Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland; Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland.
Ophthalmol Retina. 2022 Oct;6(10):906-913. doi: 10.1016/j.oret.2022.04.018. Epub 2022 May 2.
Cataract surgery is commonly performed to improve vision in patients with retinitis pigmentosa (RP). However, the risk of postoperative cystoid macular edema (CME) in RP remains unclear. Here, we leveraged a large multiyear claims database to estimate the risk of CME after cataract surgery in patients with and without RP.
Retrospective multicenter cohort.
Patients aged 18 to 65 years who underwent single-phase cataract surgery between January 1, 2020, and December 31, 2018. Identified using the IBM MarketScan claims database.
We evaluated the baseline characteristics and outcomes and estimated the hazard ratio (HR) using a multivariable mixed-effects approach. The eyes of patients with RP were categorized as group R1, and those without diagnoses of RP by the time of surgery were categorized as group R0.
Incident postoperative CME in the same eye that underwent cataract extraction within 12 months of the procedure.
We included 468 123 patients and 615 645 eyes. This included 124 eyes with RP (R1) and 615 521 without RP (R0). The mean ages were 50.5 ± 9.8 years in R1 and 57.9 ± 6.1 years in R0. The cumulative incidence of CME at 12 months was 5.8% (95% confidence interval [CI] 1.2%-10.3%) in R1, and it was 1.1% (95% CI 1.1%-1.2%) in R0. On average, CME was reported in R1 subjects 3.9 weeks later than in R0 subjects (95% CI 2.04-6.5 weeks; P <0.001). The subjects in R1 had 4.83 (95% CI 2.13-10.93, P <0.001) times the risk of CME compared to the subjects in R0. A stratified analysis showed that epiretinal membrane (ERM) decreased the risk of CME in R1 (HR 0.12 [95% CI 0.48-0.97; P = 0.004]) but increased it in R0 (HR, 4.32 [95% CI 3.13-5.95; P <0.001]).
The cataract surgery-related risk of CME among patients with RP may be >4 times that among people without RP. Men and individuals aged 18 to 34 and 55 to 65 years may be at the greatest risk, whereas ERM may lower the risk. Further study is warranted to stratify the risk by RP genotype and phenotype and illuminate the natural history, angiographic features, and functional consequences of postoperative CME.
白内障手术通常用于改善色素性视网膜炎（RP）患者的视力。然而，RP 患者术后发生囊样黄斑水肿（CME）的风险尚不清楚。在这里，我们利用一个大型多年索赔数据库来估计有和没有 RP 的患者白内障手术后发生 CME 的风险。
回顾性多中心队列研究。
2020 年 1 月 1 日至 2018 年 12 月 31 日期间接受单阶段白内障手术的 18 至 65 岁患者。使用 IBM MarketScan 索赔数据库确定。
我们评估了基线特征和结果，并使用多变量混合效应方法估计了风险比（HR）。将 RP 患者的眼睛归类为 R1 组，将手术时未诊断为 RP 的患者的眼睛归类为 R0 组。
在手术后 12 个月内同一眼行白内障摘除术后发生的术后 CME。
我们纳入了 468123 名患者和 615645 只眼。其中包括 124 只 RP 眼（R1）和 615521 只无 RP 眼（R0）。R1 的平均年龄为 50.5±9.8 岁，R0 为 57.9±6.1 岁。12 个月时 CME 的累积发生率在 R1 为 5.8%（95%置信区间[CI] 1.2%-10.3%），在 R0 为 1.1%（95% CI 1.1%-1.2%）。平均而言，R1 患者比 R0 患者报告 CME 晚 3.9 周（95% CI 2.04-6.5 周；P<0.001）。与 R0 组相比，R1 组发生 CME 的风险高 4.83 倍（95% CI 2.13-10.93，P<0.001）。分层分析表明，视网膜内膜（ERM）降低了 R1 患者发生 CME 的风险（HR 0.12[95% CI 0.48-0.97；P=0.004]），但增加了 R0 患者发生 CME 的风险（HR，4.32[95% CI 3.13-5.95；P<0.001]）。
RP 患者白内障手术相关 CME 的风险可能是无 RP 患者的 4 倍以上。男性和 18 至 34 岁以及 55 至 65 岁的个体风险最大，而 ERM 可能降低风险。需要进一步研究来根据 RP 基因型和表型分层风险，并阐明术后 CME 的自然史、血管造影特征和功能后果。
