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Anatomic and Functional Outcomes after Pars Plana Vitrectomy for Giant Retinal Tear-Related Retinal Detachment: The
Peter Kiraly1, Tsveta Ivanova2, Evita E Christou2
1Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom.
Purpose:
To evaluate anatomic and functional outcomes after primary pars plana vitrectomy (PPV) for giant retinal tear-related rhegmatogenous retinal detachment (GRT-RRD) and to compare outcomes between gas and silicone oil (SO) tamponade.
Design:
Retrospective, single-center cohort study.
Participants:
One hundred ten consecutive eyes undergoing primary PPV for GRT-RRD at a tertiary vitreoretinal service (2012-2024).
Methods:
Demographic, preoperative, and intraoperative variables were extracted from routinely collected clinical records. Baseline characteristics and outcomes were first compared between SO and gas groups using univariable analyses. To address confounding by indication, full propensity score matching was then performed. Single-surgery anatomic success (SSAS) was assessed with Firth logistic regression and final best-corrected visual acuity (BCVA) with weighted linear regression using G-computation.
Main Outcome Measures:
Single-surgery anatomic success, final anatomic success (FAS), and final BCVA (logarithm of the minimum angle of resolution [logMAR]).
Results:
Mean age was 50.1 (16.0) years, and 83 of 110 (75.5%) patients were men. Macular detachment was present in 46 of 110 (41.8%) eyes. Gas tamponade was used in 76 of 110 (69.1%) eyes (SF6 5 of 110 [4.5%], C2F6 53 of 110 [48.2%], and C3F8 18 of 110 [16.4%]) and SO in 34 of 110 (30.9%) eyes. Single-surgery anatomic success was achieved in 97 of 110 (88.2%) eyes and FAS in 103 of 107 (96.3%). After propensity score matching, male sex was associated with higher odds of SSAS (odds ratio [OR], 4.54; 95% confidence interval [CI], 1.75-11.75; P = 0.002), whereas proliferative vitreoretinopathy (PVR) grade C was associated with lower odds of SSAS (OR, 0.10; 95% CI, 0.02-0.45; P = 0.003). In the overall matched cohort, SO showed a trend toward worse final BCVA versus gas (mean difference [MD], +0.138 logMAR; 95% CI, -0.015 to 0.291; P = 0.077) with similar SSAS. In macula-on matched eyes, SO was associated with worse final BCVA (MD, +0.179 logMAR; 95% CI, 0.018-0.341; P = 0.030) with comparable SSAS (92.6% vs. 90.0%; P = 1.000).
Conclusions:
Primary PPV for GRT-RRD achieved high rates of SSAS and FAS, with C2F6 used as the most common tamponade. After adjustment for confounding, male sex was associated with higher SSAS and PVR grade C with lower SSAS. Single-surgery anatomic success was comparable between groups, whereas visual outcomes showed a trend toward better outcomes with gas in the overall cohort; macula-on analysis should be interpreted cautiously because of the small sample size.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
