Abstract
Purpose :
Proliferative vitreoretinopathy (PVR) is the most common cause of retinal detachment (RD) repair failure. The impact of primary (preoperative) PVR on the occurrence of multiple surgical failures has not been studied in detail. We aimed to characterize the association between primary PVR and multiple failures of RD repair using a nationwide healthcare claims database.
Methods :
We selected cases of initial RD repair from the IBM® MarketScan® Commercial Claims and Encounters Database (2010-2017). Cases were categorized by the absence (P0 group) or presence (P1 group) of primary PVR. We defined surgical failure as the occurrence of a subsequent RD repair procedure with concurrent PVR. The frequency of surgical failures and the inter-surgical intervals (ISI) were compared between the groups. Kaplan-Meier analysis was used to estimate the probability of surgical failures in each group over time. Hazard ratios (HR) were adjusted for age, sex, and procedure.
Results :
A total of 27,137 cases of initial RD repair were included, with 24,500 (90.3%) in P0 and 2,637 (9.7%) in P1. The median age of patients was 56 years. The frequency (%) of one, two, three, or four surgical failures in P0 vs. P1 was 1.88 vs. 10.24 (p<0.001), 0.26 vs. 2.50 (p<0.001), 0.07 vs. 0.64 (p<0.001), and 0.03 vs. 0.08 (p=0.272), respectively. The median ISI between the initial repair and the first failure was 70 days in P0 and 59 days in P1 (p=0.021). The cumulative probability of the first failure at 60 months was 2.8% in P0 and 16.3% in P1 (p<0.001). Subsequently, the cumulative probability of a second failure at 60 months was 19.2% in P0 and 29.6% in P1 (p=0.002). The risk of the first failure was higher in P1 than in P0 (HR: 6.02, 95% confidence interval (CI): 5.24-6.92, p<0.001). The risk of the second failure was also higher in P1 than in P0 (HR: 1.67, CI: 1.23-2.28, p=0.001). There was no difference in the risk of the third failure between the groups (HR: 0.76, CI: 0.41-1.40, p=0.372).
Conclusions :
RD cases with primary PVR were >6 times more likely to undergo repeat surgery than those without. Primary PVR may increase the risk of requiring multiple RD repair surgeries. Healthcare claims analysis may be a useful tool to study population-based estimates of the incidence and recurrence pattern of RD repair failure.
This is a 2021 ARVO Annual Meeting abstract.