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Fortified Barrier Laser on the Vitreous Base in Vitrectomy for Rhegmatogenous Retinal Detachment

Fortified Barrier Laser on the Vitreous Base in Vitrectomy for Rhegmatogenous Retinal Detachment. Ji Eun Lee, 1 Jae Jung Lee, 1 Sung Who Park, 1 In Young Chung, 2 Hyun Woong Kim 3. 1. Pusan National University Hospital, Busan, Korea

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Fortified Barrier Laser on the Vitreous Base in Vitrectomy for Rhegmatogenous Retinal Detachment

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  1. Fortified Barrier Laser on the Vitreous Base in Vitrectomy forRhegmatogenous Retinal Detachment Ji Eun Lee,1 Jae Jung Lee,1 Sung Who Park,1 In Young Chung,2 Hyun Woong Kim3 1. Pusan National University Hospital, Busan, Korea 2. Gyeongsang National University Hospital, Jinju, Korea 3. Inje University Busan Baik Hospital, Busan, Korea

  2. Background • Pars plana vitrectomy (PPV) • PPV is now the most popular procedure as the first surgery for rhegmatogenous retinal detachment (RRD). • Single surgery success rate : 70-98%a-e • 360 degree prophylactic laserf-g • It may reduce recurrence by producing the second ora serrata. • Disadvantages : time-consuming, potential overtreatment, risk of laser-related complications a. Heimann H, Zou X, Jandeck C, et al.Graefes Arch Clin Exp Ophthalmol 2006;244:69-78. b. Mendrinos E, Dang-Burgener NP, Stangos AN, et al. Am J Ophthalmol 2008;28:1063-1070. c. Lai MM, Ruby AJ, Sarrafizadeh R, et al.Retina 2008;28:729-734. d. Dugas B, Lafontaine PO, Guillaubey A, et al.Graefes Arch Clin Exp Ophthalmol 2009;247:319-324. e. Azad RV, Chanana B, Sharma YR, Vohra R. Acta OphthalmolScand 2007;85:540-545. f. Iwase T, Jo YJ, Oveson BC. BMC Ophthalmol 2013;13:77 g. Koh HJ, Cheng L, Kosobucki B, Freeman WR. Retina 2007;27:744-749.

  3. Fortified barrier laser on the Vitreous base • The residual vitreous in the vitreous base • It causes traction force to the retina. • The main reason for recurrence after PPV. • Additional laser to the vitreous base • Adjacent to the retinal break • It was expected to reduce recurrence as well as to avoid the drawbacks of 360 degree laser. 360 degree laser fortified barrier laser

  4. Purpose & Methods • To investigate the efficacy of fortified barrier laser (FBL) on the vitreous base comparing to conventional barrier laser (CBL) in vitrectomy for RRD. • Study design • Retrospective case series • Inclusion criteria • RRD without PVR C • PPV not combined with buckle or silicone oil tamponade • FBL vs CBL • Primary outcome : single surgery success rate (SSSR)

  5. Surgical procedures • Vitrectomy • Concurrent phacoemulsification & IOL implantation • Machine : Constellation (Alcon) or Eva (DORC) • Meticulous removal of the vitreous • Barrier laser • CBL : 3–4 rows of laser burn were made around each break. • FBL : CBL + additional 3–4 rows of laser burn about 0.5 clock-hour long adjacent to the break along the posterior border of the vitreous base Vitreous base

  6. Demographics * fortified barrier laser, † conventional barrier laser

  7. Surgical outcomes * fortified barrier laser, † conventional barrier laser, ǂ best-corrected visual acuity

  8. Case 1 Before operation After operation

  9. Case2 Before operation After operation

  10. Conclusions • The modified barrier laser technique fortified along the vitreous base was a simple and effective procedure in PPV for RRD to reduce the recurrence rate without increasing the risk of complications related to photocoagulation.

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