Prophylactic Laser and Cryotherapy in the Fellow Eye of Patients With Giant Retinal Tears: A Systematic Review and Meta-Analysis

Giant retinal tears (GRTs) are associated with a substantial risk of rhegmatogenous retinal detachment (RD) in the fellow eye. Prophylactic retinal therapy, including laser photocoagulation and cryotherapy, is employed in particular individuals to reduce this risk; however, clinical consensus remains limited due to heterogeneous data. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of prophylactic treatment in preventing RD in the fellow eye of patients with unilateral GRT. A comprehensive literature search was performed via PubMed, ScienceDirect, the Cochrane Library, and ClinicalTrials.gov through July 2025. Patients with unilateral GRT who underwent either observation or prophylactic treatment in their fellow eyes were the subjects of eligible studies. Extracted data included associated risk factors, ocular and systemic comorbidities that might predispose to GRT formation, demographics, treatment modality, follow-up duration, and the incidence of RD or new GRT formation. Risk of bias was assessed using the Joanna Briggs Institute checklist. A random-effects meta-analysis was performed to calculate the pooled relative risk for RD in treated versus untreated fellow eyes, while heterogeneity was evaluated with the I² statistic and publication bias with funnel plots and Egger's test. A total of 803 fellow eyes were included across the eligible studies. Prophylactic treatment significantly reduced the risk of RD compared with observation (OR 0.14; 95% CI 0.07-0.28; p<0.001), with negligible heterogeneity (I²=0%). Subgroup analyses demonstrated consistent benefit for both laser-only and combined laser/cryotherapy approaches. Complications, when described, reduced the risk of RD during treatment, were typically mild, and included post-treatment retinal tears and epiretinal membrane formation; no adverse visual outcomes attributable to prophylactic treatment were consistently recorded. Prophylactic laser photocoagulation alone or in combination with cryotherapy appears effective and safe in reducing RD risk in the fellow eyes of patients with GRT. These findings support the selective use of prophylactic treatment in high-risk eyes; however, high-quality prospective studies are required to validate the long-term advantages.