Analysis Of Risk Factors In Vitreomacular Interface Diseases For In-patient Cases

BACKGROUND: Vitreomacular interface(VMI) diseaseis are defined as a kind of age-related degeneration on the vitreomacular interface. Traditionally, VMI diseases refer to epiretinal membrane(ERM), macular hole(MH), vitreomacular traction syndrome(VTS) and macular schisis. Our previous study found that VMI diseases were the third commonest indication of the patients performed out vitreoretinal surgery in our hospital and have been one of the most important diseases resulting in serious vision loss. The key to control VMI diseases is prevention, which is based on the knowledge of population incidence and their pathogenesis. However, there is no report about the studies.OBJECTIVE: To investigate the clinic characteristics of vitreomacular interface(VMI) diseases of in-paitent cases in Shanghai General Hospital Affiliated to Shanghai Jiao Tong University(SGHASJTU) in the last five years, and to clerify the related risk factors for development and progression of VMI diseases.METHOD:(1) Clinical data of the in-patient cases diagnosed as VMI diseases at the Department of SGHASJTU from 2010 to 2014 including gender, age, primary diagnosis and secondary diagnosis was retrospectively collected to describe the characteristics of in-patients with VMI diseases;(2) In-patients who were diagnosed as VMI diseases at the Department of Ophthalmology in SGHASJTU from January 2014 to December 2014 and health subjects who undertook physical examination in Medical Examination Center of SGHASJTU from August 2014 to December 2014 as sex and age-matched controls were recruited. Detailed ophthalmology examination and a questionnaire survey were carried out to collect clinical data including educational background, habits of smoking and drinking, refractive status, ocular histories and systemic diseases histories such as diabetes, hypertension, hyperlipidemia, etc. All subjects provided informed consent and agreed to have their blood samples collected for sex hormones analysis including follicle stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2) and progesterone(P), testosterone(T) and prolactin(PRL).(3) Univariate and multivariate logistic regression analysis was performed to study the effect of various risk factors, using the presence of VMI diseases as a dependent variable.RESULT:(1) A steadily rising trend was seen in the last five years, and a total of 979 in-paitents were diagnosed with VMI diseases, with a male: female ratio of 1:2.4, whose mean age was 61.6 years old, and male and female patients were 62.3 and 61.4 years old, respectively. The incidence rose with age smoothly in male patients, while in female patients, a peak was seen in post-menopause, namely around the age between 56 to 65 years old. The first three diagnoses were idiopathic MH(502 patients), idiopathic ERM(454 patients), and vitreomacular traction syndrome(24 patients) with a male: female ratio of 1:2.3, 1:2.4 and 1:3.8 respectively. The composition of VMI diseases is similar in male and female. Patients combined diabetes and hypertension account for 3.5% and 11.5%;(2) 73 patients with VMI diseases were recruited for the risk factor analysis with the mean age of 63.4 years old. The male: female ratio is 20:53. In male patients, IMH, IERM and VTS were respectively seen in 9, 11 and 1 patients. In female patients, IMH, IERM and VTS were respectively seen in 27, 23, 3 patients. In univariate logistic regression analysis, no risk factor was found statistically significant in male patients, while in female patients, serum estrodiol(E2), progesterone(P), prolactin(PRL) and testosterone(T) level were significantly lower than age-matched controls. Further anaylsis performed in female IERM and IMH subjects showed significantly lower serum level of E2 and T in IERM patients and significantly lower level of E2, P and T in IMH patients.CONCLUSION: It is a steadily rising trend for the patients with VMI in the in-patients in our hospital in the last five years. The highest incidence of the diseases was found in early postmenopausal women. In male patients, age of onset was later and rose with age. Several sex hormone levels, especially E2 and T, differ between female patients and controls, while no risk factor was statistically significant in male patients, which implies different pathogenesis of VMI diseases between male and female.