目的:比较Alcon Acrysof IQ PanOptix TFNT00 (PanOptix)晶状体常数优化前后对人工晶状体(intraocular lens,IOL)度数计算准确性的影响,以及不同眼轴长度晶状体常数优化的效果。方法:回顾性收集2021年6月—2022年3月在上海爱尔眼科医院行白内障超声乳化手术联合植入PanOptix IOL患者的术前眼球生物学测量参数、植入IOL度数和术后1~3个月的显然验光结果。联合SRK/T、Hoffer Q、Holladay 1、Haigis公式,通过回归法计算优化的晶状体常数A、pACD、SF,通过多元线性回归计算优化的晶状体常数a0、a1和a2。观察晶状体常数优化前后平均绝对预测误差值(mean absolute error,MAE)及中位绝对预测误差值(median absolute error,MedAE),预测误差在±0.25、±0.50、±0.75、±1.00 D以内的百分比的差异,评价晶状体常数优化对IOL计算准确性的影响。随后,按照眼轴长度进行分组(非高度近视组:<26.00 mm; 高度近视组:≥26.00 mm),比较非高度近视组和高度近视组优化晶状体常数的差异。结果:共92眼(54位患者)纳入研究。优化前的晶状体常数A、pACD、SF、a0、a1和a2分别为119.1、5.63、1.83、1.39、0.40和0.10;优化后分别为119.35、6.14、2.36、?3.42,0.12和0.34。在全部眼轴组,晶状体常数优化前,SRK/T、Hoffer Q、Holladay 1、Haigis公式的MAE值分别为0.44、0.50、0.54、0.46 D;优化后,MAE值分别为0.43、0.54、0.51、0.35 D,其中Haigis公式优化前后比较差异有统计学意义(P=0.001)。在非高度近视组,晶状体常数优化前,4条公式的MAE值分别为0.46、0.40、0.40、0.42 D;优化后,MAE值分别为0.46 D、0.38 D、0.39 D、0.38 D,比较差异均无统计学意义(均P>0.05)。在高度近视组,晶状体常数优化前,4条公式的MAE值分别为0.42、0.59、0.66、0.50 D;优化后,MAE值分别为0.36、0.48、0.47、0.31 D,其中Holladay 1和Haigis公式优化前后比较差异有统计学意义(P 分别为 0.020、0.002)。结论:PanOptix IOL的晶状体常数优化可以提高IOL度数计算的准确性,在高度近视组中比非高度近视组中优化意义更大。
Objective: To assess the benefits of intraocular lens (IOL) constant optimization of Alcon Acrysof IQ PanOptix TFNT00 (PanOptix) on the accuracy of IOL power calculation, and the effects of constant optimization between different axial length (AL) groups were further compared. Methods: Patients who underwent phacoemulsification and implantation with PanOptix IOL between June, 2021 and March, 2022 were included in this retrospective study. The preoperative biological ocular parameters, implanted IOL power, and subjective 1-3 months postoperative refraction were collected. Combined with SRK/T, Hoffer Q, Holladay 1 and Haigis formulas, the optimized IOL constant A, surgeon factor (SF), post-surgery anterior chamber depth (pACD), and a0, a1, a2 were back-calculated. Refractive outcomes using optimized IOL constants were re-calculated combined with the corresponding formulas. Compare the mean absolute error (MAE), medium absolute error (MedAE) and percentage of eyes with IOL prediction errors (PE) within ±0.25, ±0.50, ±0.75 and ±1.00 (diopter)D when using the optimized constants and the manufacture constants. Patients were divided into two groups according to AL (non-high myopia: <26.0 mm; high myopia: ≥26 mm), compare the difference of IOL constant optimization between AL subgroups. Results: A total of 92 eyes of 54 patients were enrolled. The manufacture lens constant of A, pACD, SF, a0, a1 and a2 are respectively 119.1, 5.63, 1.83, 1.39, 0.4 and 0.1; and the optimized values are respectively 119.35, 6.14, 2.36, ?3.42, 0.12 and 0.34. In all patients group, with manufacture lens constant, the MAE values of SRKT, Hoffer Q, Holladay 1 and Haigis formula are 0.44, 0.50, 0.54, 0.46 D; with optimized lens constants, the MAE values are 0.43, 0.54, 0.51, 0.35 D, and there is a statistical difference of Haigis formula after optimization (P=0.001). In non-high myopia group, with manufacture lens constant, the MAE values are 0.46, 0.40, 0.40, 0.42 D; with optimized lens constants, the MAE values are0.46, 0.38, 0.39, 0.38 D, and no statistical difference has been found(P>0.05). In high myopia group, with manufacture lens constant, the MAE values are 0.42, 0.59, 0.66, 0.50 D; with optimized lens constants, the MAE values are 0.36, 0.48, 0.47, 0.31 D, and there are statistical differences of Holladay 1 and Haigis formula after optimization (P = 0.020, 0.002). Conclusion: IOL constant optimization of PanOptix IOL can improve the accuracy of IOL calculation, which is more significant in the high myopia group.
