Clinical and Surgical Predictors of Visual and Anatomical Outcomes Following Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment
TL;DR
The findings underscore the importance of preserving macular attachment, minimizing surgical delay, and recognizing PVR as a key determinant of both functional recovery and recurrence in optimizing outcomes after PPV for RRD.
Abstract
Objective: To investigate the clinical and surgical factors affecting visual outcomes and recurrence rates following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Methods: This retrospective study included 226 patients who underwent PPV for RRD between 2022 and 2024 at a tertiary care center in Türkiye. Demographic data, duration of symptoms, macular status, presence of proliferative vitreoretinopathy (PVR), type of intravitreal tamponade, pre-and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and recurrence rates were analyzed. Results: Patients had a mean age of 57.9±14.4 years and were predominantly male (67.7%); 76.5% were macula-off, and 25.7% had PVR. Mean BCVA improved significantly from 1.8±0.7 to 1.0±0.6 logMAR (p<0.001), with preoperative BCVA independently predicting postoperative BCVA ( β =0.185, p=0.003). Visual improvement was poorer in eyes with macula-off status (p=0.044) and preoperative PVR (p=0.046), better with earlier surgical intervention (<7 days; p=0.030), and greater with C3F8 tamponade than with other agents (p=0.043), while combined cataract surgery did not influence outcomes (p=0.917). IOP increased modestly from 13.9±3.9 to 15.3±3.9 mmHg (p<0.001); 17.3% of patients required antiglaucoma-tous therapy, more often with silicone oil (SO) tamponade (p=0.023), without affecting final BCVA (p=0.917). Recurrent RRD occurred in 18.6% of patients and was higher in those with PVR (39.7% vs. 11.3%; p<0.01). Multivariable analysis identified PVR as the only independent predictor of recurrence (OR=3.44, p=0.023), and recurrence was lower with C3F8 than with SO (11.1% vs. 24.1%; p=0.026). Conclusion: These findings underscore the importance of preserving macular attachment, minimizing surgical delay, and recognizing PVR as a key determinant of both functional recovery and recurrence in optimizing outcomes after PPV for RRD. ABSTRACT