Laser retinopexy

The purpose of laser retinopexy is to create firm chorioretinal adhesions around areas of retinal holes or breaks to prevent liquefied vitreous from entering into the subretinal space and causing a retinal detachment. Three rows of interlocking confluent laser spots should be applied to completely surround the retinal break. The factors that determine the effectiveness of laser retinopexy include the wavelength of laser used, the power of the laser, duration of treatment, and the spot size. Laser retinopexy frequently uses argon or diode laser (green, yellow, or infrared light) as it is well absorbed by melanin and hemoglobin with poor absorption by xanthophyll pigments. The laser spots should be gray to moderately white burns, and the power of the laser can be titrated to produce such results, usually requiring several hundred (200-300) mW. The duration of treatment can be adjusted with shorter duration treatments requiring more power and longer treatment times being more effective when applying treatment through poor media clarity or shallow subretinal fluid. Spot sizes of 100-500 μm are standard for laser retinopexy. Smaller spot sizes can yield higher power per unit of area than larger spot sizes, and caution should be used when small spot sizes are used not to rupture Bruch's membrane.