Acta Ophthalmologica 2015
Letter to the Editor Retinal detachment following laser retinopexy Ashraf A. Khan,1 Danny Mitry,2 Colin Goudie,1 Jas Singh1 and Harry Bennett1 1
Princess Alexandra Eye Pavilion, Edinburgh, UK; 2Moorfields Eye Hospital, London, UK doi: 10.1111/aos.12709
Editor, etinal breaks have been treated by argon laser retinopexy for many decades (Gratton et al. 1984). Its use was first reported by Zweng (1972) in the 1960s and has since become established as the primary mode of treatment for retinal breaks. Prevention of progression to retinal detachment (RD) is the main objective and is dependent on numerous factors (Levin et al. 2009). Retinal breaks are difficult to treat if they are very anterior and if there is significant subretinal fluid or vitreous haemorrhage present. The benefit of laser retinopexy for symptomatic retinal breaks is well documented (Hyams et al. 1974; Smiddy et al. 1991; Blindbaek & Grauslund 2014), although little information exists regarding and risk of developing RD, despite this being the main objective. We performed a subgroup analysis of all patients recruited in the Scottish retinal detachment study at one centre. Patients who had received prior laser retinopexy were identified, and case notes were retrospectively analysed. We looked at location, size and number of breaks initially treated, the time interval between treatment and RD and whether further breaks were found at the time of RD. Further information such as laser parameters, visual acuity, refractive error, subretinal fluid, vitreous haemorrhage and other co-morbidities were also recorded. Additionally, all patients who had undergone laser retinopexy over the study period were identified from the laser record logbook given that a dated, contemporaneous entry, with
R
patient details, is a mandatory requirement for every laser procedure. From this, we are able to estimate the RD rate following laser retinopexy for retinal breaks. The Scottish retinal detachment study was a prospective populationbased epidemiology study (Mitry et al. 2009). Between 1 November 2007 and 31 October 2009, a comprehensive system was established in which each patient with primary RRD in UK was approached for study inclusion. Criteria for inclusion into this study were patients recruited into the Scottish retinal detachment study at one centre who had received previous laser retinopexy. Nine patients were identified as suitable for inclusion into the study, six male three female with a mean age of 53.7 years. A distinct feature enables these patients to be divided into two groups. Five developed RD within 100 days of the initial retinopexy (early RD); the remaining four developed RD between 747 and 1739 days (late RD). Over this time period, 158 patients underwent laser retinopexy. Five of these patients (early RD group) developed a RD giving a RD rate of 3.16% within 3 years. Four patients had multiple breaks at presentation requiring retinopexy (three early RD, onr late RD); six had significant subretinal fluid of >1 clock hour (four early RD, two late RD). Five patients had vitreous haemorrhage (four early RD, one late RD) at the time of initial retinopexy. All early RDs had new breaks identified at the time of RD, whereas in the late RD group, two patients had new breaks and two had progression from the same break. Laser retinopexy is a safe and effective treatment for symptomatic retinal breaks. Our patients can be divided into early RD and late RD groups, as the two seem to have different characteristics. In our series, early detachments occurred from new or missed breaks. This emphasizes the importance of complete peripheral retinal examination to ensure that breaks are not missed as even those with multiple breaks did not detach early from the treated breaks. Of the patients in the late RD group, two detached from the same treated
retinal break. This may be due to initial undertreatment with slow progression, or from minor innocuous ocular trauma, which may progress to RD through areas of weak retinal adhesion. The primary objective when performing a laser retinopexy is to prevent RD. The failure rate of primary laser retinopexy has not been previously reported. Our study provides information regarding the rate of RD following laser retinopexy which may be of benefit when consenting patients to the procedure. Importantly, patients must be informed that despite seemingly adequate initial treatment, some patients still develop RD from new breaks and this may occur after a significant period of time has passed.
References Blindbaek S & Grauslund J (2014): Prophylactic treatment of retinal breaks - a systematic review. Acta Ophthalmol 93: 3–8. Gratton I, Gazocchi M, Simonini F et al. (1984): Argon laser photocoagulation in the management of retinal detachment and predisposing lesions. Lasers Surg Med 4: 337–344. Hyams SW, Meir E, Ivry M et al. (1974): Chorioretinal lesions predisposing to retinal detachment. Am J Ophthalmol 78: 429–437. Levin M, Naseri A & Stewart JM (2009): Resident-performed prophylactic retinopexy and the risk of retinal detachment. Ophthalmic Surg Lasers Imaging 40: 120–126. Mitry D, Charteris DG, Yorston D et al. (2009): Rhegmatogenous retinal detachment in Scotland: research design and methodology. BMC Ophthalmol 9: 2. Smiddy WE, Flynn HW, Nicholson DH et al. (1991): Results and complications in treated retinal breaks. Am J Ophthalmol 112: 623– 630. Zweng HC (1972): Laser photocoagulation in rhegmatogenous retinal separation. In: Pruett RC & Regan CDJ (eds). Retina congress. New York, NY: Appleton-Century-Crofts 551–554.
