From the Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, (M.G.R.R., S.P.), Palo Alto.
Department of Ophthalmology, Wayne and Gladys Valley Center for Vision, University of California, (A.R.A.), San Francisco.
Am J Ophthalmol. 2021 Sep;229:71-81. doi: 10.1016/j.ajo.2021.04.007. Epub 2021 Apr 22.
To examine associations between primary repair, patient characteristics, and rhegmatogenous retinal detachment (RRD) reoperation.
Retrospective cohort study.
We used administrative claims to identify enrollees with incident RRD treatment by laser barricade, pneumatic retinopexy (PR), pars plana vitrectomy (PPV), or scleral buckle (SB) between 2003 and 2016. Analysis excluded patients with less than 3 years of continuous enrollment, previous RRD diagnosis, or repair. We determined reoperation frequency (PPV, PR, or SB) within 90 days postrepair and used multivariable logistic regression to identify associations between reoperation and patient and primary repair characteristics.
Of 16,190 patients with documented primary RRD repair, 2,918 (18.0%) required reoperation within 90 days. Reoperation was significantly associated with male sex (odds ratio [OR] 1.24, P < .001), pseudophakia (OR 1.25, P < .001), vitreous hemorrhage (OR 1.22, P = .001), and worse systemic health (OR 1.19-1.25, P < .05, for Charlson Comorbidity Index ≥3). Pseudophakia had higher reoperation odds after all primary procedures except PPV. In addition, 28.7% of primary PR cases required reoperation, vs 19.1% of SB and 17.9% of PPV repairs. Adjusting for other patient characteristics, PR had highest odds of reoperation (OR 1.90, P < .001, vs primary PPV). Primary laser barricade had lowest odds of reoperation (OR 0.49, P < .001). PPV was the most frequent reoperation procedure.
Nearly 1 in 5 patients require reoperation within 90 days after primary RRD repair. Cases requiring only primary laser barricade had lowest reoperation odds, likely representing less severe RRDs. Primary PR had highest reoperation odds; PPV and SB were similar to each other. These findings are important for patient education and surgical decision-making.
研究原发性修复、患者特征与孔源性视网膜脱离（RRD）再手术之间的关联。
回顾性队列研究。
我们使用行政索赔数据，确定了 2003 年至 2016 年间接受激光阻挡、气液交换（PR）、经睫状体平坦部玻璃体切除术（PPV）或巩膜扣带术（SB）治疗的新发 RRD 患者。分析排除了连续入组时间少于 3 年、有 RRD 既往史或修复术的患者。我们确定了修复后 90 天内的再手术频率（PPV、PR 或 SB），并使用多变量逻辑回归分析识别再手术与患者和原发性修复特征之间的关系。
在 16190 例有记录的原发性 RRD 修复患者中，2918 例（18.0%）在 90 天内需要再次手术。再手术与男性（比值比 [OR] 1.24，P <.001）、白内障（OR 1.25，P <.001）、玻璃体积血（OR 1.22，P =.001）和较差的全身健康状况（OR 1.19-1.25，P <.05，Charlson 合并症指数≥3）显著相关。除了 PPV 外，所有主要手术中白内障的再手术几率更高。此外，28.7%的原发性 PR 病例需要再手术，而 SB 和 PPV 修复术的再手术率分别为 19.1%和 17.9%。调整其他患者特征后，PR 的再手术几率最高（OR 1.90，P <.001，与原发性 PPV 相比）。原发性激光阻挡术的再手术几率最低（OR 0.49，P <.001）。PPV 是最常见的再手术程序。
近 1/5 的患者在原发性 RRD 修复后 90 天内需要再次手术。仅接受原发性激光阻挡术的患者再手术几率最低，可能代表 RRD 程度较轻。原发性 PR 的再手术几率最高；PPV 和 SB 彼此相似。这些发现对于患者教育和手术决策很重要。
