Alshaikhsalama Ahmed M, Alsoudi Amer F, Mukhtar Ali, Wai Karen, Koo Euna, Kossler Andrea, Ludwig Chase, Mruthyunjaya Prithvi, Rahimy Ehsan
Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas.
Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
JAMA Ophthalmol. 2025 Jul 3. doi: 10.1001/jamaophthalmol.2025.1851.
Proliferative vitreoretinopathy (PVR) is a major cause of retinal detachment (RD) repair failure, resulting in poor visual outcomes. Cannabis use continues to increase globally and may affect PVR development through its anti-inflammatory and neuroprotective properties, although this association remains unclear.
To assess the risk of developing PVR among patients with concomitant cannabis use who underwent primary RD repair.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined data from electronic health records for a multicenter research network extracted for the period February 1, 2005, to February 1, 2025. Participants were patients who underwent initial RD repair with pars plana vitrectomy (PPV) with or without scleral buckle (SB), primary SB, or pneumatic retinopexy. The records were used to identify patients diagnosed with concomitant cannabis-related disorder together with confirmatory testing of cannabis in urine or blood compared with a control group without documented use. Exclusion criteria were a history proliferative diabetic retinopathy or less than 6 months of follow-up.
Primary RD repair and cannabis-related disorder.
Relative risk (RR) of developing PVR and requiring a subsequent complex RD repair at 6 months and 1 year of follow-up.
After propensity score matching, each cohort had 1193 patients. The mean (SD) age was 53.2 (16.1) years; 1662 were male (69.7%), 641 were female (26.9%), and for 83 patients (3.5%), the sex was unknown. At 6 months, patients with concomitant cannabis use with RD repaired by any method had a reduced risk of developing subsequent PVR (25 events [2.10%] vs 52 events [4.36%]; RR, 0.48; 95% CI, 0.30-0.77; P = .002) and requiring complex RD repair (37 [3.10%] vs 60 [5.03%]; RR, 0.62; 95% CI, 0.41-0.92; P = .02) when compared with controls. Similar results were observed at 1 year for both outcomes.
Patients who underwent initial repair for RD with concomitant cannabis use were less likely to develop PVR and require subsequent complex RD repair compared with matched patients without documented cannabis exposure; however, the absolute difference in rates was small. While this protective association noted with cannabis use could be due to the population using it rather than an effect of the cannabis itself, the findings suggest that cannabis use might have a role in reducing PVR development. Intervention trials would be needed to try to control for confounding factors.
增殖性玻璃体视网膜病变（PVR）是视网膜脱离（RD）修复失败的主要原因，会导致不良的视觉预后。全球大麻使用量持续增加，其抗炎和神经保护特性可能会影响PVR的发展，尽管这种关联尚不清楚。
评估在接受原发性RD修复的同时使用大麻的患者中发生PVR的风险。
设计、设置和参与者：这项回顾性队列研究检查了从多中心研究网络的电子健康记录中提取的2005年2月1日至2025年2月1日期间的数据。参与者是接受了玻璃体切除术（PPV）联合或不联合巩膜扣带术（SB）、原发性SB或气体视网膜固定术进行初次RD修复的患者。这些记录用于识别被诊断患有大麻相关疾病并经尿液或血液中大麻确证检测的患者，并与无使用记录的对照组进行比较。排除标准为增殖性糖尿病视网膜病变病史或随访时间少于6个月。
原发性RD修复和大麻相关疾病。
在随访6个月和1年时发生PVR以及需要进行后续复杂RD修复的相对风险（RR）。
在倾向得分匹配后，每个队列有1193名患者。平均（标准差）年龄为53.2（16.1）岁；男性1662名（69.7%），女性641名（26.9%），83名患者（3.5%）性别未知。在6个月时，通过任何方法修复RD且同时使用大麻的患者发生后续PVR的风险降低（25例[2.10%]对52例[4.36%]；RR，0.48；95%CI，0.30 - 0.77；P = 0.002），并且与对照组相比，需要进行复杂RD修复的风险也降低（37例[3.10%]对60例[5.03%]；RR，0.62；95%CI，0.41 - 0.92；P = 0.02）。在1年时，两个结局均观察到类似结果。
与无大麻暴露记录的匹配患者相比，接受初次RD修复且同时使用大麻的患者发生PVR以及需要进行后续复杂RD修复的可能性较小；然而，发生率的绝对差异较小。虽然观察到的这种与大麻使用相关的保护关联可能是由于使用大麻的人群本身而非大麻本身的作用，但研究结果表明大麻使用可能在降低PVR发展方面发挥作用。需要进行干预试验以控制混杂因素。
