Mulder Verena C, Tode Jan, van Dijk Elon Hc, Purtskhvanidze Konstantine, Roider Johann, van Meurs Jan C, Treumer Felix
The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.
Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany.
Br J Ophthalmol. 2017 Sep;101(9):1285-1289. doi: 10.1136/bjophthalmol-2016-309134. Epub 2017 Jan 11.
BACKGROUND/AIMS: Patients with rhegmatogenous retinal detachment (RRD) who develop postoperative proliferative vitreoretinopathy (PVR) have been found to have higher preoperative laser flare values than patients with RRD who do not develop this complication. Measurement of laser flare has therefore been proposed as an objective, rapid and non-invasive method for identifying high-risk patients. The purpose of our study was to validate the use of preoperative flare values as a predictor of PVR risk in two additional patient cohorts, and to confirm the sensitivity and specificity of this method for identifying high-risk patients.
We combined data from two independent prospective studies: centre 1 (120 patients) and centre 2 (194 patients). Preoperative aqueous humour flare was measured with a Kowa FM-500 Laser Flare Meter. PVR was defined as redetachment due to the formation of traction membranes that required reoperation within 6 months of initial surgery. Logistic regression and receiver operating characteristic analysis determined whether higher preoperative flare values were associated with an increased risk of postoperative PVR.
PVR redetachment developed in 21/314 patients (6.7%). Median flare values differed significantly between centres, therefore analyses were done separately. Logistic regression showed a small but statistically significant increase in odds with increasing flare only for centre 2 (OR 1.014; p=0.005). Areas under the receiver operating characteristic showed low sensitivity and specificity: centre 1, 0.634 (95% CI 0.440 to 0.829) and centre 2, 0.731 (95% CI 0.598 to 0.865).
Preoperative laser flare measurements are inaccurate in discriminating between those patients with RRD at high and low risk of developing PVR.
背景/目的：已发现发生术后增生性玻璃体视网膜病变（PVR）的孔源性视网膜脱离（RRD）患者术前激光闪光值高于未发生此并发症的RRD患者。因此激光激光因此，有人提出测量激光闪光是一种识别高危患者的客观、快速且非侵入性的方法。我们研究的目的是在另外两个患者队列中验证术前闪光值作为PVR风险预测指标的用途，并确认该方法识别高危患者的敏感性和特异性。
我们合并了两项独立前瞻性研究的数据：中心1（120例患者）和中心2（194例患者）。使用Kowa FM - 500激光闪光仪测量术前房水闪光。PVR定义为因牵引膜形成导致的视网膜再脱离，需要在初次手术后6个月内再次手术。逻辑回归和受试者工作特征分析确定术前较高的闪光值是否与术后PVR风险增加相关。
314例患者中有21例（6.7%）发生PVR视网膜再脱离。各中心的中位闪光值差异显著，因此分别进行分析。逻辑回归显示仅中心2的闪光值增加时优势比有小但具有统计学意义的增加（OR 1.014；p = 0.005）。受试者工作特征曲线下面积显示敏感性和特异性较低：中心1为0.634（95% CI 0.440至0.829），中心2为0.731（95% CI 0.598至0.865）。
术前激光闪光测量在区分发生PVR风险高和低的RRD患者方面不准确。
