COST ANALYSIS OF SCLERAL BUCKLE,PARS PLANA VITRECTOMY, AND PARS PLANA VITRECTOMY WITH SCLERAL BUCKLE FOR RETINAL DETACHMENT REPAIR
(Retina. 2021;41(12):2472-2478. doi:10.1097/IAE.0000000000003297）
Purpose
To compare the cost and utility of scleral buckle (SB), pars plana vitrectomy (PPV),and PPV with SB (PPV/SB) for moderately complex rhegmatogenous retinal detachment repair.
比较巩膜扣带术（SB）、玻璃体平坦部切除术（PPV）和内外联合手术（PPV/SB）治疗中度复杂性孔源性视网膜脱离的成本和实用性。
Methods
Cost-utility analysis using data from the Primary Retinal Detachment Outcomes Study. The model estimated costs, lifetime utility, and lifetime cost per quality-adjusted life year for treatment of moderately complex rhegmatogenous retinal detachment with SB, PPV, or PPV/SB. Data from the Centers for Medicare and Medicaid Services were used to calculate costs in hospital and ambulatory surgery center settings.
使用来自原发性视网膜脱离结果研究的数据进行成本-效用分析。该模型估计了使用SB、PPV或PPV/SB治疗中度复杂孔源性视网膜脱离的成本、术式平均有效期和有效性性价比成本。医疗保险和医疗补助服务中心的数据用于评估医院和门诊手术中心维护的成本。
Results
Total costs (2020 US dollars) for repair of a moderately complex rhegmatogenous retinal detachment in hospital (ambulatory surgery center) settings were $5,975 ($3,774) for the SB group, $8,125 ($5,082) for the PPV group, and $7,551 ($4,713) for the PPV/SB group. The estimated lifetime quality-adjusted life years gained were 5.4, 4.7, and 4.7 in the SB, PPV, and PPV/SB groups, respectively. The cost per quality-adjusted life year for hospital and ambulatory surgery center settings was $1,106 a ($699) for the SB group, $1729 ($1,081) for the PPV group, and $1,607 ($1,003) for the PPV/SB group.
在医院（门诊手术中心）治疗中度复杂孔源性视网膜脱离的总成本，SB组为5975美元，PPV组为8125美元，PPV/SB组为7551美元。SB组、PPV组和PPV/SB组的平均有效期分别为5.4、4.7和4.7年。医院和门诊手术中心不同术式对患者的性价比成本为SB组为1106美元，PPV组为1729美元，PPV/SB组为1607美元。
Conclusion
Scleral buckle, PPV, and PPV/SB yielded very favorable cost-utility results for the repair of moderately complex rhegmatogenous retinal detachment, with slightly better results for SB, compared with current willingness to pay standards.
SB、PPV和PPV/SB对中度复杂性孔源性视网膜脱离的治疗产生了非常有利的恢复结果，与目前的支付意愿性价比相比，SB的效果稍好。
本文研究了巩膜扣带术（SB）、玻璃体平坦部切除术（PPV）和内外联合手术（PPV/SB）三种方式治疗中度复杂性孔源性视网膜脱离的成本和实用性性价比，得出巩膜扣带术的术式具有便宜，有效的优势。
本文创新之处在于通过科学的对比，分析了三种手术方式的费用比较和有效性的比较，得出了巩膜扣带术是最佳的意向手术，暗示外路手术对比内路手术具有远期效果优势和费用优势。
文章不足之处在于未对中度复杂性孔源性视网膜脱离的PVR进行分级，无法预估远期的PVR是否需要进一步手术处理。
Progression Patterns of Myopic Traction Maculopathy in the Fellow Eye After Pars Plana Vitrectomy of the Primary Eye
(Invest Ophthalmol Vis Sci. 2021;62(14):28.doi:10.1167/iovs.62.14.28）
Purpose
This retrospective study investigated the patterns and risk factors of progression of myopic traction maculopathy (MTM) of fellow eyes after pars plana vitrectomy (PPV) of primary eyes.
这项回顾性研究调查了原发眼平坦部玻璃体切除术（PPV）后对侧眼近视牵引性黄斑病变（MTM）进展的模式和危险因素。
Methods
The study population comprised 153 patients with MTM in both myopic eyes who sequentially underwent PPV (2006–2021). Observation periods were from PPV of the primary eye (baseline) to PPV of the fellow (end). MTM was graded based on optical coherence tomography (OCT) images and the ATN (atrophy [A], traction [T], and neovascularization [N]) system. An increase in T grade was considered MTM progression.
研究人群包括153名双眼近视的近视牵引性黄斑病变患者，他们依次接受PPV（2006-2021年）。观察期从第一只眼的PPV（基线）到第二只眼的PPV（结束）。根据光学相干断层扫描（OCT）图像和ATN（萎缩[A]、牵引[T]和新血管化[N]）系统对近视牵引性黄斑病变进行分级。T级的增加被认为是近视牵引性黄斑病变进展。
Results
MTM progressed in 43.8% of fellow eyes during 34.57 ± 34.08 months. The progression of fellow eyes correlated with T grade of primary eyes (P < 0.001). Risk factors for the progression of MTM in fellow eyes were primary eyes in T4–T5, age at baseline <60 years, and fellow eyes with partial posterior vitreous detachment (PVD;P < 0.001, P = 0.042, and P = 0.002, respectively). Fellow eyes in T1/T2 at baseline progressed faster compared with those in T0 (P < 0.001); the annual rate of progression to T3–T5 of the T0 (T1–T2) groups was 9.98% (24.59%).
