360-Degree Laser versus Localized Retinopexy in the Surgical Management of Primary Rhegmatogenous Retinal Detachment using Pars Plana Vitrectomy.

Abstract

Purpose: To compare the effect of applying 360-degree laser (endolaser cerclage) versus local retinopexy on the re-detachment rate in patients who underwent pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD).

Methods: A retrospective, single-centre, cohort study was conducted. All patients who underwent PPV for RRD at a tertiary referral centre between December 2018 and January 2023 were included. The patients were allocated to subgroups based on their received treatment and the occurrence of re-detachment was assessed to determine the success of the procedure. Other risk factors evaluated included age, macula status, tamponade (gas, silicone oil) and proliferative vitreoretinopathy (PVR).

Results: A total of 973 eyes were included, with endolaser cerclage being performed in 311 and localized retinopexy in 662 cases. With an overall re-detachment rate of 7.0%, the rate was significantly lower in the endolaser cerclage group (3.9% vs 8.5%, p = 0.009), even when controlling for confounding factors. Further subgroup analysis revealed a higher risk of re-detachment in patients with a primary PVR (p = 0.011), macula-off situation (p = 0.006) and silicone oil tamponade (p = 0.008). Combined phacoemulsification did not increase the re-detachment rate but rather lowered it. Additionally, no difference was observed in the occurrence of secondary PVR re-detachment between the endolaser cerclage and localized retinopexy groups (p = 0.705).

Conclusion: The data suggests that using 360-degree laser retinopexy during retinal detachment repair improves surgical outcomes and should be considered a preferred treatment option, especially in cases of severe retinal detachment.