Risk of rhegmatogenous retinal detachment following pars plana vitrectomy for full-thickness macular hole and epiretinal membrane in pseudophakic eyes

Purpose: To estimate the risk of rhegmatogenous retinal detachment (RRD) following pars plana vitrectomy (PPV) for full-thickness macular hole (FTMH) or epiretinal membrane (ERM) in pseudophakic eyes. Methods: We conducted a nationwide Danish registry-based cohort study from 2010 to 2023. Eyes entered the study at phacoemulsification surgery (age ≥ 50) and were followed until outcome (RRD), exposure (PPV), or censoring (death, end of study, or competing events). PPV was analysed as a time-dependent exposure occurring after phacoemulsification surgery, with eyes considered exposed from the time of PPV onwards. Results: A total of 680 858 eyes were included. Median follow-up was 4.8 years (IQR, 2.5–7.9) after phacoemulsification and 5.0 years (2.5–7.9) after PPV, with a median interval of 76 days (39–328) between procedures. The 1-year cumulative incidence of RRD after PPV for FTMH was 0.62% (95% CI, 0.40–0.93), significantly higher in males. For ERM, it was 0.43% (0.27–0.66), with no sex difference. Compared to phacoemulsification alone, the hazard ratio (HR) for RRD was increased in males operated on for FTMH (HR 2.60; 1.62–4.17) and in females operated on for ERM (HR 1.93; 1.07–3.49). Among those who remained event-free 1 year postoperatively, no significant difference in RRD risk was observed between groups. Conclusions: PPV in pseudophakic eyes has a low risk of RRD but higher than that of phacoemulsification surgery after the first year, with notable sex variations for FTMH. Among those who remained event-free 1 year postoperative, no difference in RRD risk was observed between PPV and phacoemulsification surgery.