■糖尿病视网膜病变临床研究网络协议S表明,玻璃体切除术治疗玻璃体出血(VH)或牵拉性视网膜脱离(TRD)在最初分配给全视网膜光凝(PRP)的眼睛中更为常见,而抗血管内皮生长因子(抗VEGF)治疗增生性糖尿病视网膜病变(PDR)。这些临床意义值得在临床实践中进一步评估。
■探讨PRP单药治疗的PDR与抗VEGF单药治疗的匹配患者相比的结果。
■使用聚合电子健康记录研究网络的回顾性队列研究。在2023年1月至9月期间接受PRP或抗VEGF单药治疗的PDR患者在倾向评分匹配之前被纳入。单药治疗或PRP和抗VEGF联合治疗后随访6个月或更少的患者被排除在外。数据在2023年9月进行了分析。
■使用当前程序术语代码,通过PRP或抗VEGF药物的单一疗法对患有新PDR诊断的患者进行分层。
■平坦部玻璃体切除术(PPV)的发生率,VH,或TRD。
■在6020名患者中(PRP队列:平均[SD]年龄,64.8[13.4];6424[50.88%]女性;3562[28.21%]黑人,6180[48.95%]白色,2716[21.51%]未知种族;抗VEGF队列:平均[SD]年龄,66.1[13.2];5399[50.52%]男性;2859[26.75%]黑人,5377[50.31%]白色,和2382[22.29%]未知种族)接受治疗的人,与5年抗VEGF单药治疗的患者相比,PRP单药治疗与较高的PPV发生率相关(RR,1.18;95%CI,1.05-1.36;RD,1.37%;95%CI,0.39%-2.37%;P<.001),在1年和3年有类似的关联。PRP单药治疗与5年时VH发生率较高相关(相对危险度[RR],1.72;95%CI,1.52-1.95;风险差异[RD],7.05;95%CI,5.41%-8.69%;P<.001)和更高的5年TRD率(RR,2.76;95%CI,2.26-3.37;RD,4.25%;95%CI,3.45%-5.05%;P<.001),在6个月时有相似程度的关联,1年,3年,与使用抗VEGF单药治疗的患者相比。
■这些发现支持以下假设:用PRP单药治疗的PDR患者更有可能发生VH,TRD,与接受抗VEGF单药治疗的匹配患者相比,接受PPV治疗。然而,考虑到相对风险的广泛范围,混杂因素可能解释了PRP和抗VEGF单药治疗与所评估结局之间的某些关联.
UNASSIGNED: The Diabetic Retinopathy Clinical Research Network Protocol S suggested that vitrectomy for vitreous hemorrhage (VH) or tractional retinal detachment (TRD) was more common among eyes assigned initially to panretinal photocoagulation (PRP) vs anti-vascular endothelial growth factor (anti-VEGF) for proliferative diabetic retinopathy (PDR). These clinical implications warrant further evaluation in the clinical practice setting.
UNASSIGNED: To explore outcomes of PDR treated with PRP monotherapy compared with matched patients treated with anti-VEGF monotherapy.
UNASSIGNED: Retrospective cohort study using an aggregated electronic health records research network. Patients with PDR who received PRP or anti-VEGF monotherapy between January and September 2023 were included before propensity score matching. Patients were excluded with 6 or fewer months\' follow-up after monotherapy or with a combination of PRP and anti-VEGF. Data were analyzed in September 2023.
UNASSIGNED: Patients with new PDR diagnoses stratified by monotherapy with PRP or anti-VEGF agents using Current Procedural Terminology code.
UNASSIGNED: Incidence of pars plana vitrectomy (PPV), VH, or TRD.
UNASSIGNED: Among 6020 patients (PRP cohort: mean [SD] age, 64.8 [13.4]; 6424 [50.88%] female; 3562 [28.21%] Black, 6180 [48.95%] White, and 2716 [21.51%] unknown race; anti-VEGF cohort: mean [SD] age, 66.1 [13.2]; 5399 [50.52%] male; 2859 [26.75%] Black, 5377 [50.31%] White, and 2382 [22.29%] unknown race) who received treatment, PRP monotherapy was associated with higher rates of PPV when compared with patients treated with anti-VEGF monotherapy at 5 years (RR, 1.18; 95% CI, 1.05-1.36; RD, 1.37%; 95% CI, 0.39%-2.37%; P < .001), with similar associations at 1 and 3 years. PRP monotherapy was associated with higher rates of VH at 5 years (relative risk [RR], 1.72; 95% CI, 1.52-1.95; risk difference [RD], 7.05; 95% CI, 5.41%-8.69%; P < .001) and higher rates of TRD at 5 years (RR, 2.76; 95% CI, 2.26-3.37; RD, 4.25%; 95% CI, 3.45%-5.05%; P < .001), with similar magnitudes of associations at 6 months, 1 year, and 3 years, when compared with patients treated with anti-VEGF monotherapy.
UNASSIGNED: These findings support the hypothesis that patients with PDR treated with PRP monotherapy are more likely to develop VH, TRD, and undergo PPV when compared with matched patients treated with anti-VEGF monotherapy. However, given the wide range in relative risk, confounding factors may account for some of the association between PRP vs anti-VEGF monotherapy and outcomes evaluated.