Occurrence risk establishment of predictive mode of surgically induced astigmatism in elderly patients with diabetic cataract

doi:10.11958/20251200

Abstract

Abstract:

Objective To construct and verify the risk profile model of surgically induced astigmatism (SIA) in elderly patients with diabetic catarac. Methods A total of 309 patients admitted to our hospital for phacoemulsification were selected as the study objects. Patients were divided into the SIA group (n=158) and the non-SIA group (n=151) according to whether SIA occurred after surgery. Multivariate Logistic regression analysis was used to analyze the factors influencing the occurrence of SIA in diabetic cataract patients, and the nomogram model of SIA in diabetic cataract patients was constructed. ROC curve, calibration curve and decision curve were used for evaluation and verification of the model. Results The patient age and the lens nucleus hardness level Ⅲ-Ⅳ, incision size ≥3.00 mm, incision shape as trapezoidal transparent corneal incision, corneal incision length ≥1.75 mm and horizontal diameter of the cornea were significantly higher in the SIA group than of the non-SIA group (P<0.05). There were no significant differences in gender, body mass index (BMI), duration of diabetes, history of hypertension, history of cardiovascular disease, grading of diabetic retinopathy, axial length, anterior chamber depth, central corneal thickness, total corneal refractive power, astigmatism axis position and ultrasound phacoemulsification time between the two groups of patients (P>0.05). Multivariate Logistic regression results showed that incision size, incision shape, corneal incision length and corneal horizontal diameter were the factors affecting the occurrence of SIA in diabetic cataract patients (P<0.05). The R software was used to incorporate four influencing factors to generate a nomogram model that could be used to predict the occurrence of SIA in diabetic cataract patients. ROC curve analysis results showed that the area under the curve (AUC) value of this histogram to predict SIA in diabetic cataract patients was 0.810 (95%CI=0.761-0.860). Hosmer-Lemeshow test and calibration curve analysis showed that the model fit well (χ²=11.142, P=0.194). The results of decision curve analysis showed that when the probability of high risk threshold 0.35-0.8, the clinical net benefit rate of the column graph model was greater than 0. Conclusion Incision size, incision shape, corneal incision length and corneal horizontal diameter are influential factors for the occurrence of SIA in patients with diabetic cataract. Based on the above influential factors, the columniogram model for predicting the occurrence risk of SIA in patients with diabetic cataract has good differentiation, accuracy and clinical applicability.

Key words: cataract, astigmatism, phacoemulsification, diabetes mellitus, nomograms, operative astigmatism

CLC Number:

R700.4

Figures/Tables 6

References 25

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组别	n	年龄/岁	性别（男/女）	BMI/（kg/m²）			糖尿病病程/年	高血压史	心血管疾病史		眼轴长度/mm
非SIA组	151	65.56±4.98	79/72	24.03±3.59			10.46±2.58	65（43.05）	17（11.26）		23.95±4.11
SIA组	158	68.33±5.19	86/72	24.67±3.21			10.91±2.75	76（48.10）	21（13.29）		24.61±4.27
t或χ²		4.783^＊	0.139	1.654			1.482	0.795	0.296		1.383
组别	晶状体核硬度分级		糖尿病视网膜病变分级			前房深度/mm	角膜水平直径/mm	中央角膜厚度/μm	全角膜屈光力/D		散光轴位/°
组别	Ⅰ—Ⅱ级	Ⅲ—Ⅳ级	Ⅰ—Ⅱ级	Ⅲ—Ⅳ级		前房深度/mm	角膜水平直径/mm	中央角膜厚度/μm	全角膜屈光力/D		散光轴位/°
非SIA组	78（51.66）	73（48.34）	78（51.66）	73（48.34）		3.02±0.43	10.87±0.48	541.63±40.51	42.81±3.17		93.16±10.93
SIA组	49（31.01）	109（68.99）	67（42.41）	91（57.59）		2.94±0.39	11.26±0.54	539.81±39.64	42.19±3.14		91.07±11.29
t或χ²	13.591^＊		2.653			1.714	6.699^＊	0.399	1.727		1.652
组别	切口大小		切口形状				角膜切口长度			超声乳化时间
组别	<3.00 mm	≥3.00 mm	梯形透明角膜切口		单平面透明角膜切口		<1.75 mm	≥1.75 mm		<10 min		≥10 min
非SIA组	96（63.58）	55（36.42）	103（65.19）		55（34.81）		101（66.89）	50（33.11）		92（60.93）		59（39.07）
SIA组	63（39.87）	95（60.13）	39（25.83）		112（74.17）		59（37.34）	99（62.66）		87（55.06）		71（44.94）
χ²	17.366^＊		48.166^＊				26.994^＊			1.089

