NATIONAL OUTCOMES OF CATARACT-EXTRACTION - INCREASED RISK OF RETINAL COMPLICATIONS ASSOCIATED WITH ND-YAG LASER CAPSULOTOMY
NATIONAL OUTCOMES OF CATARACT-EXTRACTION - INCREASED RISK OF RETINAL COMPLICATIONS ASSOCIATED WITH ND-YAG LASER CAPSULOTOMY
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DOI：
10.1016/s0161-6420(92)31775-0
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发表时间：
1992-10-01
期刊：
影响因子：
13.7
通讯作者：
STEINBERG, EP
中科院分区：
文献类型：
--
作者：
JAVITT, JC;TIELSCH, JM;STEINBERG, EP
目的：作者研究了57,103随机选择的医疗保险受益人进行囊外白内障摘除术在1986年或1987年，以确定可能的关联性能钕（Nd）：YAG激光囊切开术和随后的视网膜破裂或detachment.Methods的风险：白内障手术的情况下，确定从医疗保险索赔提交于1986年和1987年，并通过1988年底进行了跟踪。根据医生账单和出院记录中列出的程序和诊断代码，确定白内障手术、后囊切开术和视网膜并发症的发生率。寿命表和考克斯的比例风险模型被用来分析视网膜脱离或破裂的风险，在接受和不接受囊切开术的患者在观察period of observation.Results：在57,103人确定为已接受囊外白内障摘除术在1986年或1987年，13,709随后接受Nd：YAG激光囊切开术在1986年和1988年之间。在1986年至1988年期间，共有337人患有无晶状体或人工晶状体视网膜脱离，另外194人接受了视网膜裂孔修复术。比例风险模型显示，在接受囊切开术的患者中，视网膜破裂或脱离的风险增加了3.9倍（95%置信区间：2.89至5.25）。年轻的患者年龄，男性，和白色种族也与视网膜并发症的风险增加后，囊外白内障extraction.Conclusion：作者的结论是，有一个统计学上显着增加的风险，视网膜脱离或破裂的患者接受囊切开术后，白内障摘除术。因此，应推迟晶状体囊切开术，直到患者因晶状体囊混浊导致的损害证明与晶状体囊切开术相关的视网膜并发症风险增加。
Purpose: The authors studied 57,103 randomly selected Medicare beneficiaries who underwent extracapsular cataract extraction in 1986 or 1987 to determine the possible association between performance of neodymium (Nd):YAG laser capsulotomy and the risk of subsequent retinal break or detachment.Methods: Cases of cataract surgery were identified from Medicare claims submitted in 1986 and 1987 and were followed through the end of 1988. Episodes of cataract surgery, posterior capsulotomy, and retinal complications were ascertained based on procedure and diagnosis codes listed in physician bills and hospital discharge records. Lifetable and Cox's proportional hazards models were used to analyze the risk of retinal detachment or break in patients undergoing and not undergoing capsulotomy during the period of observation.Results: Of the 57,103 persons identified as having undergone extracapsular cataract extraction in 1986 or 1987, 13,709 subsequently underwent Nd:YAG laser capsulotomy between 1986 and 1988. A total of 337 persons had aphakic or pseudophakic retinal detachments between 1986 and 1988 and an additional 194 underwent repair of a retinal break. Proportional hazards modeling shows a 3.9-fold increase in the risk of retinal break or detachment among those who underwent capsulotomy (95% confidence interval: 2.89 to 5.25). Younger patient age, male sex, and white race also were associated with increased risk of retinal complications after extracapsular cataract extraction.Conclusion: The authors conclude that there is a statistically significant increase in the risk of retinal detachment or break in those patients who undergo capsulotomy after cataract extraction. Therefore, capsulotomy should be deferred until the patient's impairment caused by capsular opacification warrants the increased risk of retinal complications associated with performance of capsulotomy.