- Design
- Propensity-matched analysis of a multinational surgical registry
- Population
- 7,466 eyes with low-to-moderate complexity primary rhegmatogenous detachment
- Primary outcome
- Single-operation anatomical success and postoperative acuity
- Effect
- C3F8 vs SF6 success OR 0.83 (0.58 to 1.13); acuity 0.09 logMAR worse (0.04 to 0.13)
This BEAVRS–EURETINA registry analysis, published 15 September in the British Journal of Ophthalmology, compared SF6, C2F6 and C3F8 gas tamponade after repair of low-to-moderate complexity rhegmatogenous retinal detachment from 2012 to 2024, using propensity-score matching. It included 7,466 eyes for anatomical outcomes and 5,734 for vision.
C3F8 showed no anatomical advantage over SF6 (OR 0.83, 95% CI 0.58 to 1.13). C2F6 was modestly favoured over C3F8 (OR 1.28, 1.01 to 1.65) and perhaps over SF6 (OR 1.19, 0.97 to 1.48). Final acuity was similar for C2F6 and SF6, but about 0.1 logMAR — one line — worse with C3F8 than either. C3F8 was associated with more cystoid macular oedema than SF6 (OR 2.72) and more raised pressure than C2F6.
Longer-acting gas is often chosen as insurance in straightforward detachments. These data suggest that insurance does not pay: it lengthens positioning and travel restrictions while giving slightly worse vision. C3F8 keeps its place in complex cases, which this analysis excluded.
- Use SF6 or C2F6 rather than C3F8 as the default for low-to-moderate complexity detachments.
- Reserve C3F8 for complex detachments, such as those with inferior breaks or PVR.
- Warn patients given C3F8 of a higher chance of macular oedema and raised pressure.
- Shorter-acting gases shorten flying and altitude restrictions.
Why it matters
Challenges the habit of reaching for the longest-acting gas as a safety margin.
Don't overread it
Registry data with matching, not randomisation; surgeons' reasons for choosing a gas may not be fully captured.
The statistics, in plain English
A difference of 0.1 logMAR is about one line on a Snellen chart. The anatomical odds ratios had confidence intervals close to 1, so differences in reattachment are small and uncertain; the vision and complication differences are clearer.
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