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Gibt es geschlechtsspezifische Unterschiede bei rhegmatogener Ablatio retinae?

Augenabteilung, KH Hietzing mit Neurologischem Zentrum Rosenhügel, Wien, Austria
Spektrum der Augenheilkunde (Impact Factor: 0.18). 12/2010; 24(6):316-321. DOI: 10.1007/s00717-010-0448-0

ABSTRACT

BACKGROUND: In literature, women are reported to be more likely to turn to a doctor or preventive medical checkup. In ophthalmology, there are only a few studies regarding this issue. In our study we aimed to evaluate gender specific differences in rhegmatogenous retinal detachment. METHODS: All patients with rhegmatogenous retinal detachment (n=103), referred to the Department of Ophthalmology at the Medical University of Vienna within one year, were evaluated retrospectively. Age, Gender, duration of symptoms, referral, size of detachment, kind of surgery, visual acuity pre- and postoperatively, time to surgery were collected. RESULTS: 58.3% of patients were male, 41.6% female. Mean age at time of surgery was 58.3 years. Women tended to be older than men (57.4 vs. 59.6 years, p = 0.481). Mean duration of symptoms was 14.2 days. Women waited twice as long as men (10 vs. 20 days, p = 0.066). Women were more likely to suffer from proliferative vitreoretinopathy (PVR) (7.0% vs. 1.7%, p = 0.306), men were more likely to have macula-off retinal detachment (72.1% vs. 53.3%, p = 0.066). Preoperatively visual acuity was slightly better in female patients (0.38 vs. 0.41 Snellen, p = 0.748), postoperatively visual gain was higher in women (0.38 vs. 0.48 Snellen, p = 0.166). Regarding the size of retinal detachment, no gender specific differences were found. Surgery was performed at a mean of 0.55 days without gender specific differences. Women were more likely to be treated with buckling procedures (97.7% vs. 78.3%, p = 0.007), men with gas tamponade (26.7% vs. 11.6%, p = 0.083). CONCLUSIONS: Women are treated with a longer duration of symptoms and a higher rate of PVR. Symptoms might progress slower in women, they are more likely to have macula still attached. Altogether a mean duration of symptoms of 14 days is way too long. Better education of patients could result in earlier treatment and higher success rates.

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    ABSTRACT: HINTERGRUND: In der Literatur gibt es zahlreiche Hinweise, dass Ärzte eher zu aggressiveren Methoden und intensiveren Therapien tendieren, Ärztinnen sich dafür mehr Zeit für PatientInnen nehmen. Ziel dieser Studie war es, geschlechtsspezifische Unterschiede zwischen Operateurinnen und Operateuren zu evaluieren. MATERIAL UND METHODE: Retrospektiv wurden die Daten von allen PatientInnen (n=103), die innerhalb eines Jahres mit rhegmatogener Ablatio retinae an die Universitätsaugenklinik, AKH Wien, kamen, evaluiert. Alter, Geschlecht der PatientInnen, Geschlecht des/der Operateurs/Operateurin, Symptomdauer, Wartezeit bis zur Operation, Ausmaß der Ablatio, Bestehen einer proliferativen Vitreoretinopathie (PVR), Mitbeteiligung der Makula, Art der Versorgung, sowie prä- und postoperativer Visus wurden erhoben. RESULTATE: 58,3% der PatientInnen waren männlich. Das Durchschnittsalter war 58,3 Jahre. Frauen waren etwas älter als Männer (57,4 vs. 59,6 Jahre, p=0,481). Ärzte operierten signifikant jüngere PatientInnen (56,6 vs 63,5 Jahre, p=0,028). Die durchschnittliche Symptomdauer war bei Operateuren 12,3, bei Operateurinnen 20 Tage. Operateure operierten PatientInnen mit einem signifikant besseren präoperativen Visus (0,45 vs. 0,19 Snellen, p=0,002). Postoperativ verzeichneten Operateurinnen einen signifikanten Visusanstieg (0,19 auf 0,33 Snellen, p=0,008), während sich der postoperative Visus bei Operateuren nur minimal verbesserte (0,45 auf 0,46, p=0,306). Bei Operateurinnen wurde häufiger eine PVR gefunden (12% vs. 1,3%, p=0,043), weiters war die Macula häufiger abgehoben (56% vs. 33,3%, p=0,059). Die Operation erfolgte bei Operateuren durchschnittlich nach 0,46, bei Operateurinnen nach durchschnittlich 0,84 Tagen (p=0,025) und somit nach signifikant kürzerer Wartezeit. Bezüglich der Anwendung einer Vitrektomie oder Buckle-Chirurgie gab es keine signifikanten Unterschiede. SCHLUSSFOLGERUNG: Operateure operieren signifikant jüngere PatientInnen mit einem signifikant besseren präoperativen Visus nach signifikant kürzerer Zeit von Eintreffen im Krankenhaus bis zur Operation. Andererseits erreichen von Ärztinnen operierte PatientInnen einen postoperativen signifikanten Visusanstieg. BACKGROUND: According to literature, male doctors are supposed to use more aggressive methods and more intensive therapies. Female doctors are assumed to take more time on their patients. In our study we aimed to evaluate gender specific differences in surgical treatment of rhegmatogenous retinal detachment. MATERIAL AND METHODS: All patients with rhegmatogenous retinal detachment (n=103), referred to the Department of Ophthalmology at the Medical University of Vienna within one year, were evaluated retrospectively. Age and gender of patients, gender of surgeons, duration of symptoms, time to surgery, size of detachment, existence of preoperatively proliferative vitreoretinopathy (PVR), existence of macula-off retinal detachment, kind of surgery, visual acuity pre- and postoperatively were collected. RESULTS: 58.3% of patients were male. Mean age of patients was 58.3 years, women tended to be older than men (57.4 vs. 59.6 years, p=0.481). Male surgeons operated on significant younger patients (56.6 vs. 63.5 years, p=0.028). Mean duration of symptoms was 12.3 days in case of male surgeons, 20 days in case of female surgeons. Men did surgery on patients with a significant better preoperative visual acuity (0.45 vs. 0.19 Snellen, p= 0.002). Patients of female surgeons had a significant increase of postoperative visual acuity (0.19 to 0.33 Snellen, p=0.008), whereas patients of male surgeons only had a minimal improvement of postoperative visual acuity (0.45 to 0.46, p= 0.306). There was more often a preoperative PVR (12% vs. 1.3%, p=0.043) and macula-off retinal detachment (56% vs. 33.3%, p=0.059) in cases of female surgeons. The mean time to surgery was 0.46 days in case of male, 0.84 days in case of female suregeons (p=0.025). There were nearly no differences in the use of vitrectomy or buckle-procedures. CONCLUSIONS: Male surgeons operate on significant younger patients with a significant better preoperative visual acuity after significant shorter time to surgery. On the other hand there is a significant rise of postoperative visual acuity in cases of female surgeons. SchlüsselwörterAblatio retinae–Gender–Geschlechtsspezifische Unterschiede KeywordsRetinal detachment–Gender–Gender specific differences
    No preview · Article · Sep 2011 · Spektrum der Augenheilkunde