Risk Of Rhegmatogenous Retinal Detachment Research Articles

Using Real-World Data to Assess the Association of Retinal Detachment with Topical Pilocarpine Use

PurposeTo examine the association between topical pilocarpine and the risk of new-onset rhegmatogenous retinal detachment (RRD). DesignRetrospective clinical cohort study. MethodsWe used an aggregated electronic health records research network, TriNetX, to examine the risk of RRD (ICD-10: H33.0x) following the initiation of pilocarpine. The primary study group included adult patients over 40 years who received topical pilocarpine (1.25% or any dose with the exclusion of other indications) for the first time. Our control group consisted of patients with presbyopia who were started on artificial tears and had no history of topical pilocarpine use during the study period. We matched both cohorts using propensity score matching (PSM) based on demographics, systemic comorbidities, and known risk factors for RRD. ResultsAfter matching, the three-month risk of RRD was significantly higher in the pilocarpine group (0.53%) compared to the control (0.25%) (RR: 2.18, 95% CI: 1.07-4.45, p=0.03). The 6-month risk of RRD remained elevated at 0.60% in the study group versus 0.31% in the control group (RR: 1.93, 95% CI: 1.01-3.67, p=0.04). At one year, the risk increased to 0.78% in the pilocarpine group and 0.33% in the control group (RR: 2.33, 95% CI: 1.28-4.27, p=0.005). A Cox proportional hazards model indicated that pilocarpine use was associated with a 3.14-fold increased risk of RRD (95% CI: 1.66-5.93, p<0.001) compared to controls, after adjusting for demographics and comorbidities. Additional risk factors for RRD included male sex (aHR: 2.36, p=0.001), myopia (aHR: 2.36, p=0.001), vitreous degeneration (aHR: 2.22, p=0.020), lattice degeneration (aHR: 3.71, p=0.010), and pseudophakia (aHR: 3.48, p<0.001). ConclusionsOur study quantified the increased risk of RRD associated with topical pilocarpine use.

Fellow Eye Risk of Rhegmatogenous Retinal Detachment in the United States: IRIS Registry (Intelligent Research in Sight) Analysis.

This study aimed to investigate the rate of rhegmatogenous retinal detachment (RRD) in the fellow eye of patients after developing an RRD in one eye. This is a retrospective cohort study of patients with a new RRD diagnosis in the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) from 2016 to 2020. The association between risk factors of RRD and fellow-eye RRD was evaluated using Cox regression. Among the 201,622 patients who developed a new RRD in at least one eye, 6,740 (3.34%) developed an RRD in the fellow eye at a mean time of 406.02 days (SD = 373.74) from the first eye diagnosis. Of those 6,740 eyes, 1,889 (28.03%) had lattice degeneration, 3,938 (58.43%) had PVD, 588 (8.72%) had cataract surgery, and 38 (0.56%) had complex cataract surgery. Adjusted regression modeling showed that male sex (HR 1.73, [95% confidence interval (CI) 1.64 to 1.83]; P < 0.001), younger age at first eye RRD diagnosis (HR 1.02, [95% CI 1.01 to 1.02]; P < 0.001), active smoking (HR 1.13, [95% CI 1.05 to 1.22]; P = 0.002), and cataract surgery (HR 1.33, [95% CI 1.23 to 1.45]; P < 0.001) were associated with increased risk of a fellow eye RRD. On the other hand, fellow eye PVD was associated with a lower risk of RRD (HR 0.80, [95% CI 0.76 to 0.84]; P < 0.001). Among patients with an RRD in one eye, male sex, younger age of first eye RRD diagnosis, active smoking, and cataract surgery were associated with a higher risk of developing a fellow eye RRD, whereas fellow eye PVD was associated with a lower risk of fellow eye RRD. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Involvement of Sclera in Lattice Retinal Degeneration: An Optical Coherence Tomography Study.

