Surgical Outcomes of Pars Plana Vitrectomy with Air Tamponade for Rhegmatogenous Retinal Detachment

Background and Objectives: This study aimed to evaluate the outcomes of pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD), including selected eyes with grade C proliferative vitreoretinopathy (PVR), and identify factors associated with the initial surgical failure. Materials and Methods: This retrospective, single-center study included 209 eyes of 209 patients treated with PPV and air tamponade. Primary anatomical success was defined as retinal reattachment without additional retinal detachment surgery throughout follow-up. Univariable and multivariable Firth’s penalized logistic regression models were used to explore factors associated with primary surgical failure. Results: Primary anatomical success was achieved in 195/209 eyes (93.3%, 95% CI: 89.1–96.0%) after a mean follow-up of 15.5 (17.8) months, including 15/19 eyes with grade C PVR (78.9%, 95% CI: 56.7–91.5%). Mean visual acuity improved from 1.3 (0.7) logMAR preoperatively to 0.8 (0.6) logMAR at final follow-up (p < 0.001). In the exploratory multivariable model, male sex (OR = 4.24, 95% CI: 1.18–22.53, p = 0.025) and pseudophakia (OR = 4.61, 95% CI: 1.24–16.38, p = 0.024) were nominally associated with primary surgical failure, although these findings require cautious interpretation due to the small number of events. Despite the absence of statistical significance (p = 0.063), a trend toward a lower primary success rate was observed in the grade C PVR (78.9%, 95% CI: 56.7–91.5%) group. Conclusions: PPV with air tamponade achieved a favorable primary anatomical success rate in selected eyes with RRD, including those with PVR grade C, suggesting that with appropriate case selection, even PVR grade C eyes may achieve anatomical reattachment with a single PPV and air tamponade.