Department of Ophthalmology, The Permanente Medical Group, Oakland, California; Department of Ophthalmology, The University of California - San Francisco, San Francisco, California.
Division of Research, Kaiser Permanente, Northern California, Oakland, California.
Ophthalmology. 2022 Jan;129(1):67-72. doi: 10.1016/j.ophtha.2021.07.020. Epub 2021 Jul 27.
To evaluate the risk factors for retinal tear (RT) or rhegmatogenous retinal detachment (RRD) associated with acute, symptomatic posterior vitreous detachment (PVD) in a large comprehensive eye care setting.
Retrospective cohort study.
A total of 8305 adult patients in the Kaiser Permanente Northern California Healthcare System (KPNC) during calendar year 2018 who met inclusion criteria.
The KPNC electronic medical record was queried to capture acute, symptomatic PVD events. Each chart was reviewed to confirm diagnoses and capture specific data elements from the patient history and ophthalmic examination.
Presence of RT or RRD at initial presentation or within 1 year thereafter.
Of 8305 patients who presented with acute PVD symptoms, 448 (5.4%) were diagnosed with RT and 335 (4.0%) were diagnosed with RRD. When considering variables available before examination, blurred vision (odds ratio [OR], 2.7; confidence interval [CI], 2.2-3.3), male sex (OR, 2.1; CI, 1.8-2.5), age < 60 years (OR, 1.8; CI, 1.5-2.1), prior keratorefractive surgery (OR, 1.6; CI, 1.3-2.0), and prior cataract surgery (OR, 1.4; CI, 1.2-1.8) were associated with higher risk of RT or RRD, whereas symptoms of flashes were mildly protective (OR, 0.8; CI, 0.7-0.9). Examination variables associated with a high risk of RT or RRD included vitreous pigment (OR, 57.0; CI, 39.7-81.7), vitreous hemorrhage (OR, 5.9; CI, 4.6-7.5), lattice degeneration (OR, 6.0; CI, 4.7-7.7), and visual acuity worse than 20/40 (OR, 3.0; CI, 2.5-3.7). Late RTs or RRDs occurred in 12.4% of patients who had vitreous hemorrhage, lattice degeneration, or a history of RT or RRD in the fellow eye at initial presentation but only 0.7% of patients without any of these 3 risk factors. Refractive error had an approximately linear relationship with age at presentation of PVD, with myopic patients presenting at a younger age (r = 0.4).
This study, based in a comprehensive eye care setting, found the rate of RT and RRD associated with acute PVD to be lower than rates previously reported by retina subspecialty practices. Several patient features strongly predicted the presence of initial and late complications of acute PVD.
在一个大型综合性眼科医疗机构中，评估与急性、有症状性后玻璃体脱离（PVD）相关的视网膜裂孔（RT）或孔源性视网膜脱离（RRD）的危险因素。
回顾性队列研究。
在 2018 年日历年内符合纳入标准的 Kaiser Permanente Northern California Healthcare System（KPNC）的 8305 名成年患者。
通过 KPNC 电子病历查询急性、有症状性 PVD 事件。对每一份病历进行审查，以确认诊断，并从病史和眼科检查中获取特定的数据元素。
初次就诊或此后 1 年内是否存在 RT 或 RRD。
在 8305 名出现急性 PVD 症状的患者中，448 例（5.4%）被诊断为 RT，335 例（4.0%）被诊断为 RRD。在考虑检查前可用的变量时，视力模糊（比值比[OR]，2.7；置信区间[CI]，2.2-3.3）、男性（OR，2.1；CI，1.8-2.5）、年龄<60 岁（OR，1.8；CI，1.5-2.1）、先前的角膜屈光手术（OR，1.6；CI，1.3-2.0）和先前的白内障手术（OR，1.4；CI，1.2-1.8）与 RT 或 RRD 风险增加相关，而闪光症状则轻度保护（OR，0.8；CI，0.7-0.9）。与 RT 或 RRD 风险高相关的检查变量包括玻璃体色素（OR，57.0；CI，39.7-81.7）、玻璃体出血（OR，5.9；CI，4.6-7.5）、格子样变性（OR，6.0；CI，4.7-7.7）和视力低于 20/40（OR，3.0；CI，2.5-3.7）。在初次就诊时存在玻璃体出血、格子样变性或对侧眼有 RT 或 RRD 病史的患者中，12.4%发生迟发性 RT 或 RRD，但在没有这 3 种危险因素的患者中，仅 0.7%发生迟发性 RT 或 RRD。屈光不正与 PVD 发病时的年龄呈近似线性关系，近视患者发病年龄较小（r=0.4）。
这项基于综合性眼科医疗机构的研究发现，与急性 PVD 相关的 RT 和 RRD 发生率低于视网膜专科实践报告的发生率。一些患者特征强烈预测急性 PVD 初始和迟发性并发症的发生。
