ImportanceThe 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.ObjectiveTo explore outcomes of PDR treated with PRP monotherapy compared with matched patients treated with anti-VEGF monotherapy.Design, Setting, and ParticipantsRetrospective 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.ExposuresPatients with new PDR diagnoses stratified by monotherapy with PRP or anti-VEGF agents using Current Procedural Terminology code.Main Outcome MeasuresIncidence of pars plana vitrectomy (PPV), VH, or TRD.ResultsAmong 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.Conclusions and RelevanceThese 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.

中文翻译：

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增殖性糖尿病视网膜病变患者进展至睫状体平坦部玻璃体切除术


重要性糖尿病视网膜病变临床研究网络 S 方案表明，与抗血管内皮生长因子（抗 VEGF）治疗相比，最初接受全视网膜光凝（PRP）治疗的眼睛中，玻璃体切除术治疗玻璃体出血（VH）或牵拉性视网膜脱离（TRD）更为常见。增殖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。目的探讨 PDR 单一疗法与抗 VEGF 单一疗法的匹配患者相比的结果。设计、设置和参与者使用聚合电子健康记录研究网络进行回顾性队列研究。在倾向评分匹配之前，纳入了 2023 年 1 月至 9 月期间接受 PRP 或抗 VEGF 单药治疗的 PDR 患者。单一治疗或 PRP 与抗 VEGF 联合治疗后随访时间不超过 6 个月的患者被排除。数据于 2023 年 9 月进行分析。暴露新诊断出 PDR 的患者通过 PRP 或抗 VEGF 药物单一疗法进行分层当前的程序术语代码.主要结果指标平坦部玻璃体切除术 (PPV)、VH 或 TRD 的发生率。结果在 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%] 白人，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%] ] 白人和 2382 [22.29%] 未知种族）接受治疗时，与 5 年时接受抗 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%；磷< 。001），1 年和 3 年具有类似的关联。 PRP 单药治疗与 5 年 VH 发生率较高相关（相对风险 [RR]，1.72；95% CI，1.52-1.95；风险差 [RD]，7.05；95% CI，5.41%-8.69%；磷< .001）和 5 年 TRD 发生率较高（RR，2.76；95% CI，2.26-3.37；RD，4.25%；95% CI，3.45%-5.05%；磷< .001），与接受抗 VEGF 单一疗法治疗的患者相比，在 6 个月、1 年和 3 年时的相关性程度相似。 结论和相关性这些发现支持以下假设：接受 PRP 单一疗法治疗的 PDR 患者更有可能与接受抗 VEGF 单一疗法治疗的匹配患者相比，出现 VH、TRD 并接受 PPV。然而，鉴于相对风险范围广泛，混杂因素可能解释 PRP 与抗 VEGF 单一疗法和评估结果之间的一些关联。