Pars plana Vitrectomy for the Treatment of Rhegmatogenous Retinal Detachments: Overview of Anatomical/Functional Success Rates and Drivers of Failure

INTRODUCTION: This study aims to investigate the anatomical and functional success rate of pars plana vitrectomy (PPV) for the treatment of primary rhegmatogenous retinal detachment. METHODS: Retrospective, consecutive series, single-centre study of vitrectomy naïve patients that underwent PPV for primary rhegmatogenous retinal detachment between 2021 and 2023. Recorded preoperative data included lens status, retinal defects, extent of the detachment (total versus subtotal), macula status, presence of proliferative vitreoretinopathy and best corrected visual acuity (BCVA, in logmar). Inferior detachments were defined based on the presence of a retinal break in the detached retina between 5-7 clock hours. Intraocular tamponade was performed with either C3F8 gas or silicone oil and a low threshold for retinectomy was adopted. Anatomical success was defined as complete retinal reattachment 3 months after oil removal or gas absorption; functional success was defined as BCVA equal or better than 1.00. RESULTS: This study included 104 eyes from 104 patients (59% male) with a mean age of 61.9±12.5 years; 17 (16.2%) were high myopes and 34 (32.4%) had already undergone cataract surgery. Most (56; 53.8%) presented with multiple retinal defects; 43 (41.3%) had inferior retinal detachments. Tamponade was performed with C3F8 gas in 84.8% of cases. Single-surgery reattachment success was 86.5%; final anatomical success was 100% after a median of 2 surgeries (only 1 patient required 4 surgeries for final reattachment). Surgery in inferior defects had an overall single surgery success rate of 81.4% versus 90% in the remaining patients (x²=1.75, p=0.42); moreover, in a binary logistic model, no single included variable independently predicted anatomical success. Only 30.5% of patients had a preoperative BCVA equal or less than 1.0. Postoperative visual acuity improved from 1.71±0.09 to 0.58±0.05, with overall better final BCVA in macula-on patients (0.64 vs 0.22, p<0.001). Functional success was achieved in 84.8% of patients, a relevant increase from baseline (x²=7.2, p=0.007). CONCLUSION: Pars plana vitrectomy is increasingly considered the gold standard for the treatment of rhegmatogenous retinal detachments. Our success rate closely resembles the available published data, with high overall success rates in achieving anatomical reattachment and preserving or restoring visual function.