Assessment of photocoagulation for predisposing lesions in the prevention of rhegmatogenous retinal detachment

Abstract

Purpose : Rhegmatogenous retinal detachment (RRD) is an important cause of visual loss. Within its pathophysiology there are 3 main mechanisms: anomalous vitreous currents, vitreous traction and rhegmatogenous lesions. Prophylactic treatment based on photocoagulation to predisposing lesions (PL) is intended to prevent future RRD. However, there is still controversy between expectant behavior or photocoagulation and even there is controversy about which lesions should be treated. The purpuse of this study was to determine the frequency of RRD and clinical characteristics of patients with PL treated with photocoagulation.

Methods : A retrospective study was carried out in an ophthalmological center “Instituto de Oftalmología - Fundación Conde de Valenciana I.A.P”. Patients with diagnosis of RRD with previous photocoagulated PL were evaluated with a follow-up of 10 years. Patients under 18 years of age, non-compliance with follow-up, lesions not treated with photocoagulation and a history of retinal surgery in the eye of interest at the first visit were excluded.

Results : 296 files were analyzed, 10 patients presented RRD (3.3%). 60% were women, 80% had history of myopia and the most frequent symptom was myodesopsia (50%, p = 0.017). The average number of years to present DRR after treatment was 7.4. From 10 patients who presented RRD, some had >1 predisposing lesions: lattice degeneration (n = 6, 60%) being the most frequent; following tear (n = 3.30%) and less frequently hole (n = 3.30%). 6 of the 10 RRD were secondary to a previously treated lesions and the rest of them developed from new ones.

Conclusions : Previous reports have been made about prophylactic treatment for PL, however there is not yet a systematic approach. The incidence found in other reports for RRD from photocoagulated PL is 2.1 to 8.8%, similar to that found in our work (3.3%). In contrast to the incidence of DRR secondary to a symptomatic not treated PL is 35 to 47%, so prophylactic treatment should be considered in this group.

This is a 2020 ARVO Annual Meeting abstract.