交感性眼炎（Sympathetic ophthlmia)是一种罕见的双眼肉芽肿性全葡萄膜炎，在一只眼外伤或内眼手术后发生。这些刺激性事件（手术或外伤）可能导致葡萄膜或视网膜释放抗原，从而引起自身免疫性葡萄膜炎。大多数交感性眼炎发生在刺激性事件后的5天到6个月，90%在1年内发生。
今天分享的文章是一篇本月发表在Ophthalmology上的大型全国性数据库研究，总结了日本全国的交感性眼炎发病率。
To analyze the incidence of sympathetic ophthalmia (SO) after inciting events (eye trauma or intraocular surgery).
分析刺激性事件（眼部外伤或内眼手术）后交感性眼炎（SO）的发病率。
Design: Retrospective cohort study.
设计：回顾性队列研究。
Subjects: Patients undergoing inciting events between 2012 and 2019. Onset of SO was defined as the first date of SO diagnosis.
对象：在2012至2019年间经历刺激性事件的患者。SO发病定义为首次诊断SO的日期。
Methods: A nationwide administrative claims database in Japan was used. We calculated the cumulative incidence of SO after inciting events stratified by sex, 10-year age groups, and a categorical variable of “primary/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, in which age groups and the “primary/repeated” variable were considered time-dependent and sex was considered time-independent. We then restricted the population to those with only one inciting event during the observation period to investigate the pure effect of each inciting event.
方法：本研究采用了日本全国性行政索赔数据库。我们使用Kaplan–Meier法计算了刺激性事件后SO的累计发病率，根据性别和10岁年龄组分层，并使用分类变量“初次/重复”反映刺激性事件的历史（无刺激性事件、刺激性事件不含外伤、刺激性事件包含外伤）。我们还使用Cox回归估计了调整后的风险比，其中年龄和“初次/重复”变量视为时间依赖性指标，性别视为非时间依赖性指标。我们将研究人群局限在观察期内只有一次刺激性事件的患者，从而研究每个刺激性事件的净影响。
注：文章中primary（初次）刺激性事件指该事件发生前的1年内无其他刺激性事件；repeated（重复）刺激性事件是指该事件发生前的1年内有其他刺激性事件，重复的发生的事件按照是否包含外伤进一步分类。
Main Outcome Measures: Cumulative incidence of SO over 60 months.
主要结局指标：60个月内SO的累计发病率。
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, 0.79–1.29]). The 40–49-year-old group had the highest incidence of 0.104% among the age groups (aHR vs. ≥80-year-old group (0.041%), 2.44 [1.56–3.80]). Repeated inciting events with and without trauma had higher incidences of SO (0.47% and 0.072%, respectively; aHR vs. primary inciting events, 11.68 [7.74–17.64] and 2.21[1.59–3.07], respectively) than primary inciting events (0.036%). The incidence of SO after vitrectomy was much lower than that after trauma (0.016% vs. 0.073 %), and the incidence after scleral buckling was even lower.
共有888041起符合标准的刺激性事件（704717名患者）。SO病例总数为263，60个月内SO的累计发病率为0.044%。女性性别与SO的发病无关（aHR, 1.01 [95% 置信区间, 0.79–1.29]）。各年龄组中，40-49岁组发病率最高，为0.104%（与≥80岁组 (0.041%)相比，aHR为2.44 [1.56–3.80]）。与初次刺激性事件相比（0.036%），重复刺激性事件（包含或不包含外伤）的SO发病率较高（分别为0.47%和0.072%；与初次刺激性事件相比的aHR分别为11.68 [7.74–17.64]和2.21[1.59–3.07]）。玻切术后SO的发病率低于外伤后（0.016% vs. 0.073），巩膜扣带术后的发病率更低。
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 developing SO. Trauma was 4–5 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.
60个月内SO的累计发病率至少为0.044%。重复刺激性事件，尤其是包含外伤时，可增加发生SO的风险。外伤导致SO的可能性是玻切手术的4-5倍。本研究的结论有助于在外伤后和内眼手术前对患者提供SO风险的咨询。
