Ring Indenter Scleral Self-Indentation Versus Assistant-Assisted Indentation for Basal Vitrectomy in Primary Rhegmatogenous Retinal Detachment: A Retrospective Cohort Study.

Abstract

To evaluate the safety and efficacy of a ring indenter scleral self-indentation technique for basal vitrectomy under noncontact wide-angle viewing in primary rhegmatogenous retinal detachment (RRD) repair compared with conventional assistant-assisted indentation. This single-center retrospective cohort study enrolled 99 eyes of 99 primary RRD patients who underwent pars plana vitrectomy with basal vitreous shaving from August 2023 to May 2025, with ≥6 months follow-up. Patients were divided into study group (52 eyes, surgeon's finger ring scleral self-indentation) and control group (47 eyes, conventional assistant-assisted indentation). Main outcomes: retinal redetachment rate, final BCVA, and shaving-induced retinal breaks (SIRBs) incidence. The baseline demographic and clinical characteristics were comparable between the two groups. The retinal redetachment rate was 1.92% (1/52) in the study group and 2.13% (1/47) in the control group (P=1.000). Both groups demonstrated significant improvements in BCVA after the surgery compared with the preoperative values (P<0.0001). No significant differences were observed between the two groups in the final BCVA (P=0.365) and BCVA improvement (P=0.168). The incidence of SIRBs was one case in each group (P=1.000). No intraoperative instrument displacement, infusion cannula dislodgement, or anesthesia-related complications occurred in either group. The ring indenter scleral self-indentation technique is a safe and effective alternative to assistant-assisted indentation for basal vitreous clearance during RRD vitrectomy. This cost-effective technique eliminates the need for assistant support or chandelier illumination, offering the advantages of autonomous and precise manipulation, clear visualization, and manpower conservation.