Protective Role of 360° Laser Retinopexy in Patients with Rhegmatogenous Retinal Detachment: a Systematic Review and Meta-analysis

Abstract

Purpose Visual impairment from retinal re-detachment could be debilitating. The aim of this review is to evaluate the role of 360° laser retinopexy on success rate of rhegmatogenous retinal detachment (RRD) repair by a meta-analysis study. Methods The PubMed, Scopus, and the Cochrane Library databases were searched comprehensively from the date of database inception to January 2021, evaluating the role of 360° laser retinopexy in visual and anatomical success rate of RRD repair. This review was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. Results Among 202 articles screened for eligibility, six studies were found to be eligible for inclusion in our final analysis. Our meta-analysis demonstrates that prophylactic treatment with circumferential laser photocoagulation has no significant effect on the initial rate of retinal re-detachment or final best-corrected visual acuity following pars plana vitrectomy repair of RRD. Subgroup analysis of studies (n = 3) with 23-gauge pars plana vitrectomy, however, favors attachment rate in patients undergoing 360° prophylactic laser treatment. Conclusions Three hundred and sixty degree laser retinopexy appears to have favorable outcomes in patients undergoing 23-gauge retinal detachment repair. This protective effect, however, is not apparent with inclusion of 20-gauge vitrectomy studies.

360-Degree laser retinopexy in primary vitrectomy for rhegmatogenous retinal detachment: factors associated with its use and impact on surgical outcomes

“…In the current study, all operations were performed with 25-gauge instruments. Our finding of no significant differences in surgical outcomes between 360-degree and limited laser retinopexy is incongruent with the hypothesis made by Soekamto et al [ 9 ] that application of 360-degree laser plays a protective role following primary RRD repair using smaller gauge vitrectomy instruments.…”

“…However, the factors associated with its use and the impact on surgical outcomes is not well understood, with conflicting reports in the literature. The theoretical benefit of applying 360-degree laser retinopexy is to seal any missed breaks and barricade any potential anterior re-detachment of the retina [ 4 , 9 ]. However, this must be weighed against the theoretical increased risk of ERM development, postoperative CMO and new tears at laser boundaries.…”

“…A recent systematic review and meta-analysis by Soekamto et al [ 9 ] found that prophylactic treatment with 360-degree laser had no significant effect on the initial rate of retinal re-detachment or final best-corrected visual acuity following PPV repair of RRD. Subgroup analysis of the six included studies found patients undergoing 23-gauge PPV alone had significantly higher attachment rates upon application of 360-degree laser when compared to limited laser.…”

“…One method proposed to reduce re-detachment rates in patients undergoing PPV is 360-degree prophylactic endolaser photocoagulation. Theoretically, application of 360-degree laser creates a chorioretinal scar that may wall off subretinal fluid conduits from anterior to posterior retinal areas and cover any missed breaks [ 4 , 9 ]. However, studies that have looked at its use in primary PPV for RRD have yielded conflicting results [ 4 , 10 – 14 ].…”

360 Degree Endolaser Versus Focal Endolaser in Primary Rhegmatogenous Retinal Detachment Repair

“…1,2 Pars plana vitrectomy has become the most common method of repairing retinal detachments because of its speed, efficacy, and ease of recovery. [2][3][4] Studies have shown that the causes of recurrent retinal detachment after initial PPV repair are missed breaks, opening of old breaks because of persistent or renewed vitreous traction, proliferative vitreoretinopathy, or new break formation. 5 Because of this, research has been directed toward investigating the efficacy of different procedures that can be used as an adjunct during the primary repair to reduce the risk of retinal redetachments.…”