The aim of the study was to evaluate the local status of the sclera in lattice retinal degeneration. Patients with lattice degeneration, snail-track degeneration, or horseshoe retinal breaks were included. One lesion of a single eye in each patient was captured with cross-sectional optical coherence tomography (OCT) along and across the greatest lesion dimension. The maximum height of scleral indentation was measured and compared between different lesion types and between lattice lesions with and without retinal breakage or local detachment. The correlation between the maximum height of the scleral indentation of lattice lesions and the age of the patients was calculated. Seventy-five eyes of 75 patients (44.4 ± 14.7 years; 35 males and 30 females) were included. OCT showed variable local scleral indentation in 52 out of 55 (94.5%) lattice lesions, in five out of nine (55.5%) snail-tack lesions, and in three out of eleven (27.3%) horseshoe breaks. The maximum scleral indentation within lattice lesions, snail-tack lesions, and horseshoe breaks was 227.2 ± 111.3, 22.0 ± 49.2, and 88.5 ± 48.4 µm, respectively (p < 0.001 for snail-tack lesions and horseshoe breaks compared to lattice lesions). Lattice lesions with retinal breaks and/or local retinal detachment had statistically significantly lower scleral indentation than those without (p = 0.01). The height of the scleral indentation of lattice lesions was positively correlated with patient age (r = 0.51, p = 0.03). In conclusion, scleral indentation is one of the hallmarks of lattice retinal degeneration and may be associated with a reduced risk of rhegmatogenous retinal detachment.

The effect of patient symptom awareness on the visual outcome in retinal detachment.

To explore whether a patient's prior knowledge of the symptoms associated with rhegmatogenous retinal detachment (RRD) relates to the visual outcome after treatment. We performed a prospective survey study on 126 patients receiving treatment for primary RRD between March and July 2021. Thirty-seven per cent (n = 47) of patients responded that they were aware of the RRD symptoms prior to the detachment. A history of RRD in the fellow eye or knowledge of family members treated for RRD was frequently reported as a reason for the patient's awareness of RRD symptoms. Patients aware of RRD symptoms presented significantly more often with an attached macula (χ2, p = 0.002) and a better visual outcome following surgery (Mann-Whitney U, p = 0.028) compared to patients who were not aware of RRD-related symptoms. Among 76 patients with a myopic refractive error, only 15% (n = 11) indicated that they had been warned about the increased RRD risk related to myopia, suggesting that three-quarters of patients were not actively informed by their eye care professionals. RRD symptom awareness is significantly related to a higher rate of macula-on RRDs and better visual outcomes after treatment. There is limited awareness of increased RRD risk in myopic RRD patients. These findings suggest that counselling individuals at high risk of RRD about related symptoms is inadequate and better counselling may improve visual outcomes following RRD treatment.

Visual Acuity Prior to Cataract Surgery and Risk of Retinal Detachment - A Population-Based Study.

To analyze preoperative visual acuity before cataract surgery regarding the risk of rhegmatogenous retinal detachment (RRD) after cataract surgery. The preoperative visual acuity in an observational cohort study of patients undergoing cataract surgery in Skåne, southern Sweden, during 2015-2017 was analyzed with data retrieved from the Swedish National Cataract Register. This was then cross-referenced with patients undergoing surgery for retinal detachment at the Skåne University Hospital in Lund from 2015 to 2020. The main outcome was the risk-benefit ratio of measuring preoperative visual acuity before cataract surgery and the risk of RRD. The mean visual acuity in the whole study group (N=58,624), expressed as LogMAR, was 0.40 ± 0.32 (SD). In the group with RRD (n=298), the mean visual acuity was 0.44 ± 0.36 (p=0.07). In the subgroups of RRD, those aged <60 years 0.49 ± 0.44 (p=0.07), aged <60 years and axial length (AL) >25 mm 0.42 ± 0.38 (p=0.68), and in those aged <60 years, AL >25 mm and male sex 0.44 ± 0.39 (p=0.53). However, there is considerable variations in visual acuity of the various groups and in the high-risk group with RRD aged <60 years with AL>25 mm, 15% had a visual acuity of 0.8 or better in the operated eye. There must be strong indications for performing cataract surgery in those with a high risk of retinal detachment, and the patient must be given adequate information on the risk of retinal detachment.

