C3F8 gave no anatomical advantage and worse vision than SF6 or C2F6 in routine retinal detachment

Design

Propensity-matched analysis of a multinational surgical registry

Population

7,466 eyes with low-to-moderate complexity primary rhegmatogenous retinal detachment

Primary outcome

Single-operation anatomical success and postoperative visual acuity

Effect

C3F8 vs C2F6: 0.10 logMAR worse (95% CI 0.07 to 0.14); C3F8 vs SF6 CMO OR 2.72 (1.13 to 6.57)

Using a European vitreoretinal registry from 2012 to 2024, researchers compared the three common tamponade gases in low-to-moderate complexity primary rhegmatogenous retinal detachments: 7,466 eyes for anatomical success and 5,734 for vision, with propensity matching and pre-specified equivalence margins.

C3F8 showed no anatomical advantage over SF6 (OR 0.83, 95% CI 0.58 to 1.13). It was associated with worse postoperative acuity than C2F6 (0.10 logMAR, about one line) and SF6 (0.09 logMAR), more cystoid macular oedema than SF6 (OR 2.72), and more raised pressure than C2F6. C2F6 and SF6 gave similar vision; C2F6 showed a possible small anatomical benefit over both other gases, but the intervals came close to no effect.

Some surgeons choose C3F8 for the longer tamponade it gives. For uncomplicated detachments, these data suggest it buys nothing anatomically and costs vision. The results do not apply to complex detachments with proliferative vitreoretinopathy, where longer tamponade may still be needed.

• Consider SF6 or C2F6 rather than C3F8 for low-to-moderate complexity primary retinal detachments.
• Reserve longer-acting C3F8 for cases with a specific reason to need longer tamponade.
• Watch for cystoid macular oedema and raised pressure after C3F8.
• Counsel patients that longer-acting gas means longer posturing and flight and altitude restrictions.

Why it matters

Choosing the longest-acting gas by default may cost about a line of vision without improving reattachment.

Don't overread it

This is registry data with matching, not randomisation; surgeons may have chosen C3F8 for eyes they judged riskier.

The statistics, in plain English

A difference of 0.10 logMAR is about one line on a vision chart. The anatomical odds ratios hover near 1 with wide intervals, so differences in reattachment are uncertain; the vision and complication differences are clearer.

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