Topouzis F, Yu F, Coleman A L
Jules Stein Eye Institute and Department of Ophthalmology, University of California Los Angeles School of Medicine 90095-7004, USA.
Ophthalmology. 1998 Dec;105(12):2276-81. doi: 10.1016/S0161-6420(98)91229-5.
To identify factors associated with an increased risk of adverse outcomes after cyclodestructive or drainage device procedures.
Retrospective, cohort analysis.
A total of 5570 Medicare patients who were older than 65 years of age and who underwent cyclodestructive or drainage device procedures in 1994 participated.
The authors identified cyclodestructive and drainage device procedures from claims to the Health Care Finance Administration (HCFA) by International Classification of Diseases (ICD-9) procedure codes, Current Procedural Terminology procedure codes, and HCFA Common Procedural Classification System codes. The authors analyzed adverse outcome rates using hierarchical logistic regression. Race, age group, gender, length of observed follow-up, state in which surgery took place, ocular procedures performed before and at the same time as the index surgery, and ocular diagnosis were included as covariates in the model.
The authors defined an adverse outcome as the occurrence after the index surgery of at least one of the following: repeat cyclodestructive or drainage device procedure, retinal hole-tear repair, retinal detachment repair, surgery for endophthalmitis, vitrectomy, enucleation, evisceration, surgery for ocular hypotony, and/or extrusion or revision of drainage device. Adverse outcomes were also defined without the inclusion of repeat cyclodestructive or drainage device procedures.
When repeat cyclodestructive or drainage device procedures were not included in the definition of an adverse outcome, eyes with a drainage device procedure were 3.8 times more likely to have an adverse outcome than eyes with a cyclodestructive procedure (odds ratio [OR], 3.8; 95% confidence interval [CI], 3.07, 4.67). Subjects with concurrent corneal transplant had increased odds of an adverse outcome compared to subjects without a concurrent corneal transplant (OR, 2.00; 95% CI, 1.27, 3.15). When the definition of an adverse outcome included repeat cyclodestructive or drainage device procedures, the odds of an adverse outcome were similar for both cyclodestructive and drainage device procedures (OR, 0.94; 95% CI, 0.79, 1.13).
Cyclodestructive procedures need to be repeated more frequently than drainage device procedures. However, if the patient has a drainage device procedure, then that patient is more likely to have other types of adverse ophthalmic events than if he or she had a cyclodestructive procedure. Because the average follow-up of subjects in this study is 5 months (range, 0-12 months), outcomes that might take longer to manifest themselves would be excluded from this study.
确定与睫状体破坏术或引流装置手术后不良结局风险增加相关的因素。
回顾性队列分析。
共有5570名65岁以上的医疗保险患者参与，他们在1994年接受了睫状体破坏术或引流装置手术。
作者通过国际疾病分类（ICD-9）手术编码、现行手术术语（CPT）手术编码和医疗保险财务管理局（HCFA）通用手术分类系统编码，从向HCFA提交的索赔中识别出睫状体破坏术和引流装置手术。作者使用分层逻辑回归分析不良结局发生率。种族、年龄组、性别、观察随访时间长度、手术所在州、与索引手术同时及之前进行的眼科手术以及眼科诊断作为协变量纳入模型。
作者将不良结局定义为索引手术后至少出现以下情况之一：重复睫状体破坏术或引流装置手术、视网膜裂孔-撕裂修复、视网膜脱离修复、眼内炎手术、玻璃体切除术、眼球摘除术、眼内容剜出术、低眼压手术和/或引流装置挤出或翻修。不良结局的定义也包括不纳入重复睫状体破坏术或引流装置手术的情况。
当不良结局的定义不包括重复睫状体破坏术或引流装置手术时，接受引流装置手术的眼睛出现不良结局的可能性是接受睫状体破坏术眼睛的3.8倍（比值比[OR]，3.8；95%置信区间[CI]，3.07，4.67）。与未同时进行角膜移植的受试者相比，同时进行角膜移植的受试者出现不良结局的几率增加（OR，2.00；95%CI，1.27，3.15）。当不良结局定义包括重复睫状体破坏术或引流装置手术时，睫状体破坏术和引流装置手术出现不良结局的几率相似（OR，0.94；95%CI，0.79，1.13）。
睫状体破坏术比引流装置手术更频繁地需要重复进行。然而，如果患者接受了引流装置手术，那么该患者比接受睫状体破坏术的患者更有可能出现其他类型的不良眼科事件。由于本研究中受试者的平均随访时间为5个月（范围，0 - 12个月），可能需要更长时间才会显现的结局将被排除在本研究之外。
