Prophylactic 360 degrees cryotherapy in fellow eyes of patients with spontaneous giant retinal tears.

Abstract

To assess the effect of prophylactic 360 degrees peripheral retinal cryotherapy in fellow eyes of patients with spontaneous giant retinal tears (GRTs) on the incidence of retinal detachment. Retrospective, noncomparative case series. Forty-eight consecutive patients (31 male, 17 female) with spontaneous GRTs were included. The average age was 41 +/- 2 years. The average refraction of the fellow eye was -4.0 +/- 0.8 diopters (D). Patients underwent vitrectomy and silicone oil tamponade in the affected eye and 360 degrees peripheral cryotherapy in the unaffected fellow eye during the same anesthetic. Attachment of the retina in the fellow eye was determined clinically by indirect ophthalmoscopy. During a mean follow-up of 84 +/- 10 months after cryotherapy, one patient (2%) experienced a retinal tear without retinal detachment, and three patients (6%) experienced a retinal detachment in the fellow eye. These occurred 18 +/- 9 months after prophylactic treatment and were the result of a small retinal break in two cases and a GRT posterior to the treated area in one case. Prophylaxis of fellow eyes with 360 degrees cryotherapy appears to be associated with a lower incidence of retinal detachment than that reported in natural history studies. A prospective, randomized clinical trial of such prophylaxis is desirable but would require a sample size of at least 645 patients in each arm of the study, as well as long-term follow-up of at least 5 years to show an unequivocal difference in outcome.