Unit of Vitreoretinal Surgery, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
Acta Ophthalmol. 2018 Aug;96(5):442-451. doi: 10.1111/aos.13641. Epub 2018 Jan 16.
Vitreoretinal (VR) surgery is the third most common intraocular surgery after refractive and cataract surgery. The impact of statin therapy on VR surgery outcomes remains unclear, despite a potentially beneficial effect. We explored the association of preoperative statin therapy and the need for revitrectomy after primary vitrectomy.
Our historical, population-based, register-based, VR surgery cohort consisted of 5709 patients operated in a tertiary, academic referral hospital in Finland, during 2008-2014, covering 6.5 years. Subgroup analysis was performed as follows: eyes operated due to (i) rhegmatogenous retinal detachment (RRD), (ii) VR interface diseases (macular pucker/hole), (iii) diabetic maculopathy or proliferative retinopathy, (iv) vitreous haemorrhage, (v) lens subluxation, (vi) vitreous opacities or (vii) other VR indication. The primary end-point event was revitrectomy during a postoperative follow-up period of 1 year due to retinal redetachment, vitreous rehaemorrhage, postoperative endophthalmitis, recurrent pucker or unclosed macular hole.
Rhegmatogenous retinal detachment (RRD) was the second most frequent indication of VR surgery, including 1916 patients, with 305 re-operations with rate 0.20 (95% CI 0.18-0.23) per person-year. Statin treatment in time of operation was associated with lower risk of re-operation according to relative scale (incidence rate ratio 0.72, 95% CI 0.53-0.97), but not in absolute scale (incidence rate difference -0.58, 95% CI -4.30 to 3.15 for 100 person-years). No association with statin therapy and vitrectomy outcome was observed in the other VR subgroups.
Use of statin treatment was associated with a 28% lower risk of revitrectomy in patients operated due to RRD. Further randomized clinical trials are highly warranted.
玻璃体视网膜（VR）手术是继屈光和白内障手术后的第三大常见眼内手术。尽管他汀类药物治疗可能具有有益作用，但它对 VR 手术结果的影响仍不清楚。我们探讨了术前他汀类药物治疗与原发性玻璃体切除术后行玻璃体再切除术之间的关系。
我们的历史、基于人群的、基于登记的 VR 手术队列包括 2008-2014 年期间在芬兰一家三级学术转诊医院接受手术的 5709 名患者，覆盖了 6.5 年。进行了亚组分析，如下所示：（i）孔源性视网膜脱离（RRD）、（ii）VR 界面疾病（黄斑前膜/裂孔）、（iii）糖尿病性黄斑病变或增殖性视网膜病变、（iv）玻璃体积血、（v）晶状体半脱位、（vi）玻璃体混浊或（vii）其他 VR 指征而接受手术的眼睛。主要终点事件是在术后 1 年的随访期间，由于视网膜再脱离、玻璃体积血、术后眼内炎、复发性黄斑前膜或未闭合的黄斑裂孔，再次行玻璃体切除术。
RRD 是 VR 手术的第二大常见指征，包括 1916 例患者，再手术率为 0.20（95%CI 0.18-0.23）/人年。手术时接受他汀类药物治疗与再手术风险降低相关（相对标度的发生率比为 0.72，95%CI 0.53-0.97），但在绝对标度上无差异（发生率差值-0.58，95%CI-4.30 至 3.15/100 人年）。在其他 VR 亚组中，未观察到他汀类药物治疗与玻璃体切除术结果之间的关联。
RRD 患者接受他汀类药物治疗与玻璃体再切除术风险降低 28%相关。强烈需要进一步的随机临床试验。
