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June-Gone Kim, Hyun Seung Yang; Complete prevention of retinal detachment using prophylactic intraoperative septated circumferential barrier laser during macular surgery: long-term follow-up results. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2853.
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To investigate the efficacy and safety of using a prophylactic intraoperative septated circumferential barrier laser (SCBL) to prevent retinal detachment (RD) after complete phacovitrectomy.
Four hundred and seventy-eight consecutive patients who underwent a phacovitrectomy between 2004 and 2011 to treat cataract combined epiretinal membrane (ERM) and macular hole (MH) using 20G, 23G and 25G conventional vitrectomy system were analyzed retrospectively. Patients who were under 50 years old and had a history of severe diabetic retinopathy, glaucoma, high myopia, severe ocular disease, uveitis, previous laser treatment, any kind of intraocular injection and a posterior capsular tear during the surgery excluded. Three hundred and four patients received SCBL (group 1) and 174 patients did not (group2). In the SCBL procedure, one or two rows of circumferential moderate intensity burns were placed anteriorly to the equator with a subsequent 5-6 septate laser burns made from the circumferential laser marks to the anterior vitreous base perpendicularly at intervals of about 60 degrees (Fig. 1).
The average age was 69.9 years and the minimum follow-up period was 12 months (average: 35.9 months). The average axial length and spherical equivalent were 23.9 mm and -0.45D, respectively. The SCBL procedure required an additional 213±21.2 seconds. SCBL was associated with a significant reduction of RD (from 1.7% in group 2 to 0% in group 1; P=0.048). Postoperative complications related to SCBL such as anatomical failure in MH, macular edema and ERM were not significantly different between the two groups (P=0.67, P=0.83, and P=0.81, respectively) at 1 year follow up.
Prophylactic intraoperative SCBL produces a significant benefit by preventing postoperative RD without any significant complications in ERM and MH surgery.
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