Nugteren, M.B. (2015) Is huid autofluorescentie als maat voor advanced glycation endproducts een voorspeller van het succes van primaire vitrectomie bij rhegmatogene ablatio retinae? thesis, Medicine.
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Abstract
Purpose Proliferative vitreoretinopathy (PVR) is a serious sight-threatening condition and the main complication after surgical treatment of rhegmatogenous retinal detachment (RRD), often requiring re-operation. Advanced glycation endproducts (AGEs) might be involved in the inflammatory response that occurs in PVR. Therefore, measurement of AGEs using skin autofluorescence (AF) could be an important predictor for the onset of the disease and the failure of surgical treatment. Method This was investigated in a prospective cohort study of 267 patients undergoing vitrectomy in the University Medical Center Groningen (UMCG) between November 2013 and October 2014 for the treatment of primary RRD. Skin AF was measured with the aid of the AGE Reader. The primary endpoint was recurrence of retinal detachment for which re-operation was required within 3 months. With regression analysis models the impact of clinical risk factors were determined on the risk of surgical failure, skin AF, and the two biggest risk factors that in the pilot study proved to be related with skin AF: area of RRD and preoperative PVR. Results Skin autofluorescence (AF) was significantly higher in the group of patients for which a primary surgical treatment failed (P = 0.019). Multivariate analysis for surgical failure showed a predicting role for RRD area (OR 2.91, 95% CI 1.34 to 6.35, P = 0.007) and age (OR 1.06, 95% CI 1.02 -1.10, P = 0.005). The model was moderately predictive (Nagelkerke R Square = 0.138, Chi-square = 19.0). PVR was not significantly associated with surgical failure (P = 0.066), and PVR was not found to be a predictor of surgical failure in multivariate analysis. The incidence of PVR in the group with surgical failure was twice that of the group without (24% versus 12%). An additional analysis was carried out in which pseudophakic patients and diabetic patients were excluded (n = 176), in order to have a similar population to the pilot study. Multivariate analysis showed a predictive role for PVR (OR 5.585, 95% CI 1.627 to 19.174, P = 0.006), in addition to the area of RRD (OR 4.453, 95% CI 1426-13903, P = 0.010) and systolic blood pressure (OR 1.033, 95% CI 1.003 to 1.064, P = 0.030), Nagelkerke R Square = 0.262, Chi Square = 22.1. Skin AF in univariate analysis was associated with RRD area (P = 0.017), and not associated with PVR (P = 0.740) In multivariate analysis, no association was found. Conclusion Skin AF could be used as a predictor of surgical failure, but has no added value in addition to the predictors RRD area and age. Preoperative PVR showed not to be a predictor of surgical failure in the total group. In phakic patients without diabetes, surgical failure was predicted by preoperative PVR, the area of the detachment, and systolic blood pressure. This model was slightly better than the predictive model of the entire group. A possible conclusion is that pseudophakia might have a protective effect on surgical failure. A larger patient population is necessary to be able to demonstrate the weak links with more certainty. Possible relationships between pseudophakia and surgical failure may also be clarified this way. The relationships of skin AF with PVR and RRD area found in the pilot were not confirmed. The relationship between skin AF and vitreous AGEs needs to be elucidated in further research to be able to say more about the role of AGEs in PVR.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleider: and Los, Dr. L.I. UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/494 |
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