Key Takeaway: Peripheral laser photocoagulation for retinal degeneration does not significantly increase the risk of epiretinal membrane (ERM) formation, but certain treatment parameters might.
Prophylactic laser treatment for peripheral retinal degeneration is a cornerstone of our practice to prevent retinal detachment. While highly effective, concerns about its potential to cause inflammation and secondary ERM formation persist. A new retrospective study provides much-needed clarity.
The Bottom Line: Reassuring but with Caveats
The study followed 726 eyes treated with laser for peripheral degeneration (excluding those with retinal breaks to isolate the laser’s effect). Over a mean follow-up of nearly 2.5 years, the incidence of new ERM was 4.41%.
Crucially, this rate is slightly lower than the 5-year cumulative incidence (5.3%) reported in the population-based Blue Mountains Eye Study, where patients received no treatment. This key comparison suggests the laser itself is not a major driver of ERM.
Who is at Risk? Identifying the Modifiable Factors
Clinical Implications: A Refined Surgical Approach
This data supports a refined approach to prophylactic treatment:
- Reassurance: You can counsel patients that the laser treatment itself carries a very low, non-incremental risk of causing vision-threatening ERM.
- Precision Treatment: The principle of “less is more” is validated. When treating extensive areas of degeneration, consider staging treatment or being judicious with spot count, especially near the posterior border.
- Risk Stratification: Older patients with extensive lattice degeneration requiring broad treatment are at higher baseline risk. This should be noted in counseling, though the risk is attributable more to their age and pathology than the laser.
The Bigger Picture
This study helps disentangle the effect of laser treatment from the underlying retinal pathology. Previous studies showing higher ERM rates often included eyes with retinal breaks, where the break itself (causing RPE dispersion and inflammation) is a significant confounder.
By studying eyes with degeneration only, this research provides cleaner evidence that a well-applied laser barrier is a safe procedure.
Final Thought: Prophylactic laser remains a safe and effective tool. By minimizing laser burden where possible—using the minimum number and extent of spots needed to secure the retina—we can likely further mitigate any theoretical risk.
Based on: Xie B, Lin Y, et al. “Epiretinal membrane formation following laser photocoagulation for peripheral retinal degeneration: incidence and risk factors.” Eye (2025).
Very Useful Paper. Thanks