既往玻璃体内注射治疗患者白内障手术并发症的风险。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-01-16 DOI:10.1016/j.ajo.2025.01.004

CINDY S. ZHAO MD , KACPER CHWIALKOWSKI PhD , KAREN M. WAI MD , PRITHVI MRUTHYUNJAYA MD, MHS , EHSAN RAHIMY MD , EUBEE B. KOO MD

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引用次数: 0

摘要

目的比较玻璃体内注射（IVI）药物治疗前后白内障手术并发症的发生率。采用TriNetX （Cambridge， MA）汇总电子健康记录研究网络进行回顾性队列研究。受试者：使用倾向评分匹配（PSM）来平衡基线人口统计学、全身和眼部合并症，将白内障手术后20年内有IVI治疗史的患者与对照组进行比较。排除白内障手术前有晶状体切除术或玻璃体部切除术（PPV）病史的患者。白内障手术后20年内的介入治疗。主要观察指标：白内障手术后14、30和90天内，视网膜脱离（RD）、视网膜脱离修复、前体玻璃体切除术、晶状体保留、人工晶状体脱位、需要二次晶状体手术和眼内炎的发生率。结果在PSM之前，分别有16,356例和512,152例患者在白内障手术前接受和未接受IVI药物治疗。经PSM后，两组均有14240例患者。较高的发病率(RR 1.34；95% ci, 1.16-1.54；p<0.0005)，既往IVI组白内障手术后90天内的总并发症发生率（447/ 13719 = 3.3%）相对于对照组（340/ 13945 =2.4%）。暴露组在30天RD修复的风险增加(RR 1.84；95% ci, 1.27-2.66；p=0.001)和90天(RR 2.05；95% ci, 1.65-2.54；p < 0.0005)。IVI无其他并发症。特别地，IVI与较高的前玻璃体切除术率无关，除了糖尿病视网膜病变（DR）患者在第90天(RR 1.24；95% ci, 0.85-1.79；p = 0.001)。与没有IVI病史的DR患者相比，DR患者有更高的晶状体切除术、RD修复和二次手术的风险（p < 0.0005）。结论既往IVI患者白内障术后并发症较多，主要为RD，术前规划应考虑IVI治疗史。

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Risk of Cataract Surgery Complications in Patients With Prior Intravitreal Injection Therapy

Objective

To compare cataract surgery complications in patients with and without prior intravitreal injection (IVI).

Design

A retrospective cohort study using the TriNetX aggregated research network.

Subjects

Patients with IVI therapy within twenty years of cataract surgery were compared to controls using propensity score matching (PSM) to balance for demographics, systemic, and ocular co-morbidities. Patients with lensectomy or pars plana vitrectomy (PPV) prior to cataract surgery were excluded.

Intervention

IVI within twenty years of cataract surgery.

Main Outcome Measures

Rate of retinal detachment (RD), RD repair, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), secondary lens procedure, and endophthalmitis within 14, 30, and 90 days of cataract surgery.

Results

Prior to PSM, 16,356 and 512,152 patients did and did not, respectively, have IVI pharmacotherapy prior to cataract surgery. After PSM, both groups had 14,240 patients. A higher rate (RR 1.34; 95% CI:1.16-1.54) of aggregate complications within 90 days of cataract surgery was found in the group with prior IVI (447/13,719 = 3.3%) relative to controls (340/13,945=2.4%). The exposure group saw an increased risk of RD repair at 30 days (RR 1.84; 95% CI:1.27-2.66) and 90 days (RR 2.05; 95% CI:1.65-2.54). IVI was only associated with higher rates of anterior vitrectomy in patients with diabetic retinopathy (DR) at 90 days (RR 1.24; 95% CI:0.85-1.79). Patients with DR and IVI exposure had more lensectomies, RD repairs, and secondary procedures.

Conclusions

Patients with prior IVI saw more complications following cataract surgery, primarily for RD. IVI treatment history should be considered in pre-operative planning.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.