Laser Treatment After Minimized Eye Movement for Repair of Retinal Detachment

Retinal detachment repair is typically performed via three potential procedures: pneumatic retinopexy, scleral buckling, and vitrectomy. Restricting or minimizing eye movement has been previously shown to decrease subretinal fluid, and was previously more commonly performed via bilateral patching. In this study, Dr. Gregg Kokame shares a retrospective series of 39 eyes of 35 patients from June 1989 through August 2019 who underwent laser treatment and minimized eye movement (LTMEM) for retinal detachment repair. 

In select patients in the study with shallow peripheral detachments, unilateral eye patching was used to encourage compliance with minimized eye movement, which decreased subretinal fluid and then allowed subsequent indirect laser treatment with scleral depression to surround the retinal breaks. Patients were advised to avoid reading, writing, computer use, and physical activity, but allowed to watch television. The primary outcome was retinal reattachment with LTMEM alone. The secondary outcome was retinal reattachment with LTMEM and subsequent surgery. If the patient failed LTMEM alone, scleral buckling was performed. 

The average age of the 35 patients was 39 years and 11% had bilateral involvement. Refractive error was more than -6.00 diopters in 44% (17/39) eyes. All of the patients were phakic and the retinal detachment was asymptomatic in 69% (27/39) of eyes. Retinal reattachment was achieved by LTMEM alone in 79% (31/39) of eyes with 3 eyes requiring more than one laser procedure. The 8 eyes that failed LTMEM, underwent successful reattachment with scleral buckling. The average best corrected visual acuity for the 31 eyes that underwent LTMEM treatment was stable at 20/25 and the average time to resolution of subretinal fluid was 44.5 days (range 1 day to 13 months). None of the 39 eyes developed proliferative vitreoretinopathy or significant epiretinal membrane. 

Dr. Kokame’s team highlights the cost effectiveness of this treatment as it avoids a trip to the operating room. LTMEM may be an excellent option for patients with shallow, peripheral detachments as well as those patients who may decline surgery, such as the index patient in this study. Lastly, when access to the operating room is limited, such as during the recent COVID-19 pandemic, LTMEM provides us with one more option in our toolbox for the repair of retinal detachments. Caution must be taken in patient selection. Dr. Kokame’s patients were young, phakic, and had peripheral detachments. Also, be aware of the limited but potential risk for the detachment to extend into the macula.