瘢痕疙瘩、增生性瘢痕和纤维化与增生性玻璃体视网膜病变术后风险的相关性。

Association of Cutaneous Keloids, Hypertrophic Scarring, and Fibrosis with Risk of Postoperative Proliferative Vitreoretinopathy.

机构信息

Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.

Byers Eye Institute, Stanford Health Care, Palo Alto, California.

出版信息

Ophthalmology. 2024 Aug;131(8):961-966. doi: 10.1016/j.ophtha.2024.01.032. Epub 2024 Feb 1.

DOI:10.1016/j.ophtha.2024.01.032

PMID:38296203

Abstract

PURPOSE

To assess an association between cutaneous keloids, hypertrophic scarring, and fibrosis (KHF) and risk of postoperative proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) repair.

DESIGN

Retrospective, population-based cohort study.

PARTICIPANTS

Patients aged ≥ 18 years who underwent initial retinal detachment (RD) repair with pars plana vitrectomy with or without scleral buckle (SB) (Current Procedural Terminology [CPT] 67108), pneumatic retinopexy (67110), and primary SB (67107) from January 1, 2003, to March 1, 2023.

METHODS

A de-identified electronic health record database through TriNetX, a global health research network, was used to analyze patients. Patients were queried for International Classification of Diseases, 10 Revision (ICD-10) codes L91.0 (hypertrophic scar) and L90.5 (scar conditions and fibrosis of skin). Frequency of subsequent diagnosis of PVR (H35.2) and CPT codes for secondary surgery including complex RD repair (67113) were determined. Patients with proliferative diabetic retinopathy (PDR) (ICD-10 H10.35/H11.35) were excluded. Descriptive statistics (Z-test) and propensity score matching (PSM) were used to match for age, sex, and race.

MAIN OUTCOME MEASURES

Prevalence of H35.2 and CPT 67113 within 180 days after RRD repair in the KHF cohort versus the non-KHF cohort.

RESULTS

Among patients with CPT 67108, 1061 in each cohort (KHF and non-KHF) were analyzed after PSM. The mean (standard deviation) age was 60.7 (15.2) years. Within 180 days, 10.1% of patients in the KHF cohort and 3.4% in the non-KHF cohort had a diagnosis of PVR (H35.2) (P < 0.001, odds ratio [OR], 3.2; 95% confidence interval [CI], 2.13-4.71). A total of 8.3% of patients in the KHF cohort and 5.4% of patients in the non-KHF cohort underwent complex RD repair (CPT 67113) (P = 0.008; OR, 3.2; 95% CI, 1.13-2.25). When including all RD repair types (CPT 67108, 67110, 67107), the rate of PVR diagnosis was still significantly greater in the KHF cohort than in the non-KHF cohort (9.0% vs 4.2%, P < 0.01; OR, 2.28; 95% CI, 1.64-3.16).

CONCLUSIONS

A dermatologic history of KHF may be a risk factor for PVR after RD repair.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

摘要

目的

评估增生性玻璃体视网膜病变（PVR）与增生性瘢痕、肥厚性瘢痕和纤维化（KHF）之间的关联。

设计

回顾性、基于人群的队列研究。

参与者

2003 年 1 月 1 日至 2023 年 3 月 1 日期间，接受经睫状体平坦部玻璃体切除术联合或不联合巩膜扣带术（67108 下的现行治疗程序术语）、充气视网膜固定术（67110）和原发性巩膜扣带术（67107）治疗原发性视网膜脱离（RRD）的年龄≥18 岁的患者。

方法

通过 TriNetX（一个全球性的健康研究网络）的电子病历数据库分析患者。通过国际疾病分类第 10 版（ICD-10）代码 L91.0（肥厚性瘢痕）和 L90.5（瘢痕状况和皮肤纤维化）查询患者。确定随后诊断为 PVR（H35.2）和继发性手术（包括复杂 RRD 修复术[67113]）的 CPT 代码的频率。排除增殖性糖尿病性视网膜病变（PDR）（ICD-10 H10.35/H11.35）患者。使用描述性统计（Z 检验）和倾向评分匹配（PSM）来匹配年龄、性别和种族。

主要观察指标

RRD 修复后 180 天内 KHF 队列与非 KHF 队列中 H35.2 和 CPT 67113 的发生率。

结果

在接受 CPT 67108 的患者中，在 PSM 后对每个队列（KHF 和非 KHF）中的 1061 名患者进行了分析。平均（标准差）年龄为 60.7（15.2）岁。在 180 天内，KHF 队列中有 10.1%的患者和非 KHF 队列中有 3.4%的患者被诊断为 PVR（H35.2）（P < 0.001，比值比[OR]为 3.2；95%置信区间[CI]为 2.13-4.71）。KHF 队列中有 8.3%的患者和非 KHF 队列中有 5.4%的患者接受了复杂 RRD 修复术（CPT 67113）（P = 0.008；OR 为 3.2；95%CI 为 1.13-2.25）。当包括所有 RRD 修复类型（CPT 67108、67110、67107）时，KHF 队列中 PVR 的诊断率仍明显高于非 KHF 队列（9.0%比 4.2%，P < 0.01；OR 为 2.28；95%CI 为 1.64-3.16）。