三级、四级和五级增殖性玻璃体视网膜病变的风险：全国数据库分析（2010-2017 年）。
Risk of Tertiary, Quaternary, and Quinary Proliferative Vitreoretinopathy: Analysis of a Nationwide Database (2010-2017).
机构信息
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
出版信息
Ophthalmol Retina. 2023 Jun;7(6):489-495. doi: 10.1016/j.oret.2023.01.015. Epub 2023 Jan 27.
OBJECTIVE
Primary proliferative vitreoretinopathy (PVR) is established as an important cause of the failed repair of a fresh retinal detachment (RD) and the consequent need for secondary repair. However, the burden of multiple repairs beyond the initial failure has not been studied in detail. We aimed to determine the association between primary PVR and the occurrence of tertiary, quaternary, and quinary RD repairs, using a nationwide database.
DESIGN
Retrospective cohort study of insurance claims.
SUBJECTS
Cases of rhegmatogenous RD that underwent primary surgical repair.
METHODS
Cases of primary RD repair from 2010 to 2017 were categorized based on the absence (P0 group) or presence (P1 group) of primary PVR. In each group, we analyzed the frequency of subsequent RD repair procedures with concurrent PVR.
MAIN OUTCOME MEASURE
The risk of secondary and higher multiples of PVR-associated RD repair.
RESULTS
A total of 27 137 cases were included, with 24 500 (90.3%) in the P0 group and 2637 (9.7%) in the P1 group. The frequency (%) of cases ultimately requiring secondary, tertiary, quaternary, and quinary repair in P0 versus P1 was 1.88 versus 10.24 (P < 0.001), 0.26 versus 2.50 (P < 0.001), 0.07 versus 0.64 (P < 0.001), and 0.03 versus 0.08 (P = 0.272), respectively. The risk of undergoing secondary repair was higher in the P1 than in the P0 group (hazard ratio [HR], 6.02; 95% confidence interval [CI], 5.24-6.92; P < 0.001). The risk of undergoing tertiary repair was also higher in the P1 than in the P0 group (HR, 1.67; CI, 1.23-2.28; P = 0.001). There was no difference in the risk of undergoing quaternary repair between the groups (HR, 0.76; CI, 0.41-1.40; P = 0.37). Senary repairs were not detected in this dataset.
CONCLUSIONS
Primary PVR may increase the risk of requiring multiple sequential retinal reattachment surgeries beyond the initial repair failure. Retinal detachment cases with primary PVR at the initial presentation of RD were more likely to undergo secondary and tertiary repairs than cases without primary PVR. Health care claims analysis may be a useful tool to study population-based estimates for multiple recurrences of RD in cases with PVR.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
目的
原发性增殖性玻璃体视网膜病变（PVR）已被确立为导致新鲜视网膜脱离（RD）修复失败和需要进行二次修复的重要原因。然而，对于初始失败后多次修复的负担，尚未进行详细研究。我们旨在使用全国性数据库确定原发性 PVR 与三次、四次和五次 RD 修复发生之间的关联。
设计
保险索赔的回顾性队列研究。
受试者
接受原发性手术修复的孔源性 RD 病例。
方法
根据是否存在（P0 组）或存在（P1 组）原发性 PVR，对 2010 年至 2017 年的原发性 RD 修复病例进行分类。在每组中，我们分析了伴有并发 PVR 的后续 RD 修复手术的频率。
主要观察指标
继发性和更高倍数 PVR 相关 RD 修复的风险。
结果
共纳入 27137 例，其中 P0 组 24500 例（90.3%），P1 组 2637 例（9.7%）。P0 组与 P1 组最终需要二次、三次、四次和五次修复的病例频率（%）分别为 1.88%比 10.24%（P<0.001）、0.26%比 2.50%（P<0.001）、0.07%比 0.64%（P<0.001）和 0.03%比 0.08%（P=0.272）。与 P0 组相比，P1 组接受二次修复的风险更高（风险比[HR]，6.02；95%置信区间[CI]，5.24-6.92；P<0.001）。与 P0 组相比，P1 组接受三次修复的风险也更高（HR，1.67；CI，1.23-2.28；P=0.001）。两组接受四次修复的风险无差异（HR，0.76；CI，0.41-1.40；P=0.37）。该数据集未检测到六次修复。
结论
原发性 PVR 可能增加初始修复失败后需要多次连续视网膜复位手术的风险。在 RD 初次就诊时存在原发性 PVR 的 RD 病例，与不存在原发性 PVR 的病例相比，更有可能接受二次和三次修复。医疗保健索赔分析可能是研究 PVR 病例 RD 多次复发的基于人群估计的有用工具。
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