Abstract
Purpose :
To study the outcomes at 1 year after pars plana vitrectomy (PPV) in patients with a history of systemic corticosteroid use prior to PPV.
Methods :
A retrospective cohort study was performed using TriNetX (Cambridge, MA, USA), a federated electronic health records research network comprising multiple health organizations in the United States. Patients who underwent PPV were identified using a series of ICD-10 codes and stratified into 2 cohorts - with or without a history of systemic corticosteroid use prior to PPV. Each subject was matched to a control based on age, sex, BMI and the presence or absence of hypertension, diabetes mellitus, chronic lower respiratory diseases, heart failure, nicotine dependence and alcohol related disorders. The primary endpoint of the study was the incidence of vitreous hemorrhage (VH), choroidal hemorrhage, retinal detachment or break, iridocyclitis, retinal edema, cystoid macular degeneration, macula pucker, glaucoma, cataract, corneal edema, central retinal vein occlusion (CRVO) and central retinal artery occlusion (CRAO).
Results :
A total of 25,752 patients were included in the analysis with 12,876 patients in each of the cohorts after propensity matching. At 1-year post-PPV, the cohort with a history of systemic corticosteroid use prior to PPV were at greater risk for choroidal hemorrhage (RR 2.16; CI 1.42, 3.28), retinal detachment or break (RR 1.09; CI 1.04, 1.15), iridocyclitis (RR 1.59; CI 1.38, 1.82), retinal edema (RR 1.27; CI 1.15, 1.41), cystoid macular degeneration (RR 1.61; CI 1.45, 1.8), macula pucker (RR 1.42; CI 1.35, 1.5), glaucoma (RR 1.42; CI 1.34, 1.51), cataract (RR 1.28; CI 1.2, 1.36) and corneal edema (RR 2.37; CI 1.55, 3.62).
Conclusions :
Patients with a history of systemic corticosteroid use prior to PPV are at greater risks of long-term complications at 1-year post-PPV, possibly from a heightened inflammatory response from an underlying disease process treated by the corticosteroid. These findings can facilitate pre-operative counseling with patients regarding potential surgical risks and post-operative complications.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.