Factors Associated With the Use of 360-Degree Laser Retinopexy During Primary Vitrectomy With or Without Scleral Buckle for Rhegmatogenous Retinal Detachment and Impact on Surgical Outcomes

Andrew Tye, MD  |  January 16, 2021

January 2021

Wang JC, Ryan EH, Ryan C, Kakulavarapu S, Mardis PJ, Rodriguez M, Stefater JA, Forbes NJ, Gupta O, Capone A Jr, Emerson GG, Joseph DP, Eliott D, Yonekawa Y; Primary Retinal Detachment Outcomes (PRO) Study Group. FACTORS ASSOCIATED WITH THE USE OF 360-DEGREE LASER RETINOPEXY DURING PRIMARY VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLE FOR RHEGMATOGENOUS RETINAL DETACHMENT AND IMPACT ON SURGICAL OUTCOMES (PRO STUDY REPORT NUMBER 4). Retina. 2020 Nov;40(11):2070-2076. doi: 10.1097/IAE.0000000000002728. PMID: 31876884.

This paper represents the 4th report from the Primary Retinal Detachment Outcomes (PRO) Study.  Please refer to previous posts by Drs. Vakharia and Toy for summaries of PRO Study Reports 2 and 3, respectively.

The purpose of this study was twofold: 1) to investigate the clinical and surgical factors associated with the use of 360-degree laser retinopexy (360 LR) during non-complex primary retinal detachment repair (vitrectomy or scleral/buckling vitrectomy) and 2) to assess the impact of 360 LR on anatomical and visual outcomes.

In this multicenter, retrospective study, 2248 surgeries by 61 surgeons were included.  There was a significant association between the use of 360 LR and younger patient age, number of retinal breaks, extent of retinal detachment, and surgeon ID.  There was no significant difference in single surgery anatomical success rate between 360 LR and non-360 LR groups (85.4% vs. 86.7%, P = 0.44).

Interestingly, final anatomical success rate (P < 0.001) and visual acuity (P < 0.001) were significantly lower in cases having undergone 360 LR.  The authors hypothesize that the use of 360 LR may be associated with lower final success rates in cases that fail initial repair due to the presence of retinal breaks that form at the edge of LR or increased incidence of proliferative vitreoretinopathy.  However, this hypothesis could not be tested as these latter variables were not tracked in this study.

The takeaway point from this paper is that use of 360-degree laser retinopexy during retinal detachment repair was not associated with better surgical outcomes, and actually may be associated with worse outcomes.

Andrew Tye, MD

The Permanente Medical Group
Union City, CA

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