Prophylactic Retinopexy in Fellow Eyes After Contralateral Retinal Detachment: A Systematic Review and Meta-analysis

Topic To evaluate whether prophylactic retinopexy reduces the risk of retinal detachment (RD) in fellow eyes after contralateral RD, and to explore whether effect estimates differ by lesion subtypes. Clinical relevance Patients with RD in one eye are at increased risk of RD in the fellow eye. Prophylactic retinopexy is commonly used for peripheral retinal lesions in these high-risk fellow eyes, but the magnitude of benefit across lesion subtypes remains uncertain. Methods This registered systematic review and meta-analysis (PROSPERO: CRD420251142739) searched MEDLINE, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov through September 20, 2025. Studies comparing prophylactic retinopexy with observation in fellow eyes of patients with prior contralateral RD were included. Risk ratios (RRs) of RD were pooled using random-effects models. Risk of bias was assessed using ROBINS-I and evidence certainty using GRADE.” Results Nine observational studies, including 5,084 fellow eyes (1,768 treated; 3,316 observed), were included. The pooled incidence of RD was 4.47% (95% CI; 2.85–6.95%; I 2 = 70.6%) in treated fellow eyes and 7.5% (95% CI; 3.41–15.84%; I 2 = 90.6%) in untreated fellow eyes. Prophylactic retinopexy in fellow eyes was associated with a reduced risk of fellow-eye RD compared with observation (RR 0.43; 95% CI, 0.33–0.57; I 2 = 0%; 8 studies, 4,339 fellow eyes; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] = Low). In analyses restricted to laser retinopexy, results were (RR 0.33; 95% CI, 0.22–0.49; I 2 = 0%; 4 studies, 1,273 fellow eyes, GRADE = Low).. Point estimates favored treatment in LD-only (RR 0.33; 95% CI, 0.10–1.03; I 2 = 42.5%; 3 studies, 482 fellow eyes; GRADE = Very Low) and LDRT cohorts (RR 0.17; 95% CI, 0.01–2.11; I 2 = 66.3%; 3 studies, 319 fellow eyes; GRADE = Very Low), though statistical significance was not achieved in either subgroup analysis. Conclusion Low-certainty evidence suggests that prophylactic retinopexy is associated with a reduced risk of RD in fellow eyes of patients with prior contralateral RD. The LD-only subgroup yielded narrower protective confidence interval than the LDRT subgroup, although both analyses remained imprecise. These findings may support consideration for a randomized study of prophylaxis in selected high-risk fellow eyes.