Aim: To present longterm results of laser photocoagulation for retinal ruptures in preventing retinal detachment.
Methods: Retrospective analysis of 405 patients (430 eyes) operated on (treated) with argon laser photocoagulation for retinal tear from January 1992 to January 2002. Inclusion criteria were retinal rupture(s) on one or both eyes. Follow up period was 2 to 9 years. Indications for laser treatment were symptomatic retinal ruptures, ruptures with vitreoretinal tractions, ruptures associated with high myopia, retinal pathology in the fellow eye, aphakia, pseudophakia, eye trauma, vitreous hemorrhage, and ruptures with shallow retinal detachment not exceeding 1-2 disc diameter. Laser treatment was done with Coherent 900, Novus and Ultima lasers, usually in one session under topical anesthesia. Laser surgery consisted of 2-3 continuous rows surrounding the lesion, power setting 100-300 mW, time 0.2 s, spots 100-200 micron in size.
Results: The types of tear were analyzed and tabularly presented. There were 20 (4.6%) round holes with no operculum, 32 (7.4%) round holes with operculum and 143 (33%) horseshoe tears with visible vitreoretinal tractions. Retinal ruptures were associated with vitreous hemorrhage in 96 (22.3%) eyes, myopic changes were found in 82 (19%) eyes, and pseudophakia in 56 (13%) eyes. Posterior vitreous detachment was found in 146 (34%) eyes and traumatic ruptures were found in 27 (6.3%) eyes. The position and number of retinal ruptures were analyzed. Single ruptures were found in 255 (59%) and multiple ruptures in 175 (45%) eyes. In the group of single ruptures, superotemporal localization was found in 120 (28%) eyes. The most common complication following laser treatment was retinal detachment in 24 (6%) eyes. Two (0.5%) eyes developed proliferative vitreoretinopathy. Twenty-four eyes with retinal detachment after laser treatment were operated on. Scleral buckling procedure was done in 20 (83%) and pars plana vitrectomy in 4 (17%) eyes. Two (8.5%) eyes underwent repeat vitrectomy due to postoperative complications.
Discussion: Today there is a strong suggestion that all symptomatic retinal ruptures should be treated. Ruptures with small and shallow retinal detachments should be treated. If there is vitreoretinal traction and retinal defect, these eyes should be treated. There are some medical eye conditions where it is wise to perform laser treatment for retinal rupture (aphakia, pseeudophakia, myopia, retinal changes in fellow eye, vitreous hemorrhage, trauma). In our study there was a number of asymptomatic retinal ruptures that were treated. The reason was a very long period of time elapsed from the treatment of our first patients (15 years before), when it was considered necessary to treat these patients.
Conclusion: The most serious complication of retinal rupture, retinal detachment, can be prevented by early laser photocoagulation. There are some conditions associated with retinal rupture that require obligatory treatment. In our study, the success rate was 94%. No major complications attributable to laser treatment were noted.