PROPHYLACTIC 360° LASER AFTER VITRECTOMY — DOES IT REDUCE RE-DETACHMENT? SYSTEMATIC REVIEW

Abstract

Purpose:
To evaluate whether prophylactic 360° endolaser retinopexy performed during pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) reduces postoperative re-detachment compared with localized retinopexy or PPV without encircling laser.A systematic review was conducted following PRISMA guidelines. Comprehensive searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar identified studies comparing intraoperative 360° endolaser retinopexy with localized or no laser treatment in adult patients undergoing PPV for primary RRD. Eligible study designs included randomized trials, cohort studies, case-control studies, and comparative case series. Outcomes extracted included postoperative retinal re-detachment, proliferative vitreoretinopathy (PVR), visual acuity, and complications. Study quality was assessed using ROBINS-I and RoB 2.0 tools. Due to heterogeneity, results were synthesized narratively. From 172 records, 13 studies met eligibility criteria. Comparative evidence consistently demonstrated no significant reduction in postoperative re-detachment with routine 360° laser compared to localized retinopexy. Some studies reported reduced recurrence due to occult or missed breaks, particularly in pseudophakic or high-risk eyes, but these findings were not uniform. Non-comparative and technical reports provided theoretical justification yet lacked control groups and consistent outcome measures. Overall, evidence showed substantial variability in surgical techniques, laser parameters, and definitions of re-detachment in Conclusion,
Current evidence does not support the routine use of prophylactic 360° endolaser retinopexy during PPV for all primary RRD cases. Potential benefit may exist for selected high-risk subgroups, particularly eyes prone to occult breaks or with limited intraoperative visualization. A tailored, case-by-case approach is preferred over universal application. High-quality, standardized randomized trials are needed to define which patient groups, if any, derive meaningful benefit from 360° laser prophylaxis.