Three hundred sixty-degree prophylactic laser retinopexy versus focal laser during rhegmatogenous retinal detachment repair: A systematic review and meta-analysis.

Purpose

To compare the anatomic, functional and safety outcomes of intra-operative 360-degree prophylactic laser retinopexy versus focal laser retinopexy during pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) and to assess the certainty of evidence.

Methods

PubMed, Web of Science and Scopus were searched on June 27, 2025. Randomized controlled trials and comparative observational studies evaluating 360-degree versus focal laser during PPV for RRD were included. Two reviewers independently extracted data and assessed risk of bias (ROB-2, NIH tools). Pooled analyses were conducted using random-effects models, and the certainty of evidence was graded using GRADE. The primary outcome was single-surgery anatomic success (SSAS). Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP) and post-operative complications.

Results

Thirteen studies comprising 3639 eyes were included. Compared with focal laser, 360-degree laser achieved higher odds of SSAS (OR: 1.82; 95% CI, 1.40-2.39; I 2  = 0%; moderate-certainty). No differences were observed in final BCVA (MD = 0.06; 95% CI, -0.01 to 0.13; I 2  = 75.5%) or BCVA improvement (MD: -0.06; 95% CI, -0.22 to 0.11; I 2  = 0%). Rates of epiretinal membrane (OR = 1.11; 95% CI: 0.80-1.54, I 2  = 26.85%, moderate certainty), proliferative vitreoretinopathy (OR = 0.62; 95% CI: 0.36-1.08, I 2  = 0%, moderate certainty), cystoid macular oedema and macular hole were comparable between groups.

Conclusion

Adjunctive 360-degree laser retinopexy during PPV for RRD was associated with higher SSAS without a measurable increase in post-operative complications. However, no improvement in visual acuity outcomes was observed. Given the predominance of observational evidence, further well-designed randomized trials are warranted to clarify the magnitude of benefit.