Acta ophthalmologica · 2026
Three hundred sixty-degree prophylactic laser retinopexy versus focal laser during rhegmatogenous retinal detachment repair: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализОбзорНазвание и аннотация: Перевод пока не подготовлен
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Yaldo Luke, Ting Albert, Pasha Saif, Sporn Kyle, Abdelaal Abdelaziz, Ong Joshua
Аннотация
PURPOSE: To compare the anatomic, functional and safety outcomes of intra-operative 360-degree prophylactic laser retinopexy versus focal laser retinopexy during pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) and to assess the certainty of evidence.
METHODS: PubMed, Web of Science and Scopus were searched on June 27, 2025. Randomized controlled trials and comparative observational studies evaluating 360-degree versus focal laser during PPV for RRD were included. Two reviewers independently extracted data and assessed risk of bias (ROB-2, NIH tools). Pooled analyses were conducted using random-effects models, and the certainty of evidence was graded using GRADE. The primary outcome was single-surgery anatomic success (SSAS). Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP) and post-operative complications.
RESULTS: Thirteen studies comprising 3639 eyes were included. Compared with focal laser, 360-degree laser achieved higher odds of SSAS (OR: 1.82; 95% CI, 1.40-2.39; I2 = 0%; moderate-certainty). No differences were observed in final BCVA (MD = 0.06; 95% CI, -0.01 to 0.13; I2 = 75.5%) or BCVA improvement (MD: -0.06; 95% CI, -0.22 to 0.11; I2 = 0%). Rates of epiretinal membrane (OR = 1.11; 95% CI: 0.80-1.54, I2 = 26.85%, moderate certainty), proliferative vitreoretinopathy (OR = 0.62; 95% CI: 0.36-1.08, I2 = 0%, moderate certainty), cystoid macular oedema and macular hole were comparable between groups.
CONCLUSION: Adjunctive 360-degree laser retinopexy during PPV for RRD was associated with higher SSAS without a measurable increase in post-operative complications. However, no improvement in visual acuity outcomes was observed. Given the predominance of observational evidence, further well-designed randomized trials are warranted to clarify the magnitude of benefit.
METHODS: PubMed, Web of Science and Scopus were searched on June 27, 2025. Randomized controlled trials and comparative observational studies evaluating 360-degree versus focal laser during PPV for RRD were included. Two reviewers independently extracted data and assessed risk of bias (ROB-2, NIH tools). Pooled analyses were conducted using random-effects models, and the certainty of evidence was graded using GRADE. The primary outcome was single-surgery anatomic success (SSAS). Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP) and post-operative complications.
RESULTS: Thirteen studies comprising 3639 eyes were included. Compared with focal laser, 360-degree laser achieved higher odds of SSAS (OR: 1.82; 95% CI, 1.40-2.39; I2 = 0%; moderate-certainty). No differences were observed in final BCVA (MD = 0.06; 95% CI, -0.01 to 0.13; I2 = 75.5%) or BCVA improvement (MD: -0.06; 95% CI, -0.22 to 0.11; I2 = 0%). Rates of epiretinal membrane (OR = 1.11; 95% CI: 0.80-1.54, I2 = 26.85%, moderate certainty), proliferative vitreoretinopathy (OR = 0.62; 95% CI: 0.36-1.08, I2 = 0%, moderate certainty), cystoid macular oedema and macular hole were comparable between groups.
CONCLUSION: Adjunctive 360-degree laser retinopexy during PPV for RRD was associated with higher SSAS without a measurable increase in post-operative complications. However, no improvement in visual acuity outcomes was observed. Given the predominance of observational evidence, further well-designed randomized trials are warranted to clarify the magnitude of benefit.