David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA.
Am J Ophthalmol. 2019 Aug;204:1-6. doi: 10.1016/j.ajo.2019.02.032. Epub 2019 Mar 6.
Patients afflicted with clinically significant vitreous floaters suffer from vision-degrading myodesopsia, characterized by impairment in contrast sensitivity function (CSF) and decreased quality of life. This study determined the cost-effectiveness of limited vitrectomy for this condition.
Retrospective, interventional case series and third-party insurer cost-utility analysis.
Sixty-seven patients suffering from unilateral vitreous floaters (20 non-myopic patients with posterior vitreous detachment [PVD]; 17 myopic patients [>-2 diopters] without PVD; 30 myopic patients with PVD) completed the National Eye Institute Visual Function Questionnaire (VFQ-39) and were tested with best-corrected visual acuity (BCVA) and CSF measurements before and after limited vitrectomy. A reference case cost-utility analysis was performed.
The mean VFQ-39 increased 19% (P < 0.00001) after surgery, with general vision improving 27% for the entire group and 37% for non-myopic PVD (P < 0.00001 for each). VFQ-39 correlations with time tradeoff utilities indicated a 14.4% improvement in quality of life. Mean BCVA improved 13.5% postoperatively (P < 0.00001) and CSF improved 53% (P < 0.00001). The incremental patient value gain conferred by limited vitrectomy was 2.38 quality-adjusted life-years (QALYs), and the average cost-utility ratio in 2018 U.S. real dollars was $1,574/QALY.
Limited vitrectomy for vision-degrading myodesopsia is clinically effective, in that it improves BCVA, CSF, and patient well-being. It is also highly cost-effective ($1,574/QALY), with an average cost-utility ratio vs. no therapy that is superior to cataract surgery ($2,262/QALY), amblyopia therapy ($2,710/QALY), and retinal detachment repair ($45,304/QALY). Myopic patients without PVD had the lowest cost-utility ratio of all ($1,338/QALY).
患有明显玻璃体浮游物的患者会出现影响视力的眼球震颤，其特征是对比敏感度功能 (CSF) 受损和生活质量下降。本研究旨在确定有限玻璃体切除术对此类疾病的成本效益。
回顾性、干预性病例系列和第三方保险公司成本效用分析。
67 名单侧玻璃体浮游物患者（20 名非近视伴后玻璃体脱离 [PVD] 患者；17 名近视>-2 屈光度无 PVD 患者；30 名近视伴 PVD 患者）完成了国家眼科研究所视觉功能问卷 (VFQ-39)，并在有限玻璃体切除术前和术后进行了最佳矫正视力 (BCVA) 和 CSF 测量。进行了参考病例成本效用分析。
术后 VFQ-39 平均增加 19%（P<0.00001），整个组的一般视力提高了 27%，非近视 PVD 组提高了 37%（均 P<0.00001）。VFQ-39 与时间权衡效用的相关性表明生活质量提高了 14.4%。术后平均 BCVA 提高 13.5%（P<0.00001），CSF 提高 53%（P<0.00001）。有限玻璃体切除带来的患者价值增益为 2.38 个质量调整生命年 (QALY)，2018 年美国实际美元的平均成本效用比为 1574 美元/QALY。
有限玻璃体切除治疗视力下降的眼球震颤在临床上是有效的，因为它可以提高 BCVA、CSF 和患者的健康状况。它也具有很高的成本效益（1574 美元/QALY），与不治疗相比，其平均成本效用比优于白内障手术（2262 美元/QALY）、弱视治疗（2710 美元/QALY）和视网膜脱离修复（45304 美元/QALY）。无 PVD 的近视患者的成本效用比最低（1338 美元/QALY）。
