Impact of retinal break location on surgical outcomes in primary uncomplicated rhegmatogenous retinal detachment: Superior versus inferior breaks

Abstract Purpose To compare the anatomical and functional outcomes of pars plana vitrectomy (PPV) for primary uncomplicated rhegmatogenous retinal detachment (RRD) with superior versus inferior retinal breaks. Methods This retrospective study included 675 eyes of 675 patients, of which 476 had exclusively superior breaks and 199 had at least one inferior break. Patients underwent primary PPV with air or gas endotamponade (SF₆, C 2 F₆ or C₃F₈) between January 2015 and March 2025. The primary outcome was single‐surgery anatomical success at 6 months. Redetachment‐free survival was analysed using Kaplan–Meier estimates and the log‐rank test. Secondary analyses included final anatomical success, tamponade choice, concurrent phacoemulsification and postoperative best‐corrected visual acuity. Results Six‐month anatomical status was evaluable in 489 eyes. Single‐surgery anatomical success (SSAS) was achieved in 90.0% of eyes with superior breaks compared with 78.3% of eyes with inferior breaks ( p < 0.001). After adjustment for symptom duration, lens status, retinal‐detachment extent, number of retinal breaks and tamponade agent, inferior‐break location remained associated with lower odds of success (adjusted OR 0.46, 95% CI 0.22–0.98; p = 0.044). At final follow‐up, success rates were 91.6% and 83.9%, respectively ( p = 0.003). Redetachment‐free survival was significantly lower in eyes with inferior breaks (log‐rank p = 0.001). No significant association between concurrent phacoemulsification and anatomical success was detected, although the combined‐surgery subgroups were small. Final visual acuity was similar in macula‐on detachments. In macula‐off detachments, the statistically significant difference favouring superior breaks was approximately 0.11 logMAR and of limited clinical relevance. Conclusions The presence of at least one inferior retinal break was associated with lower 6‐month anatomical success and reduced redetachment‐free survival. The findings regarding concurrent phacoemulsification and tamponade choice should be interpreted cautiously because of limited subgroup sizes.