Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Vitreoretinal Division, Duke University Eye Center, Durham, North Carolina, USA.
Am J Ophthalmol. 2021 Feb;222:271-276. doi: 10.1016/j.ajo.2020.09.034. Epub 2020 Sep 28.
To evaluate the incidence of unexpected management changes on the first day after pars plana vitrectomy (PPV) for retinal detachment repair.
Retrospective cohort study.
The medical and billing records of a large academic private practice were electronically queried for all cases of PPV for retinal detachment performed between January 1, 2017, and December 31, 2017. All cases of PPV for rhegmatogenous or tractional retinal detachment with completed postoperative day 1 (POD1) and postoperative week 1 (POW1) visits were included. The preoperative consultation, operative report, and POD1 and POW1 (postoperative days 5-14) visits were reviewed. Main outcome measures were incidence of unexpected management changes (change in or extended positioning, additional procedure, change in drop regimen, or shortened interval follow-up) at the POD1 visit after uncomplicated PPV for retinal detachment.
Overall, 418 surgeries from 364 eyes and 355 patients were included. Eleven cases (2.6%) had an intraocular pressure (IOP) over 30 mm Hg at POD1. IOP-lowering drops were prescribed for 30 cases (7.2%). Silicone oil tamponade was positively associated with high IOP at POD1 (relative risk = 3.23, 95% confidence interval 0.96-10.84, P = 0.06). No additional management changes were made besides treating elevated IOP.
Management changes on POD1 after vitrectomy for retinal detachment repair are relatively uncommon and were solely IOP related in this patient group. There may be flexibility regarding the type of POD1 encounter necessary, including an IOP check with an ophthalmic technician or non-retinal eye care provider. Larger, prospective studies are needed to better determine the most efficient follow-up routine.
评估孔源性视网膜脱离修复的巩膜外冷凝术（PPV）后第一天出现意外处理改变的发生率。
回顾性队列研究。
通过电子查询 2017 年 1 月 1 日至 12 月 31 日期间在一家大型学术私人执业机构进行的所有孔源性视网膜脱离的 PPV 病例的医疗和计费记录。所有接受孔源性或牵拉性视网膜脱离的 PPV 治疗且完成术后第 1 天（POD1）和第 1 周（POW1）随访的患者均被纳入研究。回顾术前咨询、手术报告以及 POD1 和 POW1（术后第 5-14 天）就诊记录。主要观察指标为在无并发症的 PPV 治疗视网膜脱离后 POD1 就诊时出现的意外处理改变（改变或延长体位、附加手术、改变滴眼剂方案或缩短随访间隔）的发生率。
共有 364 只眼的 355 例患者的 418 例手术纳入研究。11 例（2.6%）患者在 POD1 时眼压（IOP）超过 30mmHg。30 例（7.2%）患者开具了降眼压滴眼液。硅油填充与 POD1 时高眼压呈正相关（相对风险=3.23，95%置信区间 0.96-10.84，P=0.06）。除了治疗升高的 IOP 之外，没有进行其他处理改变。
在该患者群体中，孔源性视网膜脱离修复的巩膜外冷凝术后 POD1 时的处理改变相对少见，且仅与眼压升高有关。在 POD1 进行的检查类型可能具有一定的灵活性，包括使用眼科技师或非视网膜眼科护理提供者进行眼压检查。需要更大规模的前瞻性研究来更好地确定最有效的随访方案。
