小儿白内障摘除术后青光眼nomogram预测模型建立和效能评价

Establishment of a Nomogram Model to Predict Glaucoma After Cataract Extraction in Children and Its Efficacy Evaluation

目的建立小儿白内障摘除术后青光眼的nomogram预测模型,并评价其预测效能。方法回顾性分析2019年1月至2023年9月郑州大学第一附属医院收治的352例624眼小儿白内障摘除术患儿的临床资料,根据术后青光眼发生情况分为青光眼组、无青光眼组。术后随访6个月~4.5 a,详细记录患儿术后青光眼发生情况,单因素、多因素logistic回归分析小儿白内障摘除术后发生青光眼的影响因素,基于多因素分析结果构建术后青光眼的nomogram预测模型,采用受试者工作特征(ROC)曲线分析该模型预测价值,并对该模型预测效能进行评价与验证。结果352例患儿术后6个月~4.5 a共发生46例术后青光眼,发生率为13.07%;青光眼患儿手术年龄[(5.82±1.90)个月]早于无青光眼组[(7.82±2.56)个月],核性白内障、伴其他眼部先天异常、先天性白内障家族史、角膜直径≤10 mm、眼内手术次数>1次、术后1个月中央角膜厚度(CCT)增加、术后瞳孔缘虹膜后粘连患儿占比高于无青光眼组,差异有统计学意义(P<0.05);logistic分析显示,手术年龄、核性白内障、伴其他眼部先天异常、先天性白内障家族史、角膜直径≤10 mm、术后1个月CCT增加、术后瞳孔缘虹膜后粘连是术后青光眼的独立影响因素(P<0.05);构建nomogram模型,其C-index为0.817,ROC曲线显示该模型预测术后青光眼的曲线下面积(AUC)为0.817,校准曲线、临床影响曲线评价显示,该模型具有良好应用价值及临床正向净收益。结论手术年龄、核性白内障、伴其他眼部先天异常、先天性白内障家族史、角膜直径≤10 mm、术后1个月CCT增加、术后瞳孔缘虹膜后粘连是小儿白内障摘除术后继发青光眼的独立影响因素,根据上述因素构建nomogram模型对术后青光眼具有一定预测价值,并具有良好区分度、校准度、实用度,可作为临床预测术后青光眼的有效模型,并对临床防治具有一定指导价值。

Objective To establish a nomogram model for predicting glaucoma after cataract extraction in children,and to evaluate its efficacy.Methods The clinical data of 352 cases of 624 children with cataract extraction treated in the First Affiliated Hospital of Zhengzhou University from January 2019 to September 2023 were retrospectively analyzed.According to the occurrence of postoperative glaucoma,the patients were divided into glaucoma group and non-glaucoma group.The patients were followed up for 6 months to 4.5 years to record the occurrence of postoperative glaucoma.The factors influencing the occurrence of postoperative glaucoma after cataract extraction were analyzed by univariate and multivariate logistic regression,and a nomogram prediction model for postoperative glaucoma was constructed based on the results of multivariate analysis.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of the model,and the predictive efficiency of the model was evaluated and verified.Results A total of 46 cases of postoperative glaucoma occurred in 352 children from 6 months to 4.5 years after operation,the incidence rate was 13.07%.The age of operation of the glaucoma children[(5.82±1.90)months]was earlier than that of the non-glaucoma group[(7.82±2.56)months].The proportion of children with nuclear cataract,other congenital eye abnormalities,family history of congenital cataract,corneal diameter≤10 mm,number of intraocular operations>1 time,the central corneal thickness(CCT)increased one month after surgery,and the proportion of postpupillary iris adhesion was higher than that in the non-glaucoma group,the differences were statistically significant(P<0.05).Logistic regression analysis showed that surgical age,nuclear cataract,and other congenital ocular abnormalities,family history of congenital cataract,corneal diameter≤10 mm,increased CCT 1 month after surgery and posterior iris adhesion of pupil margin were independent factors associated with glaucoma after cataract extraction in children(P<0.05).The C-index of the nomogram model was 0.817,and the ROC curve showed that the area under the curve(AUC)of the model predicting postoperative glaucoma was 0.817,calibration curve and clinical impact curve evaluation results showed that the model has good application value and positive clinical net benefit.Conclusion Surgical age,nuclear cataract,congenital abnormalities associated with other eyes,family history of congenital cataract,corneal diameter≤10 mm,increased CCT 1 month after surgery,and postoperative adhesion of posterior iris margin are independent factors for secondary glaucoma after cataract extraction in children.Building a nomogram model based on the above factors has certain value in predicting postoperative glaucoma,and has good differentiation,calibration and practicability.It can be used as an effective model for predicting postoperative glaucoma,and has certain guiding value for clinical prevention and treatment of this disease.