Cryotherapy vs laser photocoagulation in scleral buckle surgery: A randomized clinical trial.

ABSTRACT

OBJECTIVE: To compare the reattachment rate and visual acuity results among patients with rhegmatogenous retinal detachment who underwent scleral buckle surgery with retinopexy by intraoperative cryotherapy (cryopexy) vs postoperative (1 month later) laser photocoagulation (laserpexy). METHODS: Eighty-six patients with rhegmatogenous retinal detachment scheduled for scleral buckle surgery were randomly assigned to the cryopexy or laserpexy group. MAIN OUTCOME MEASURES: The primary outcome was the 1-week reattachment rate. Other outcome measures included later reattachment rate (1 month and 6 months), best-corrected visual acuity, rate of subsequent operations, and postoperative complications. RESULTS: The 1-week, 1-month, and 6-month anatomical success rates were similar in the 2 groups 93% (40 patients), 100%, and 100% in the cryopexy group and 95% (41 patients), 100%, and 100% in the laserpexy group, respectively. Three patients in the cryopexy group and 2 in the laserpexy group underwent 1 additional rhegmatogenous retinal detachment surgery (pars plan vitrectomy) after primary failure at 1-week follow-up. The types of postoperative complications were similar in both groups, except for eyelid edema. Visual recovery was slower in the cryotherapy group, but the difference in visual acuity after 6 months was not significant. CONCLUSIONS: In patients with uncomplicated retinal detachment, both techniques of retinopexy have shown satisfactory anatomical and functional success. Laserpexy offers faster visual acuity recuperation with fewer postoperative complications but requires a second intervention and costs more than cryotherapy. APPLICATION TO CLINICAL PRACTICE Laserpexy is a successful alternative to cryopexy in creating chorioretinal adhesion for scleral buckle surgery. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT01068379.