高度近视飞秒激光制瓣的准分子激光角膜原位磨镶手术后发生高眼压的列线图模型构建与验证  

Establishment and validation of nomogram model for intraocular hypertension after femtosecond laser in situ keratomileusis for high myopia

作　　者：汪美华 李维娜 黄雪丽 周罕英 Wang Meihua;Li Weina;Huang Xueli;Zhou Hanying(Department of Ophthalmology,The 910th Hospital of the People's Liberation Army Coalition Security Force,Quanzhou 362000,China)

机构地区：[1]解放军联勤保障部队第九一○医院眼科,泉州362000

出　　处：《中华眼底病杂志》2023年第8期675-680,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的分析高度近视患者飞秒激光制瓣的准分子激光角膜原位磨镶手术(FS-LASIK)后发生高眼压的危险因素,建立预测列线图模型并验证。方法回顾性研究。2019年1月至2021年1月在解放军联勤保障部队第九一〇医院眼科行FS-LASIK治疗的高度近视患者327例654只眼纳人研究。根据手术后是否发生高眼压将患者分为高眼压组、非高眼压组,分别为60例120只眼(18.35%,60/327)、267例534只眼(81.65%,267/327)。观察分析两组患者的临床资料,将有差异的指标进行单因素和多因素logistic回归分析,利用R3.5.3软件可视化回归分析结果得到列线图,通过一致性指数(C-index)、校准曲线、受试者工作特征曲线(ROC曲线)验证列线图模型的准确性。结果高眼压组、非高眼压组患眼角膜厚度(x2=7.424)、角膜曲率(χ^(2)=9.849)、糖皮质激素治疗(=7.222)、手术中眼压波动(χ^(2)=11.475)、角膜滞后量(χ^(2)=6.368)、手术中并发症发生(χ^(2)=6.673)例数比较,差异均有统计学意义(P<0.05)。二元logistic回归分析结果显示,角膜厚度>450μm、角膜曲率≤38D、糖皮质激素治疗、手术中眼压波动、角膜滞后量≤8.0mmHg(1mmHg=0.133kPa)、手术中并发症发生是高度近视患者FS-LASIK手术后发生高眼压的危险因素(P<0.05)。基于此建立的列线图预测模型C-index为0.722(95%可信区间0.684~0.760),校正曲线和理想曲线基本一致,ROC曲线下面积为0.709。结论角膜厚度>450μm、角膜曲率≤38D、糖皮质激素治疗、手术中眼压波动、角膜滞后量≤8.0mmHg是高度近视患者FS-LASIK手术后发生高眼压的危险因素;依据危险因素构建的列线图模型具有良好的准确性。Objective To investigate the risk factors of high intraocular pressure(IOP)after femtosecond laser in situ keratomileusis(FS-LASIK)in patients with high myopia,and construct and verify nomogram model.Methods A retrospective clinical study.From January 2019 to January 2021,327 patients(654 eyes)with high myopia treated with FS-LASIK in the Department of Ophthalmology of the 910th Hospital of the People's Liberation Army Coalition Security Force were included in the study.The patients were categorized into high IOP group and non-high IOP group according to whether high IOP occurred after surgery,which were 60 cases and 120 eyes(18.35%,60/327)and 267 cases and 534 eyes(81.65%,267/327),respectively.The clinical data of patients in the two groups were analyzed and observed,and the indicators with differences were subjected to one-way and multifactorial logistic regression analyses,and the results of the regression analyses were visualized to obtain the column line graphs using R3.5.3 software,and the accuracy of the column line graphs was verified by the consistency index(C-index),the calibration curves,and the subject's work characteristic curves(ROC curves).Results Comparison of the number of cases of affected corneal thickness(χ^(2)=7.424),corneal curvature(χ^(2)=9.849),glucocorticoid treatment(χ^(2)=7.222),intraoperative I0P fluctuation(χ^(2)=11.475),corneal hysteresis(x=6.368),and the incidence of intraoperative complications(χ^(2)=6.673)in the hypertensive IOP group and the nonvisualized IOP group were statistically significant(P<0.05).Binary logistic regression analysis showed that corneal thickness>450μm,corneal curvature≤38 D,glucocorticoid treatment,intraoperative IOP fluctuation,corneal hysteresis≤8.0 mm Hg(1 mm Hg=0.133 kPa),and intraoperative complications were the risk factors for the occurrence of high IOP after FS-LASIK surgery in patients with high myopia(P<0.05).The C-index of the column-line graph prediction model based on this was 0.722(95%confidence interval 0.684-0.760),the calibration

关 键 词：高度近视 飞秒激光 准分子激光角膜原位磨镶手术 高眼压 列线图模型 

分 类 号：R779.63[医药卫生—眼科]