Expanded Criteria for Pneumatic Retinopexy and Potential Cost Savings
Expanded Criteria for Pneumatic Retinopexy and Potential Cost Savings
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DOI：
10.1016/j.ophtha.2013.06.037
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发表时间：
2014-01-01
期刊：
影响因子：
13.7
通讯作者：
Heier, Jeffrey S.
中科院分区：
文献类型：
--
作者：
Goldman, Darin R.;Shah, Chirag P.;Heier, Jeffrey S.
目的：探讨影响原发性孔源性视网膜脱离充气性视网膜固定术（PR）治疗效果的术前因素。此外，我们试图分析在美国孔源性视网膜脱离修复的成本，以确定充气性视网膜固定术潜在的成本节约。设计：单中心，回顾性，观察性连续病例系列和第三方支付者视角的比较成本分析。参与者：我们包括141只接受充气性视网膜固定术治疗原发性孔源性视网膜脱离的眼睛。方法：收集术前特征、解剖结果和最佳可用视力。根据选定的术前因素分析解剖和视力结果。根据术前特征将主要队列分为2组：（1）传统充气性视网膜固定术和（2）非传统充气性视网膜固定术。对充气性视网膜固定术、巩膜扣带术和玻璃体切除术进行成本比较分析。主要结果测量：6个月时的解剖学和视力结果。结果：总体解剖学成功率为78.7%，视力显著提高（最小分辨角对数[ logMAR] 0.48-0.25; P< 0.005）。最终解剖成功率为97.6%。传统组与非传统组（84.1% vs 74.4%; P = 0.16）、有晶状体眼组与人工晶状体眼组（79.1% vs 78.0%; P = 0.88）和黄斑开与黄斑关组（77.9% vs 81.1%; P 0.68）的解剖结局相似。解剖学失败的预测是存在下视网膜裂孔（P< 0.005）或视网膜裂孔上可见的玻璃体牵引（P = 0.04）。传统组与非传统组（logMAR 0.21 vs 0.27; P> 0.05）以及有晶状体眼组与人工晶状体眼组（logMAR 0.23 vs 0.28; P> 0.05）的视力结果相似。黄斑脱离组视力优于黄斑脱离组（logMAR 0.18 vs 0.42; P< 0.005）。结论：充气性视网膜固定术是治疗原发性孔源性视网膜脱离的一种有效方法。传统和非传统术前入选标准以及有晶状体眼和人工晶状体眼的解剖和视力结局相似。撕裂处下方破裂和可见的玻璃体牵引预示着失败。增加充气性视网膜固定术的使用将在保持结果的同时实现显著的成本节约。(C)2014年由美国眼科学会。
Purpose: To provide insight into the preoperative factors that affect outcome after pneumatic retinopexy (PR) for treatment of primary rhegmatogenous retinal detachment repair. Additionally, we sought to analyze the cost of rhegmatogenous retinal detachment repair in the United States to determine potential cost savings with pneumatic retinopexy.Design: Single-center, retrospective, observational consecutive case series and third party payer-perspective comparative cost analysis.Participants: We included 141 eyes undergoing pneumatic retinopexy for the treatment of primary rhegmatogenous retinal detachment.Methods: Preoperative characteristics, anatomic outcomes, and best-available visual acuity were collected. Anatomic and visual outcomes were analyzed based on the presence of selected preoperative factors. The primary cohort was divided into 2 groups based on preoperative characteristics: (1) traditional pneumatic retinopexy and (2) nontraditional pneumatic retinopexy. Comparative cost analyses were performed between pneumatic retinopexy, scleral buckling, and vitrectomy.Main Outcome Measures: Anatomic and visual outcomes at 6 months.Results: Overall anatomic success was 78.7% and visual acuity improved significantly (logarithm of the minimum angle of resolution [ logMAR] 0.48-0.25; P< 0.005). A 97.6% final anatomic success rate was achieved. Anatomic outcomes were similar between traditional versus nontraditional (84.1% vs 74.4%; P = 0.16), phakic versus pseudophakic (79.1% vs 78.0%; P = 0.88), and macula-on versus macula-off (77.9% vs 81.1%; P 0.68) groups. Anatomic failure was predicted by the presence of an inferior retinal break (P< 0.005) or visible vitreous traction on a retinal break (P = 0.04). Visual outcomes were similar between each of the traditional versus nontraditional (logMAR 0.21 vs 0.27; P> 0.05) and phakic versus pseudophakic groups (logMAR 0.23 vs 0.28; P> 0.05). Visual outcomes were better in macula-on detachments compared with those in which the macula was detached (logMAR 0.18 vs 0.42; P< 0.005). Annual health care cost savings in the United States ranging from $ 6 to $ 30 million are theoretically possible by increasing pneumatic retinopexy utilization from the current rate of 15% to 20%-35%.Conclusions: Pneumatic retinopexy is an effective treatment modality for primary rhegmatogenous retinal detachment. Anatomic and visual outcomes are similar for traditional and nontraditional preoperative inclusion criteria, as well as phakic and pseudophakic eyes. Inferior breaks and visible vitreous traction on a tear predicted failure. Increased utilization of pneumatic retinopexy would achieve significant cost savings while maintaining outcomes. (C) 2014 by the American Academy of Ophthalmology.