Epidemiology of rhegmatogenous retinal detachment in commercially insured myopes in the United States

Myopia is a known risk factor for rhegmatogenous retinal detachment (RRD). Given global trends of increasing myopia, we aimed to determine the absolute risk (incidence rate) of RRD in non-myopes, myopes and high myopes in the United States over ten years. We performed a retrospective cohort study of 85,476,781 commercially insured patients enrolled in the Merative™ Marketscan® Research Database. The incidence rate of RRD in phakic patients in the United States was 39-fold higher in high myopes than non-myopes (868.83 per 100,000 person-years versus 22.44 per 100,000 person-years) and three-fold higher in myopes than non-myopes (67.51 per 100,000 person-years versus 22.44 per 100,000 person-years). The incidence rate was significantly higher in males in each category (P < 0.01). Combined, the incidence rate of RRD in phakic patients in the United States from 2007 to 2016 was 25.27 RRDs per 100,000 person-years, a rate higher than those in prior published studies in North America, South America, Europe, Asia, and Australia. The absolute risk of myopia and high myopia increased from 2007 to 2016. The risk of RRD in phakic high myopes rose with increasing age. Notably, the magnitude of increased risk of RRD in myopes varied substantially according to the minimum follow-up period in our models and should be accounted for when interpreting data analyses.

Incidence and Risk Factors for Retinal Detachment and Retinal Tear after Cataract Surgery: IRIS® Registry (Intelligent Research in Sight) Analysis

To report the incidence of and evaluate demographic, ocular comorbidities, and intraoperative factors for rhegmatogenous retinal detachment (RRD) and retinal tear (RT) after cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Retrospective cohort study. Patients aged ≥ 40 years who underwent cataract surgery between 2014 and2017. Multivariable logistic regression was used to evaluate demographic, comorbidity, and intraoperative factors associated with RRD and RT after cataract surgery. Incidence and risk factors for RRD or RT within 1 year of cataract surgery. Of the 3 177 195 eyes of 1 983 712 patients included, 6690 (0.21%) developed RRD and 5489 (0.17%) developed RT without RRD within 1 year after cataract surgery. Multivariable logistic regression odds ratios (ORs) showed increased risk of RRD and RT, respectively, among men (OR 3.15; 95% confidence interval [CI], 2.99-3.32; P < 0.001 and 1.79; 95% CI, 1.70-1.89; P < 0.001), and younger ages compared with patients aged > 70, peaking at age 40 to 50 for RRD (8.61; 95% CI, 7.74-9.58; P < 0.001) and age 50 to 60 for RT (2.74; 95% CI, 2.52-2.98; P < 0.001). Increased odds of RRD were observed for procedure eyes with lattice degeneration (LD) (10.53; 95% CI, 9.82-11.28; P < 0.001), hypermature cataract (1.61; 95% CI, 1.06-2.45; P= 0.03), complex cataract surgery (1.52; 95% CI, 1.4-1.66; P < 0.001), posterior vitreous detachment (PVD) (1.24; 95% CI, 1.15-1.34; P < 0.001), and high myopia (1.2; 95% CI, 1.14-1.27; P < 0.001). Lattice degeneration conferred the highest odds of RT (43.86; 95% CI, 41.39-46.49; P < 0.001). In the IRIS Registry, RRD occurs in approximately 1 in 500 cataract surgeries in patients aged > 40 years within 1 year of surgery. The presence of LD conferred the highest odds for RRD and RT after surgery. Additional risk factors for RRD included male gender, younger age, hypermature cataract, PVD, and high myopia. These data may be useful during the informed consent process for cataract surgery and help identify patients at a higher risk of retinal complications. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

“White without Pressure” Associated with Other Degenerations: Features of Vitreoretinal Interface on OCT Scans (Clinical Case)

“White without pressure” warrants special attention from ophthalmologists due to the lack of consensus on its etiopathogenesis and associated risk of rhegmatogenous retinal detachment. “White without pressure” appears in various quadrants of the fundus as an area white to gray in color. It is more common in persons with high myopia.The paper presents a clinical case of a 19-year-old male with an association between “white without pressure”, “dark without pressure”, vitreoretinal tuft and symptomatic floaters in the left eye. OCT scanning (SOLIX) was employed to assess the vitreoretinal interface. OCT revealed the intraretinal location of “white without pressure” and “dark without pressure” degenerations without vitreoretinal traction. “White without pressure” degeneration is hyperreflective at the level of the outer retina in the photoreceptor ellipsoid and myoid zones, and “dark without pressure” is hyporeflective at this level. Vitreoretinal tuft is a vitreoretinal degeneration located at the level of the inner limiting membrane. It was detected as a hyperreflective site with vitreoretinal adhesion leading to traction and thickening of the corresponding retinal area. The combination of the three degenerations poses a risk of rhegmatogenous retinal detachment due to the presence of the vitreoretinal tuft.

