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Cumulative clinical risk factor burden stratifies the need for additional retinal intervention after laser retinopexy
Hiroki Sano1, Ryoji Yanai2, Yuto Hayahara2
1Department of Ophthalmology, Tokushima Red Cross Hospital, 103 Irinokuchi, Komatsushima-cho, Komatsushima, Tokushima 773-8502, Japan.
Purpose:
This study aimed to determine whether the cumulative burden of clinical risk factors at initial presentation stratifies the need for additional retinal intervention after laser retinopexy for retinal tears.
Design:
Retrospective clinical cohort study.
Subjects:
A total of 285 eyes of 285 patients who underwent initial laser retinopexy for retinal tears at a single tertiary referral center between April 2010 and December 2025.
Methods:
The medical records were retrospectively reviewed. Vitreous hemorrhage, multiple retinal tears, and subretinal fluid adjacent to the retinal tear at initial presentation were designated as the core risk factors. Each factor was assigned 1 point, yielding a core risk factor count ranging from 0 to 3. Additional retinal intervention was defined as supplemental laser treatment to the initial tear, laser treatment for new retinal tears, surgery for progression to rhegmatogenous retinal detachment, or vitrectomy for nonclearing vitreous hemorrhage.
Main Outcome Measures:
Occurrence of any additional retinal intervention after initial laser retinopexy.
Results:
During follow-up, 43 eyes (15.1%) required additional retinal intervention. Additional laser treatment was performed in 32 eyes, while surgical intervention was performed in 11 eyes. The median time to the first additional intervention was 3.0 weeks (interquartile range, 2.0-9.5 weeks). In the multivariable logistic regression analysis adjusted for the other two core factors, vitreous hemorrhage (adjusted odds ratio [OR], 22.0; 95% confidence interval [CI], 6.09-79.6; P < 0.001), multiple retinal tears (adjusted OR, 18.4; 95% CI, 5.81-58.0; P < 0.001), and subretinal fluid (adjusted OR, 17.3; 95% CI, 5.84-51.0; P < 0.001) were independently associated with additional retinal intervention. The rate of additional intervention progressively increased with the number of core risk factors: 0.6% with no factors, 22.9% with one factor, 76.9% with two factors, and 100% with three factors (Cochran-Armitage test for trend, P < 0.001). The group with all three factors included only three eyes.
Conclusions:
The cumulative number of vitreous hemorrhage, multiple retinal tears, and subretinal fluid was associated with a graded increase in additional retinal intervention after laser retinopexy. This simple count-based framework may help guide early surveillance, patient counseling, and follow-up planning.
