Surgical Management of Primary Rhegmatogenous Retinal Detachment: Experiences from a Serbian Tertiary Center

(1) Background: Rhegmatogenous retinal detachment (RRD) requires timely surgical repair, most commonly using pars plana vitrectomy (PPV), scleral buckling (SB), or pneumatic retinopexy (PR). Surgical practice varies across regions, while contemporary real-world data from Southeastern Europe remain limited. This study evaluated contemporary surgical management and 12-month outcomes of primary RRD at a Serbian tertiary referral center. (2) Methods: This retrospective, single-center observational study included 188 patients who underwent primary RRD repair between January and December 2024. Patients were treated with PPV, SB, or PR and followed for up to 12 months. Best-corrected visual acuity (BCVA) was assessed preoperatively and at postoperative day 1, day 7, and at 1, 3, 6, and 12 months. Longitudinal BCVA changes were analyzed using a linear mixed-effects model, with generalized estimating equations used as a complementary population-averaged analysis. Retinal re-detachment and postoperative intraocular pressure (IOP) elevation were also evaluated. (3) Results: PPV was performed in 104 patients (55.3%), SB in 48 (25.5%), and PR in 36 (19.1%). Baseline characteristics differed significantly among groups, including age, lens status, macular status, symptom duration, and preoperative BCVA. Longitudinal analysis demonstrated significant effects of time (F = 119.53, p < 0.001), macular status (F = 86.36, p < 0.001), symptom duration (F = 2.93, p = 0.035), and a significant time-by-surgery interaction (F = 4.86, p = 0.009). Model-estimated BCVA at 12 months was 0.77 logMAR after PPV, 0.58 after SB, and 0.28 after PR. However, PR patients had more favorable baseline characteristics. Retinal re-detachment occurred in 18.6% of patients, with no significant difference among surgical groups (p = 0.246). Early postoperative IOP elevation was significantly more frequent after PPV (22.3%) than after SB (0%) or PR (2.9%) (p < 0.001). (4) Conclusions: All three surgical approaches were associated with substantial visual recovery during 12 months of follow-up. PPV was the predominant surgical strategy, while SB remained frequently used and PR provided favorable outcomes in carefully selected patients. Because of substantial baseline differences among treatment groups, between-group outcome differences should not be interpreted as causal evidence of surgical superiority. Macular status and symptom duration were important determinants of functional recovery.