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  • Prophylactic laser doesn’t protect from RRD in acute retinal necrosis

    Retina/Vitreous

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    This retrospective study assessed the risk of rhegmatogenous retinal detachment (RRD) in patients with acute retinal necrosis (ARN) after preventive laser or vitrectomy.

    Study design

    Researchers analyzed 59 patients (63 eyes) from a single tertiary referral center who were diagnosed with ARN between 2001 and 2017. Eyes were treated with prophylactic laser (n=33), vitrectomy (n=7) or observed without therapy (n=15).

    Outcomes

    Retinal detachment was observed in 45.5% of the laser group, 14.3% of the vitrectomy group and 26.7% of the observation group. Eight eyes developed early RRD at presentation or within 10 days and did not have an opportunity for prophylaxis. A multivariate logistic regression analysis that considered zone and extent of retinal involvement found that prophylactic laser had no protective effect. However, the effect of prophylactic vitrectomy could not be tested due to the small number of RRD cases in this group.

    Limitations

    This was a relatively small study, although it is one of the larger ones for ARN. The authors state that they would need over 200 eyes to determine a statistically significant difference in the RRD incidence between non-laser and laser eyes (26.7% vs. 45.5%). Since this was a retrospective study, there may have been a selection bias because only eyes with sufficiently clear media would be able to undergo laser prophylaxis.

    Clinical significance

    This study provides additional evidence suggesting that prophylactic laser may not reduce the risk of RRD in eyes with ARN, and therefore may not be warranted.