目的:通过对改良“Z”形无线结经巩膜缝线固定人工晶状体手术和传统有线结巩膜缝线固定人工晶状体手术治疗先天性晶状体脱位的比较来评价改良术式的临床疗效。方法:回顾性病例研究。纳入2018年1月—2021年3月期间于中山大学中山眼科中心行手术治疗的先天性晶状体脱位患者73例73眼,按手术方式不同将患者分为无线结组36例36眼和有线结组37例37眼。比较两组患者术前和术后1年的球镜度(DS)、柱镜度(DC)、等效球镜(SE)、最佳矫正视力(BCVA)、眼压(IOP)、眼轴长度(AL)、角膜内皮细胞计数和术后并发症的发生率。结果:两组患者术前各项观察指标组间比较差异无统计学意义(均P>0.05)。两组患者术后1年 BCVA 均较术前提高(均P<0.05),SE均较术前降低(均P<0.05)。两组患者术后1年 BCVA 、DS、DC、SE、IOP、AL、角膜内皮细胞丢失率组间比较差异均无统计学意义(均P>0.05)。术后1年,有线结组有5例(13.5%)出现缝线暴露,无线结组未出现缝线暴露,组间比较差异有统计学意义(P<0.05)。结论:改良无线结 IOL 巩膜缝线固定手术可改善CEL患者的最佳矫正视力和屈光不正,有效减少缝线暴露及相关并发症。
Objective: To evaluate the clinical efficacy of modified “Z”-shaped knotless transscleral suture fixation intraocular lens (IOL) and traditional knotted transscleral suture fixation IOL in congenital ectopia lentis. Methods: A retrospective case study. A total of 73 eyes of 73 patients with congenital ectopia lentis who underwent surgical treatment in our hospital from January 2018 to March 2021 were included. According to different surgical methods, the patients were divided into the knotless group (36 eyes) and knotted group (37 eyes). Preoperative and postoperative of 1-year diopter sphere (DS), diopter cylinder (DC), spherical equivalent (SE), best corrected visual acuity (BCVA), intraocular pressure (IOP), and axial length (AL), corneal endothelial cell counts and the occurrence of postoperative complications rate were analyzed among two groups. Results: There was no significant difference in preoperative outcome measures between the two groups (P>0.05). BCVA at 1-year postoperative was significantly better (P<0.05), and SE at 1-year postoperative was significantly lower (P<0.05). There was no significant difference in BCVA, DS, DC, SE, IOP, AL, and corneal endothelial cell loss rate between the two groups at 1-year after operation (P>0.05). One year after the operation, there were 5 cases of suture exposure (13.5%) in the knotted group and no suture exposure in the knotless group, and the difference was statistically significant (P<0.05). Conclusions: The modified knotless IOL transscleral suture fixation can improve the best corrected visual acuity and alleviate ametropia of CEL patients, and reduce suture exposure and related complications effectively.
