While laser retinopexy is typically a safe procedure, complications may arise. Inadvertent laser to the macula, choroidal effusions (especially when large amounts of laser are used), angle closure glaucoma, ERM formation, anterior segment laser burns, hemorrhage (of the retina, vitreous, or choroid), choroidal neovascular membrane formation, and the formation of new retinal breaks are just a few examples [8]. In this study, we used OCT to study the microstructural changes following laser retinopexy in patients with high-risk peripheral retinal lesions and found no statistically significant changes in central macular thickness and peripapillary global retinal nerve fiber layer thickness at 6 months follow up periods. Also, the incidence of ERM, VMT and CME following laser retinopexy in our patients were 0% at 6 months follow up periods.

Mester U, et al. studied retrospectively 2000 eyes with retinal breaks and degenerations that had been treated with argon laser photocoagulation, with follow-up ranging from 6 to 84 months (mean 46 months). Only petectal intra- and preretinal hemorrhages occurred after photocoagulation, which resolved after a few days. Complications after treatment were limited to ERM formation in the macular area in four eyes (0.2%). Three of these four eyes had much more applied laser energy (mean 34.4 mJ) than the other 2000 eyes (mean 7.2 mJ). They came to the conclusion that extensive photocoagulation is linked to an increased risk of ERM [9]. With the exception of one study that reported a significantly higher incidence of macular ERM formation, characterized as macular pucker, after laser treatment or cryoretinopexy (40 and 43%), previous studies showed a low (0 to 2.3%) incidence of macular ERM formation, after laser treatment or cryotherapy [6]. Two hundred five eyes with retinal tears treated with laser retinopexy, cryoretinopexy, or both were reviewed retrospectively by Saran BR and colleagues (with minimum 6 months follow-up). 10% of eyes treated with cryoretinopexy, 14% of eyes treated with laser, and 18% of eyes treated with both cryoretinopexy and laser retinopexy developed an ERM. There was no statistically significant difference in the incidence of macular ERM across the treatment modalities. They found that the difference in ERM incidence in their research compared to prior studies might be due to changes in categorization, detection sensitivity, and degree of treatment [6]. Blackorby BL,et al. evaluated retrospectively 2257 eyes with retinal tears treated with laser retinopexy, or cryoretinopexy. After treatment of retinal tears, 4.32% of cryoretinopexy eyes and 2.90% of laser retinopexy eyes had an ERM. The average time to ERM formation in their research was 11.5 months for cryoretinopexy and 12 months for laser retinopexy [1]. At the 6-month follow-up in our trial, none of the patients developed ERM. This outcome might be related to the fact that our research had fewer patients or a shorter follow-up period.

In patients treated with laser retinopexy, Khan Ashraf A and colleagues observed a 3.16% incidence of retinal detachment (RD). Early detachments (within 100 days of laser retinopexy) were caused by new or overlooked breaks in their study. In their investigation, the late RD was caused by the same treated retinal break. This finding might be owing to early undertreatment with sluggish advancement, or minor innocuous ocular trauma that progresses to RD via regions of weak retinal adhesion [10]. At the 6-month follow-up in our study, none of our patients developed RD.

Only a few studies have looked at changes in macular OCT following laser retinopexy. In one research, 25 myopic eyes with peripheral lattice degenerations had their macular OCT alterations assessed following laser photocoagulation. They found that following laser photocoagulation, the vitreoretinal tractions were blunted in macular OCT [11]. Ours is the first prospective research to show changes in macular and RNFL OCT following peripheral laser photocoagulation retinopexy (for retinal breaks, retinal holes, retinal dialysis, and lattice degenerations). After peripheral laser photocoagulation retinopexy, no statistically significant differences in macular and RNFL OCT values were identified.

There is no research on IOP variations following laser retinopexy in the literature. However, there have been some reports of alterations in IOP after panretinal laser photocoagulation (PRP). Increases in IOP of more than 6 mmHg are prevalent after PRP, with 32% to 94% of patients seeing a rise in IOP of more than 6 mmHg [12, 13]. In a research by Blondeau et al., all occurrences of PRP-related ocular hypertension were diagnosed within 2 hours after laser therapy [13]. No patients in our research had a rise in IOP throughout their follow-up.

This is the first prospective research to look at vitreoretinal interface disorders development, microstructural alterations in the macular, and RNFL OCT in patients who had peripheral laser photocoagulation retinopexy. Nonetheless, there are several drawbacks to this research, the most important limitation of this study is small sample size. Retinal tears that require laser retinopexy are not as common as other retinal diseases that require photocoagulation laser therapy, so larger series would be difficult to obtain in a single institution. On the other hand, photocoagulation laser is a safe procedure, and even a study with larger sample size would not add information for decision taking, if the incidence of macular changes were low. The other limitations are absence of a control group and the use of a non-randomized technique to recruit patients from a restricted number of medical institutions, which raises the risk of selection bias. Furthermore, we followed up with the patients for roughly 6 months, and longer follow-up periods may reveal a larger complication rate. More prospective clinical studies with larger sample numbers and longer follow-ups are required to assess microstructural changes in the macula and ONH, as well as to determine the incidence of vitreoretinal interface disorders development and clinically significant macular pucker following laser retinopexy.