Visual outcomes and predictive factors after pars plana vitrectomy for macula-off rhegmatogenous retinal detachment: a retrospective cohort from Southern Thailand

Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition requiring surgery. Although pars plana vitrectomy (PPV) is the preferred treatment for macula-off RRD, outcomes and visual recovery factors vary across studies. This study aimed to evaluate the outcomes of PPV for acute macula-off RRD and identify factors associated with a favorable visual outcome in Thailand. This retrospective cohort study, we reviewed the electronic medical records of patients with acute macula-off RRD treated with PPV at Songklanagarind Hospital between 2018 and 2021, with a minimum follow-up was 12 months. Data collected included demographics, duration of macular detachment (from onset of central visual loss to surgery), best-corrected visual acuity (BCVA), and intraoperative findings. Anatomical reattachment rates and BCVA improvement were analyzed at 1, 3, 6, and 12 months using percentages and mixed-effects random-intercept linear regression. Factors associated with favorable visual outcomes were assessed using univariate and multivariate logistic regression and receiver operating characteristic curve analysis. In total, 140 eyes from 139 patients were analyzed. Mean logarithm of the minimum angle of resolution BCVA improved significantly from 1.50 (95% confidence interval [CI]: 1.41–1.59) at baseline to 0.78 (95% CI: 0.69–0.87) (p < 0.001), with retinal reattachment achieved in 132 eyes (94.3%). A final BCVA of 20/50 or better (≤ 0.4 LogMAR) was observed in 39 eyes (27.86%). Independent predictors of this outcome were PPV performed within 7 days of symptom onset (area under the receiver operating characteristic curve [AUC], 0.763; OR, 3.40; 95% CI, 1.42–8.19; p = 0.006), age ≤ 60 years (OR, 2.82; 95% CI, 1.20–6.62; p = 0.018), and the use of gas tamponade (OR, 2.59; 95% CI, 1.09–6.14; p = 0.030). PPV is an effective surgical approach for managing acute macula-off RRD. Early surgical intervention within 7 days of symptom onset, younger patient age ($$\:<$$60 years), and the use of gas tamponade may be associated with better visual outcomes. These findings may have clinical relevance by supporting risk stratification, optimizing surgical decision-making, and improving patient counseling regarding visual prognosis.