Gas tamponade choice in low-to-moderate complexity primary rhegmatogenous retinal detachment: propensity-matched comparisons of SF₆, C₂F₆ and C₃F₈.

Abstract

To compare single-operation anatomical success, postoperative visual acuity, and complications after rhegmatogenous retinal detachment (RRD) repair using sulphur hexafluoride (SF₆), perfluoroethane (C₂F₆), or perfluoropropane (C₃F₈). 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. Matched main-outcome cohorts had effective sample sizes up to 4155. For single-operation anatomical success, estimates favoured C₂F₆ over SF₆ (OR 1.19; 95% CI 0.97 to 1.48; p=0.10), and C₂F₆ over C₃F₈ (OR 1.28; 1.01 to 1.65; p=0.048), although the CIs included effects close to the null. C₃F₈ showed no anatomical advantage over SF₆ (OR 0.83; 0.58 to 1.13; p=0.35), with CIs compatible with possible harm. For postoperative visual acuity, C₂F₆ and SF₆ were similar (MD -0.01 logMAR; -0.04 to 0.01; p=0.29), while C₃F₈ was associated with worse acuity than C₂F₆ (MD 0.10 logMAR worse; 0.07 to 0.14; p<0.001) and SF₆ (MD 0.09 logMAR worse; 0.04 to 0.13; p<0.001). Cystoid macular oedema (CMO) was more common with C₃F₈ than SF₆ (OR 2.72; 1.13 to 6.57; p=0.026), while raised IOP was less likely with C₂F₆ than C₃F₈ (OR 0.41; 0.24 to 0.68; p<0.001). In matched low-to-moderate complexity RRD cohorts, C₂F₆ and SF₆ were associated with similar postoperative visual acuity. C₃F₈ was associated with worse postoperative visual acuity compared to both other gases, as well as increased risks of CMO compared to SF₆ and of raised IOP compared to C₂F₆. Anatomical estimates were consistent with a possible benefit for C₂F₆ over the other gases, and indicated no clear advantage for C₃F₈.