Correspondence: Ashraf A. Khan Princess Alexandra Eye Pavilion Chalmers Street Edinburgh EH3 9HA UK Tel: +44 131 536 1000 Fax: +44 131 536 3897 Email: [email protected]
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Letter to the Editor Retinal detachment following laser retinopexy Ashraf A. Khan,1 Danny Mitry,2 Colin Goudie,1 Jas Singh1 and Harry Bennett1 1
Princess Alexandra Eye Pavilion, Edinburgh, UK; 2Moorfields Eye Hospital, London, UK doi: 10.1111/aos.12709
Editor, etinal breaks have been treated by argon laser retinopexy for many decades (Gratton et al. 1984). Its use was first reported by Zweng (1972) in the 1960s and has since become established as the primary mode of treatment for retinal breaks. Prevention of progression to retinal detachment (RD) is the main objective and is dependent on numerous factors (Levin et al. 2009). Retinal breaks are difficult to treat if they are very anterior and if there is significant subretinal fluid or vitreous haemorrhage present. The benefit of laser retinopexy for symptomatic retinal breaks is well documented (Hyams et al. 1974; Smiddy et al. 1991; Blindbaek & Grauslund 2014), although little information exists regarding and risk of developing RD, despite this being the main objective. We performed a subgroup analysis of all patients recruited in the Scottish retinal detachment study at one centre. Patients who had received prior laser retinopexy were identified, and case notes were retrospectively analysed. We looked at location, size and number of breaks initially treated, the time interval between treatment and RD and whether further breaks were found at the time of RD. Further information such as laser parameters, visual acuity, refractive error, subretinal fluid, vitreous haemorrhage and other co-morbidities were also recorded. Additionally, all patients who had undergone laser retinopexy over the study period were identified from the laser record logbook given that a dated, contemporaneous entry, with
R
patient details, is a mandatory requirement for every laser procedure. From this, we are able to estimate the RD rate following laser retinopexy for retinal breaks. The Scottish retinal detachment study was a prospective populationbased epidemiology study (Mitry et al. 2009). Between 1 November 2007 and 31 October 2009, a comprehensive system was established in which each patient with primary RRD in UK was approached for study inclusion. Criteria for inclusion into this study were patients recruited into the Scottish retinal detachment study at one centre who had received previous laser retinopexy. Nine patients were identified as suitable for inclusion into the study, six male three female with a mean age of 53.7 years. A distinct feature enables these patients to be divided into two groups. Five developed RD within 100 days of the initial retinopexy (early RD); the remaining four developed RD between 747 and 1739 days (late RD). Over this time period, 158 patients underwent laser retinopexy. Five of these patients (early RD group) developed a RD giving a RD rate of 3.16% within 3 years. Four patients had multiple breaks at presentation requiring retinopexy (three early RD, onr late RD); six had significant subretinal fluid of >1 clock hour (four early RD, two late RD). Five patients had vitreous haemorrhage (four early RD, one late RD) at the time of initial retinopexy. All early RDs had new breaks identified at the time of RD, whereas in the late RD group, two patients had new breaks and two had progression from the same break. Laser retinopexy is a safe and effective treatment for symptomatic retinal breaks. Our patients can be divided into early RD and late RD groups, as the two seem to have different characteristics. In our series, early detachments occurred from new or missed breaks. This emphasizes the importance of complete peripheral retinal examination to ensure that breaks are not missed as even those with multiple breaks did not detach early from the treated breaks. Of the patients in the late RD group, two detached from the same treated
retinal break. This may be due to initial undertreatment with slow progression, or from minor innocuous ocular trauma, which may progress to RD through areas of weak retinal adhesion. The primary objective when performing a laser retinopexy is to prevent RD. The failure rate of primary laser retinopexy has not been previously reported. Our study provides information regarding the rate of RD following laser retinopexy which may be of benefit when consenting patients to the procedure. Importantly, patients must be informed that despite seemingly adequate initial treatment, some patients still develop RD from new breaks and this may occur after a significant period of time has passed.
References Blindbaek S & Grauslund J (2014): Prophylactic treatment of retinal breaks - a systematic review. Acta Ophthalmol 93: 3–8. Gratton I, Gazocchi M, Simonini F et al. (1984): Argon laser photocoagulation in the management of retinal detachment and predisposing lesions. Lasers Surg Med 4: 337–344. Hyams SW, Meir E, Ivry M et al. (1974): Chorioretinal lesions predisposing to retinal detachment. Am J Ophthalmol 78: 429–437. Levin M, Naseri A & Stewart JM (2009): Resident-performed prophylactic retinopexy and the risk of retinal detachment. Ophthalmic Surg Lasers Imaging 40: 120–126. Mitry D, Charteris DG, Yorston D et al. (2009): Rhegmatogenous retinal detachment in Scotland: research design and methodology. BMC Ophthalmol 9: 2. Smiddy WE, Flynn HW, Nicholson DH et al. (1991): Results and complications in treated retinal breaks. Am J Ophthalmol 112: 623– 630. Zweng HC (1972): Laser photocoagulation in rhegmatogenous retinal separation. In: Pruett RC & Regan CDJ (eds). Retina congress. New York, NY: Appleton-Century-Crofts 551–554.
Correspondence: Ashraf A. Khan Princess Alexandra Eye Pavilion Chalmers Street Edinburgh EH3 9HA UK Tel: +44 131 536 1000 Fax: +44 131 536 3897 Email: [email protected]
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