Fellow-Eye Retinal Detachment Risk as Stratified by Hyaloid Status on OCT

To evaluate the risk of a rhegmatogenous retinal detachment (RRD) in the fellow eye utilizing posterior hyaloid status as determined by optical coherence tomography (OCT) at the time of initial RRD. Retrospective chart review. Patients diagnosed with an RRD. Posterior hyaloid status-presence or absence of a posterior vitreous detachment-in both eyes at the time of initial RRD was determined by OCT imaging. Baseline characteristics including lattice degeneration, refractive error, prior ocular laser procedures, lens status and family history of RRD. Development of fellow eye RRD along with time to fellow eye RRD. In addition, OCT imaging was utilized in those fellow eyes with a visible posterior hyaloid to document whether a posterior vitreous detachment (PVD) developed during follow-up and time to such an event. A total of 1049 patients with an RRD were followed for an average of 5.7 ± 0.3 years. Overall, 153 (14.6%) patients were diagnosed with bilateral sequential RRDs during this follow-up period. There were OCT images available for 582 fellow eyes: PVD noted in 229 (39.3%) and an attached hyaloid in 353 (51.7%) fellow eyes. An RRD occurred in 7 (3.1%) fellow eyes with a PVD at presentation. Within the cohort of fellow eyes with an attached hyaloid, 29 (8.2%) developed an RRD during follow-up; however, when evaluating only those that developed a PVD during follow-up 24.6% of such eyes were found to have an RRD as well. At the time of PVD development in the fellow eye an additional 21 (17.8%) eyes were noted to have a retinal tear that was treated without progression to RRD. Optical coherence tomography imaging of the fellow eye at time of presentation with an RRD offers a significant amount of information regarding risk stratification for RRD in this eye. Patients noted to have a completely detached posterior hyaloid are at a significantly lower risk of RRD than those with a visible posterior hyaloid-who need to be monitored closely at the time of PVD development.

Visual Outcomes and Risk of Rhegmatogenous Retinal Detachment Following Posterior Capsule Rupture during Cataract Surgery: With vs without Dropped Nuclear Lens Fragments

Visual Outcomes and Risk of Rhegmatogenous Retinal Detachment Following Posterior Capsule Rupture during Cataract Surgery: With vs without Dropped Nuclear Lens Fragments

Preventing Retinal Detachment: Where are We? Implications from Stickler Syndrome.

Stickler syndrome, a rare inherited disease, carries a lifetime risk of rhegmatogenous retinal detachment (RRD) of up to 65%, higher than any other predisposing condition known. Both syndromic and non-syndromic eyes suffer RRD predominately from the same pathogenesis, vitreous tractional tears in the peripheral retina. Consequently, extraordinary publications in 2021-2022, each reporting successful prevention of RRD in Stickler syndrome, using 360-degree (encircling) laser retinopexy, provide the first strong evidence upon which similar prophylaxis in non-syndromic eyes at high risk of RRD from peripheral retinal tears can confidently go forward.

Dominant Stickler Syndrome.

The Stickler syndromes are a group of genetic connective tissue disorders associated with an increased risk of rhegmatogenous retinal detachment, deafness, cleft palate, and premature arthritis. This review article focuses on the molecular genetics of the autosomal dominant forms of the disease. Pathogenic variants in COL2A1 causing Stickler syndrome usually result in haploinsufficiency of the protein, whereas pathogenic variants of type XI collagen more usually exert dominant negative effects. The severity of the disease phenotype is thus dependent on the location and nature of the mutation, as well as the normal developmental role of the respective protein.

