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Purpose The aim of this study was to compare phacovitrectomy (phacoPPV) to lens-sparing pars plana vitrectomy (PPV) with respect to macular perfusion, thickness, and sensitivity in phakic patients with rhegmatogenous retinal detachment. Patients and methods This is a prospective, comparative, nonrandomized, interventional study that included 31 phakic eyes with primary rhegmatogenous retinal detachment. The patients were divided into two groups according to the preoperative lens status: group A who had significant cataract and group B who did not have significant cataract. Group A included 17 eyes for which phacoPPV was performed, while group B included 14 eyes for which lens-sparing PPV was performed. All patients were preoperatively evaluated clinically and with A-scan ultrasonography and were followed up for 4 months after surgery. Optical coherence tomography angiography (OCTA) and microperimetry were done at 2 and 4 months, postoperatively. Results The OCTA showed that the lens-sparing PPV was associated with significantly larger foveal avascular zone area (0.4±0.2 mm2) compared to the phacoPPV (0.2±0.1 mm2) at 2 months (P=0.048), as well as at 4 months (0.4±0.1 mm2vs. 0.2±0.1 mm2, respectively, P=0.044). However, the foveal avascular zone perimeter showed no statistically significant differences between the two groups at 2 and 4 months postoperatively. At 2 months, the deep vascular plexus (DVP) parafoveal vessel density was statistically significantly higher in the phacoPPV group (47.9±4.7%) compared to the PPV group (36.4±11.9%) (P=0.048), while at 4 months it was the DVP foveal vessel density that showed a significantly higher mean in the phacoPPV group (35.4±11.9%) compared to the PPV group (20.3±16.1%) (P=0.036). No other statistically significant intergroup differences were found with respect to other parameters for macular perfusion, and other DVP parameters. Similarly, the macular sensitivity, as well as the ganglion cell complex, and the central subfield thicknesses were comparable between the two groups. The visual outcome was also comparable at 2 and 4 months between the two groups. Conclusion PhacoPPV and lens-sparing vitrectomy were comparable with respect to OCTA, microperimetry, and visual acuity. The limited differences are too preliminary and the decision to do phacoPPV rather than lens-sparing PPV needs to be based on other determinants like the presence of preoperative lens opacity.