The IDO laser delivery system became clinically available about 1990. ORA SECUNDA CERCLAGE (OSC): CREATING A SECOND ORA 6 The net result was to discredit the concept of encircling laser prophylaxis as a rational answer to focal prophylaxis failure, even as a substantial technical advance in laser treatment was about to appear. This encircling laser prophylaxis was not widely adopted and was often considered to be ineffective and even harmful. Even after these slit-lamp–based treatments, however, breaks anterior to treatment could still cause RRD, and iatrogenic breaks also occurred at sites of laser treatment, as the retina separated from the treated pigment epithelium (Figure 2). This led physicians in Israel and France in the 1970s and 1980s to perform an equatorial "fence" of encircling laser prophylaxis, posterior to the at-risk peripheral retina. While it is true that we cannot predict the meridian of a future break, we can predict that most causative breaks will occur in the peripheral retina. Byer, 5 noting that 89% of detachments in untreated eyes with two or more risk factors arise from normal appearing areas, concluded that "if we cannot predict the danger sites, we cannot prevent detachment."ĮNCIRCLING LASER PROPHYLAXIS BY SLIT-LAMP DELIVERY In one frequently cited study 1,2 of fellow eyes undergoing cataract extraction, focal treatment of all visible lesions in 124 fellow eyes would have prevented only two of 21 subsequent detachments, because 19 of the 21 detachments (90%) were caused by new breaks in normal appearing peripheral retina. Retinopexy treatment of asymptomatic predisposing lesions appears to be effective at preventing RRD emanating from the treated lesions, but too often new tears occur in normal-appearing retina between treated lesions (Figure 1). We do have the benefit, however, of a comprehensive literature review by the American Academy of Ophthalmology Preferred Practice Patterns committee.1 This review found that focal treatment of asymptomatic holes, tears, and lattice degeneration was not supported with data of significant strength. While much has been written on the subject of RRD prophylaxis, the literature still lacks randomized, controlled trials. This report provides an overview of this study, pending further analysis and the additional follow-up needed for a final report. 4īased on this experience, and similar results in other eyes at high risk of RRD, we believe that producing a "second ora" (ora secunda) posterior to the at-risk peripheral retina by laser cerclage (ora secunda cerclage ) is the first reported retinopexy treatment that can reliably protect eyes known to be at high risk of RRD. This pilot study of 269 pseudophakic fellow eyes was presented at the 2002 combined meeting of the Retina Society and the American Society of Retina Specialists (ASRS). This is especially important to patients who have suffered loss of macular function in the first eye and for whom a second RRD could be catastrophic.īecause most causative tears in these fellow eyes have been reported to occur in normal-appearing peripheral retina, 2 we have applied encircling laser prophylaxis with the indirect ophthalmoscope (IDO), reducing the RRD rate in pseudophakic fellow eyes from an average of 19% with no treatment or focal treatment to 1.4% ( P<.001), with an average follow-up of 5 years. 1Īlthough it is not widely recognized, fellow eyes of patients with bilateral pseudophakia and first eye detachment suffer an RRD rate of approximately 26%, 2,3 probably constituting the largest group of asymptomatic eyes at high risk of RRD. We now have reasonably successful cures for RRD, but after a half century of trying retinal surgeons have still not developed effective prophylaxis. Before the 20th century, RRD was suddenly blinding to the affected eye and often bilaterally blinding due to subsequent RRD in the second eye. This is certainly on the high end of correction for more standard Ortho-k designs.Rhegmatogenous retinal detachment (RRD) is a well-recognized risk factor for detachment in the fellow eye. With his current Ortho-k design he was still under corrected by about 2.00 Diopters□ The patient baseline Rx is -7.50 -2.00 x 170. The patient was seeing another doctor and was told due to his high Rx he was at the limit of the current Orthok design. This patient came to see us to see if it was possible to get improved Ortho-k results.
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