The previous month another patient was examined by a colleague EUA and he found a retinal break without detachment in the eye with prophylaxis he added laser.
The vitreous is very abnormal and its separation causes retinal breaks.
Prophylaxis seems to work in my experience. However, I hear reports of frequent failures and these are my hypotheses:
- The prophylaxis is not targeted correctly to the pathology. For example, it encircle the lattice but not the vitreous base. In stickler disease the major pathology is giant retinal tear and not lattice associated breaks. The lattice can be quite anomalous (termed perivascular). The perivascular lattice may not even carry the increased risk for RD of typical circumferential lattice. Attention to the vitreous base and periphery is the most likely correct targets for the stickler prophylaxis
- The prophylaxis is the wrong pattern. Perhaps it is performed using a contact lens and slit-lamp rather than an indirect delivery
A common side effect of the laser is extended dilation and loss of accommodation because of treatment of the long post cillary nerve, it has always improved. I recently did cryothrapy treatment along the horizontal and laser elsewhere, but it made little difference.
Clearly, if your surgeon has had no experience or poor experience (bad outcomes) with Stickler Prophylaxis then it may not be the way to go and frequent exams may be better. In young kids who may not complain parents should test the vision of each eye on a monthly basis. When a detachment occurs more decisions are required. Scleral Buckle, Vitrectomy or both, etc. If virectomy is done the special attention needs to be given the anomalous vitreous.