Coleman A L, Yu F, Greenland S
UCLA School of Medicine, USA.
Ophthalmology. 1998 Jul;105(7):1165-9. doi: 10.1016/S0161-6420(98)97014-2.
The purpose of the study was to identify factors associated with an increased risk of complications after partial-thickness or full-thickness glaucoma surgery.
A retrospective, cohort analysis.
A total of 24,206 Medicare patients who were older than 65 years of age and who were enrolled in Medicare in 1994 underwent partial-thickness or full-thickness glaucoma surgical procedures in 1994.
The authors obtained data on all glaucoma surgery claims to the Health Care Finance Administration in 1994 and analyzed complication rates using hierarchical logistic regression, separately smoothing four sets of regression coefficients (state-level effects, systemic and ocular diagnoses, prior ocular surgeries, and concomitant ocular surgeries).
Patients were classified as having complications if their records showed at least one of the following occurrences after surgery: retinal detachment repair, endophthalmitis, scleral fistula revision-repair, or cyclodestruction.
The risk of complications was greater for full-thickness procedures than for partial-thickness procedures (odds ratio [OR] = 1.51; 95% confidence interval [CI] = 1.07, 2.12). Compared to glaucoma surgeries performed without an additional intraocular procedure, glaucoma surgery with prior phacoemulsification (OR = 0.51; 95% CI = 0.35, 0.74) was associated with lower complication rates, as was glaucoma surgery with prior argon laser trabeculoplasty (OR = 0.62; 95% CI = 0.44, 0.88). A concomitant vitrectomy (OR = 1.86, 95% CI = 1.35, 2.56) was associated with greater odds of a complication. The mean follow-up of subjects was 184 days (standard deviation, +/- 107), whereas the mean time to a complication was 49 days (standard deviation, +/- 63).
The risk of an early postoperative complication after full-thickness procedures appears to be greater than that after partial-thickness procedures. Concomitant intraocular procedures performed in conjunction with glaucoma surgery, such as a vitrectomy, can substantially increase the risk of retinal detachment repair, endophthalmitis, scleral fistula revision-repair, and/or cyclodestruction.
本研究旨在确定与部分厚度或全厚度青光眼手术后并发症风险增加相关的因素。
一项回顾性队列分析。
共有24206名年龄在65岁以上且于1994年参加医疗保险的患者在1994年接受了部分厚度或全厚度青光眼手术。
作者获取了1994年所有向医疗保健财务管理局提出的青光眼手术索赔数据，并使用分层逻辑回归分析并发症发生率，分别对四组回归系数（州级效应、全身和眼部诊断、既往眼部手术以及同期眼部手术）进行平滑处理。
如果患者的记录显示术后出现以下至少一种情况，则将其分类为发生并发症：视网膜脱离修复、眼内炎、巩膜瘘修补术或睫状体破坏术。
全厚度手术的并发症风险高于部分厚度手术（优势比[OR]=1.51；95%置信区间[CI]=1.07，2.12）。与未进行额外眼内手术的青光眼手术相比，先前进行过超声乳化白内障吸除术的青光眼手术（OR=0.51；95%CI=0.35，0.74）并发症发生率较低，先前进行过氩激光小梁成形术的青光眼手术也是如此（OR=0.62；95%CI=0.44，0.88）。同期进行玻璃体切除术（OR=1.86，95%CI=1.35，2.56）与并发症发生几率更高相关。受试者的平均随访时间为184天（标准差，±107），而发生并发症的平均时间为49天（标准差，±63）。
全厚度手术后早期并发症的风险似乎高于部分厚度手术后。与青光眼手术同时进行的眼内手术，如玻璃体切除术，可显著增加视网膜脱离修复、眼内炎、巩膜瘘修补术和/或睫状体破坏术的风险。
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