EFFICIENCY OF LASER PHOTOCOAGULATION ON THE PREVENTION OF RETINAL DETACHMENT IN ACUTE RETINAL NECROSIS: A Systematic Review and Meta-Analysis.

ABSTRACT

BACKGROUND: Retinal detachment is a severe complication of acute retinal necrosis, threatening vision. The published articles on the effectiveness of laser in preventing retinal detachment in acute retinal necrosis are controversial. Therefore, we aim to evaluate whether prophylactic laser is effective for retinal detachment after acute retinal necrosis. METHODS: PubMed, Embase, and Cochrane databases were searched, and the retrieved records were screened. Each included study has well-defined laser-treated group and control group without laser treatment or with enough data for manual grouping. The quality of the included studies was assessed using ROBINS-I ("Risk Of Bias In Nonrandomized Studies-of Interventions"). Meta-analysis was conducted to calculate the pooled odds ratios and their 95% confidence interval. Sensitivity analysis was used to test the solidarity, and subgroup analysis was performed to determine the source of heterogeneity. RESULTS: Fourteen studies with a total of 532 eyes were eventually included. The quality of the included studies was moderate. The combined results showed that the pooled odds ratio was 0.61 (95% confidence interval [0.41∼0.90], P < 0.05, I 2 = 27%). Sensitivity analysis showed that the odds ratios were similar when excluding any study. Subgroup analysis showed moderate heterogeneity among three subgroups (I 2 = 48.0%, P = 0.15 for heterogeneity), and the odds ratio in antiviral therapy and steroid combined with prophylactic laser was 0.43 (95% confidence interval [0.25∼0.74], P < 0.05, I 2 = 0%). CONCLUSION: In patients with acute retinal necrosis, laser photocoagulation is an effective treatment to prevent retinal detachment, especially in the subgroup combined with antiviral therapy and steroid.