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

ABSTRACT

BACKGROUND: This study evaluates the clinical effectiveness of employing direct retinal pigment epithelium (RPE) laser photocoagulation as a technique for achieving chorioretinal adhesion to effectively seal retinal breaks. METHODS: A total of 20 eyes from 20 patients were enrolled in the study; all selected eyes exhibited either rhegmatogenous or combined rhegmatogenous-tractional retinal detachment. During vitrectomy, direct RPE laser photocoagulation was executed, employing a power range of 100-150 mW and a duration of 120-200 ms, targeting the peripheries where the edges of each retinal break were anticipated to settle post-reattachment. This treated area's neuroretina thickness was compared to measurements obtained after conventional transretinal laser photocoagulation. RESULTS: Patients were followed for an average duration of 24 months, with a range of 11-46 months. A visible pigmentary reaction in the ophthalmoscopic examination was evident in the treated regions for all but one eye, where the retinal break was situated amidst myelinated nerve fibers. The study encountered no severe complications, and successful retinal reattachment was achieved in all 20 eyes. The mean best-corrected visual acuity (BCVA) at the final follow-up showed a statistically significant improvement compared to preoperative levels (p < 0.0001). A noteworthy difference in neuroretinal thickness was observed one-month post-surgery between areas treated with direct RPE and those treated with transretinal photocoagulation, measuring 217 µm and 104 µm, respectively. CONCLUSIONS: Our findings suggest that direct RPE laser photocoagulation is an effective therapeutic intervention for sealing retinal breaks.