²=48.0%; P=.15 for heterogeneity). The antiviral therapy and steroid combined with prophylactic laser subgroup yielded an OR of 0.43 (95% CI, 0.25-0.74; P<.05; I²=0%), while the other subgroups showed no statistically significant difference between the eyes with and without laser treatment.

Limitations of the study included potential publication bias in the meta-analysis, lack of independence in cases where both eyes from the same patient were included in the analysis, differences in the follow-up duration between studies, and data predominantly from moderate-quality retrospective studies. 

Reference

Chen M, Zhang M, Chen H. Efficiency of laser photocoagulation on the prevention of retinal detachment in acute retinal necrosis: a systematic review and meta-analysis. Retina. Published online May 6, 2022. doi:10.1097/IAE.0000000000003527