Demarcation Laser Photocoagulation for Subclinical Retinal Detachment: Can Progression to Retinal Detachment Be Prevented?

Guidelines and treatment patterns for primary rhegmatogenous retinal detachments: Expert consensus and survey in Taiwan Retina Society

Rhegmatogenous retinal detachment (RRD) is a significant cause of vision loss and requires appropriate surgical intervention. There are several approaches available, including observation, laser demarcation, pneumatic retinopexy, scleral buckling, and pars plana vitrectomy, which are chosen based on patient condition, surgeon experience, and national health insurance policies. Despite the various options, there is still no consensus on the optimal intervention. To address this, the Taiwan Retina Society assembled an expert committee with 11 experienced retina specialists to review the current evidence and develop a guideline with seven recommendations for managing RRD patients. Additionally, a survey was conducted with six questions to assess treatment patterns in Taiwan, which included input from the expert committee and an open poll at the 2023 Congress of the Taiwan Retina Society. This report provides a comprehensive summary of the current knowledge and expert consensus on the treatment of RRD, discussing the characteristics of current approaches and providing an overview of current treatment patterns in Taiwan. These findings aim to provide ophthalmologists with the best possible treatment for RRD.

Asymptomatic Rhegmatogenous Retinal Detachments: Outcomes in Patients without Initial Surgical Intervention

OBJECTIVE

To report long-term outcomes of patients with asymptomatic retinal detachments (RDs) who did not undergo initial surgical intervention.

DESIGN

Retrospective case series.

METHODS

A retrospective chart review of patients diagnosed with asymptomatic RD. Patients with symptoms of photopsias or a visual field defect at presentation were excluded.

PARTICIPANTS

Eighteen patients seen and evaluated at the Bascom Palmer Eye Institute between 2011 and 2021.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (BCVA), presence or absence of progression of RD, and whether surgical intervention occurred during follow-up.

RESULTS

The study group included 18 patients (20 eyes). The mean follow-up duration was 5.1 years (range, 0-30 years). Risk factors included myopia (95%), lattice retinal degeneration (60%), and pseudophakia (5%). Most asymptomatic RDs were located in the inferotemporal quadrant (80%), followed by the superotemporal (15%) and inferonasal (5%). No RDs were confined to the superonasal quadrant. The majority (80%) extended posterior to the equator and were ≤ 3 clock hours in size (65%). Five (25%) patients were previously treated with prophylactic laser demarcation. Final BCVA was 20/40 or better in 19 (95%) eyes and between 20/40 and 20/200 in 1 (5%) eye. During the follow-up, 2 (10%) patients exhibited progression of their asymptomatic RD and underwent surgical intervention. Retinal pathology in fellow eyes was previously diagnosed or identified during follow-up in 14 (78%) of 18 patients, of which 2 (11%) patients had bilateral asymptomatic RDs.

CONCLUSIONS

Nonsurgical management with observation may be reasonable as an initial management strategy for asymptomatic patients with RDs in select cases.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

[Non-contact navigated laser retinopexy for peripheral retinal tears and rhegmatogenous degenerations: first experience]

PURPOSE

To evaluate the first outcomes of non-contact navigated laser retinopexy for peripheral tears and rhegmatogenous degenerations of the retina.

MATERIAL AND METHODS

This prospective single-center interventional pilot study included 58 patients (68 eyes), among which 19 males and 39 females aged 47.5±16.9 years with peripheral retinal degenerations and symptomatic retinal tears who received non-contact laser retinopexy with the Navilas 577s navigated laser system and non-contact PRP widefield objective. All patients (68 eyes) underwent laser treatment for the following disorders: horseshoe tear in 13 eyes, retinal hole in 11 eyes, operculated retinal hole in 3 eyes, lattice degeneration in 19 eyes, snail track degeneration in 1 eye, vitreoretinal tufts in 16 eyes, and progressing bullous retinoschisis in 5 eyes. Pain intensity was assessed using a four-point verbal rating scale.

RESULTS

All patients were followed up for 5 to 21 months (9.0±3.3 months on average). Stable condition of the retina was observed in 65 cases (95.5%). In 3 eyes (4.4%), newly formed retinal tears prompted additional laser treatment: horseshoe tear in 2 eyes and retinal hole in 1 eye. The mean pain score during non-contact navigated laser retinopexy was 0.9±0.5. No complications associated with laser treatment were observed.

CONCLUSION

Non-contact navigated laser retinopexy performed with the Navilas 577s navigated laser system is a safe and well-tolerated procedure with effectiveness comparable to conventional laser retinopexy.