In cases of uncomplicated primary rhegmatogenous retinal detachment repair, prophylactic laser treatment appears to lower the chances of developing tears or retinal detachments in the fellow eye, even in eyes with pre-existing posterior vitreous detachments (PVDs).
Study Design
This consecutive case series with cohort control studied the impact of prophylactic laser for treating lattice degeneration in the fellow eyes of patients with retinal detachment repair from January 1, 2013, through December 31, 2017. A total of 498 patients were included in the study; 146 were in the laser prophylaxis group, and 352 were in the no laser prophylaxis group.
Outcomes
Within the 5-year follow-up period, only 17% of patients who underwent laser prophylaxis developed retinal tears/detachments as compared with 41% of patients that did not receive laser prophylaxis. Pre-existing PVD was not present in the fellow eyes of 88% of patients in the laser prophylaxis group vs 83% of patients in the no laser prophylaxis group. However, even among patients who had a pre-existing PVD, fewer retinal tears/detachments developed in the laser prophylaxis group (6% [1 of 17 eyes]) than in the no laser prophylaxis group (32% [19 of 60 eyes]).
Limitations
This is a retrospective study, so reasons surrounding the decision to perform laser prophylaxis are unknown. Generalizability is also limited by the small sampling of patients with a pre-existing PVD in the fellow eye.
Clinical Significance
This study demonstrates that laser prophylaxis of lattice degeneration in the fellow eye of patients with retinal detachments appears to decrease the rate of retinal tears and retinal detachments, even if there is a pre-existing PVD. Discussion of the benefits and risks of laser use in the fellow eye of patients with rhegmatogenous retinal detachments is recommended.
Financial Disclosures: Dr. Ajay Kuriyan discloses financial relationships with 4DMT, Adverum, Annexon, National Eye Institute, Novartis, Alcon Pharmaceuticals (Grant Support); Alimera Sciences, Allergan, Bausch + Lomb, EyePoint Pharmaceuticals (Consultant/Advisor); Iveric Bio, Optos (Lecture Fees/Speakers Bureau); Lumata Health, Recens Medical (Consultant/Advisor, Private Equity/Stock Holder); Spark Therapeutics (Consultant/Advisor, Lecture Fees/Speakers Bureau); Genentech (Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support).