Comparative outcomes of focal laser versus 360-degree laser in vitrectomy for retinal detachment: a systematic review and meta-analysis.

purposeThe choice of technique for primary repair in rhegmatogenous retinal detachment (RRD) is of extreme importance for the visual prognosis. However, no study has been able to statistically determine the role of 360° endolaser retinopexy compared to focal retinopexy during intraoperative pars plana vitrectomy (PPV), emphasizing their associated benefits and complications. Therefore, this meta-analysis aimed to compare whether performing 360° laser would result in higher rates of Single Surgery Anatomical Success (SSAS) (primary outcome), and lower rates of postoperative epiretinal membrane (ERM) and macular edema (ME) (secondary safety outcomes), and Best-Corrected Visual Acuity (BCVA) (secondary functional outcome), compared to focal endolaser.

methodsThe primary outcome was Single Surgery Anatomical Success (SSAS). The secondary outcomes included postoperative Best-Corrected Visual Acuity (BCVA) (functional), and the incidence of Epiretinal Membrane (ERM) and macular edema (safety). Eligibility criteria encompassed randomized controlled trials (RCTs) and nonrandomized cohort studies that compared 360° laser retinopexy to focal retinopexy during pars plana vitrectomy for rhegmatogenous retinal detachment (RRD). Studies published up to the search date were included. We systematically searched PubMed, Scopus, and Cochrane from May 2024 to November 2025, following the PRISMA guidelines. The primary outcomes measured were Single Surgery Anatomical Success (SSAS) and postoperative Best-Corrected Visual Acuity (BCVA). Secondary outcomes included the incidence of Epiretinal Membrane (ERM) and macular edema. We performed a meta-analysis using the random-effects model and assessed heterogeneity using the I² statistic. We evaluated the risk of bias using the Cochrane Risk of Bias tool for RCTs and the ROBINS-I tool for nonrandomized studies. We conducted a pre-specified subgroup analysis based on the study design. Finally, we assessed the Certainty of Evidence using the GRADE system.

resultsPooled analysis of 4.320 eyes and ten studies revealed that the 360-degree laser group was associated with a higher incidence of Single Surgery Anatomical Success (SSAS) (OR = 0.79; 95% CI 0.65–0.95). In contrast, the combined analysis of six articles revealed that there was no statistically significant difference in Best-Corrected Visual Acuity (BCVA) between the groups (MD = 0.06; 95% CI -0.01–0.13). The incidence of epiretinal membrane formation epiretinal membrane (ERM) was lower at the focal laser group (OR = 0.98, 95% CI 0.67–1.44). Finally, the combined analysis revealed no significant difference in the rate of macular edema between the groups (OR = 1.04; 95% CI 0.61–1.79).

conclusionCompared with focal laser therapy, 360° criterion laser prophylaxis during PPV was superior in terms of single surgery anatomical success (SSAS) in the treatment of rhegmatogenous retinal detachment (RRD). However, we must understand these findings with caution due to the broad inclusion of various study designs, particularly nonrandomized retrospective cohorts. Although this approach provided a broader evidence base, it introduces potential bias, as highlighted by the quality assessment. Furthermore, limitations in the randomization process observed in one of the two included randomized controlled trials (RCTs) slightly weaken the overall statistical support for clinical application. The absence of any statistically significant differences in functional outcomes Best-Corrected Visual Acuity (BCVA) or the development of complications between the methods indicates that, currently, the choice of treatment should be highly individualized based on the patient’s characteristics and clinical situation. Better-designed RCTs are necessary to support the superior anatomical success observed and to establish a standard of care. PROSPERO REGISTRATION ID: CRD42024568314.