Laser Retinopexy

Laser Retinopexy

Alan R. Hromas

Laser retinopexy refers to the use of photocoagulative laser in an attempt to halt the progression of retinal pathology threatening symptomatic retinal detachment. Treatment involves the application of confluent individual laser burns to demarcate an area of concern, with the goal of inducing a chorioretinal adhesion and thus preventing the start or progression of retinal detachment. This may include treatment of retinal flap tears (“horseshoe tears”), atrophic retinal holes, degenerative peripheral changes such as lattice degeneration, or subclinical peripheral retinal detachments.

The causative role of retinal breaks in retinal detachment was first asserted by Jules Gonin in 19181 and led to the treatment of retinal detachments with ignipuncture. Nearly 30 years later, Gerhard R.E. Meyer-Schwickerath introduced the concept of photocoagulation for therapeutic purposes within the eye. As applied to retinal breaks, he hypothesized that the chorioretinal scarring produced by focused light damage to the retina could prevent the accumulation or spread of subretinal fluid by effectively “tacking the retina down.” After initially performing treatment using focused rays from the sun, he worked with Zeiss to develop the powerful xenon-arc coagulator. In the ensuing 30 years, the xenon-arc coagulator was gradually replaced with the laser technology that remains the most common mode of treatment today.2 While trans-scleral cryotherapy remains commonly used for certain situations, for many surgeon’s, the associated discomfort, inflammation, and increased rate of proliferative vitreoretinopathy3 limit its use relative to laser.

There are many types of lasers employed in retinal applications. Currently, the most popular are green argon (514 nm) and frequency doubled neodymium yttrium aluminum garnet (Nd:YAG) (532 nm), and yellow krypton (568 nm) and dye (577 nm) lasers. These wavelengths lie within the peak absorption range for the tissues being treated, namely the pigmented and vascular structures of the retinal pigment epithelium and choroid.4 Yellow wavelengths are believed to penetrate more effectively through nuclear sclerotic lenses.

Laser spots generate a controlled thermal effect ultimately resulting in chorioretinal scarring and adherence of the neurosensory retina to the underlying tissues, thus its usefulness in decreasing the risk of retinal detachment in patients with retinal breaks.


Performing in-office laser retinopexy involves some degree of patient cooperation. Though the procedure is relatively safe with an adequate view and a stationary patient, sudden eye or bodily movements during the process of treatment can risk inadvertent laser to important structures (e.g., the macula and optic nerve). In patients who are too young, invalid, intoxicated, or exhibiting dementia, treatment may best be performed with laser indirect ophthalmoscopy (LIO) in the operating room under sedation. Ensuring adequate anesthesia helps with cooperation.

Performing safe laser retinopexy requires an adequate view of the posterior segment. In acute retinal breaks associated with PVD, vitreous hemorrhage is often present, which can make the view difficult. Other conditions such as corneal opacities, cataract, or inadequate mydriasis may be compounding factors.

It should be noted that in cases of acute PVD associated with vitreous hemorrhage, the risk of an underlying retinal break is high.9 If the view is inadequate to exclude the presence of an underlying break, B-Scan ultrasound should be performed to exclude any clear tear or detachment. The presence of a clear retinal detachment or a break that is untreatable due to media opacity is an indication for urgent pars plana vitrectomy,10 with the goal of treating or halting any concerning lesion prior to it progressing to a “macula off ” status and irreversible vision decrease. If B-Scan does not demonstrate a break or detachment, options include close monitoring (every two to three days) with repeat B-Scans as necessary to allow for some clearing or proceeding with pars plana vitrectomy to clear the visual axis and treat any underlying pathology.


Informed consent should include a description of the procedure to be performed, as well as the purpose, in plain language. For instance, “laser treatment to minimize or decrease the risk of progression of retinal detachment.” In addition to the proposed benefits of the procedure, the risks listed previously should be addressed.

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Jun 23, 2022 | Posted by in OPHTHALMOLOGY | Comments Off on Laser Retinopexy

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