TY - JOUR
T1 - Risk of Tertiary, Quaternary, and Quinary Proliferative Vitreoretinopathy
T2 - Analysis of a Nationwide Database (2010–2017)
AU - Aziz, Kanza
AU - Patel, Tapan
AU - Canner, Joseph K.
AU - Swenor, Bonnielin K.
AU - Singh, Mandeep S.
N1 - Publisher Copyright:
© 2023 American Academy of Ophthalmology
PY - 2023/6
Y1 - 2023/6
N2 - Objective: Primary proliferative vitreoretinopathy (PVR) is established as an important cause of the failed repair of a fresh retinal detachment (RD) and the consequent need for secondary repair. However, the burden of multiple repairs beyond the initial failure has not been studied in detail. We aimed to determine the association between primary PVR and the occurrence of tertiary, quaternary, and quinary RD repairs, using a nationwide database. Design: Retrospective cohort study of insurance claims. Subjects: Cases of rhegmatogenous RD that underwent primary surgical repair. Methods: Cases of primary RD repair from 2010 to 2017 were categorized based on the absence (P0 group) or presence (P1 group) of primary PVR. In each group, we analyzed the frequency of subsequent RD repair procedures with concurrent PVR. Main Outcome Measure: The risk of secondary and higher multiples of PVR-associated RD repair. Results: A total of 27 137 cases were included, with 24 500 (90.3%) in the P0 group and 2637 (9.7%) in the P1 group. The frequency (%) of cases ultimately requiring secondary, tertiary, quaternary, and quinary repair in P0 versus P1 was 1.88 versus 10.24 (P < 0.001), 0.26 versus 2.50 (P < 0.001), 0.07 versus 0.64 (P < 0.001), and 0.03 versus 0.08 (P = 0.272), respectively. The risk of undergoing secondary repair was higher in the P1 than in the P0 group (hazard ratio [HR], 6.02; 95% confidence interval [CI], 5.24–6.92; P < 0.001). The risk of undergoing tertiary repair was also higher in the P1 than in the P0 group (HR, 1.67; CI, 1.23–2.28; P = 0.001). There was no difference in the risk of undergoing quaternary repair between the groups (HR, 0.76; CI, 0.41–1.40; P = 0.37). Senary repairs were not detected in this dataset. Conclusions: Primary PVR may increase the risk of requiring multiple sequential retinal reattachment surgeries beyond the initial repair failure. Retinal detachment cases with primary PVR at the initial presentation of RD were more likely to undergo secondary and tertiary repairs than cases without primary PVR. Health care claims analysis may be a useful tool to study population-based estimates for multiple recurrences of RD in cases with PVR. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
AB - Objective: Primary proliferative vitreoretinopathy (PVR) is established as an important cause of the failed repair of a fresh retinal detachment (RD) and the consequent need for secondary repair. However, the burden of multiple repairs beyond the initial failure has not been studied in detail. We aimed to determine the association between primary PVR and the occurrence of tertiary, quaternary, and quinary RD repairs, using a nationwide database. Design: Retrospective cohort study of insurance claims. Subjects: Cases of rhegmatogenous RD that underwent primary surgical repair. Methods: Cases of primary RD repair from 2010 to 2017 were categorized based on the absence (P0 group) or presence (P1 group) of primary PVR. In each group, we analyzed the frequency of subsequent RD repair procedures with concurrent PVR. Main Outcome Measure: The risk of secondary and higher multiples of PVR-associated RD repair. Results: A total of 27 137 cases were included, with 24 500 (90.3%) in the P0 group and 2637 (9.7%) in the P1 group. The frequency (%) of cases ultimately requiring secondary, tertiary, quaternary, and quinary repair in P0 versus P1 was 1.88 versus 10.24 (P < 0.001), 0.26 versus 2.50 (P < 0.001), 0.07 versus 0.64 (P < 0.001), and 0.03 versus 0.08 (P = 0.272), respectively. The risk of undergoing secondary repair was higher in the P1 than in the P0 group (hazard ratio [HR], 6.02; 95% confidence interval [CI], 5.24–6.92; P < 0.001). The risk of undergoing tertiary repair was also higher in the P1 than in the P0 group (HR, 1.67; CI, 1.23–2.28; P = 0.001). There was no difference in the risk of undergoing quaternary repair between the groups (HR, 0.76; CI, 0.41–1.40; P = 0.37). Senary repairs were not detected in this dataset. Conclusions: Primary PVR may increase the risk of requiring multiple sequential retinal reattachment surgeries beyond the initial repair failure. Retinal detachment cases with primary PVR at the initial presentation of RD were more likely to undergo secondary and tertiary repairs than cases without primary PVR. Health care claims analysis may be a useful tool to study population-based estimates for multiple recurrences of RD in cases with PVR. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
KW - Epiretinal membrane
KW - Epithelial-mesenchymal transition
KW - Surgical outcomes
KW - Tractional retinal detachment
KW - Vitrectomy
UR - http://www.scopus.com/inward/record.url?scp=85150827751&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150827751&partnerID=8YFLogxK
U2 - 10.1016/j.oret.2023.01.015
DO - 10.1016/j.oret.2023.01.015
M3 - Article
C2 - 36717076
AN - SCOPUS:85150827751
SN - 2468-7219
VL - 7
SP - 489
EP - 495
JO - Ophthalmology Retina
JF - Ophthalmology Retina
IS - 6
ER -