Three hundred sixty-degree prophylactic laser retinopexy versus focal laser during rhegmatogenous retinal detachment repair: A systematic review and meta-analysis.
Luke Yaldo, Albert Ting, Saif Pasha et al.
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In 30 seconds
This systematic review and meta-analysis compared intraoperative 360-degree prophylactic laser with focal laser during pars plana vitrectomy for rhegmatogenous retinal detachment. Thirteen studies involving 3639 eyes were included. Compared with focal laser, 360-degree laser was associated with higher odds of single-surgery anatomic success (OR: 1.82; 95% CI, 1.40-2.39; I 2 = 0%; moderate-certainty). Final visual acuity and visual acuity improvement did not differ, and reported postoperative complications were comparable. The authors note that the evidence was predominantly observational and call for further well-designed randomized trials.
Key findings
- 360-degree laser was associated with higher odds of single-surgery anatomic success than focal laser (OR: 1.82; 95% CI, 1.40-2.39; I 2 = 0%; moderate-certainty).
- Final BCVA did not differ between groups (MD = 0.06; 95% CI, -0.01 to 0.13; I 2 = 75.5%).
- BCVA improvement was similar between groups (MD: -0.06; 95% CI, -0.22 to 0.11; I 2 = 0%).
- Epiretinal membrane, proliferative vitreoretinopathy, cystoid macular oedema and macular hole rates were comparable between groups.
Why it matters
Anatomic success after retinal detachment repair is clinically important, and the pooled findings suggest that adjunctive 360-degree laser may improve the likelihood of success after one operation. The absence of a measurable visual acuity benefit means the anatomic result should not be interpreted as evidence of better functional outcomes. The predominantly observational evidence also leaves uncertainty about the size and reliability of the association.
What to keep in mind
The evidence was predominantly observational; the authors state that further well-designed randomized trials are needed to clarify the magnitude of benefit.