360° LASER VERSUS LOCALIZED RETINOPEXY IN THE SURGICAL MANAGEMENT OF PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT USING PARS PLANA VITRECTOMY.

Abstract

To compare the effect of applying 360° laser (endolaser cerclage) versus local retinopexy on the re-detachment rate in patients who underwent pars plana vitrectomy for primary rhegmatogenous retinal detachment. A retrospective, single-center, cohort study was conducted. All patients who underwent pars plana vitrectomy for rhegmatogenous retinal detachment at a tertiary referral center 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. 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 proliferative vitreoretinopathy ( 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. In addition, no difference was observed in the occurrence of secondary proliferative vitreoretinopathy re-detachment between the endolaser cerclage and localized retinopexy groups ( P = 0.705). The data suggest that using 360° laser retinopexy during retinal detachment repair improves surgical outcomes and should be considered a preferred treatment option, especially in cases of severe retinal detachment.