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有症状飞蚊症的管理:玻璃体视网膜外科医生当前的态度、观念及实践

Management of Symptomatic Floaters: Current Attitudes, Beliefs, and Practices Among Vitreoretinal Surgeons.

作者信息

Cohen Michael N, Rahimy Ehsan, Ho Allen C, Garg Sunir J

出版信息

Ophthalmic Surg Lasers Imaging Retina. 2015 Sep;46(8):859-65. doi: 10.3928/23258160-20150909-11.

Abstract

BACKGROUND AND OBJECTIVE

To assess the current attitudes, beliefs, and practice patterns among vitreoretinal surgeons when dealing with symptomatic floaters in patients with otherwise healthy eyes.

PATIENTS AND METHODS

A cross-sectional, Internet-based anonymous survey of 10 questions was distributed via email to vitreoretinal specialists practicing in the United States.

RESULTS

The survey response rate was 6.1% (159 of 2,600). Forty of 159 respondents (25%) reported they would perform pars plana vitrectomy (PPV) to reduce symptomatic floaters, and 110 of 159 (69%) had previously performed PPV for this indication. When compared to those unlikely to intervene for symptomatic floaters, 33 of 40 (83%) of those likely to intervene performed more than 100 vitrectomy surgical cases annually (P<.05). Between those that had and had not performed PPV for symptomatic floaters in the past, statistically significant differences were observed regarding the likelihood to perform PPV for symptomatic floaters in the future (35% vs. 4%; P<.0001) and tendency to elect a procedure if the surgeon's own vision were impacted by symptomatic floaters (55% vs. 8%; P<.001). When compared to those likely to perform surgery for symptomatic floaters, those unlikely to intervene identified three statistically significant barriers: the surgical risks involved with PPV (28% vs. 86%; P<.001), unrealistic patient expectations (25% vs 58%; P<.001), and the possibility of ridicule from the local retina community (10% vs. 32%; P<.01).

CONCLUSION

Vitreoretinal specialists are more likely to intervene for symptomatic floaters if they have previously done so and if they perform more than 100 surgical cases per year. The major barriers preventing physicians from performing an intervention for floaters are standard risks associated with PPV, the fear of unreasonable patient expectations, and the possibility of ridicule within the local retina community.

摘要

背景与目的

评估玻璃体视网膜外科医生在处理眼部健康但有症状性飞蚊症患者时当前的态度、信念及实践模式。

患者与方法

通过电子邮件向美国执业的玻璃体视网膜专科医生发放一份基于网络的包含10个问题的横断面匿名调查问卷。

结果

调查回复率为6.1%(2600人中159人回复)。159名受访者中有40人(25%)报告他们会进行玻璃体切割术(PPV)以减少有症状性飞蚊症,159人中有110人(69%)此前曾因该适应症进行过PPV。与那些不太可能因有症状性飞蚊症进行干预的人相比,40名可能进行干预的人中33人(83%)每年进行超过100例玻璃体切割手术(P<0.05)。在过去曾对有症状性飞蚊症进行过PPV和未进行过PPV的人之间,在未来对有症状性飞蚊症进行PPV的可能性(35%对4%;P<0.0001)以及如果外科医生自身视力受有症状性飞蚊症影响时选择手术的倾向(55%对8%;P<0.001)方面观察到统计学上的显著差异。与那些可能因有症状性飞蚊症进行手术的人相比,那些不太可能进行干预的人确定了三个统计学上显著的障碍:PPV涉及的手术风险(28%对86%;P<0.001)、患者不切实际的期望(25%对58%;P<0.001)以及来自当地视网膜学界嘲笑的可能性(10%对32%;P<0.01)。

结论

玻璃体视网膜专科医生如果此前曾对有症状性飞蚊症进行过干预且每年进行超过100例手术病例,则更有可能对有症状性飞蚊症进行干预。阻止医生对飞蚊症进行干预的主要障碍是与PPV相关的标准风险、对患者不合理期望的担忧以及当地视网膜学界嘲笑的可能性。

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