Gas tamponade choice in low-to-moderate complexity primary rhegmatogenous retinal detachment: propensity-matched comparisons of SF 6 , C 2 F 6 and C 3 F 8

Aims To compare single-operation anatomical success, postoperative visual acuity, and complications after rhegmatogenous retinal detachment (RRD) repair using sulphur hexafluoride (SF 6 ), perfluoroethane (C 2 F 6 ), or perfluoropropane (C 3 F 8 ). Methods We analysed British and Eire Association of Vitreoretinal Surgeons—European Society of Retina Specialists (BEAVRS–EURETINA) registry data from 2012 to 2024. After exclusions, 7466 eyes contributed to anatomical and 5734 to visual analyses. Intraocular gas tamponades were compared using propensity-score matching and weighted regression adjustment. Equivalence was tested using prespecified margins of OR 0.80–1.25 for anatomical success and ±0.10 logMAR for postoperative visual acuity. Results Matched main-outcome cohorts had effective sample sizes up to 4155. For single-operation anatomical success, estimates favoured C 2 F 6 over SF 6 (OR 1.19; 95% CI 0.97 to 1.48; p=0.10), and C 2 F 6 over C 3 F 8 (OR 1.28; 1.01 to 1.65; p=0.048), although the CIs included effects close to the null. C 3 F 8 showed no anatomical advantage over SF 6 (OR 0.83; 0.58 to 1.13; p=0.35), with CIs compatible with possible harm. For postoperative visual acuity, C 2 F 6 and SF 6 were similar (MD −0.01 logMAR; −0.04 to 0.01; p=0.29), while C 3 F 8 was associated with worse acuity than C 2 F 6 (MD 0.10 logMAR worse; 0.07 to 0.14; p<0.001) and SF 6 (MD 0.09 logMAR worse; 0.04 to 0.13; p<0.001). Cystoid macular oedema (CMO) was more common with C 3 F 8 than SF 6 (OR 2.72; 1.13 to 6.57; p=0.026), while raised IOP was less likely with C 2 F 6 than C 3 F 8 (OR 0.41; 0.24 to 0.68; p<0.001). Conclusions In matched low-to-moderate complexity RRD cohorts, C 2 F 6 and SF 6 were associated with similar postoperative visual acuity. C 3 F 8 was associated with worse postoperative visual acuity compared to both other gases, as well as increased risks of CMO compared to SF 6 and of raised IOP compared to C 2 F 6 . Anatomical estimates were consistent with a possible benefit for C 2 F 6 over the other gases, and indicated no clear advantage for C 3 F 8 .