Clinical Characteristics and Surgical Outcomes of Bilateral Sequential Rhegmatogenous Retinal Detachment

<b>Objectives:</b> To compare the clinical characteristics and surgical outcomes of initial and subsequent eyes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD). <b>Design:</b> Single-center observational retrospective cohort study. <b>Methods:</b> Sixty-eight patients who underwent surgery for sequential, bilateral RRD between January 2016 and December 2023 were included. Baseline characteristics, surgical procedures and postoperative outcomes were collected for both eyes. The primary outcome measure was the single-surgery anatomic success (SSAS), and the secondary outcome was final best-corrected visual acuity (BCVA). <b>Results:</b> Of the sixty-eight patients, 57 (83.8%) were male with a median age of 60.8 [55.1;69.0] years at first presentation. The median interval between RRD in the two eyes was 17.1 [11.5;33.5] months. Subsequent eyes presented with shorter symptom duration (<i>p</i> < 0.001), better baseline BCVA (<i>p</i> = 0.001), fewer quadrants involved (<i>p</i> < 0.001) and less frequent macular detachment (<i>p</i> = 0.004) compared with initial eyes. Preoperative grade B or C proliferative vitreoretinopathy (PVR) was observed in 33.8% of initial and 25.0% of subsequent eyes (<i>p</i> = 0.286). SSAS was achieved in 66.2% of initial and 73.5% of subsequent eyes (<i>p</i> = 0.458), with PVR as the main cause of failure (65.2% versus 61.1%, <i>p</i> = 1). The final median BCVA was similar in both eyes (0.1 [0.0;0.4] logMAR, <i>p</i> = 0.901). <b>Conclusions:</b> Although subsequent eyes were diagnosed earlier and presented with less advanced RRD, these advantages did not result in superior anatomical or functional outcomes. The high prevalence of PVR in both eyes likely accounts for these findings, supporting the hypothesis of a shared biological predisposition.