背景:后囊混浊(PCO)是白内障手术最常见的并发症。在这项研究中,我们建立了一个模型来定量预测Nd:YAG激光囊切开术治疗危及视力的PCO的概率,以提高术后患者的生活质量。
方法:对2010年至2021年进行的白内障手术的注册分析。在对16,802例患者(25,883只眼)进行筛查后,纳入9768例患者(眼)。该队列随机分为两组:训练组(n=6838)和验证组(n=2930)。识别相关风险因素,单变量,多变量,采用最小绝对收缩和选择算子(LASSO)算法进行Cox回归分析,并创建了一个列线图来演示预测结果。
结果:在5年,Nd:YAG激光囊切开术的总累积发生率为12.0%(1169/9768).预测模型中包括以下变量:性别[风险比(HR)=1.53,95%CI1.32-1.76],年龄(HR=0.71,95%CI0.56-0.88),人工晶状体(IOL)材料(HR=2.65,95%CI2.17-3.24),高度近视(HR=2.28,95%CI1.90-2.75),和纤维蛋白原(HR=0.79,95%CI0.72-0.88)。在验证队列中,1-的曲线下面积(AUC),3-,Nd:YAG激光囊切开术的5年预测分别为0.702、0.691和0.688。对于高度近视患者的亚组,疏水性人工晶状体的保护作用消失(HR=0.68,95%CI0.51~1.12,P=0.127)。
结论:通过考虑年龄等因素,该模型可以预测白内障手术后Nd:YAG激光囊切开术对视力威胁的PCO的可能性,性别,IOL材料,高度近视,和纤维蛋白原。同时,在高度近视患者中植入疏水性IOL未显示对威胁视力的PCO有保护性影响.
BACKGROUND: Posterior capsular opacification (
PCO) is the most common complication of cataract surgery. In this study, we develop a model to quantitatively predict the probability of Nd:YAG laser capsulotomy for vision-threatening
PCO to improve the life quality of postoperative patients.
METHODS: A registry analysis of cataract procedures performed between the years 2010 and 2021. Following the screening of 16,802 patients (25,883 eyes), 9768 patients (eyes) were enrolled. The cohort was randomly divided into two groups: training (n = 6838) and validation (n = 2930). To identify relevant risk factors, univariate, multivariate, and Least Absolute Shrinkage and Selection Operator (LASSO) algorithm Cox regression analysis were employed, and a nomogram was created to demonstrate the prediction result.
RESULTS: At 5 years, the overall cumulative incidence of Nd:YAG laser capsulotomy was 12.0% (1169/9768). The following variables were included in the prediction model: sex [hazard ratio (HR) = 1.53, 95% CI 1.32-1.76], age (HR = 0.71, 95% CI 0.56-0.88), intraocular lens (IOL) material (HR = 2.65, 95% CI 2.17-3.24), high myopia (HR = 2.28, 95% CI 1.90-2.75), and fibrinogen (HR = 0.79, 95% CI 0.72-0.88). In the validation cohort, the area under the curve (AUC) of 1-, 3-, and 5-year predictions for Nd:YAG laser capsulotomy were 0.702, 0.691, and 0.688, respectively. For a subgroup of patients with high myopia, the protective effect of hydrophobic IOL disappeared (HR = 0.68, 95% CI 0.51-1.12, P = 0.127).
CONCLUSIONS: This model could predict the probability of Nd:YAG laser capsulotomy for vision-threatening
PCO after cataract surgery by taking into account factors such as age, gender, IOL material, high myopia, and fibrinogen. Meanwhile, implantation of a hydrophobic IOL in individuals with high myopia did not demonstrate a protective impact against vision-threatening
PCO.