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Factors Predicting the Need for Retreatment After Laser Refractive Surgery

机译：预测激光屈光手术后需要再治疗的因素

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Purpose:To identify the potential risk factors that increase the likelihood of requiring retreatment after refractive surgery.Methods:This retrospective study included patients who underwent laser in situ keratomileusis or photorefractive keratectomy between January 2005 and December 2012 at the Care-Vision Laser Centers, Tel-Aviv, Israel. Patients were divided into 2 groups according to whether they underwent additional refractive surgery (retreatment) during the study period.Results:Overall, 41,504 eyes (n = 21,313) were included in the final analysis of this study. Throughout the study period, there was a significant reduction in the 2-year annual retreatment rates with a decline from 4.52% for primary surgeries done in 2005 to 0.18% for surgeries performed in 2012 (quadratic R-2 = 0.96, P < 0.001). The retreatment group had significantly higher preoperative age, maximum keratometric power, sphere, cylinder, and better best-corrected visual acuity. They were more likely to have preoperative hyperopia, photorefractive keratectomy as opposed to laser in situ keratomileusis, intraoperative higher humidity conditions and lower temperature, and higher ablation depths. Significant differences in retreatment rates were found between the 5 high-volume surgeons (>1500 procedures performed) ranging from 0.48 to 3.14% (P < 0.0001). Multiple logistic regression analysis demonstrated that age, astigmatism, hyperopia, temperature, and surgeon's experience all significantly affected the need for retreatment.Conclusions:The following factors significantly increase the need for refractive retreatment: older preoperative age, higher degrees of astigmatism, hyperopia, colder operating room temperature, and less surgeon experience. Some of these factors may be incorporated into nomograms to reduce future retreatment rates.
机译：目的：确定潜在的风险因素，以增加屈光手术后需要再次治疗的可能性。方法：这项回顾性研究包括2005年1月至2012年12月在Tele的Care-Vision激光中心接受激光原位角膜磨镶术或光折射角膜切除术的患者-以色列的艾维夫。根据研究期间是否进行额外的屈光手术（再治疗）将患者分为两组。结果：本研究的最终分析包括41,504眼（n = 21,313）。在整个研究期间，两年的年度复诊率显着降低，从2005年进行的一次外科手术的4.52％下降到2012年进行的外科手术的0.18％（二次R-2 = 0.96，P <0.001） 。复治组的术前年龄，最大角膜屈光度，球面，圆柱度明显更高，并且最佳矫正视力更好。与激光原位角膜磨镶术相比，他们更有可能发生术前远视，光折射角膜切除术，术中更高的湿度条件和更低的温度以及更高的消融深度。 5名大容量外科医生（执行了> 1500例手术）之间的再治疗率存在显着差异，范围从0.48％至3.14％（P <0.0001）。多元logistic回归分析表明，年龄，散光，远视，体温和外科医生的经验都显着影响了再治疗的需要。结论：以下因素显着增加了屈光疗法的需要：术前年龄较大，散光度数更高，远视，体温降低手术室温度低，外科医生经验少。这些因素中的某些因素可以并入列线图中，以降低将来的再治疗率。

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