Risk-Stratified Outcomes of Prophylactic Laser Versus Observation for Pediatric Peripheral Retinal Lesions
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Ryan S Meshkin1, Muhammad Abidi1, Francisco Altamirano2
1Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Objective:
To compare clinical characteristics and outcomes of pediatric eyes with peripheral retinal breaks or lesions managed with prophylactic laser retinopexy versus observation, including outcomes within a predefined high-risk subgroup.
Design:
Retrospective cohort study.
Subjects:
Participants, and/or Controls: A total of 273 eyes from patients younger than 18 years diagnosed with peripheral retinal tears, holes, or lattice degeneration at a tertiary pediatric ophthalmology center. Eyes with retinal detachment at initial presentation were excluded. Observed eyes served as the comparison group for laser-treated eyes.
Methods:
Intervention, or Testing: Electronic medical records were reviewed to extract demographic data, lesion characteristics, presence of subretinal fluid (SRF), symptom status, traumatic etiology, refractive error, management strategy, and follow-up outcomes. Eyes were classified as high-risk if SRF, symptoms, or trauma were present at baseline. Outcomes were compared between observation and laser groups overall and within the high-risk subgroup.
Main Outcome Measures:
Development of retinal detachment (RD) during follow-up. Secondary outcomes included best-corrected visual acuity (BCVA) and development of complications such as epiretinal membrane or cataract during follow-up.
Results:
Of 273 included eyes, 172 (63.0%) were observed and 101 (37.0%) underwent prophylactic laser. Laser-treated eyes had significantly higher baseline risk features, including SRF, symptomatic presentation, traumatic etiology, high myopia, and complex lesion types (all p < 0.05). Over a median follow-up of 18.5 months, RD occurred in 5.0% of lasered eyes and 1.2% of observed eyes (p = 0.105). Among high-risk eyes, RD rates did not differ significantly between laser and observation groups (11.4% vs 4.2%, p = 0.413). Final BCVA and rates of epiretinal membrane or cataract formation did not differ between groups. Retinal detachment was uncommon across lesion subtypes, including lattice degeneration and atrophic holes.
Conclusions:
Prophylactic laser retinopexy in pediatric eyes was preferentially applied to lesions with greater anatomic and clinical risk but was not associated with a statistically significant reduction in retinal detachment rates compared with observation. These findings suggest that many pediatric peripheral retinal lesions may be safely managed with observation and highlight the need for pediatric-specific evidence to guide treatment decisions.