Incidence, Risk Factors, and Outcomes of Rhegmatogenous Retinal Detachment after Intravitreal Injections of Anti-VEGF for Retinal Diseases: Data from the Fight Retinal Blindness! Registry

To report the estimated incidence, probability, risk factors, and 1-year outcomes of rhegmatogenous retinal detachment (RRD) in eyes receiving intravitreal injections (IVTs) of VEGF inhibitors for various retinal conditions in routine clinical practice. Retrospective analysis of data from a prospectively designed observational outcomes registry: the Fight Retinal Blindness! Eyes of patients starting IVTs of VEGF inhibitors (ranibizumab, aflibercept, or bevacizumab) for neovascular age-related macular degeneration, diabetic macular edema, or retinal vein occlusion from January 1, 2006, to December 31, 2020. All eyes that developed RRD within 90 days of IVTs were defined as cases with RRD and were matched with control eyes. Estimated incidence, probability, and hazard ratios (HRs) of RRD were measured using Poisson regression, Kaplan-Meier survival curve, and Cox proportional hazards models. Locally weighted scatterplot smoothing curves were used to compare visual acuity (VA) between cases and matched controls. Estimated incidence of RRD. We identified 16 915 eyes of 13 792 patients who collectively received 265 781 IVTs over 14 years. Thirty-six eyes were reported to develop RRD over the study period. The estimated incidence (95% confidence interval [CI]) per year per 1000 patients and per 10 000 injections was 0.77 (0.54-1.07) and 1.36 (0.95-1.89), respectively. The probability of RRD did not significantly increase at each successive injection (P= 0.95) with the time of follow-up. Older patients (HR [95% CI]= 1.81 [1.21-3.62] for every decade increase in age, P < 0.01) were at a higher risk of RRD, whereas patients with good presenting VA (HR [95% CI]= 0.85 [0.70-0.98] for every 10-letter increase in VA, P= 0.02) were at a lower risk. Neither the type of retinal disease (P= 0.52) nor the VEGF inhibitor (P= 0.09) was significantly associated with RRD risk. Cases with RRD lost 3 lines of vision on average compared with the prior RRD VA and had significantly fewer injections than matched controls over the year after the RRD. Rhegmatogenous retinal detachment is a rare complication of VEGF inhibitor IVT in routine clinical practice with poor visual outcomes at 1 year.

Efficacy of prophylactic laser retinopexy in acute retinal necrosis: A systematic review and meta-analysis.

We performed a systematic review and meta-analysis to assess the role of prophylactic laser retinopexy in preventing rhegmatogenous retinal detachment (RRD) in acute retinal necrosis (ARN). Pubmed, Embase and Cochrane databases were searched for eligible studies from inception to July 2020. Comprehensive clinical demographics were extracted from each study by two independent investigators. A random effects model was selected to analyze the OR of RRD risk and visual outcome with 95%CI. Subsequent subgroup and sensitivity analysis were conducted to evaluate the source of heterogeneity. A total of eight studies and 247 eyes (111 prophylactic laser retinopexy eyes and 136 eyes receiving antiviral treatment) were included in this analysis. There was moderate statistical heterogeneity across all studies. When compared with routine antiviral treatment alone, RRD risk decreased in patients receiving prophylactic laser retinopexy, however, this was not statistically significant (P = 0.09, OR = 0.42, 95%CI: 0.15-1.15). There was significant improvement in BCVA during the follow-up period in the prophylactic laser retinopexy subgroup (P = 0.01, WMD = - 0.98, 95%CI: - 1.74, - 0.22). Based on current analysis, our results did not support convincing evidence of prophylactic laser in preventing RRD. Future studies featuring high-quality, multicenter trials will be required to correct baseline characteristics. This meta-analysis has been retrospectively registered in Prospero (registration number: CRD42020201008).

Vitreoretinal specialists compared with residents on outcomes of primary laser retinopexy in preventing retinal detachment in 958 eyes

ObjectiveRetinal tears are the most common vitreoretinal (VR) emergency and retinopexy aims to reduce the risk of rhegmatogenous retinal detachment (RRD). Currently retinal laser is a required competence by the...

Rhegmatogenous retinal detachment presentation and surgery in uveitic eyes

Background/aimsTo explore the occurrence, uveitis activity, features, rate of proliferative vitreoretinopathy (PVR) and outcomes following rhegmatogenous retinal detachment (RRD) in a large tertiary referral uveitis service.MethodsRetrospective analysis of subjects attending...

