Laser Photocoagulation Extent Can Be Reduced For Some With Retinal Detachment

Some patients with primary rhegmatogenous retinal detachment (RRD) can experience similar anatomical and visual results whether they undergo localized laser photocoagulation or 360-degree laser photocoagulation in limited pars plana vitrectomy (PPV), according to a study published in BMC Ophthalmology. The study suggests that routine circumferential 360-degree laser photocoagulation may not be necessary for patients without proliferative vitreoretinopathy.

Researchers retrospectively reviewed medical records of 155 eyes from 155 patients who underwent primary repair of RRD using a 23-gauge PPV with a minimum follow-up time of 6 months. The team recorded the corresponding demographic data, preoperative ophthalmic features, surgical management, and postoperative course. The primary outcomes measured were the single surgery anatomic success and visual outcome. 

A total of 83 eyes (group A) underwent localized laser photocoagulation in PPV, while the remaining 72 eyes (group B) underwent circumferential 360-degree laser photocoagulation in PPV. The average age of the patients was 55.8±11.2 years (56.5±8.9 years in group A and 53.7±12.2 years in group B, P =.12). The average follow-up period was 21.9±14.7 months. All surgeries were performed by 2 skilled vitreoretinal surgeons. In each case, the surgeons used a 23-gauge PPV instrumentation, a wide-angle viewing system, endolaser photocoagulation, and gas tamponade.

The researchers did not identify any significant difference in baseline characteristics between the 2 groups. According to the report, the single surgery anatomical success rate was 96.4 % in group A and 95.8 % in group B, demonstrating no significant difference (P =1.00). 

Primary anatomical failure was due to redetachment because of a break in 2 eyes in each group (no new break 1 eye in group A, new break 1 eye in group A, 2 eyes with no new break in group B), and proliferative vitreoretinopathy in 1 eye in each group. Other complications reported were epiretinal membrane in 7 eyes (3 in group A, 4 in group B), as well as macular hole in 1 eye in group B. 

The team did not identify any differences in pre- and postoperative best-corrected visual acuity (BCVA) and BCVA improvement (P =.144, P =.866 and P =.263, respectively). 

“In conclusion, compared with 360-degree laser photocoagulation, localized laser photocoagulation showed no difference in anatomic and visual outcome in RRD patients,” according to the researchers. “This suggests that localized laser photocoagulation in limited PPV may be as effective as 360-degree laser photocoagulation with limited PPV in primary RRD cases without severe proliferative vitreoretinopathy.”

Study limitations included its retrospective design, and possibility of selection bias because the degree of laser to apply was determined based on the surgeon’s preference. 

Disclosure: This research was supported by the Seoul National University Bundang Hospital. Please see the original reference for a full list of disclosures.