OSLI Retina

August 2020

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428 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Outcomes and Complications of In-Office Laser Demarcation of Peripheral Rhegmatogenous Retinal Detachments David Xu, MD; Hannah J. Levin, BS; Hannah Garrigan, BS; Turner D. Wibbelsman, BS; Anthony Obeid, MD, MPH; Ravi R. Pandit, MD, MPH; Thomas L. Jenkins, MD; Sonia Mehta, MD; Allen C. Ho, MD; Jason Hsu, MD; Carl D. Regillo, MD BACKGROUND AND OBJECTIVE: To evaluate the outcomes of in-office laser demarcation (LD) for peripheral rhegmatogenous retinal detachments (RRDs). PATIENTS AND METHODS: This was a retrospective analysis of peripheral RRDs treated with LD. Pa- tient demographics, visual acuity (VA), and RRD characteristics were recorded. Complications re- quiring additional procedures were recorded. Mul- tiple logistic regression was used to characterize the association of RRD anatomy to treatment com- plications. RESULTS: A total of 112 eyes of 107 patients were analyzed with mean follow-up of 20 ± 12 months. VA at baseline and last follow-up was equivalent (0.16 logMAR, Snellen equivalent 20/29). Ninety- five (84.8%) eyes were successfully treated without an additional procedure. In multivariate analysis, the presence of VH (odds ratio [OR] = 4.0; 95% con- fidence interval [CI], 1.1-17; P = .04) and RRDs in the inferior 6 clock hours (OR = 6.2; 95% CI, 1.5-29; P = .01) were associated with complications. CONCLUSIONS: LD is successful in treating periph- eral RRDs. RRD characteristics less conducive to laser include presence of VH and inferior RRD. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:428-434.] INTRODUCTION In-office laser demarcation (LD) is an accepted treatment modality for small peripheral rhegmatog- enous retinal detachments (RRDs) as an alternative to operative repair of RRD by pars plana vitrectomy (PPV), scleral buckling (SB), or pneumatic retinopexy (PR). Treatment involves applying three or more con- fluent rows of laser photocoagulation surrounding the margins of the detachment to establish a barrier of ret- ina-retinal pigment epithelium (RPE) adhesion pre- venting further extension of subretinal fluid (SRF). 1 The procedure is less invasive than the other means of repair. It also avoids the risks of ocular surgery and anesthesia, has minimal recovery time, is cost-effec- tive, and can be performed on the day of presentation in the office setting. Prior case series of in-office LD demonstrated ex- cellent results in treating asymptomatic peripheral retinal detachments, 2-4 macula-sparing persistent or recurrent detachments following scleral buckling, 5 macula-sparing RD in teenagers, 6 and even RRDs as- sociated with cytomegalovirus retinitis. 7,8 Despite these encouraging results, case selection is an impor- tant factor for the success of the procedure. A high rate of failure has been reported for symptomatic RRDs as opposed to those that were asymptomatic. 2 Anecdotal teaching has suggested that superior RRD are less suitable for LD, possibly attributed to faster RRD progression that extends beyond the barricade. Apart from this, there is limited guidance to aid in selection of candidates for in-office LD based on the presenting characteristics of the detachment. From Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania. Originally submitted December 9, 2019. Revision received June 15, 2020. Accepted for publication July 1, 2020. Presented at the Retina Society meeting in London, England, on September 12, 2019. The authors report no relevant financial disclosures. Address correspondence to Carl D. Regillo, MD, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut St., Suite 1020, Philadelphia, PA 19107; email: cregillo@midatlanticretina.com. doi: 10.3928/23258160-20200804-02

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