Procedural Variation in Pars Plana Vitrectomy for the Management of Rhegmatogenous Retinal Detachment: A Retrospective Cohort Study

Abstract

Rhegmatogenous retinal detachment (RRD) is the most prevalent sight-threatening retinal condition, necessitating prompt intervention. Pars plana vitrectomy (PPV) is the preferred method for treating RRD. In this study, we aimed to investigate the procedural variation outcomes of PPV for RRD. This single-center retrospective cohort study aims to investigate the outcomes of primary PPV for patients with RRD who presented to Hamad General Hospital, Doha, Qatar from January 2018 to December 2022. Primary outcomes included anatomical retinal reattachment and best-corrected visual acuity (BCVA). The impact of tamponade choice and internal limiting membrane (ILM) peeling on outcomes was also assessed. Analyses were conducted using the R Statistical language (version 4.1.2; R Core Team, 2021). A total of 187 patients with RRD underwent PPV, either alone or combined with cataract surgery. The average age of the patients was 49.98 ± 12.99 years, and their visual acuity was 1.11 ± 0.69 LogMAR. Among the patients, 114 (61%) had an early-retinal detachment. The macula was on in 54 (28.9%) cases. Success rates were observed in 88.2% (N = 164), while 11.8% failed (N = 11). The success rate was statistically significantly affected by pre-BCVA, quadrants of retinal detachment, and duration of retinal detachment (p-value = 0.002, 0.002, 0.024, respectively). The choice of gas tamponade showed a significantly better BCVA at 0.37 + 0.41 LogMAR. Combined phacoemulsification with Intraocular lens (IOL) implantation and vitrectomy do not significantly affect the overall success of the operation. The final visual acuity showed a significant difference in the effect of ILM peeling with visual acuity better in patients who did not undergo ILM peeling at 0.52 ± 0.49 LogMAR. Combined phacovitrectomy does not significantly affect reattachment success and expedite visual recovery compared to vitrectomy. Gas tamponade shows superior visual outcomes over silicone oil, while ILM peeling requires careful consideration due to its association with poorer visual outcomes. Early intervention and appropriate procedural choices are crucial for optimizing RRD repair outcomes. Further prospective, multicenter studies are necessary to validate these findings.