A Pioneering Study of Retinal Pigment Epithelial Photocoagulation to Seal Retinal Breaks and Prevent Hypotony during Pars Plana Vitrectomy

Background: During vitrectomy, a relatively high level of accuracy is required when using retinal laser energy, which is difficult to control in the presence of subretinal fluid and other conditions. We explored the clinical effects of retinal pigment epithelium (RPE)photocoagulation in closing retinal breaks and preventing hypotony during vitrectomy. We describe the possible indications of RPE photocoagulation. Methods: This was a prospective, non-random, uncontrolled case series study. We recruited 20 patients, with retinal detachment in 20 eyes. In this study, RPE photocoagulation was performed under the detached retina and retinal holes. RPE laser photocoagulation was performed in 3-4 rows at the edge of the periphery around the hole and the tear, replacing the traditional retinal photocoagulation and closing part or all of the retinal break. The energy of RPE photocoagulation was 100-150mJ for 120-200ms to seal the breaks, and the same energy but little gaps for the RPE without covering of retina. Results: After vitrectomy, in 19 eyes, there was a visible pigmentation reaction around the hole and tear, except for 1 eye the retinal hole located in the myelinated nerve fibre area. The mean best-corrected visual acuity (BCVA) at 6 months after surgery was significantly higher than that before surgery (p=0.002). At the last follow-up, the mean BCVA remained significantly higher than that before surgery (p=0.001).There was no significant difference in BCVA between the 6th month and the last follow-up (p=0.806).The thickness of the neurosensory layer in RPE photocoagulation and retinal photocoagulation area at 1 month after surgery was 216.33±54.42μm and 87.67±34.65μm, respectively. By the end of the follow-up, there were no serious complications, and the retinas of all 20 eyes were reattached. No hypotony occurred after surgery. Conclusions: The effects of RPE photocoagulation and retinal photocoagulation are similar in closing retinal breaks. The RPE laser sealed the retinal breaks and did not damage the neurosensory layer, but still caused pigmentation formation on the RPE, resulting in adhesion between the neurosensory layer and the RPE layer. Laser photocoagulation could be considered as comparable to glue instead of welding when closing the retinal breaks. Trial registration ChiCTR1900021504,2019-02-24.

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