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Tanuj Banker, Gayatri Reilly, Eric Weichel, Kyle Godfrey, Retina Group of Washington Retinal Detachment Study Group; Endolaser Associated with Cystoid Macular Edema (CME) and Epiretinal Membrane (ERM) Formation Following Small Gauge Retinal Detachment (RD) Repair. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2860.
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To analyze the relationship between the number of endoscopic laser spots used during small gauge (23/25g) pars plana vitrectomy (PPV) repair of uncomplicated primary RD and the development of post-operative CME and ERM.
A consecutive interventional case series from 2007 to 2012 (n=89) by one group of retinal surgeons performing primary RD repair using either 23 or 25 gauge PPV instrumentation with or without scleral buckle (SB), along with endolaser use. Exclusion criteria included preoperative proliferative vitreoretinopathy, postoperative retinal re-detachment, pre-existing macular disease, previous PPV or SB, and documented follow-up of less than three months. Postoperative ERM/CME was confirmed with either optical coherence tomography (OCT) or fluorescein angiography (FA). Primary outcome measures included a determination of the mean number of laser spots used during repair. Secondary outcome measures included an assessment of visual acuity (VA).
Eighty-nine eyes from patients with a mean age of 62.6 +/- 17.7 years were followed for a mean time of 368 days. The mean preoperative visual acuity was 20/200 (logMAR 0.98 +/- 0.97), improving to 20/40 (logMAR 0.34 +/- 0.45) postoperatively (p < 0.001). The mean number of laser spots in eyes with CME was 1080.5 +/- 583.9 vs. 811.9 +/- 472.8 spots in eyes with postoperative CME (p < 0.0283). The maximum number of spots in eyes with CME was 2363 and the minimum was 272. The maximum number of spots in eyes without CME was 2444 and the minimum was 80. The mean number of laser spots in eyes with ERM was 929.7 +/- 545.1 vs. 758.5 +/- 454.0 spots in eyes without postoperative ERM (p < 0.1461). The maximum number of spots in eyes with ERM was 2444 and the minimum was 212. The maximum number of spots in eyes without ERM was 1943 and the minimum was 245.
Small gauge RD repair may require endolaser 360 degrees, endolaser to the area of retinal detachment or focal laser surrounding retinal tears. These results suggest that applying more endospots may be a risk factor for the development of CME. Consequentially, patients undergoing extensive laser use should be carefully monitored to rule out post-operative CME.
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