Navigated pattern laser system versus single-spot laser system for postoperative laser retinopexy

Abstract

Purpose: To compare three 360°-laser retinopexy (LRP) approaches (using navigated pattern laser system, single-spot slit-lamp (SL) laser delivery and single-spot indirect-ophthalmoscope (IO) laser delivery) in regard to procedure duration, procedural pain score, technical difficulties and the ability to achieve surgical goals. Patients and Methods. Eighty-six rhegmatogenous retinal detachment patients (86 eyes) were included in this prospective randomized study. Ten patients were underwent scleral buckling procedure, 37 patients were underwent vitrectomy, 7 patients had a combined procedure, and 32 patients had silicone oil tamponade. The mean procedural time, procedural pain score (using 4-point Verbal Rating Scale), number of laser burns, and achievement of the surgical goals were compared between three groups (pattern LRP (NAVILAS laser system), 36 patients; SL-LRP, 28 patients; and IO-LRP, 22 patients). Results. In the pattern LRP group, the time needed for LRP and pain level (12.4 ± 5.4 min and 1.1 ± 0.5 scores, respectively) were statistically significantly lower, whereas the number of applied laser burns (1108.7 ± 345.5) was higher compared to those in the SL-LRP group (21.7 ± 7.6 min, 1.8 ± 0.5 scores, and 714.5 ± 219.8 burns) and in the IO-LRP group (17.0 ± 10.1 min, 1.9 ± 0.5 scores, and 408.1 ± 95.5 burns). In the pattern LRP, SL-LRP, and IO-LRP groups, surgical goals were fully achieved in 28 (77.8 %), 17 (60.7 %), and 13 patients (59.1 %), respectively (p > 0.05). In the pattern LRP, SL-LRP and IO-LRP groups, the mean duration of follow-up after silicone oil removal was 6.6 ± 3.1 months, 8.1 ± 4.5 months and 7.1 ± 4.1 months, respectively (ANOVA3x, p = 0.35), with re-detachment found in 1 case (8.3 %), 2 cases (18.2 %), and 1 case (11.1 %), respectively. Conclusions. The navigated pattern approach allows improving the treatment time and pain in postoperative 360° LRP. Moreover, 360° pattern LRP is at least as effective in achieving the surgical goal as the conventional (slit-lamp or indirect ophthalmoscope) approaches with a single-spot laser.