Unlike traditional DLP, the case we reported in this study chose to directly apply laser to the area around the retinal hole, after a single laser treatment, the patient's retinal hole is closed and the retina was gradually reattached. Compared with traditional DLP, laser photocoagulation directly sealing retinal tears also avoids surgery. This method is not only effective, but also reduces the complications brought by traditional DLP, such as the risk of visual field loss caused by multiple lasers. Moreover, traditional DLP has a high probability that the existing large number of laser spots will become new multiple retinal tears after laser treatment fails, leading to further progression of retinal detachment. We effectively reduce this possibility by using a single laser to directly act around the retinal tears. Meanwhile,we emphasize that a single laser can directly seal retinal tears, allowing patients to spend less time and money.
Optimal management strategy for certain MSRRDs including those that have been named limited, subclinical, and asymptomatic is ambiguous. Byer concluded in his study that because subclinical RRDs remain localized or progress only very slowly, surgical intervention(such as scleral buckling,pneumatic retinopexy) should be discouraged.⁴ Scleral buckling may have associated morbidity, including buckle-induced refractive error, diplopia, or vision-threatening infection or hemorrhage. Complications reported with pneumatic retinopexy include hemorrhage, infection, increased intraocular pressure, and new retinal breaks, among others.⁵In comparison, laser photocoagulation rapidly enhances retinal adhesion in vitro and in vivo to 140% of normal in 24 hours, and twice normal between 3 days and 4 weeks,⁶ which seems safer and simpler. In the case we reported, the patient have smooth, shallow macular-sparing detachments without proliferative retinopathy. The juvenile patient have more formed vitreous, which retards the speed of retinal detachment and allows sufficient time for a stronger barrier effect of laser photocoagulation to be established,and the patient has atrophic hole as causative break, meaning that the vitreoretinal traction force is less in those eyes than eyes with acute retinal tears.³Considering these factors, we choose to directly apply the laser around the retinal hole,rather than at the boundary between the normal retina and the separated retina like traditional DLP, even in the presence of subretinal fluid.One month post treatment, the retinal hole is sealed and obvious laser spots have formed. The reduction of subretinal fluid can also be observed which indicates that treatment was effective. We believe that laser irradiation on the retina initiates a fibrin reaction between the retinal pigment epithelium and the retinal nerve epithelium, which temporarily compresses the hole. We also believe that the laser treatment produces a scorching inflammatory reaction which causes choroid and retinal scars to adhere, thus sealing the teal.
Therefore, laser sealing of retinal tear may yield the most optimal results for patients with subclinical RRDs. However, it is not clear the extent of retinal detachment protrusion in which retinal laser photocoagulation is still effective. In this study, the protrusion of retinal detachment in the posterior pole is 420micrometers. The new method of laser treatment for RRD we reported,compared with surgical treatment, laser sealing of retinal tear,avoiding various complications caused by the surgery mentioned above. Compared to traditional DLP, it only requires a single laser, reducing the various risks caused by multiple lasers.Additionally, this method saves patients time and money. We therefore propose this modality as a viable treatment option for patients have smooth, shallow MSRRDs without proliferative retinopathy,special emphasis is placed on patients with low retinal detachment protrusions.