Comparison of the effect of gas and silicone oil tamponades on visual outcomes in the surgical treatment of rhegmatogenous retinal detachment

The choice of tamponade material for pars plana vitrectomy during rhegmatogenous retinal detachment surgery determines the overall success of the procedure. This study examined how gas and silicone oil tamponades affect visual results, retinal thickness measurements, and treatment-related complications. Records of patients who underwent vitrectomy for primary rhegmatogenous retinal detachment in our clinic between January 2020 and December 2025 were retrospectively reviewed. A total of 113 eyes were included in the study, of which 68 were treated with gas and 45 with silicone oil tamponade. Propensity score matching was performed to eliminate baseline differences between groups, with a balance target of standardized mean difference < 0.20 for all covariates, and 40 patients in each group were analyzed. Visual acuity, intraocular pressure, retinal thickness parameters on optical coherence tomography, and complications were evaluated. At six months, the median BCVA was 0.18 (IQR 0.10–0.40) logMAR in the gas group and 0.48 (IQR 0.22–0.90) logMAR in the silicone oil group (p = 0.003; mean: 0.32 ± 0.49 vs. 0.64 ± 0.59 logMAR), with 70% of silicone oil eyes still having oil in situ at this time point. Post-tamponade clearance BCVA remained superior in the gas group (median 0.18 vs. 0.42 logMAR, p = 0.038). Clinically significant visual improvement was achieved in the gas group 70% and silicone oil group 47.5%. A significant decrease in parafoveal retinal thickness, including RNFL, GCL, and GCL + IPL layers, and increase in intraocular pressure were observed in the silicone oil group. Post-tamponade clearance anatomical success rates were similar in both groups (95.0% vs. 87.5%, p = 0.432). In the multivariate analysis, tamponade type was found to be an independent factor affecting visual outcomes. Gas tamponade provides better functional outcomes than silicone oil in the treatment of primary rhegmatogenous retinal detachment. In addition to anatomical success, long-term visual prognosis and the potential for inner retinal layer toxicity should also be considered when selecting tamponade.