Can Preventive Retinal Laser Reduce Detachment Risk in the Fellow Eye?

After retinal detachment in one eye, the fellow eye carries increased risk, particularly when peripheral retinal lesions such as lattice degeneration (LD), retinal tears (RTs), or atrophic holes are present. Prophylactic retinopexy is used to create adhesion around selected lesions, but the benefit of preventive treatment for asymptomatic peripheral abnormalities—especially lattice degeneration—remains uncertain.

Primary objective: To estimate the pooled risk ratio for retinal detachment in prophylactically treated versus observed fellow eyes after contralateral RD and to examine whether results differed by peripheral lesion subtype.

• Design: Registered systematic review and meta-analysis (PROSPERO CRD420251142739), reported in accordance with PRISMA 2020 and MOOSE guidance.
• Search: MEDLINE, EMBASE, Scopus, Cochrane Library/CENTRAL, and ClinicalTrials.gov; literature searched from January 1980 through September 20, 2025. Reference and citation searching identified additional reports.
• Included evidence: Nine observational studies comprising 5,084 fellow eyes: 1,768 treated and 3,316 observed. No randomized controlled trials contributed to the included evidence base.
• Eligibility: Studies compared prophylactic laser or cryotherapy with observation in fellow eyes after contralateral RD and reported RD outcomes. Studies with fewer than 15 eyes, non-English publications, conference abstracts, animal studies, and studies published before 1980 were excluded.
• Lesion groups: Analyses included isolated lattice degeneration (LD-only), lattice degeneration with associated retinal tear (LDRT), and lattice degeneration with associated atrophic hole (LDAH), where data permitted.

• Primary outcome: Retinal detachment incidence in treated versus untreated fellow eyes.
• Secondary outcomes: RD risk by lesion subtype, treatment modality, and complications where reported.
• Effect measure: Risk ratios (RRs) were pooled using random-effects Mantel–Haenszel methods, with restricted maximum-likelihood estimation of between-study variance.
• Additional analyses: Laser-only subgroup analysis, lesion-specific subgroup analyses, sensitivity analyses by publication era and control definition, and leave-one-out analyses.
• Evidence assessment: Risk of bias was evaluated using tools for nonrandomized studies and randomized trials; certainty was graded using GRADE.

• Observed event counts across all nine studies: 73 RDs among 1,768 treated eyes (4.12%) versus 272 among 3,316 observed eyes (8.20%). These are crude proportions across included studies.
• Pooled incidence: 4.47% in treated eyes (95% CI 2.85%–6.95%; I² = 70.6%) and 7.50% in untreated eyes (95% CI 3.41%–15.84%; I² = 90.6%).
• Primary comparative meta-analysis: Across 8 studies and 4,339 eyes, prophylactic treatment was associated with lower RD risk (RR 0.43; 95% CI 0.33–0.57; I² = 0%). GRADE certainty was low.
• Interpretation: The overall estimate favors prophylaxis, but because the evidence is observational, it demonstrates an association rather than proving that treatment alone caused the risk reduction.

• Laser-only subgroup: Four studies including 1,273 eyes found a lower RD risk with prophylactic laser (RR 0.33; 95% CI 0.22–0.49; I² = 0%; low-certainty evidence).
• Isolated lattice degeneration: Three studies including 482 eyes yielded RR 0.33 (95% CI 0.10–1.03; I² = 42.5%). The confidence interval included 1, so the subgroup did not establish a statistically significant reduction.
• Lattice degeneration with retinal tear: Three studies including 319 eyes yielded RR 0.17 (95% CI 0.01–2.11; I² = 66.3%). This estimate was highly imprecise and not statistically significant.
• Lattice degeneration with atrophic hole: Only two studies reported outcomes, and the evidence was not suitable for pooled analysis. One large cohort reported fewer RDs in treated eyes, but this isolated finding is insufficient to establish a definitive subgroup effect.
• Between-subgroup comparison: No studies directly compared treatment effects between LD-only and LDRT cohorts. Their point estimates should not be used to claim that one lesion subtype benefits more than another.

The findings suggest a potential protective association for prophylactic retinopexy in fellow eyes after contralateral RD, a population with elevated baseline risk. However, the study does not establish that every peripheral retinal lesion should be treated. Decisions need to account for lesion type, symptoms, vitreoretinal traction, posterior vitreous detachment (PVD) or hyaloid status, and the individual patient’s risk profile.

The article notes that the 2025 American Academy of Ophthalmology Preferred Practice Pattern recommends prompt treatment of acute symptomatic horseshoe tears, while evidence remains insufficient to establish routine prophylactic treatment for lattice degeneration or atrophic holes in fellow eyes after RD. The present results are hypothesis-generating and do not replace individualized retinal specialist assessment.

Strengths: Prospective registration; systematic searching across multiple databases; duplicate screening and data extraction; random-effects meta-analysis; sensitivity analyses; and formal appraisal of risk of bias and evidence certainty.

Limitations: All nine included studies were observational, with potential confounding by indication and differences in baseline lesion severity. Most studies had moderate risk of bias, and two had serious overall risk of bias. Lesion classification and reporting varied, some lesion-specific outcomes were unavailable, and lens status, PVD, and other important risk modifiers were inconsistently reported. Follow-up ranged from 20 to 96 months, potentially missing later detachments in shorter studies. Low statistical heterogeneity in the primary RR analysis does not exclude clinically important differences between studies.

• Use the overall RR of 0.43 as an observational pooled association, not as proof of a causal treatment effect or a universal treatment mandate.
• Do not interpret the LD-only or LDRT subgroup point estimates as statistically established benefits; both confidence intervals include the null.
• Assess the full clinical context, including lesion characteristics and vitreoretinal status, when discussing prophylaxis with a patient who has had RD in the other eye.
• Explain that evidence certainty is low overall and very low for the reported LD-only and LDRT subgroup estimates.
• Randomized or otherwise methodologically rigorous prospective studies with standardized lesion classification and patient-level risk factors are needed to identify which fellow eyes are most likely to benefit.

This meta-analysis of nine observational studies found that prophylactic retinopexy was associated with a lower risk of retinal detachment in fellow eyes after contralateral RD (pooled RR 0.43; 95% CI 0.33–0.57). The laser-only analysis also favored treatment. However, lesion-specific estimates were imprecise and not statistically significant for isolated lattice degeneration or lattice degeneration with retinal tear, and the overall certainty of evidence was low. The results support further prospective evaluation and individualized clinical decision-making rather than a blanket recommendation to treat all peripheral lesions.

Khatami P, Huh SM, Nezhadi N, Ashamalla M, Tavakoli Hedayatpour A, Sajjadi S, Butt FR, Esomchukwu O, Tao BK, Muni R, Kertes PJ, Navajas EV, Popovic MM. Prophylactic Retinopexy in Fellow Eyes After Contralateral Retinal Detachment: A Systematic Review and Meta-Analysis. Ophthalmology Retina. 2026. doi:10.1016/j.oret.2026.08.008.