角膜移植术后发生继发性青光眼的预测模型构建-现代医学

角膜移植术后发生继发性青光眼的预测模型构建

作者：任静张玮

单位：南京医科大学附属南京医院(南京市一医院)眼科, 江苏南京 210006

分类号：R772.2

出版年·卷·期（页码）：2024·52·第九期（1427-1433）

摘要：

目的： 探讨角膜移植术后继发性青光眼的风险因素并构建预测模型。方法： 回顾性分析2020年1月至2023年1月于本院行角膜移植术的366例患者的临床资料，根据术后是否出现继发性青光眼分为继发性青光眼组(n=57)和非继发性青光眼组(n=309)。比较两组患者临床风险因素，确定角膜移植术后继发性青光眼的风险因素，根据结果构建预测模型，绘制ROC曲线分析预测模型对术后继发性青光眼的价值。结果： 共纳入366名角膜移植术后患者，继发性青光眼发生率为15.57%(57/366)。逐步Logistic回归分析显示感染性角膜原发病(OR=2.419，95%CI 1.132～5.982)、术前前房积脓(OR=4.353，95%CI 1.655～7.931)、术前溃疡灶面积＞角膜1/2(OR=3.972，95%CI 1.524～7.082)、术前青光眼病史(OR=4.230，95%CI 1.628～6.263)、既往眼科手术史(OR=2.948，95%CI 1.135～7.836)、无晶状体眼或人工晶状体眼(OR=2.398，95%CI 1.135～7.421)、穿透性角膜移植术(OR=2.872，95%CI 1.098～6.827)、联合手术(OR=1.862，95%CI 1.120～7.862)、长期使用激素(OR=3.981，95%CI 1.209～8.876)、吸烟(OR=3.981，95%CI 1.209～8.876)是角膜移植术后继发性青光眼的风险因素。根据上述风险因素构建预测模型，风险预测模型预测角膜移植术后继发性青光眼的ROC 曲线下面积为0.804(95% CI 0.745～0.914)，敏感度和特异度分别为0.83和0.78。结论： 根据角膜移植术后继发性青光眼的风险因素构建的预测模型对角膜移植术后护理有较大参考价值，且具有便利、易操作的优点，适合临床应用。

Objective: To investigate the risk factors of secondary glaucoma after keratoplasty and construct a prediction model. Methods: The clinical data of 366 patients who had corneal transplantation at our facility between January 2020 and January 2023 were examined retrospectively. Based on the occurrence of secondary glaucoma after surgery, the patients were divided into two groups: secondary glaucoma group(n=57) and non-secondary glaucoma group(n=309).The clinical risk factors of the two groups were compared to identify the risk factors for secondary glaucoma following corneal transplantation. The prediction model was constructed according to the results, and the receiver operating characteristic(ROC) curve was plotted to assess the predictive accuracy of the model for the development of secondary glaucoma following corneal transplantation. Results: A total of 366 patients after keratoplasty were included in this study. The incidence of secondary glaucoma was 15.57%(57/366). Stepwise Logistic regression analysis showed that infectious cornea(OR=2.419, 95%CI 1.132-5.982), preoperative hypopyema(OR=4.353, 95%CI 1.655-7.931), preoperative ulcer area>1/2 cornea(OR=3.972，95%CI 1.524-7.082), preoperative glaucoma history(OR=4.230, 95%CI 1.628-6.263), previous ophthalmic surgery history(OR=2.948, 95%CI 1.135-7.836), aphakic or pseudophakia(OR=2.398, 95%CI 1.135-7.421), penetrating keratoplasty(OR=2.872, 95%CI 1.098-6.827), combined surgery(OR=1.862, 95%CI 1.120-7.862), long-term use of hormones(OR=3.981, 95%CI 1.209-8.876) and smoking(OR=3.981, 95%CI 1.209-8.876) were risk factors for secondary glaucoma after keratoplasty. The area under the ROC curve of the model was 0.804(95%CI 0.745-0.914), and the sensitivity and specificity were 0.83 and 0.78, respectively. Conclusion: The risk prediction model based on the risk factors of secondary glaucoma after corneal transplantation has great reference value for nursing after corneal transplantation, and is convenient, easy to conduct and suitable for clinical application.

