Retinal displacement after retinal detachment surgery: Comparative analysis of vitrectomy, scleral buckling, and pneumatic retinopexy

Purpose To evaluate the incidence of postoperative retinal displacement (RD) following three surgical techniques—pars plana vitrectomy (PPV), scleral buckling (SB), and pneumatic retinopexy (PR)—for macula-off rhegmatogenous retinal detachment (RRD). Methods In this retrospective observational study, 183 eyes with primary macula-off RRD were treated between June 2021 and June 2023 at a tertiary care retina center. Patients underwent one of three surgical techniques: PPV, SB, or PR. RD was assessed using fundus autofluorescence imaging and correlated with early face-down positioning (EFP) and other clinical variables. Results RD incidence varied by technique: 36.3% after PPV, 21.2% after SB, and 8.1% after PR. In PPV cases, gas tamponade was associated with higher RD rates than silicone oil (68.4% vs. 29.8%, p = 0.010), and perfluorocarbon liquid (PFCL) use was associated with increased RD (44.1% vs. 0%, p = 0.009). Adherence to EFP had no significant protective effect ( p = 0.985). Metamorphopsia was more frequent in patients with RD ( p = 0.040); final visual acuity was similar across groups. Conclusions RD is most common after PPV and least frequent after PR. Surgical choices, particularly tamponade type and PFCL use, significantly influence RD risk and should guide surgical planning.