Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.
Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
Am J Ophthalmol. 2018 Dec;196:82-90. doi: 10.1016/j.ajo.2018.08.024. Epub 2018 Aug 23.
To evaluate trends for rhegmatogenous retinal detachment (RRD) repair and the influence of patient characteristics on repair type in a large US population including children and adults, between 2003 and 2016.
Retrospective cohort study.
Setting: Administrative claims for beneficiaries in a large nationwide managed-care network, including Medicare Advantage, employer-sponsored, and commercial insurance.
Beneficiaries undergoing RRD primary repair procedures.
RRD repair procedure type.
We identified 31 995 beneficiaries with RRD over the study period, mean age 59.8 years. Ocular comorbidities, including pseudophakia (16.9%), vitreous hemorrhage (14.6%), myopia (2.9%), and lattice degeneration (11.0%), were more common among RRD than non-RRD patients. Pars plana vitrectomy (PPV) was consistently the most common repair procedure, increasing over time. Scleral buckle utilization declined and utilization of other procedures remained relatively constant. After adjustment for age, demographics, and geographic region, PPV was more likely among patients with pseudophakia (OR = 1.81, P < .001) and vitreous hemorrhage (OR = 1.38, P < .001). Lattice degeneration (OR = 1.42, P < .001) and younger age were associated with higher odds of scleral buckle. Pneumatic retinopexy was more likely among patients with better systemic health and less likely among patients with ocular comorbidities including vitreous hemorrhage or lattice degeneration.
PPV is increasingly the most common RRD repair procedure across a broadly representative US population. However, other techniques are still preferred for some patients and, in aggregate, choice of repair procedure seems influenced by patient characteristics in a manner consistent with recommendations in the literature.
评估 2003 年至 2016 年期间，在美国一个包括儿童和成人的大型人群中，视网膜脱离（RRD）修复的趋势，以及患者特征对修复类型的影响。
回顾性队列研究。
设置：在一个大型全国管理式医疗网络的受益人中进行行政索赔，包括医疗保险优势、雇主赞助和商业保险。
接受 RRD 初次修复手术的受益人。
RRD 修复手术类型。
在研究期间，我们确定了 31995 名患有 RRD 的受益人，平均年龄为 59.8 岁。眼部合并症，包括后房型人工晶状体（16.9%）、玻璃体积血（14.6%）、近视（2.9%）和格子样变性（11.0%），在 RRD 患者中比非 RRD 患者更常见。经睫状体平坦部玻璃体切除术（PPV）一直是最常见的修复手术，且随着时间的推移呈上升趋势。巩膜扣带术的应用减少，而其他手术的应用保持相对稳定。在调整年龄、人口统计学和地理位置后，在患有后房型人工晶状体（比值比 [OR] = 1.81，P <.001）和玻璃体积血（OR = 1.38，P <.001）的患者中，更可能进行 PPV。格子样变性（OR = 1.42，P <.001）和年龄较小与巩膜扣带术的高几率相关。在全身健康状况较好的患者中，更有可能进行气动视网膜复位术，而在患有玻璃体积血或格子样变性等眼部合并症的患者中，这种手术的可能性较小。
在一个具有广泛代表性的美国人群中，PPV 逐渐成为 RRD 修复的最常见方法。然而，对于某些患者，其他技术仍然是首选，并且总体而言，修复手术的选择似乎受到患者特征的影响，这与文献中的建议一致。