在随访34.57±34.08个月内，43.8%的患者出现对侧眼近视牵引性黄斑病变进展。对侧眼的进展与原发眼的T分级相关（P<0.001）。对侧眼近视牵引性黄斑病变进展的危险因素为：T4-T5期的原发眼、基线年龄<60岁、对侧眼有部分玻璃体后脱离（PVD；分别为P<0.001、P=0.042和P=0.002）。与T0组相比，基线检查时T1/T2组的对侧眼进展更快（P<0.001）；T0组进展到T3-T5分级的进展率为9.98%，T1-T2组进展到T3-T5分级的进展率为24.59%。
Conclusion
Risk factors for the progression of MTM in fellow eyes included PPV when relatively young, primary eye at high T grade, and partial PVD of the fellow eye. Personalized follow-up for fellow eyes should be based on the severity of MTM of both eyes.
对侧眼近视牵引性黄斑病变进展的危险因素包括相对年轻时的PPV史、高T级原发眼和对侧眼部分玻璃体后脱离。对双眼的个体化随访应基于双眼近视牵引性黄斑病变的严重程度。
本文研究了原发眼平坦部玻璃体切除术后对侧眼近视牵引性黄斑病变进展的危险因素，得出3条相关危险因素包括：相对年轻时的PPV史、高T级原发眼和对侧眼部分玻璃体后脱离。
文章创新之处在于打破了以往的局部观察，将患者的双眼相关性做了进一步的联系观察，将双眼视觉作为一个整体，而非单独考虑，提出了双眼近视牵引患者的个性化随访需要基于双眼的病程发展。
本文的不足之处在于未设计相关的对照研究，未来可进一步继续优化设计方案的科学性。
The Effect of Achieving Target Intraocular Pressure on Visual Field Worsening
(Ophthalmology. 2021;128(12):1736-1747. doi:10.1016/j.ophtha.2021.07.025）
Purpose
To estimate the effect of achieving target intraocular pressure (IOP) values on visual field (VF) worsening in a treated clinical population.
评估在接受治疗的临床人群中，达到目标眼压（IOP）值对视野（VF）恶化的影响。
Design
Retrospective analysis of longitudinal data.
纵向数据的回顾性分析。
Participants
Older adults (>50 years) with recently diagnosed unilateral nAMD with a fellow (study) eye free of nAMD.
最近诊断为单侧nAMD的老年人（>50岁），另一位（研究）患者的眼睛没有nAMD。
Methods
The primary dependent variable was the slope of the mean deviation (MD) over time (decibels[dB]/year). The primary independent variable was mean target difference (measured IOP e target IOP). We created simple linear regression models and mixed-effects linear models to study the relationship between MD slope and mean target difference for individual eyes. In the mixed-effects models, we included an interaction term to account for disease severity (mild/suspect, moderate, or advanced) and a spline term to account for the differing effects of achieving target IOP (target difference 0) and failing to achieve target IOP (target difference >0).
主要因变量是平均偏差（MD）随时间的斜率。主要自变量为平均目标差（测量的眼压和目标眼压）。我们创建了简单的线性回归模型和混合效应线性模型来研究个体眼睛的平均偏差斜率和平均目标差之间的关系。在混合效应模型中，我们包括了一个相互作用项来说明疾病的严重程度（轻度/可疑、中度或晚期），以及一个样条项来说明达到目标眼压（目标差异0）和未能达到目标眼压（目标差异>0）的不同影响。
Main Outcome Measures
Rate of change in MD slope (changes in dB/year) per 1 mmHg change in target difference at different stages of glaucoma severity.
在青光眼严重程度的不同阶段，每1mmHg目标差异的平均偏差斜率变化率(dB/year) 。
Results
Across all eyes, a simple linear regression model demonstrated that a 1 mmHg increase in target difference had a 0.018 dB/year (confidence interval [CI], 0.026 to 0.011; P < 0.05) effect on MD slope. The mixed-effects model shows that eyes with moderate disease that fail to achieve their target IOP experience the largest effects, with a 1 mmHg increase in target difference resulting in a 0.119 dB/year (CI, 0.168 to 0.070;P < 0.05) worse MD slope. The effects of missing target IOP on VF worsening were more pronounced than the effect of absolute level of IOP on VF worsening, where a 1 mmHg increase in IOP had a 0.004 dB/year(CI, 0.011 to 0.003; P > 0.05) effect on the MD slope.
在所有人的眼睛中，简单的线性回归模型表明，目标差异增加1mmHg对平均偏差斜率有0.018（置信区间[CI]，0.026至0.011；P<0.05）的影响。混合效应模型显示，未能达到目标眼压的中度疾病眼睛受到的影响最大，目标差异增加1 mmHg，导致平均偏差斜率降低0.119（CI，0.168至0.070；P<0.05）。缺少目标眼压对视野恶化的影响比绝对眼压水平对视野恶化的影响更为显著，其中眼压增加1 mmHg对平均偏差斜率的影响为0.004（CI，0.011至0.003；P>0.05）。
Conclusion
In treated patients, failing to achieve target IOP was associated with more rapid VF worsening.Eyes with moderate glaucoma experienced the greatest VF worsening from failing to achieve target IOP.
在接受治疗的患者中，未能达到目标眼压与更快的视野恶化相关。中度青光眼患者因未能达到目标眼压而经历了最大的视野恶化。
本研究探索了青光眼患者眼压控制和不控制对患者视野恶化的影响，得出中度的青光眼患者控制眼压在目标眼压内对术后视野的影响最小，需要重视青光眼患者的眼压监控。
文章创新点是关注青光眼患者视野的变化，通过科学的方案设计分析出眼压控制对于视野的影响，提出关注青光眼患者周边视网膜的预后情况。
文章的不足之处为数据相对短期，没有远期数据支撑
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