Direct Laser Photocoagulation of the Retinal Pigment Epithelium: A Novel Method to Seal Retinal Breaks during Pars Plana Vitrectomy for Retinal Detachment

Abstract

Aims: To examine the clinical effectiveness of employing direct retinal pigment epithelium (RPE) laser photocoagulation to create chorioretinal adhesion around the retinal breaks. Methods: Twenty eyes of 20 patients were included in the study; all eyes had rhegmatogenous or combined rhegmatogenous-tractional retinal detachment. Direct RPE laser photocoagulation during vitrectomy, using power of 100-150 mw for of 120-200 ms duration, was performed in the area where the edges of each retinal break would settle following retinal reattachment. The thickness of the neuroretina over the treated area was compared to that measured after traditional transretinal laser photocoagulation. Results: The mean follow-up time was 24 (11-46) months. Postoperatively, an ophthalmoscopically visible pigmentary reaction developed over the treated area, except for a single eye where the retinal break was located in an area of myelinated nerve fibres. There were no serious complications, and the retinas in all 20 eyes remained reattached. The mean best-corrected visual acuity (BCVA) at the final follow-up was significantly higher than that before surgery (p=0.001). The thickness of the neuroretina at 1 month after surgery greatly differed between areas of direct versus transretinal laser photocoagulation: 217 μm in the former and 104 μm in the latter group. Conclusions: The efficacy of direct RPE photocoagulation in retinal break sealing equals the effect of traditional transretinal photocoagulation, but without risking damaging the neurosensory retina, and the laser application is not hindered by retinal opacities.