Is Intraoperative 360° Prophylactic Endolaser Photocoagulation Need in the Treatment of Uncomplicated Retinal Detachment ?


ABSTRACT

Purpose:

The aim of this study was to demonstrate whether intraoperative 360° prophylactic endolaser photocoagulation is needed for the treatment of uncomplicated retinal detachment or not.

Setting:

This prospective, randomized, comparative and interventional study included 50 consecutive patients who underwent pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) by a single surgeon (ABB). Fifty eyes of 50 patients who underwent transconjunctival PPV with a 23-G system between June 2014 and January 2015 were registered. Surgeries were performed under local anesthesia at Akdeniz University hospital, Department of Ophthalmology.

Methods:

The patients were randomly assigned into two groups; in Group +360° endolaser (n = 25) laser applied to all existing breaks as well as a 360° laser retinopexy anterior to the equator, while in Group -360° endolaser (n = 25) laser was applied only to the retinal breaks. Patients with any of the following characteristics were excluded: pediatric patients, proliferative vitreoretinopathy (PVR) grade C or worse, giant tear, retinal dialysis, eye trauma and traumatic RRD, proliferative diabetic retinopathy, stiffness of the retina and the need for retinectomies, and a follow up less than three months. Data points collected included age, sex, ocular history, duration of symptoms, lens status, location of the retinal breaks, extent of retinal detachment, macula status, grade of proliferative vitreoretinopathy (PVR), tamponade agent, final best corrected visual acuity (BCVA), final anatomic status of retina and epiretinal membrane and macular hole development status. Patients wit h a mean follow up time of 8.26 months, primary anatomical success rate, a final best-corrected visual acuity and postoperative complications were analyzed and compared between the groups after a single operation in the first and third month.

Results:

Statistical analyses showed no statistically significant difference between the two groups in the baseline demographic, clinical characteristics (age, gender, duration of symptoms and lens status) and initial retinal detachment characteristics (number of retinal breaks, retinal breaks localization, extent of the RRD, macular status and grade of proliferative vitreoretinopathy). After the primary procedure, the retina was reattached in 96% (24 of 25) of cases in group 1 and in 88% (22 of 25) of cases in group 2 at first and third month. Mean final best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.66 in group 1 and 0.85 in group 2 at third month. Epiretinal membrane development was 4 cases in group 1 and 4 cases in group 2 at third month. No statistically significant difference in the anatomical, functional and complication outcomes between the two groups was recorded.

Conclusion:

Peripheral retinal breaks after vitrectomy usually occur along the posterior margin of the vitreous base and are most common in the meridians of the pars plana sclerotomies. These breaks are thought to be caused by traction on the vitreous base. As a result these breaks may cause redetachment. Additional procedures in vitrectomy are applied to reduce the risk of peripheral retinal breaks and retinal redetachments including scleral buckling or 360° prophylactic endolaser photocoagulation. There are not many publications about the benefits of applying 360° prophylactic endolaser photocoagulation in PPV for RRD. When comparing the anatomical, functional and complication outcomes which similar between both treatment groups. We think that the similarity of the results about prophylactic 360º photocoagulation suggests that, the procedure is of no significant value in either long standing, complicated or fresh and uncomplicated cases of RRD. In conclusion, PPV without the 360° peripheral endolaser can provide successful anatomic outcome and functional improvement in phakic, pseudophakic, inferior, superior, macula‑on, and macula‑off uncomplicated primary RRDs. A randomized, prospective, large clinical trial is necessary to definitively determine the efficacy, complications like ERM or PVR and the best indication for 360° peripheral endolaser.


CONTACT DETAILS

 

Ahmet Burak Bilgin
Antalya, Turkey
Email : gozdrburakbilgin@gmail.com
Cell Phone: +905465473336
Work Phone: +902422496600