晶状体脱位是指由于各种病因引起的悬韧带发育异常及断裂,从而导致晶状体的位置异常。晶状体脱位的类型复杂,临床处理也各不相同。本文报道了一名老年男性,因外伤分别致右眼晶状体全脱位,左眼人工晶状体不全脱位,伴高同型半胱氨酸血症,在入院后行双眼手术,术式不一,但都获得了预期效果。
Ectopai lentis refers to the abnormal development and rupture of the suspensory ligament caused by various causes, which leads to the abnormal position of the lens. The types of lens dislocation are complex and the clinical treatment methods are different. This article reports an elderly man who suffered from complete dislocation of the right eye lens and incomplete dislocation of the left eye intraocular lens in the left eye, respectively, accompanied by hyperhomocysteinemia due to trauma. After admission, he underwent binocular surgery after admission, and the surgical methods were different, but the expected results were obtained.
目的:探讨一种改良的简便的儿童晶状体不全脱位摘除技术的手术方法及临床效果。方法:对23例(40眼)晶状体不全脱位儿童采用改良手术方法进行脱位晶状体摘除,术中先做巩膜隧道切口,3个角膜缘穿刺口,经穿刺口放置前房维持器,在维持前房灌注下,截囊针撕囊,水分离后抽吸针头吸净晶状体内容物。撤去前房维持器,用撕囊镊和线镊将囊袋从主切口拖出。若有玻璃体脱出则行前部玻璃体切除术,然后行人工晶状体巩膜缝线固定术。术后中位随访39.0个月,观察其手术效果。结果:术后患儿平均裸眼视力为(0.44±0.22)LogMAR,平均最佳矫正视力为(0.20±0.16)LogMAR,较术前均显著提高(P<0.001)。所有患儿术中眼内压稳定,术中术后没有继发视网膜脱离、脉络膜上腔出血等眼底并发症的发生。结论:改良的儿童晶状体不全脱位摘除技术具有对玻璃体扰动少、手术时间较短、简便易学、对手术设备要求低的优点,值得临床推广。
Objective: To investigate the operation method and clinical effects of a modified-simple technique in children with subluxated lens extraction. Methods: Lens extraction was performed in 40 eyes of 23 children. During operation, the scleral tunnel and 3 lateral corneal incision were made, and anterior chamber maintainer was inserted through one corneal incision. Under stable anterior chamber perfusion, anterior capsulorrhexis was made by needle capsulotome. After hydro-dissection, the content of lens was withdrawn by suction needle completely. Then anterior chamber maintainer was removed, and the capsular bag was dragged out by capsulorhexis forceps and fixation forceps. Anterior vitrectomy was performed if there was prolapse of vitreous. Then scleral intraocular lens fixation was performed. The surgical effects were observed at median 39.0 months postoperative. Results: After surgery, the average uncorrected visual acuity was (0.44±0.22) LogMAR, the average best corrected distant visual acuity was (0.20±0.16) LogMAR. The uncorrected visual acuity and best corrected distant visual acuity were improved postoperative(P<0.001). The intraocular pressure of all patients was stable during operation. During and after operation, there were no fundus complications, such as secondary retinal detachment and suprachoroidal hemorrhage. Conclusion: Modified-simple technique of subluxated lens extraction of children has little disturbance on vitreous and takes shorter time of operation. It is simple, easy to learn and requires simple surgical equipment. This modified technique deserves to be generalized.
