Prophylactic Treatment Lowers Risk of Fellow-eye RRD, Retinal Break in Non-pathologic Myopes

When debating whether to perform prophylactic treatment of lattice regions in patients who experienced a prior contralateral retinal break or detachment, clinicians should consider the individual’s myopic status, researchers argue. Their recent study found that patients with non-pathologic myopia derived the greatest benefit. Photo: Jay M. Haynie, OD. Click image to enlarge. Patients with lattice degeneration in the fellow eye after a retinal break or detachment in the other eye are at substantially higher risk of developing another break or detachment. According to a new study, prophylactic laser retinopexy or cryopexy may meaningfully lower that risk for certain patients. The findings, published recently in the Retina journal, revealed that a prior unilateral rhegmatogenous retinal detachment (RRD) or retinal break (RB) increased the odds of a fellow-eye RRD/RB more than fourfold overall. This risk was especially high in myopic patients, who appeared to benefit most from prophylactic treatment.The retrospective cohort analysis included de-identified patient data from the TriNetX Health Research Network. Records were obtained from patients with unilateral lattice degeneration using eye-specific ICD-10 coding, and researchers cross-checked retinal breaks and detachments using CPT treatment codes. They used logistic regression to calculate the likelihood of RRD or RB in the fellow eye and estimated the number needed to treat (NNT) for prophylactic laser retinopexy and cryopexy. The results showed that patients with a prior RRD/RB in one eye were more likely to experience a detachment or break in the fellow eye than those without a previous unilateral event (odds ratio, OR: 4.47). The association was even stronger in myopic patients (adjusted OR: 5.67) but remained significant in non-myopes (adjusted OR: 4.02). In contrast, high/pathologic myopia did not appear to increase the odds of fellow-eye RRD/RB, which the authors theorized may be because “highly myopic eyes have an inherently higher baseline risk of detachment due to their more severe structural changes.”Lens status also mattered. Phakic patients with prior unilateral RRD/RB had a greater likelihood of fellow-eye disease than the overall cohort (adjusted OR: 5.56), while pseudophakic patients also showed elevated risk but to a lesser degree (adjusted OR: 1.84). However, the researchers caution that “these results may have been biased by the disproportionately lower number of pseudophakic and aphakic eyes in our cohort.”The treatment analysis suggested that higher-risk patients—especially non-pathologic myopes—may benefit substantially from prophylactic laser or cryopexy. For preventing fellow-eye RRD, the NNT was 4.63 in the cohort with prior RRD, compared with 43.29 in those without prior RRD. For myopic patients, the NNT was 3.59, while in non-myopes it was 5.53. For preventing fellow-eye RB, the NNT was 3.83 with prior RB vs. 45.70 without prior RB; among myopes, the NNT was 3.16. “Laser retinopexy and cryopexy possibly circumvent the degenerative process of lattice formation by creating scars that reinforce the retina to the underlying retinal pigment epithelium,” the authors explained in their paper. While current literature on prophylactic laser retinopexy or cryopexy is mixed, the cumulative evidence—including that presented in this study—suggests the strongest potential benefit in patients with major risk factors, such as prior contralateral RRD/RB and myopia.The authors concluded their report by advising clinicians to account for patients’ myopic status when considering prophylactic treatment of lattice regions, as such interventions “were found to confer greater benefits for patients with non-pathologic myopia than those without myopia in preventing RRD/RB.” They caution, however, that “prospective studies that can validate the utility of this intervention are necessary before these findings can be fully adopted into clinical practice.”Click here for the journal source. Arnal L, Mesfin Y, Salvi A, et al. The risk of retinal breaks or detachment in fellow eye with lattice degeneration after primary rhegmatogenous retinal detachment. Retina. July 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.