Alsoudi Amer F, Wai Karen M, Koo Euna, Parikh Ravi, Mruthyunjaya Prithvi, Rahimy Ehsan
Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
JAMA Ophthalmol. 2024 Jul 1;142(7):662-668. doi: 10.1001/jamaophthalmol.2024.1844.
The Diabetic Retinopathy Clinical Research Network Protocol S suggested that vitrectomy for vitreous hemorrhage (VH) or tractional retinal detachment (TRD) was more common among eyes assigned initially to panretinal photocoagulation (PRP) vs anti-vascular endothelial growth factor (anti-VEGF) for proliferative diabetic retinopathy (PDR). These clinical implications warrant further evaluation in the clinical practice setting.
To explore outcomes of PDR treated with PRP monotherapy compared with matched patients treated with anti-VEGF monotherapy.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using an aggregated electronic health records research network. Patients with PDR who received PRP or anti-VEGF monotherapy between January and September 2023 were included before propensity score matching. Patients were excluded with 6 or fewer months' follow-up after monotherapy or with a combination of PRP and anti-VEGF. Data were analyzed in September 2023.
Patients with new PDR diagnoses stratified by monotherapy with PRP or anti-VEGF agents using Current Procedural Terminology code.
Incidence of pars plana vitrectomy (PPV), VH, or TRD.
Among 6020 patients (PRP cohort: mean [SD] age, 64.8 [13.4]; 6424 [50.88%] female; 3562 [28.21%] Black, 6180 [48.95%] White, and 2716 [21.51%] unknown race; anti-VEGF cohort: mean [SD] age, 66.1 [13.2]; 5399 [50.52%] male; 2859 [26.75%] Black, 5377 [50.31%] White, and 2382 [22.29%] unknown race) who received treatment, PRP monotherapy was associated with higher rates of PPV when compared with patients treated with anti-VEGF monotherapy at 5 years (RR, 1.18; 95% CI, 1.05-1.36; RD, 1.37%; 95% CI, 0.39%-2.37%; P < .001), with similar associations at 1 and 3 years. PRP monotherapy was associated with higher rates of VH at 5 years (relative risk [RR], 1.72; 95% CI, 1.52-1.95; risk difference [RD], 7.05; 95% CI, 5.41%-8.69%; P < .001) and higher rates of TRD at 5 years (RR, 2.76; 95% CI, 2.26-3.37; RD, 4.25%; 95% CI, 3.45%-5.05%; P < .001), with similar magnitudes of associations at 6 months, 1 year, and 3 years, when compared with patients treated with anti-VEGF monotherapy.
These findings support the hypothesis that patients with PDR treated with PRP monotherapy are more likely to develop VH, TRD, and undergo PPV when compared with matched patients treated with anti-VEGF monotherapy. However, given the wide range in relative risk, confounding factors may account for some of the association between PRP vs anti-VEGF monotherapy and outcomes evaluated.
糖尿病视网膜病变临床研究网络方案S表明，在最初分配接受全视网膜光凝（PRP）与抗血管内皮生长因子（抗VEGF）治疗的增殖性糖尿病视网膜病变（PDR）患者眼中，玻璃体切除术治疗玻璃体积血（VH）或牵引性视网膜脱离（TRD）更为常见。这些临床意义值得在临床实践环境中进一步评估。
探讨PRP单药治疗与匹配的抗VEGF单药治疗的PDR患者的治疗效果。
设计、设置和参与者：使用汇总电子健康记录研究网络进行的回顾性队列研究。纳入2023年1月至9月期间接受PRP或抗VEGF单药治疗的PDR患者，进行倾向评分匹配。单药治疗后随访6个月或更短时间或接受PRP和抗VEGF联合治疗的患者被排除。2023年9月进行数据分析。
使用当前程序术语代码按PRP或抗VEGF药物单药治疗分层的新诊断PDR患者。
玻璃体切割术（PPV）、VH或TRD的发生率。
在6020例接受治疗的患者中（PRP队列：平均[标准差]年龄64.8[13.4]岁；女性6424例[50.88%]；黑人3562例[28.21%]，白人6180例[48.95%]，种族未知2716例[21.51%]；抗VEGF队列：平均[标准差]年龄66.1[13.2]岁；男性5399例[50.52%]；黑人2859例[26.75%]；白人5377例[50.31%]，种族未知2382例[22.29%]），与接受抗VEGF单药治疗的患者相比，PRP单药治疗在5年时PPV发生率更高（风险比[RR]，1.18；95%置信区间，1.05 - 1.36；风险差值[RD]，1.37%；95%置信区间，0.39% - 2.37%；P <.001），在1年和3年时也有类似关联。PRP单药治疗在5年时VH发生率更高（相对风险[RR]，1.72；95%置信区间，1.52 - 1.95；风险差值[RD]，第7.05；95%置信区间，5.41% - 8.69%；P <.001），在5年时TRD发生率更高（RR，2.76；95%置信区间，2.26 - 3.37；RD，4.25%；95%置信区间，3.45% - 5.05%；P <.001），与接受抗VEGF单药治疗的患者相比，在第6个月、1年和3年时关联程度相似。
这些发现支持以下假设：与匹配的接受抗VEGF单药治疗的患者相比，接受PRP单药治疗的PDR患者更有可能发生VH、TRD并接受PPV。然而，鉴于相对风险范围较宽，混杂因素可能解释了PRP与抗VEGF单药治疗及评估结局之间的部分关联。