目的:在硅油取出联合白内障手术患者中,使用扫频源光学相干断层扫描生物测量仪OA-2000进行生物测量,比较10种人工晶状体(IOL)屈光力计算公式的准确性。方法:回顾性分析2021年3月—7月于中山大学中山眼科中心接受硅油取出联合白内障手术的患者共62例(62眼),所有患者均使用扫频源光学相干断层扫描生物测量仪OA-2000进行生物学参数测量。计算并比较新公式[Barrett Universal II (BUII)、Emmetropia Verifying Optical(EVO) 2.0、Hill-Radial Basis Function (Hill-RBF) 3.0、Hoffer QST、Kane、Pearl-DGS]及传统公式(Haigis、Hoffer Q、Holladay 1、SRK/T)的预测准确性,主要评价指标为绝对预测误差中位数(MedAE)及平均绝对预测误差(MAE)。按眼轴长度≤23 mm(组1),>23 mm且≤26 mm(组2)与>26 mm(组3)进行亚组分析。结果:6个新公式、Haigis、SRK/T公式均出现近视漂移(-0.47 ~-0.27 D,P<0.05),而HofferQ及Holladay 1公式无系统误差(P>0.05)。Kane公式的MedAE(0.55 D)及MAE(0.81 D)最小,但公式间比较差异无统计学意义(P>0.05)。组1中所有公式均出现近视漂移(-1.46~ -1.25 D,P<0.05),而其他亚组比较差异无统计学意义(-0.32 ~ 0.41 D,P>0.05)。在组1中,Pearl-DGS公式的MedAE(0.97 D)及MAE(1.26 D)最小,且优于Hill-RBF 3.0(P=0.01)及SRK/T公式(P=0.02);组2中,Kane公式具有最小的MedAE(0.44 D)及MAE(0.66 D);组3各个公式屈光预测准确性比较差异无统计学意义(P>0.05)。结论:在使用OA-2000进行术前生物测量时,Kane公式在接受硅油取出联合白内障手术患者中的预测准确性较高;而眼轴长度≤23 mm时,Pearl-DGS公式可能更为准确。
Objective: To compare the accuracy of 10 intraocular lens (IOL) power calculation formulas in patients undergoing combined silicone oil removal and cataract surgery, biometry is performed using the swept-source optical coherence tomography biometer OA-2000. Methods: A retrospective analysis. A total of 62 patients (62 eyes) who underwent combined silicone oil removal and cataract surgery in Zhongshan Ophthalmic Center, Sun Yat-sen University from March to July in 2021 were enrolled. Preoperative biometry was performed by OA-2000 in all patients. New-generation formulas (Barrett Universal II [BUII], Emmetropia Verifying Optical [EVO] 2.0, Hill-Radial Basis Function [Hill-RBF] 3.0, Hoffer QST, Kane and Pearl-DGS) and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T) were evaluated. The median absolute prediction error (MedAE) and mean absolute prediction error (MAE) were the main parameters used to assess accuracy. Subgroup analyses were performed based on the axial length of 23 mm and 26 mm. Results: Six new-generation formulas, Haigis, and SRK/T showed myopic shift (-0.47 ~ -0.27 D, P<0.05), while no systematic bias was found in Hoffer Q and Holladay 1 displayed (P>0.05). The smallest MedAE (0.55 D) and MAE (0.81 D) were found in Kane formula, but there was no statistically significant difference compared with other formulas (P>0.05). The myopic shift (-1.46 ~ -1.25 D, P<0.05) in eyes shorter than 23 mm were found in all formulas, while there was no significant systematic bias (-0.32 ~ 0.41 D, P>0.05) in other subgroups. In axial length shorter than 23 mm, the Pearl-DGS formula stated the smallest MedAE (0.97 D) and MAE (1.26 D), and was significantly more accurate than Hill-RBF 3.0 (P=0.01) and SRK/T (P=0.02). In eyes with an axial length between 23 mm and 26 mm, the Kane formula had the lowest MedAE (0.44 D) and MAE (0.66 D). No significant difference was found in eyes longer than 26 mm. Conclusion: The Kane formula showed the highest accuracy in patients undergoing combined silicone oil removal and cataract surgery measured by OA-2000, whereas the Pearl-DGS formula could be more accurate in eyes with an axial length shorter than 23 mm.