参考文献：

[1] PINEDA R.Corneal transplantation in the developing world:lessons learned and meeting thechallenge[J].Cornea,2015,34(Suppl 10):S35-S40.
[2] KORNMANN H L,GEDDE S J.Glaucoma management after corneal transplantation surgeries[J].Curr Opin Ophthalmol,2016,27(2):132-139.
[3] SAINI C,DAVIES E C,UNG L,et al.Incidence and risk factors for glaucoma development and progression after corneal transplantation[J].Eye(Lond),2023,37(10):2117-2125.
[4] 谢立信,史伟云,刘敬,等.穿透性角膜移植术后继发性青光眼的临床分析[J].中华眼科杂志,2000(2):35-37.
[5] GOMEZ-BENLLOCH A,MONTESEL A,PAREJA-ARICO L,et al.Causes of corneal transplant failure:a multicentric study[J].Acta Ophthalmol,2021,99(6):e922-e928.
[6] KITAZAWA K,TODA M,UENO M,et al.Donor corneal endothelial cell maturity and its impact on graft survival in glaucoma patients undergoing corneal transplantation[J].Am J Ophthalmol,2024,262:1-9.
[7] ANG M,SNG C C A.Descemet membrane endothelial keratoplasty and glaucoma[J].Curr Opin Ophthalmol,2018,29(2):178-184.
[8] 尹文惠,李素霞,董春晓,等.穿透性角膜移植术后发生继发性青光眼的影响因素及治疗方法[J].眼科新进展,2020,40(3):230-234.
[9] 费安裕,林咸平,陈峰,等.穿透性角膜移植联合白内障囊外摘除术后并发恶性青光眼[J].中国实用眼科杂志,2004(5):397.
[10] WU S,XU J.Incidence and risk factors for post-penetrating keratoplasty glaucoma:a systematic review and meta-analysis[J].PLoS One,2017,12(4):e0176261.
[11] PARKER J,DIRISAMER M,NAVERRAS M,et al.Outcomes of Descemet membrane endothelial keratoplasty in phakic eyes[J].J Cataract Refract Surg,2012,38(5):871-877.
[12] 李兰,杨文艳,李云川.穿透性角膜移植术后继发性青光眼的影响因素及治疗[J].眼科新进展,2012,32(2):169-171.
[13] BORDERIE V M,LORIAUT P,BOUHERAOUA N,et al.Incidence of intraocular pressure elevation and glaucoma after lamellar versus full-thickness penetrating keratoplasty[J].Ophthalmology,2016,123(7):1428-1434.
[14] SHARMA R A,BURSZTYN L L,GOLESIC E,et al.Comparison of intraocular pressure post penetrating keratoplasty vs Descemet's stripping endothelial keratoplasty[J].Can J Ophthalmol,2016,51(1):19-24.
[15] VU P Q,AGGARWAL S,LU Y,et al.Comparison of intraocular pressure,usage of topical steroids,need for intraocular pressure lowering drops,and incidence of glaucoma surgery up to 2 years after penetrating keratoplasty and endothelial keratoplasty[J].J Glaucoma,2020,29(12):1120-1125.
[16] ARUNDHATI A,CHEW M C,LIM L,et al.Comparative study of long-term graft survival between penetrating keratoplasty and deep anterior lamellar keratoplasty[J].Am J Ophthalmol,2021,224:207-216.
[17] 马建洲,孙红彬,马丽娜.血清和房水核心蛋白多糖水平与糖尿病视网膜病变的关系[J].东南大学学报(医学版),2023,42(4):584-589.

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