Stereopsis and Vision-Related Quality of Life After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: A Prospective Cohort Study

To determine whether macular involvement (on or off) at the time of rhegmatogenous retinal detachment (RRD) influences postoperative stereopsis and to explore factors associated with vision-related quality of life (VR-QoL). In this prospective, single-centre observational cohort study conducted at the University Hospital of Tours, patients who underwent successful unilateral pars plana vitrectomy (PPV) for RRD were examined for 6 to 18 months postoperatively between June 2024 and March 2025. Surgical success was defined as anatomical reattachment at 3 months postoperatively. The following data were collected: intraoperative macular involvement, diplopia (orthoptic exam and optotype frame test), stereoacuity (The Netherlands Organization test), distance monocular best-corrected visual acuity, metamorphopsia (M-CHARTS), aniseikonia (New Aniseikonia Test), central retinal thickness and ellipsoid zone integrity on optical coherence tomography, retinal ghost vessels (autofluorescence), and VR-QoL assessed using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Univariate analysis was performed to assess stereopsis, and factors associated with VR-QoL were investigated using multivariate linear regressions. Forty-five patients were included [median age (range): 67 (46–82) years; women: 18 (40%), men: 27 (60%)]. Median duration from RRD repair and assessment was 10 (range 6–18) months. Stereoacuity was significantly worse in the macula-off group than in the macula-on group (p = 0.045). Multivariate analysis revealed that diplopia correlated negatively with the NEI VFQ-25 composite score (p = 0.004). No other variable showed any significant association with the NEI VFQ-25 composite score or its subscales (p > 0.05). Postoperative stereopsis is significantly reduced in patients with macula-off RRD compared to those with macula-on RDD despite successful anatomical repair. However, neither stereopsis loss nor monocular qualitative or quantitative visual loss was significantly associated with VR-QoL in this cohort. Binocular diplopia, regardless of its mechanism, particularly affects VR-QoL, highlighting the importance of tailored postoperative assessment in patients with RRD.