马方综合征(Marfan syndrome,MFS)是与晶状体异位有关的常见的全身性疾病,约50%~80%的MFS患者存在晶状体异位。该文报道一例21岁的男性患者,因患有MFS致双眼晶状体半脱位伴双眼并发性白内障,先后实施白内障摘除人工晶状体植入合并囊袋张力环悬吊固定术,术后保留低度近视,随访期间未发现眼压升高、人工晶状体严重移位及囊袋皱缩等并发症。
Marfan syndrome (MFS) is a common systemic disease associated with lens heterotopia, and about 50%~80% of Marfan patients have lens heterotopia. This article reports a case of a 21-year-old male patient who suffered from bilateral lens subluxation and concurrent cataract due to MFS, who underwent cataract extraction and IOL implantation with CTR suspension fixation was performed to preserve low-grade myopia after surger y. No complications such as increased intraocular pressure, intraocular lens severely displacement and capsular bag shrinkage were found during follow-up.
目的:探讨超声乳化晶状体吸除联合囊袋上经巩膜缝线固定人工晶状体(intraocular lens,IOL)植入术治疗球形晶状体(microspherophakia,MSP)的有效性和安全性。方法:采用回顾性分析,选取2019年1月至 2020年6月期间在复旦大学附属眼耳鼻喉科医院进行治疗的MSP患者37例(37眼),随机分为两组,纳入行超声乳化晶状体吸除联合囊袋上巩膜缝线固定IOL植入术(supra-capsular and scleral-fixated intraocular lens implantation,SCSF-IOL)的MSP患者20例(20眼)和行超声乳化晶状体吸除联合改良型囊袋张力环植入术(transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation,MCTR-IOL)的MSP患者17例(17眼),观察两组术后最佳矫正视力及并发症等情况。结果:两组术后最佳矫正视力比术前均有改善(P<0.001),而组间比较差异无统计学意义(P=0.326)。两组的IOL倾斜度相当(P=0.216)。预防性Nd:YAG激光后囊膜切开术在SCSFIOL术后1周至1个月进行。在SCSF-IOL组,2眼(10.00%)需要重复激光治疗,1眼(5.00%)出现囊口偏心。后囊膜混浊是MCTR组最常见并发症(6眼,35.29%)。随访期间两组均未出现IOL脱位、继发性青光眼和视网膜脱离。结论:SCSF-IOL是治疗球形晶状体的简单易行的手术方式,疗效与MCTR-IOL相当。Nd:YAG激光后囊膜切开术是预防SCSF-IOL术后囊袋并发症的必要手段。
Objective: To investigate the efficacy and safety of phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens (IOL) implantation in the treatment of microspherophakia (MSP). Methods: by retrospective analysis, 37 MSP patients (37 eyes) who were treated in our hospital from January 2019 to June 2020 were randomly divided into two groups, including 20 MSP patients (20 eyes) who treated by SCSF-IOL and 17 MSP patients (17 eyes) who treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL). The best corrected vision and complications were observed. Results: the best corrected vision was significantly improved in both groups (P < 0.001), but there was no remarkable difference between the two groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd: YAG laser posterior capsulotomy was performed from 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment, and one eye (5.00%) had a decentered capsule opening. Posterior capsular opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up. Conclusions: SCSF-IOL is a simple and viable surgical option for managing MSP and is comparable with the MCTR-IOL. Nd: YAG laser posterior capsulotomy is a necessary mean to prevent residual capsule complications after the SCSF-IOL procedure.
