Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan.
Department of Vision Informatics, Osaka University Graduate School of Medicine, Osaka, Japan.
Graefes Arch Clin Exp Ophthalmol. 2020 Sep;258(9):1871-1880. doi: 10.1007/s00417-020-04744-2. Epub 2020 May 19.
To determine the preoperative factors associated with selecting scleral buckling (SB) or pars plana vitrectomy (PPV) to treat rhegmatogenous retinal detachments (RRDs) in the era of microincision vitrectomy surgery.
A nationwide, multicenter, observational study in the Japan Retinal Detachment Registry was done. From February 2016 to March 2017, 3446 cases were registered, and 3219 among them were analyzed. The factors related to the patient or surgeon were selected; the surgeon's factor included years of experience, number of cases registered, and current activity. The odds ratio (OR) for factors associated with SB or PPV was estimated by a mixed logistic regression model.
SB was selected in 24.2% (779/3219), PPV was in 71.5% (2238/3219), and PPV+SB was in 6.3% (202/3219). Multivariate analysis showed that age [< 70 years old, OR 4.27, 95% confidence interval (CI) 2.34-7.79, P < 0.001], visual acuity [1.0+ (OR 7.41, 95% CI 3.47-15.82, P < 0.001)], pseudo-phakia (OR 4.83, 95%CI 2.11-10.56, P < 0.001), retinal tear (OR 6.92, 95% CI 4.83-9.92, P < 0.001), breaks at/near the vitreous base (OR 8.07, 95% CI 3.50-18.62, P < 0.001), 90+° retinal tear (OR 108.24, 95% CI 7.44-1574.34, P < 0.001), and number of breaks 4+ (OR 3.15, 95% CI 1.95-5.09, P < 0.001), were significantly associated with selecting PPV over SB. The surgeons' activity defined as the number of cases experienced during the registry period was related to the selection of PPV (OR 3.83, 95% CI 2.11-6.93, P < 0.001).
The choice of PPV for the RRD was associated not only with patients' preoperative factors but also the surgeon's activity. Active surgeons selected PPV more than SB.
在微创玻璃体切割手术时代，确定与选择巩膜扣带术（SB）或经睫状体平坦部玻璃体切除术（PPV）治疗孔源性视网膜脱离（RRD）相关的术前因素。
在日本视网膜脱离登记处进行了一项全国性、多中心、观察性研究。2016 年 2 月至 2017 年 3 月，共登记了 3446 例病例，其中 3219 例进行了分析。选择与患者或外科医生相关的因素；外科医生的因素包括经验年限、登记病例数和当前活动。通过混合逻辑回归模型估计与 SB 或 PPV 相关的因素的比值比（OR）。
24.2%（779/3219）选择 SB，71.5%（2238/3219）选择 PPV，6.3%（202/3219）选择 PPV+SB。多变量分析显示，年龄[<70 岁，OR 4.27，95%置信区间（CI）2.34-7.79，P<0.001]、视力[1.0+（OR 7.41，95%CI 3.47-15.82，P<0.001)]、假晶状体（OR 4.83，95%CI 2.11-10.56，P<0.001）、视网膜裂孔（OR 6.92，95%CI 4.83-9.92，P<0.001）、玻璃体基底部附近的裂孔（OR 8.07，95%CI 3.50-18.62，P<0.001）、90°+视网膜裂孔（OR 108.24，95%CI 7.44-1574.34，P<0.001）和 4+个裂孔（OR 3.15，95%CI 1.95-5.09，P<0.001）与选择 PPV 而非 SB 显著相关。外科医生的活动定义为在登记期间经历的病例数与选择 PPV 有关（OR 3.83，95%CI 2.11-6.93，P<0.001）。
RRD 选择 PPV 不仅与患者术前因素有关，还与外科医生的活动有关。积极的外科医生选择 PPV 多于 SB。
