Phacovitrectomy versus Vitrectomy for Primary Rhegmatogenous Retinal Detachment in Phakic Eyes: A Multicenter Propensity-Matched Study

Summary

Primary RRD PPV vs PPV+ lensectomy: Similar anatomic success. Multicenter propensity-matched study, 6113 eyes.

Abstract

Objective: To compare anatomic and visual outcomes of pars plana vitrectomy (PPV) versus phacovitrectomy for primary rhegmatogenous retinal detachment in phakic eyes using a multicenter database.

Design: Multicenter propensity score-matched cohort study.

Participants: Phakic eyes of patients aged >45 years undergoing primary rhegmatogenous retinal detachment repair were recorded in the British and Eire Association of Vitreoretinal Surgeons-European Society of Retina Specialists vitreoretinal database (2008-2024). Eyes with oil or perfluorocarbon liquid tamponade, secondary detachments, redo surgery, macular holes, buckles, relaxing retinectomy, or inadequate follow-up (<8 weeks) were excluded. The visual cohort excluded eyes with coexisting pathology affecting vision or missing postoperative visual acuity.

Methods: Generalized propensity score matching was performed. Primary anatomic success was assessed using weighted regression models. Follow-up logarithm of the minimum angle of resolution visual acuity was assessed using weighted linear regression. Sensitivity analyses adjusted for baseline cataract and restricted to eyes pseudophakic at outcome assessment.

Main outcome measures: Primary anatomic success (stable retinal reattachment ≥8 weeks after surgery without oil or perfluorocarbon liquid tamponade), follow-up logarithm of the minimum angle of resolution visual acuity and postoperative complications ≥8 weeks.

Results: A total of 6113 eyes were included in anatomic analyses (PPV 5647/6113 [92.4%]; phacovitrectomy 466/6113 [7.6%]) and 4726 eyes in visual analyses (PPV 4313/4726 [91.3%]; phacovitrectomy 413/4726 [8.7%]). Anatomic success exceeded 90% in both groups. In matched analyses, phacovitrectomy showed no significant difference in anatomic success compared with PPV (odds ratio, 1.20; 95% confidence interval, 0.92-1.60; P = 0.19; adjusted risk ratio, 1.02; 95% confidence interval, 0.97-1.07; P = 0.41). In the matched visual cohort, phacovitrectomy was associated with better visual acuity (-0.056 logarithm of the minimum angle of resolution; ≈3 ETDRS letters; 95% confidence interval, -0.091 to -0.009; P = 0.019). This attenuated after accounting for baseline cataract and restricting to pseudophakic eyes. Cystoid macular edema was more frequent after phacovitrectomy (8/413 [1.94%] vs. 15/4313 [0.35%]; P < 0.001). Other complications were uncommon.

Conclusions: Phacovitrectomy achieved anatomic outcomes comparable to PPV for primary rhegmatogenous retinal detachment repair in phakic eyes. A small visual advantage was observed but attenuated in sensitivity analyses, suggesting the benefit is largely lens-related rather than a retinal treatment effect.