目的: 建立人晶状体上皮细胞原代培养的简便方法并比较不同来源人晶状体上皮细胞的生物学特性。方法: 取胎龄 20 周合法引产胚胎眼晶状体囊膜、中山眼科中心眼库眼晶状体囊膜和白内障患者术中撕取的前囊膜, 分别在培养皿中铺平, 加10 μL 10%DMEM 培养液润湿后加盖盖玻片防止卷曲并促进粘贴, 添加培养液浸没盖玻片, 37℃培养。同时取相同来源的囊膜按照组织块法培养。观察细胞增殖情况并比较原代人晶状体上皮细胞与人晶状体上皮细胞系 SRA01/04 β晶体蛋白的表达差异。结果: 在盖玻片辅助下, 胚胎眼晶状体囊膜第2天即可见明显的增殖细胞由囊膜缘长出, 眼库眼囊膜和白内障患者术中撕取的囊膜在3~4 d 的潜伏期后亦可见增殖细胞长出; 组织块法培养出现部分组织块漂浮, 且胚胎眼囊膜潜伏期延长至3~4 d, 眼库眼囊膜和白内障患者晶状体囊膜潜伏期延长至4~5 d。结论: 盖玻片辅助的改良组织块培养法能尽快获得体外培养的原代晶状体上皮细胞, 且操作简便, 值得推广应用于晶状体病的研究。
Purpose: To set up an easy procedure of tissue culture for human lens epithelial cells in vitro and to observe the biological characteristics.Methods: Capsules from embryo of 20 weeks, eye bank of Zhongshan Ophthalmic Centre and patients with cataract were spread on culture utensil. 10 μ L of 10% DMEM medium was added and a piece of coverslip was lay to prevent crimp. Then the capsules were cultured under 37℃after adding enough medium. Capsules from the same source were cultured by traditional tissue culture method. Expressions of β crystallin between primary tissue culture cells and SRA01/04 cell line were compared by western blotting.Results: With coverslip assisted, the cells could be observed proliferated and migrated from the edge of embryo capsule 2 days later, and for capsules from eye bank and age-related cataract patients, the interval time was 3 to 4 days. By traditional tissue culture method, the interval time of embryo capsule was 3 to 4 days, and for capsules from eye bank and age-related cataract patients, the interval time was the same. And capsules floated sometimes.Conclusions: By coverslip assisted primary tissue culture human lens epithelial cells could grow faster and easier, and the method is worthy to be spread in research of lens diseases.
Ⅱ期人工晶状体(intraocular lens,IOL)植入常用于矫正先天性白内障摘除术后无晶状体眼状态。IOL屈光力计算是影响儿童Ⅱ期IOL植入术后视功能发育和改善的关键因素之一。现有IOL屈光力计算公式是基于成人有晶状体眼的数据研发,能准确预测成人眼IOL植入的屈光力,但是对儿童Ⅱ期IOL植入的屈光力预测准确性欠佳,主要原因包括:1)儿童II期植入术前为无晶状体眼,缺乏部分公式定义中的有晶状体眼的前房深度(是指从角膜前表面中央顶点到晶状体前表面的距离)和晶状体厚度。2)公式根据囊袋内植入IOL预测屈光力,但儿童Ⅱ期IOL睫状沟植入术在临床上应用更为广泛。当IOL植入睫状沟时有效晶状体位置发生前移,可能引起屈光预测误差。3)成人眼的发育已完成,目标屈光度多为正视或近视眼(-3.00 ~ +1.00 D),但是儿童眼仍在发育,需针对其特性测算合适的远视目标屈光度(+0.50 ~ +12.00 D)以适应眼球发育引起的屈光变化。为使Ⅱ期IOL植入患儿达到术前预设的目标屈光度,对现有公式进行选择与优化至关重要。
Secondary intraocular lens (IOL) implantation is a common treatment for pediatric aphakia. The accurate prediction of IOL power calculation plays a pivotal role in the postoperative development and improvement of visual function for pediatric secondary IOL implantation. Current IOL power calculation formulas were developed based on data from adult phakic eyes and displayed good performance in adult population. However, the formulas showed poor performance in pediatric aphakic population due to the following reasons: 1) In these pediatric aphakic patients, the unavailability of phakic anterior chamber depth (the distance from corneal epithelium to the anterior surface of the lens) and lens thickness (LT) greatly limits the application of some IOL power calculation formulas. 2) IOL power calculation formulas predict the effective lens position on the basis of in-the-bag IOL implantation, whereas sulcus implantation is more widely used in pediatric secondary implantation. Effective lens position in capsular placement is more posterior to ciliary sulcus IOL placement. When applying the initial IOL power calculated for capsular implantation to sulcus implantation, it can lead to refractive errors. 3) Adult eyes have completed their development, with target refractions often being emmetropic or myopic (-3.00 ~ +1.00 D), while pediatric eyes are still developing, necessitating the calculation of an appropriate hyperopic (+0.50 ~ +12.00 D) target refraction to accommodate refractive changes due to ocular growth.To achieve the predetermined target refractive outcomes, the selection and optimization of IOL power calculation formulas is critically important for pediatric secondary IOL implantation.
