Prophylactic intraoperative 360 degrees laser retinopexy for prevention of retinal detachment.

摘要

PURPOSE: To evaluate the effect of intraoperative 360 degrees laser retinopexy anterior to the equator for the prevention of retinal detachment after vitrectomy. DESIGN: Retrospective comparative consecutive case-control study. PARTICIPANTS: A consecutive case series of 220 patients with vitreal or macular diseases excluding retinal detachment who underwent vitrectomy by a single surgeon (W.R.F.) in a teaching situation between July 1999 and January 2003. A consecutive cohort of patients who had undergone 360 degrees laser retinopexy was identified (n=115) and compared with a control group of patients who had not received laser retinopexy (n=105). For the 360 degrees laser treatment group, three rows of medium-white burns were placed anterior to the equator. METHODS: Demographic and clinical data were extracted from patients' medical records. The baseline characteristics and the risk of retinal detachment over time were analyzed and compared between the 360 degrees laser treatment group and the controlgroup. MAIN OUTCOME MEASURE: Occurrence of retinal detachment after vitrectomy. RESULTS: There was no significant difference in baseline characteristics between the two consecutive series (the 360 degrees laser treatment group and the control group). Intraoperative 360 degrees laser retinopexy was associated with a threefold reduction in the incidence of retinal detachment after surgery from 13.3% to 3.5% (Kaplan-Meier analysis log-rank test, P=0.0225; Cox proportional hazards regression, P=0.0321). CONCLUSIONS: Intraoperative 360 degrees laser retinopexy following vitrectomy showed an encouraging reduction (approximately 74%) in the rate of postoperative retinal detachment without any apparent adverse effects. Considering the vision-threatening nature of retinal detachment, this adjunctive treatment should be considered to be used in vitrectomy procedures.