Corneal Nerve Damage and Ocular Surface Impairment After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

To evaluate the impact of pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment on corneal innervation and ocular surface integrity, and to assess the influence of intraoperative tamponade type (silicone oil vs. gas) on corneal sensitivity, tear film stability, epithelial damage, and subbasal nerve morphology.

In this prospective multicenter study, 50 eyes of 50 patients undergoing primary PPV with 360-degree endolaser photocoagulation were enrolled. The patients were stratified based on tamponade type: silicone oil (n = 30) or C3F8 gas (n = 20). Assessments performed at baseline and 1 month postoperatively included Cochet-Bonnet corneal sensitivity, tear break-up time, fluorescein staining, and in vivo confocal microscopy for subbasal nerve analysis (corneal nerve fibers density, corneal nerve fibers length, corneal nerve branch density). Corneal epithelial complications (persistent epithelial defects and neurotrophic ulcers) were also recorded.

Postoperatively, significant reductions were observed in corneal sensitivity (from 4.2 ± 1.1 cm to 2.5 ± 1.3 cm, P = 0.0006), tear break-up time (from 7.4 ± 2.1 to 3.6 ± 2.5 seconds, P = 0.0003), and subbasal nerve parameters (corneal nerve fibers density, corneal nerve fibers length, corneal nerve branch density, all P < 0.001). Corneal complications were reported in 8 patients (16%), 6 of whom were in the silicone oil group. Silicone oil was associated with significantly worse outcomes in all parameters compared with gas tamponade (P < 0.001).

PPV for rhegmatogenous retinal detachment significantly impairs corneal innervation and ocular surface integrity, with silicone oil tamponade associated with more severe reductions in corneal sensitivity, tear film stability, and subbasal nerve morphology. These findings highlight the importance of tamponade choice and warrant strategies to minimize postoperative ocular surface damage.