目的:建立并评估儿童Ⅱ期人工晶状体(intraocular lens,IOL)植入术后青光眼相关不良事件(glaucoma-related adverse events,GRAEs)的预测模型。方法:选取于中山大学中山眼科中心行Ⅱ期IOL植入术的无晶状体眼患儿205例(356眼),并在术后对其随访3年。采用Cox比例风险模型确定GRAEs的预测因子,并建立列线图预测模型。采用随时间变化的受试者工作特征(receiver operating characteristic,ROC)曲线、决策曲线分析、Kaplan-Meier曲线评估模型性能,并通过Bootstrapping的C指数和校准图进行内部验证。结果:行Ⅱ期IOL植入术时年龄较大(HR=1.50, 95% CI: 1.03 ~2.19)、术后一过性高眼压(HR=9.06, 95% CI: 2.97~27.67)和IOL睫状沟植入术(HR=14.55, 95% CI: 2.11~100.57)是GRAEs的危险因素(均P<0.05),并据此建立了两个列线图预测模型。在术后1、2、3年,模型1的ROC曲线下面积(area under curve,AUC)分别为0.747(95% CI: 0.776 ~0.935)、0.765 (95% CI: 0.804 ~0.936)和0.748 (95% CI: 0.736~0.918),模型2的AUC分别为0.881 (95% CI: 0.836 ~0.926)、0.895 (95% CI: 0.852 ~0.938)和0.848 (95% CI: 0.752~0.945)。在内部验证和评价中,两种模型均表现出良好的性能和临床净效益。Kaplan-Meier曲线显示两个不同的风险组在两个模型中都能被显著且稳健地区分。此外,本研究也构建了在线风险计算器。结论:两种列线图均能灵敏、准确地识别Ⅱ期IOL植入术后GRAEs的高危患儿,有助对其进行早期识别和及时干预。
Aims: To establish and evaluate predictive models for glaucoma-related adverse events (GRAEs) following secondary intraocular lens (IOL) implantation in paediatric eyes. Methods: 205 children (356 aphakic eyes) receiving secondary IOL implantation at Zhongshan Ophthalmic Center with a 3-year follow-up were enrolled. Cox proportional hazard model was used to identify predictors of GRAEs and developed nomograms. Model performance was evaluated with time-dependent receiver operating characteristic (ROC) curves, decision curve analysis, Kaplan-Meier curves and validated internally through C-statistics and calibration plot of the bootstrap samples. Results: Older age at secondary IOL implantation (HR=1.5, 95% CI: 1.03 to 2.19), transient intraocular hypertension (HR=9.06, 95% CI: 2.97 to 27.67) and ciliary sulcus implantation (HR=14.55, 95% CI: 2.11 to 100.57) were identified as risk factors for GRAEs (all p<0.05). Two nomograms were established. At postoperatively 1, 2 and 3 years, model 1 achieved area under the ROC curves (AUCs) of 0.747 (95% CI: 0.776 to 0.935), 0.765 (95% CI: 0.804 to 0.936) and 0.748 (95% CI: 0.736 to 0.918), and the AUCs of model 2 were 0.881 (95% CI: 0.836 to 0.926), 0.895 (95% CI: 0.852 to 0.938) and 0.848 (95% CI: 0.752 to 0.945). Both models demonstrated fine clinical net benefit and performance in the interval validation. The Kaplan-Meier curves showing two distinct risk groups were well discriminated and robust in both models. An online risk calculator was constructed. Conclusions: Two nomograms could sensitively and accurately identify children at high risk of GRAEs after secondary IOL implantation to help early identification and timely intervention.