Влияние локализации витреоретинального сращения на конфигурацию клапанного разрыва и вероятность развития регматогенной отслойки сетчатки

Purpose. To evaluate the relationship between the shape of horseshoe tear and the localization of vitreoretinal tractions (VRT) using methods of the peripheral vitreoretinal interface visualization and classify horseshoe tears by shape for surgical planning. Material and methods. We studied horseshoe tears parameters of 52 patients (52 eyes). The localization of VRT was determined by wide-field OCT, the horseshoe tear shape was determined as the ratio of length to width of the tear (l/b) by multispectral laser scanning. The ratio of the obtained data was evaluated by the Spearman correlation analysis. We used Ward's method of hierarchical clustering to classify the horseshoe tears by shape. The obtained data were used to perform YAG- laser excision of the vitreoretinal adhesion zone in patients with rhegmatogenous retinal detachment as part of the combined microinvasive laser-surgical technology. Results. The l/b ratio ranged from 1/4 to 3/1. A strong negative correlation has been revealed between the horseshoe tear shape and the fixation of vitreoretinal tractions (rs -0.95; p &lt;0.05). Horseshoe tears were identified in 4 groups using Ward's method of clustering. Each group corresponded to a specific localization of VRT. The extension of VRT beyond the tear was associated with a high risk of rhegmatogenous retinal detachment. Conclusion. A significant correlation has been found between the studied factors confirm the possibility of using data on the horseshoe tear shape for an approximate evaluation of vitreoretinal adhesion localization. The obtained data allows to determine the exact VRT excision zone when performing combined laser-surgical technology without the need for preoperative wide-field OCT. Key words: rhegmatogenous retinal detachment, wide-field OCT, horseshoe tear, vitreoretinal traction, YAG – laser retinotomy.

Клинические характеристики и результаты хирургического лечения регматогенной отслойки сетчатки у пациентов в возрасте 18-40 лет

The risk of rhegmatogenous retinal detachment (RRD) increases with age and its more common in the older age group, but several studies report a secondary peak of RRD in young patients. At the same time, RRD in young patients has clinical features. Purpose. To describe clinical features and surgical outcomes of RRD in young adults. Materials and мethods. Retrospective study of 33 patients (33 eyes) aged between 18 and 40 years, who underwent primary surgery between June 2018 and February 2021. The mean age of the patients was 33.9±6.7 years. All patients underwent either scleral buckling or pars plana vitrectomy. We analyzed demographic data, RRD characteristics, primary and final anatomic anatomic success rate and best-corrected visual acuity (BCVA) at the conclusion of follow-up. Results. The main etiologies were myopia (87.8%) and trauma (15%). were Macula on RRD was in 69.7% of patients. Primary anatomic success was in 69.7% cases, final anatomic success- 94%. (14 out of 16 eyes) after vitrectomy. The mean BCVA value improved to 0.65±0.35 (p=0.042). Conclusion. RRD in young adults aged between 18 and 40 years has clinical features and differs from that in older adults. The main causes are myopia, especially of high myopia and trauma. Macula off RRD is less common than macula on RRD. Primary anatomic success is less favorable compared to final anatomic success. The functional prognosis remains satisfactory and increased to 0.65±0.35 (p=0.042).

The impact of COVID-19 on primary retinopexy in preventing retinal detachment in a tertiary eye hospital emergency department.

To review the effect of COVID-19 on rhegmatogenous retinal detachment (RRD) rate following primary retinopexy. Retrospective consecutive case series of 183 patients attending Birmingham and Midlands Eye Centre undergoing primary retinopexy (cryotherapy and laser) between March 23rd to June 30th in 2019 (Group 1) and 2020 (Group 2). In total we reviewed 183 retinopexies, 122 in Group 1 and 61 in Group 2, a reduction of 50%. In Group 2 compared to Group 1, we showed a significant difference in characteristics of patients having primary retinopexy with an increase in proportion of male patients from 50 (41.0%) to 39 (63.9%) (p = 0.005), increase in high myopes from 1 (0.8%) to 4 (6.6%) (p = 0.043), more slit lamp laser retinopexy from 83 (68.0%) to 52 (85.2%) (p = 0.013) and less cryopexy from 21 (17.2%) to 2 (3.3%) (p = 0.008). In Group 2, primary retinopexy resulted in significantly more 3-month RRD rate 1 (0.8%) to 5 (8.2%) (p = 0.016). There were no changes in number of patients requiring further retinopexy (p = 1.000). This study demonstrates a reduction of primary retinopexy, an increased risk for RRD following primary retinopexy and a significant shift in type of primary retinopexy performed, demographics, operator and change in characteristics of type of retinal break observed during this pandemic. This study contributes to the growing literature of the secondary effects of the COVID-19 pandemic on other aspects of healthcare that is not just limited to the virus itself.

