Management and Outcomes of Bilateral Simultaneous Rhegmatogenous Retinal Detachments

<b>Purpose:</b> To describe a modified approach to managing bilateral simultaneous rhegmatogenous retinal detachment (RRD) based on factors other than macular status to guide surgical timing and sequencing. <b>Methods:</b> We retrospectively reviewed 47 patients with bilateral simultaneous RRD and grouped them into cohorts by macular status at presentation: cohort AA (both macula-attached, n = 23), cohort DD (both detached, n = 10), and cohort DA (1 attached and 1 detached, n = 14). Cohort DA was further divided, based on which eye was operated on first, into 3D (macula-detached eye first, n = 6) and 3A (macula-attached eye first, n = 4). Mean postoperative logMAR visual acuity (VA) is reported. <b>Results:</b> The mean ± SD time to surgery was 3.4 ± 10.2 days for the first eye and 19.4 ± 30.2 days for the second. No patients experienced RD progression in the second eye between surgeries. There was no difference in postoperative VA between the first and second-operated eyes in cohort AA (0.1 vs 0.1, <i>P</i> = .90) and cohort DD (0.4 vs 0.9, <i>P</i> = .10). In cohort DA, in macula-detached eyes, visual outcomes were significantly better when the macula-detached eye was operated on first (0.5 in group 3D vs 0.9 in group 3A, <i>P</i> = .03). In macula-attached eyes, no significant difference was observed (0.1 in group 3D vs 0.2 in group 3A, <i>P</i> = .63). Across all cohorts, the first-operated eye tended to be more symptomatic, lack signs of chronicity, or have a larger detachment. <b>Conclusions:</b> Bilateral simultaneous RRD often presents with chronic features. Surgical decision-making should consider symptom duration and clinical indicators of chronicity, not just macular status. Prioritizing eyes with more acute presentation may improve visual outcomes, while eyes with chronic findings may tolerate delayed repair.