Purpose

To analyze the incidence of sympathetic ophthalmia (SO) after inciting events (eye trauma or intraocular surgery).

Design

Retrospective cohort study.

Participants

Patients experiencing inciting events between 2012 and 2019. Onset of SO was defined as the first date of SO diagnosis.

Methods

Using a nationwide administrative claims database in Japan, we calculated the cumulative incidence of SO after inciting events stratified by sex, 10-year age groups, and a categorical variable of primary or repeated, reflecting the history of inciting events in the past year (no inciting events, inciting events without trauma, or inciting events with trauma) using the Kaplan-Meier approach. We also estimated the adjusted hazard ratio (aHR) by Cox regression. We then restricted the population to those with only 1 inciting event during the observation period to investigate the pure effect of each inciting event.

Main Outcome Measures

Cumulative incidence of SO over 60 months.

Results

A total of 888 041 inciting events (704 717 patients) were eligible. The total number of SO cases was 263, and the cumulative incidence of SO was 0.044% over 60 months. Female sex was not associated with onset of SO (aHR, 1.01; 95% confidence interval [CI], 0.79–1.29; P = 0.95). The group 40 to 49 years of age showed the highest incidence of 0.104% among the age groups (aHR vs. ≥80 years of age group [0.041%], 2.44 [95% CI, 1.56–3.80]; P < 0.001). Repeated inciting events with and without trauma showed higher incidences of SO (0.469% and 0.072%, respectively) than primary inciting events (0.036%) (aHR 11.68 [7.74–17.64] and 2.21 [95% CI, 1.59–3.07], respectively); P < 0.001 and P < 0.001, respectively). The incidence of SO after vitrectomy was much lower than after trauma (0.016% vs. 0.073%), and the incidence after scleral buckling was even lower.

Conclusions

The cumulative incidence of SO over 60 months was estimated to be 0.044% at minimum. Repeated inciting events, especially those with trauma, increased the risk of SO developing. Trauma was 4 to 5 times as likely to induce SO than vitrectomy. The present findings will be valuable for counseling patients about the risks of SO after trauma and before performing intraocular surgeries.

中文翻译：

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煽动性事件后交感性眼炎的发生率

目的

分析诱发事件（眼外伤或眼内手术）后交感性眼炎 (SO) 的发生率。

设计

回顾性队列研究。

参与者

患者在 2012 年至 2019 年期间经历了煽动事件。SO 的发病被定义为 SO 诊断的第一个日期。

方法

使用日本全国行政索赔数据库，我们计算了按性别、10 岁年龄组和主要或重复分类变量分层的煽动事件后 SO 的累积发生率，反映了过去一年中煽动事件的历史（无使用 Kaplan-Meier 方法的煽动事件、无创伤的煽动事件或有创伤的煽动事件。我们还通过 Cox 回归估计了调整后的风险比 (aHR)。然后，我们将人群限制在观察期间只有 1 个激发事件的人群，以研究每个激发事件的纯效应。

主要观察指标

SO 的累积发病率超过 60 个月。

结果

共有 888 041 起激发事件（704 717 名患者）符合条件。SO病例总数为263例，60个月累计SO发病率为0.044%。女性与 SO 的发病无关（aHR，1.01；95% 置信区间 [CI]，0.79-1.29；P = 0.95）。40 至 49 岁组的发病率最高，为 0.104%（aHR 与 ≥80 岁年龄组 [0.041%]，2.44 [95% CI，1.56-3.80]；P < 0.001）。有和无创伤的重复激发事件显示 SO 的发生率（分别为 0.469% 和 0.072%）高于主要激发事件（0.036%）（aHR 分别为 11.68 [7.74–17.64] 和 2.21 [95% CI，1.59–3.07] ); P < 0.001 和P< 0.001，分别）。玻璃体切除术后SO的发生率远低于创伤后（0.016% vs. 0.073%），巩膜扣带术的发生率更低。

结论

60 个月内 SO 的累积发生率估计至少为 0.044%。反复的煽动事件，尤其是那些有创伤的事件，会增加发生 SO 的风险。外伤诱发 SO 的可能性是玻璃体切除术的 4 到 5 倍。目前的研究结果对于在创伤后和进行眼内手术之前向患者咨询 SO 的风险是有价值的。