From the Department of Ophthalmology, Amphia Hospital, Breda, the Netherlands (Eggermont, Reus); Department of Ophthalmology, The Rotterdam Eye Hospital, Rotterdam, the Netherlands (Eggermont); Department of Medical Advice, VGZ Health Insurance Company, Eindhoven, the Netherlands (Witteman); Vektis, Zeist, the Netherlands (van Erkelens); Department of Innovation and Advice, CZ, Health Insurance Company, Tilburg, the Netherlands (Vermeulen); Zorgverzekeraars Nederland, Zeist, the Netherlands (Vunderink).
J Cataract Refract Surg. 2023 Apr 1;49(4):373-377. doi: 10.1097/j.jcrs.0000000000001118. Epub 2022 Dec 21.
To determine the practice variation in the rate of Nd:YAG laser capsulotomy within 1 year after cataract surgery and to identify possible associations with physician practice styles.
All hospitals and private clinics in the Netherlands.
Retrospective observational study.
In the national medical claims database, we identified all laser capsulotomies performed in the Netherlands within a year after cataract surgery in the years 2016 and 2017. Centers with the lowest and highest percentages of Nd:YAG laser capsulotomies were interviewed on their physician practice styles related to the development of posterior capsule opacification.
The incidence of Nd:YAG laser capsulotomy varied between 1.2% and 26.0% in 2016 (median 5.0%) and between 0.9% and 22.7% in 2017 (median 5.0%). The rate of capsulotomy was highly consistent over time for each center (Pearson correlation coefficient, 0.89, P < .001). In general, ophthalmology centers with a high rate of Nd:YAG laser capsulotomy more often did not (routinely) polish the posterior lens capsule, performed cortex removal with coaxial irrigation/aspiration (I/A, instead of bimanual), and more often used hydrophilic intraocular lenses (IOLs) (compared with only using hydrophobic IOLs).
We found a significant practice variation in performing Nd:YAG laser capsulotomy within 1 year after cataract surgery in the Netherlands. Routinely polishing the posterior capsule, using bimanual I/A, and the use of hydrophobic IOLs are associated with a lower incidence in Nd:YAG laser capsulotomy. Incorporating these practice styles may lower the practice variation and thus prevent added medical burden for the patient and decrease costs.
确定白内障手术后 1 年内 Nd:YAG 激光后囊切开术的实施率，并确定与医生实践风格相关的可能关联。
所有荷兰的医院和私人诊所。
回顾性观察性研究。
在国家医疗索赔数据库中，我们确定了 2016 年和 2017 年白内障手术后 1 年内荷兰所有激光后囊切开术。对激光后囊切开术比例最低和最高的中心进行了访谈，了解与后囊混浊发展相关的医生实践风格。
2016 年 Nd:YAG 激光后囊切开术的发生率为 1.2%至 26.0%（中位数为 5.0%），2017 年为 0.9%至 22.7%（中位数为 5.0%）。每个中心的囊切开术率在时间上高度一致（皮尔逊相关系数为 0.89，P<.001）。一般来说，Nd:YAG 激光后囊切开术发生率较高的眼科中心更不会（常规）抛光后晶状体囊，使用同轴灌洗/抽吸（I/A，而不是双手）进行皮质去除，并且更常使用亲水性人工晶状体（IOL）（与仅使用疏水性 IOL 相比）。
我们发现荷兰白内障手术后 1 年内 Nd:YAG 激光后囊切开术的实施率存在显著差异。常规抛光后囊、使用双手 I/A 和使用疏水性 IOL 与 Nd:YAG 激光后囊切开术发生率较低相关。采用这些实践风格可能会降低实践差异，从而为患者减轻医疗负担并降低成本。
