Heimann H, Bornfeld N, Bartz-Schmidt U K, Hilgers R-D, Heussen N
St. Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
Klin Monbl Augenheilkd. 2009 Dec;226(12):991-8. doi: 10.1055/s-0028-1109873. Epub 2009 Dec 15.
The effect of the surgeon on the outcome of surgical treatment for rhegmatogenous retinal detachment (RRD) has previously been analysed in a few studies only. In the prospective multicentre SPR study, scleral buckling (SBS) and primary vitrectomy (PV) were compared in RRD with medium complexity in a randomised fashion. In this study, we examined the surgeon factor on the outcome of RRD surgery within the SPR study.
An analysis of the surgeon as a factor on the functional outcome (logMAR visual acuity), primary anatomic success (retinal reattachment central to the aequator without any additional retina-affecting surgery including laser, cryo and macular pucker surgery) and final anatomic success (retinal reattachment one year postoperatively) was carried out.
Overall, 416 phakic patients (209 SBS, 207 PV) and 265 pseudophakic patients (133 SB, 132 PV) were recruited by 45 surgeons in 25 centres. In the phakic group, the mean functional outcome of individual surgeons was between 0.2 and 0.74 (mean, 0.41, SD 0.41). This difference reached statistical significance (p = 0.0398). In the pseudophakic subgroup, the mean functional outcome was between 0.09 and 0.64 (mean, 0.42, SD 0.49) without reaching a statistical significance (p = 0.0715). Primary success per surgeon varied between 41.67 % and 90.00 % (mean, 63.16 %) in the phakic subgroup and 33.33- 80.95 % (mean, 61.75 %) in the pseudophakic subgroup. Final anatomic success was achieved in 92.86 - 100.00 % (mean, 97.96 %) in the phakic subgroup and 80.00 - 100.00 % (mean, 95.44 %) in the pseudophakic subgroup. There was no statistically significant correlation between surgeon and anatomic outcomes.
In the phakic subgroup, a statistically significant correlation between surgeon and functional success could be demonstrated for RRD with medium complexity. This correlation was not interrelated to the surgical method. Functional outcome in pseudophakic patients and anatomic outcomes in both subgroups of phakic and pseudophakic patients showed no statistically significant correlation between surgeon and anatomic success.
先前仅有少数研究分析了外科医生对孔源性视网膜脱离（RRD）手术治疗结果的影响。在一项前瞻性多中心SPR研究中，对中度复杂性RRD患者随机比较了巩膜扣带术（SBS）和一期玻璃体切除术（PV）。在本研究中，我们在SPR研究范围内探讨了外科医生因素对RRD手术结果的影响。
分析外科医生这一因素对功能结局（logMAR视力）、初次解剖学成功（赤道中心部视网膜复位，无需进行任何包括激光、冷冻和黄斑皱襞手术在内的其他影响视网膜的手术）和最终解剖学成功（术后一年视网膜复位）的影响。
总体而言，25个中心的45名外科医生招募了416例有晶状体眼患者（209例行SBS，207例行PV）和265例无晶状体眼患者（133例行SBS，132例行PV）。在有晶状体眼组中，各外科医生的平均功能结局在0.2至0.74之间（平均0.41，标准差0.41）。这种差异具有统计学意义（p = 0.0398）。在无晶状体眼亚组中，平均功能结局在0.09至0.64之间（平均0.42，标准差0.49），未达到统计学意义（p = 0.0715）。在有晶状体眼亚组中，每位外科医生的初次成功率在41.67%至90.00%之间（平均63.16%），在无晶状体眼亚组中为33.33%至80.95%（平均61.75%）。有晶状体眼亚组的最终解剖学成功率为92.86%至100.00%（平均97.96%），无晶状体眼亚组为80.00%至100.00%（平均95.44%）。外科医生与解剖学结局之间无统计学显著相关性。
在有晶状体眼亚组中，对于中度复杂性RRD，可证明外科医生与功能成功之间存在统计学显著相关性。这种相关性与手术方法无关。无晶状体眼患者的功能结局以及有晶状体眼和无晶状体眼两个亚组的解剖学结局显示，外科医生与解剖学成功之间无统计学显著相关性。
