To compare anatomical and visual outcomes of pars plana vitrectomy (PPV) versus phacovitrectomy for primary rhegmatogenous retinal detachment (RRD) repair in phakic eyes using a large multicentre database. Multicentre propensity score–matched cohort study. Phakic eyes of patients aged >45 years undergoing primary RRD repair recorded in the BEAVRS–EURETINA vitreoretinal database (2008–2024). Eyes with oil or PFCL tamponade, secondary or complex detachments, redo surgery, macular holes, buckles, relaxing retinectomy, or inadequate follow-up (<8 weeks) were excluded. The visual cohort excluded eyes with co-pathology affecting vision or missing postoperative visual acuity. Generalised full propensity score matching was performed. Primary anatomical success was assessed using weighted logistic regression and a log-linked Poisson model with robust variance. Follow-up logMAR visual acuity was assessed using weighted linear regression. Sensitivity analyses adjusted for baseline cataract and restricted analyses to eyes pseudophakic at outcome assessment. Primary anatomical success (stable retinal reattachment ≥8 weeks after surgery without oil or PFCL tamponade), follow-up logMAR visual acuity ≥8 weeks, and postoperative complications ≥8 weeks. A total of 6 113 eyes were included in anatomical analyses (PPV 5 647/6 113 (92.4%); phacovitrectomy 466/6 113 (7.6%)) and 4,726 eyes in visual analyses (PPV 4 313/4 726 (91.3%); phacovitrectomy 413/4 726 (8.7%)). Anatomical success exceeded 90% in both groups. In matched analyses, phacovitrectomy showed no significant difference in anatomical success compared with PPV (OR 1.20, 95% CI 0.92–1.60; p=0.19; adjusted RR 1.02, 95% CI 0.97–1.07; p=0.41). In the matched visual cohort, phacovitrectomy was associated with better follow-up visual acuity (–0.056 logMAR, ≈3 ETDRS letters; 95% CI –0.091 to –0.009; p=0.019). This attenuated after accounting for baseline cataract and restricting to pseudophakic eyes. Cystoid macular oedema was more frequent after phacovitrectomy (8/413 (1.94%) vs 15/4 313 (0.35%); p<0.001). Other complications were uncommon, although epiretinal membrane rates were slightly higher after PPV. Phacovitrectomy achieved anatomical outcomes comparable to PPV for primary RRD 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.
Gough et al. (Sun,) studied this question.