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PROPHYLACTIC PREOPERATIVE LASER RETINOPEXY DOES NOT REDUCE THE OCCURRENCE OF RHEGMATOGENOUS RETINAL COMPLICATIONS IN MACULAR SURGERY

Garg, Aakriti, MD*; Chang, Jonathan S., MD*; Tosi, Gian Marco, MD; Esposti, Pierluigi, MD; Chen, Royce W., MD*; Horowitz, Jason, MD*; Hoang, Quan V., MD, PhD*,‡; Schiff, William M., MD§; Barile, Gaetano R., MD§; Chang, Stanley, MD*

doi: 10.1097/IAE.0000000000001780
Original Study

Purpose: Knowledge on the utility of prophylactic 360° laser retinopexy before pars plana vitrectomy in the absence of peripheral retinal pathology is limited. This study compares the occurrence of rhegmatogenous events in the setting of small-gauge pars plana vitrectomy with and without prophylactic preoperative laser.

Methods: Our multicenter, retrospective case–control analysis reviewed patients who underwent epiretinal membrane removal or macular hole repair through 23- or 25-gauge pars plana vitrectomy: 205 controls who did not receive prophylactic laser and 176 cases who received preoperative prophylactic laser retinopexy anterior to the equator. Main outcome measures were the rate and characteristics of postoperative retinal tears and detachments. Patients with previous pars plana vitrectomy or significant retinal disease were excluded.

Results: Of those patients with prophylactic laser and those without, there was no significant difference in the number of retinal breaks (1.7% vs. 0.49%, respectively; P = 0.339) or retinal detachments (0% vs. 0.49%, respectively; P = 1.00). Of the lasered group, there was one sclerotomy-related retinal break and two non–sclerotomy-related retinal breaks. Of the nonlasered group, there was one non–sclerotomy-related retinal break and one sclerotomy-related retinal detachment.

Conclusion: Preoperative prophylactic peripheral laser retinopexy does not seem to offer an added benefit in the prevention of intraoperative and postoperative rhegmatogenous events.

Preoperative prophylactic peripheral laser retinopexy in the setting of small-gauge pars plana vitrectomy for macular disease does not seem to offer an added benefit in the prevention of intraoperative and postoperative rhegmatogenous events. Sparing patients this additional procedure may reduce potential morbidity.

*Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York;

Ophthalmology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy;

Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; and

§Ophthalmology, Manhattan Eye Ear and Throat Duke-NUS Medical School, Hospital, New York, New York.

Reprint requests: Jonathan S. Chang, MD, 2870 University Avenue, Suite 206 Madison, WI 53705; e-mail: jsc2101@columbia.edu

Supported by an unrestricted grant to Columbia University by Research to Prevent Blindness and the Gerstner Family Foundation. The funding organizations had no role in the design or conduct of this research.

None of the authors has any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.