Prophylactic Laser in The Fellow Eyes with Lattice


- Objective: To evaluate the effectiveness of prophylactic treatment (PTx) of lattice degeneration (LD) in reducing the risk of retinal tears (RT) and rhegmatogenous retinal detachment (RRD) in the fellow eyes of patients who have undergone primary RRD repair in the first eye.

- Methods:
  - Retrospective cohort study of 498 patients who underwent primary RRD repair between 2013 and 2017.
  - Patients were divided into two cohorts: those who received PTx for LD in the fellow eye (PTx cohort, 146 eyes) and those who did not (No-PTx cohort, 352 eyes).
  - Follow-up period was 5 years.
  - Primary outcome: Proportion of patients developing new RT/RRD in the fellow eye.
  - Secondary outcomes: Visual acuity (logMAR BCVA), myopia status, posterior vitreous detachment (PVD), and pseudophakia.

- Results:
  - Incidence of RT/RRD: PTx cohort had significantly fewer RT/RRD (17%) compared to the No-PTx cohort (41%).
  - Effect of PTx: PTx reduced RT/RRD risk regardless of PVD status or myopia.
  - Cataract Surgery: PTx patients who underwent phacoemulsification had fewer RT/RRD (22%) compared to the No-PTx cohort (31%).
  - Visual Acuity: No significant difference in final BCVA between PTx and No-PTx cohorts.
  - Laser Retinopexy: PTx patients who developed RT/RRD received more laser spots, but this was not statistically significant.

- Discussion:
  - PTx of LD in the fellow eye appears to reduce the risk of RT/RRD, especially in patients without preexisting PVD.
  - The majority of RTs occurred adjacent to or within areas of previously noted LD.
  - PTx may delay the progression from RT to RRD.
  - Cataract surgery in phakic eyes with prior PTx showed a reduced risk of RT/RRD postoperatively.
  - Limitations include retrospective design, lack of standardized PTx techniques, and potential confirmation bias.

- Conclusion:
  - Prophylactic treatment of LD in the fellow eye of patients with a history of primary RRD repair reduces the risk of subsequent RT/RRD.
  - PTx is effective across different degrees of myopia and PVD status.
  - Further prospective studies with standardized protocols are needed to confirm these findings.

- Key Words: Rhegmatogenous retinal detachment, lattice degeneration, prophylaxis, laser retinopexy, myopia, cataract surgery, posterior vitreous detachment.