传统和非传统原发性气动巩膜外冷凝术治疗视网膜脱离的解剖学、视觉和财务结果。
Anatomic, Visual, and Financial Outcomes for Traditional and Nontraditional Primary Pneumatic Retinopexy for Retinal Detachment.
机构信息
East Bay Retina Consultants, Inc, Oakland, California, USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA.
East Bay Retina Consultants, Inc, Oakland, California, USA.
出版信息
Am J Ophthalmol. 2019 Apr;200:187-200. doi: 10.1016/j.ajo.2019.01.008. Epub 2019 Jan 24.
PURPOSE
To determine factors predictive of anatomic, visual, and financial outcomes after traditional and nontraditional primary pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RD).
DESIGN
Retrospective interventional case series and cost comparison.
METHODS
Participants: Total of 178 eyes (156 patients) with PR-repaired primary RD by a single surgeon at a clinical practice from January 2001 to December 2013 and followed for ≥1 year. The cohort had 2 subgroups: traditional (TPR) and nontraditional (NTPR) PR.
MAIN OUTCOME MEASURES
Characteristics associated with best-corrected visual acuity (BCVA) and anatomic outcomes. Cost analysis and potential cost savings comparing PR to scleral buckle and vitrectomy.
RESULTS
One hundred thirty-one of 178 eyes (73.5%) were successfully treated at 1 year (postoperative year 1): 72.8% (75/103) in TPR and 74.6% (56/75) in NTPR. Macula-off detachment (-0.44 logMAR, P < .001) and clock hours of RD (-0.84 logMAR, P < .001) correlated with improved BCVA; pseudophakia (0.26 logMAR, P = .002) and inferior retinal tears (0.62 logMAR, P = .009) correlated with worsening BCVA. Pseudophakia (-0.15, P = .03), inferior quadrant RD (-0.27, P < .001), and proliferative vitreoretinopathy (-0.68, P < .001) correlated with anatomic failure. Total average cost for TPR and NTPR was $1248.37 ± $882.11 and $1471.91 ± $942.84, respectively (P = .10). PR had a potential cost savings of 62% and 60.8% when compared to scleral buckle and vitrectomy, respectively.
CONCLUSIONS
PR results in successful anatomic and visual outcomes in both TPR and NTPR repair of primary RD. Preoperative pseudophakia is associated with worse visual outcomes and less anatomic success. The cost of primary PR and subsequent procedures to achieve final anatomic success was not significantly different between TPR and NTPR, and supports the possible cost-effectiveness of expanded indications for PR.
目的
确定影响传统和非传统原发性气动巩膜外固定术（PR）治疗孔源性视网膜脱离（RD）后解剖、视力和经济结果的因素。
设计
回顾性干预性病例系列和成本比较。
方法
参与者：2001 年 1 月至 2013 年 12 月期间，由一名外科医生在一家临床实践中接受 PR 修复原发性 RD 的 156 例患者共 178 只眼，随访时间≥1 年。该队列分为 2 个亚组：传统 PR（TPR）和非传统 PR（NTPR）。
主要观察指标
与最佳矫正视力（BCVA）和解剖学结果相关的特征。PR 与巩膜扣带和玻璃体切除术的成本分析和潜在成本节约比较。
结果
178 只眼中有 131 只（73.5%）在 1 年内（术后 1 年）成功治疗：TPR 为 72.8%（75/103），NTPR 为 74.6%（56/75）。黄斑脱离（-0.44 对数视力，P <.001）和 RD 时钟小时数（-0.84 对数视力，P <.001）与 BCVA 改善相关；白内障（0.26 对数视力，P =.002）和下方视网膜裂孔（0.62 对数视力，P =.009）与 BCVA 恶化相关。白内障（-0.15，P =.03）、下方象限 RD（-0.27，P <.001）和增殖性玻璃体视网膜病变（-0.68，P <.001）与解剖学失败相关。TPR 和 NTPR 的总平均成本分别为 1248.37 ± 882.11 美元和 1471.91 ± 942.84 美元（P =.10）。与巩膜扣带和玻璃体切除术相比，PR 分别有 62%和 60.8%的潜在成本节约。
结论
TPR 和 NTPR 修复原发性 RD 均能获得成功的解剖和视力结果。术前白内障与视力结果较差和解剖成功率较低有关。TPR 和后续手术以达到最终解剖成功的主要 PR 成本在 TPR 和 NTPR 之间没有显著差异，支持 PR 适应证扩大的可能成本效益。
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