Rates of Reoperation and Retinal Detachment after Macular Hole Surgery

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• 作者：Kamyar Vaziri ; MD¹ ; Stephen G. Schwartz ; MD ; MBA¹ ; ^{sschwartz2@med.miami.edu" class="auth_mail" title="E-mail the corresponding author} ; Krishna S. Kishor ; MD¹ ; Jorge A. Fortun ; MD¹ ; Andrew A. Moshfeghi ; MD ; MBA² ; William E. Smiddy ; MD¹ ; Harry W. Flynn Jr. ; MD¹
• 关键词：CPT ; Current Procedural Terminology ; ICD-9 ; International Classification of Disease ; Ninth edition ; ILM ; internal limiting membrane ; RD ; retinal detachment
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：123
• 期：1
• 页码：26-31
• 全文大小：199 K

文摘

To evaluate rates of reoperation and retinal detachment (RD) after macular hole surgery.

Design

Retrospective cross-sectional study.

Participants

Patients in the insurance claim–based MarketScan databases from 2007 through 2013 with a record of macular hole surgery.

Methods

Patients with macular hole surgery were identified. Cases of definite (the same eye was coded both times) and presumed (the eye laterality was not coded) macular hole reoperations within 2, 3, and 12 months were queried. In addition, cases of postoperative RD within 2, 3, and 12 months were captured.

Main Outcome Measures

Rates of macular hole reoperation and postoperative RD, including subgroup analysis based on presence or absence of internal limiting membrane (ILM) peeling.

Results

Records of 23465 macular hole surgeries among 20 764 patients were analyzed. Among presumed reoperations, the rates of reoperation were 4.3% (4.1% after ILM peeling and 5.0% after no ILM peeling; P = 0.01) within 2 months of surgery, 5.5% (5.3% after ILM peeling and 6.2% after no ILM peeling; P = 0.03) within 3 months of surgery, and 9.5% (9.0% after ILM peeling and 11.0% after no ILM peeling; P = 0.01) within 12 months of surgery. The rates for definite reoperations were 1.3% (1.2% after ILM peeling and 1.8% after no ILM peeling; P = 0.04) at 2 months, 1.7% (1.6% after ILM peeling and 2.5% after no ILM peeling; P = 0.004) at 3 months, and 4.1% (3.3% after ILM peeling and 7.5% after no ILM peeling; P < 0.001) at 12 months. The cumulative rate of postoperative RD was 1.81±0.09% to 2.18±0.5% after 2 months, 2.27±0.10% to 3.18±0.67% after 3 months, and 3.92±0.16% to 5.70±1.1% after 12 months. Internal limiting membrane peeling was associated negatively with postoperative RD at 2 months (2.3% vs. 1.7%; P = 0.007), 3 months (2.8% vs. 2.1%; P = 0.004), and 12 months (4.7% vs. 3.3%; P < 0.001).

Conclusions

In this sample, reoperations for macular hole were performed at low rates. Internal limiting membrane peeling was associated with lower rates of reoperation and RD.