Commentary: Prophylactic laser barrage before laser-assisted in-situ keratomileusis.

The debate on prophylactic laser barrage, especially before refractive surgery, continues to divide retina specialists. There are surgeons who believe that every predisposing lesion must be treated, while some are sceptical about the preventive role of laser to the retinal lesions. Rhegmatogenous retinal detachment (RD) is common in myopes in eyes with lattice degeneration and posterior vitreous detachment (PVD).[1] Low myopes (−1.00 to −3.00 D) have a fourfold increased risk of RD over emmetropic patients. This risk increases significantly when the patient’s refractive error exceeds −3.00 D.[2] Lattice degeneration is present in 6–8% of the population and increases the risk of retinal detachment. Myopes, in addition to having peripheral retinal degenerations and lattice, have PVD at a younger age compared to emmetropes. The procedure of laser-assisted in-situ keratomileusis (LASIK) increases the risk of RD due to sudden fluctuation in the intraocular pressure (IOP) during the procedure. The increase in IOP that occurs during suction prior to engaging the microkeratome, and rapid lowering of IOP when the suction ring is decompressed, or the shock wave generated by the excimer laser may lead to PVD resulting in retinal tears.[3] Hence, LASIK patients should undergo an extensive retinal evaluation with prophylactic photocoagulation of lattice degeneration, atrophic holes, and/or flap tears in an attempt to reduce any risk of an RD. The prophylactic treatment of high-risk lesions is believed to prevent RD. Ruiz-Moreno et al. retrospectively studied 1554 consecutive eyes (878 patients) undergoing LASIK and reported a low incidence (0.25%) of RD in their patients after prophylactic barrage laser to lesions predisposing to RD.[4] Several other studies have reported a higher incidence of RD in patients who had undergone prior LASIK than would be predicted from myopia alone.[5] Till date, there have been no prospective studies directly comparing prophylactic treatment versus nontreatment and showing any definite RD risk reduction for asymptomatic retinal lesions in general. In a recent study by Srinivasan et al., of the 694 eyes that had undergone LASIK, 5 eyes (0.7%) developed RD over 7 years.[6] Increased risk of RD was not associated with age at LASIK surgery, gender, laterality and spherical equivalent. While RD was statistically significantly higher in eyes which had prior prophylactic laser photocoagulation, the number of eyes who developed RD was so low that it could not be clinically meaningful, with very wide confidence intervals of the hazard ratio. Only three eyes had lattice degeneration prior to LASIK which were lasered, and one eye with lattice was unlasered. Ideally, a study should compare a substantial number of eyes which had lattice degeneration prior to LASIK and assign them to prophylactic laser or no laser. Hence, it cannot be conclusively proven from this study that prophylactic laser adversely increases the risk of RD after LASIK. Proliferation of the epiretinal membrane (ERM) or macular pucker has been occasionally observed following treatment for a retinal break. However, a direct cause-and-effect relationship of treatment of a retinal break to ERM remains unclear. After laser photocoagulation of the retinal lesions, the adhesive force between the retina and choroid increases over a few days to 2 weeks. Hence, refractive surgery is recommended after at least 7 days following laser photocoagulation. Patients at high risk should also be educated about the symptoms of PVD and retinal detachment as well as about the value of periodic follow-up examinations. Patients should be counselled that the refractive surgery does not reduce the risk of RD, even though the refractive error may be cured after LASIK. In conclusion, all patients should have a thorough dilated indirect ophthalmoscopy with scleral depression prior to refractive surgery. Treatment of any retinal lesion predisposing to the development of RD is mandatory.