糖尿病状态对玻璃体切除术后白内障手术率的影响。

The Influence of Diabetes Status on the Rate of Cataract Surgery Following Pars Plana Vitrectomy.

机构信息

Epidemiology Department, College of Public Health and Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

出版信息

Ophthalmol Retina. 2020 May;4(5):486-493. doi: 10.1016/j.oret.2019.09.011. Epub 2019 Sep 28.

DOI:10.1016/j.oret.2019.09.011

PMID:31786136

Abstract

PURPOSE

We aimed to evaluate the association between diabetic status and the rates of cataract extraction (CE) following pars plana vitrectomy (PPV).

DESIGN

Retrospective cohort, multicenter database study.

PARTICIPANTS

Patients were selected from an insurance claims database (PharMetrics LifeLink) that included persons who had filed claims between 2006 and 2015 in the United States.

METHODS

We analyzed the records of 22 146 patients who underwent PPV performed by 2705 retina physicians. The vitrectomy group included patients ≥18 years of age who had undergone PPV. The control group included patients who were matched to the vitrectomy group 1:2 based on sex, diabetes mellitus (DM) status, region of the United States, and Charleston Comorbidity Index.

MAIN OUTCOME MEASURES

Hazard ratios (HRs) and rates of cataract surgery in patients with and without diabetes who had undergone prior PPV.

RESULTS

The hazard ratio for post-PPV CE was lower among patients with diabetes (3.307; 95% confidence interval [CI], 3.051-3.583) than among patients without diabetes (4.889; 95% CI, 4.670-5.119). This association was significant for all subgroups of patients with diabetes except in patients with diabetes and without retinopathy (4.086; 95% CI, 3.511-4.754). There was a significantly longer time between PPV and CE in patients with diabetes (537 days; 95% CI, 459-677 days) compared with those without diabetes (295 days; 95% CI, 278-312 days). The type of DM (type 1 vs. type 2) did not influence the rate of post-PPV cataract surgery. In persons with diabetes who underwent PPV, we observed a trend for a lower HR of cataract surgery in eyes with proliferative retinopathy (0.903; 95% CI, 0.725-1.124), and nonproliferative retinopathy (0.965; 95% CI, 0.721-1.290) compared with eyes with no retinopathy.

CONCLUSIONS

Eyes of patients with diabetes had a significantly decreased risk of undergoing CE after PPV surgery compared with eyes of patients without diabetes.

摘要

目的

我们旨在评估糖尿病状态与接受经睫状体平坦部玻璃体切割术（PPV）治疗后的白内障摘除（CE）率之间的关系。

设计

回顾性队列，多中心数据库研究。

参与者

患者从保险索赔数据库（PharMetrics LifeLink）中选择，该数据库包含 2006 年至 2015 年间在美国提出索赔的人员。

方法

我们分析了 22146 名接受由 2705 名视网膜医师进行的 PPV 手术的患者的记录。玻璃体切割组包括年龄≥18 岁的接受 PPV 治疗的患者。对照组包括根据性别、糖尿病（DM）状态、美国地区和Charlson 合并症指数与玻璃体切割组 1：2 匹配的患者。

主要观察指标

接受过先前 PPV 治疗的糖尿病和非糖尿病患者的白内障手术后的危险比（HR）和白内障手术率。

结果

与无糖尿病的患者（4.889；95%置信区间 [CI]，4.670-5.119）相比，患有糖尿病的患者（3.307；95%CI，3.051-3.583）在接受 PPV 后发生 CE 的风险较低。这种关联在除了患有糖尿病且无视网膜病变的患者外（4.086；95%CI，3.511-4.754）的所有糖尿病患者亚组中均具有统计学意义。患有糖尿病的患者与无糖尿病的患者相比，PPV 与 CE 之间的时间间隔明显更长（537 天；95%CI，459-677 天），而无糖尿病的患者为 295 天（95%CI，278-312 天）。DM 的类型（1 型与 2 型）并不影响接受 PPV 手术后的白内障手术后的发生率。在接受 PPV 的糖尿病患者中，我们观察到与无视网膜病变的眼睛相比，增殖性视网膜病变（0.903；95%CI，0.725-1.124）和非增殖性视网膜病变（0.965；95%CI，0.721-1.290）的眼睛的白内障手术 HR 较低，呈下降趋势。