组别	n	年龄/岁	性别（男/女）	BMI/（kg/m²）			糖尿病病程/年	高血压史	心血管疾病史		眼轴长度/mm
非SIA组	151	65.56±4.98	79/72	24.03±3.59			10.46±2.58	65（43.05）	17（11.26）		23.95±4.11
SIA组	158	68.33±5.19	86/72	24.67±3.21			10.91±2.75	76（48.10）	21（13.29）		24.61±4.27
t或χ²		4.783^＊	0.139	1.654			1.482	0.795	0.296		1.383
组别	晶状体核硬度分级		糖尿病视网膜病变分级			前房深度/mm	角膜水平直径/mm	中央角膜厚度/μm	全角膜屈光力/D		散光轴位/°
组别	Ⅰ—Ⅱ级	Ⅲ—Ⅳ级	Ⅰ—Ⅱ级	Ⅲ—Ⅳ级		前房深度/mm	角膜水平直径/mm	中央角膜厚度/μm	全角膜屈光力/D		散光轴位/°
非SIA组	78（51.66）	73（48.34）	78（51.66）	73（48.34）		3.02±0.43	10.87±0.48	541.63±40.51	42.81±3.17		93.16±10.93
SIA组	49（31.01）	109（68.99）	67（42.41）	91（57.59）		2.94±0.39	11.26±0.54	539.81±39.64	42.19±3.14		91.07±11.29
t或χ²	13.591^＊		2.653			1.714	6.699^＊	0.399	1.727		1.652
组别	切口大小		切口形状				角膜切口长度			超声乳化时间
组别	<3.00 mm	≥3.00 mm	梯形透明角膜切口		单平面透明角膜切口		<1.75 mm	≥1.75 mm		<10 min		≥10 min
非SIA组	96（63.58）	55（36.42）	103（65.19）		55（34.81）		101（66.89）	50（33.11）		92（60.93）		59（39.07）
SIA组	63（39.87）	95（60.13）	39（25.83）		112（74.17）		59（37.34）	99（62.66）		87（55.06）		71（44.94）
χ²	17.366^＊		48.166^＊				26.994^＊			1.089

变量	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.416	0.273	2.573	0.129	1.516（0.887~2.588）
晶状体核硬度分级	0.839	0.526	2.604	0.112	2.314（0.825~6.488）
切口大小	2.178	0.373	8.293	<0.001	8.829（4.250~18.33）
切口形状	-1.342	0.296	6.988	<0.001	0.261（0.146~0.466）
角膜切口长度	1.764	0.621	5.295	0.005	5.836（1.727~19.710）
角膜水平直径	1.452	0.243	5.979	<0.001	4.272（2.653~6.877）
常数项	-4.796	1.417	5.174	0.002	0.008

变量	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.416	0.273	2.573	0.129	1.516（0.887~2.588）
晶状体核硬度分级	0.839	0.526	2.604	0.112	2.314（0.825~6.488）
切口大小	2.178	0.373	8.293	<0.001	8.829（4.250~18.33）
切口形状	-1.342	0.296	6.988	<0.001	0.261（0.146~0.466）
角膜切口长度	1.764	0.621	5.295	0.005	5.836（1.727~19.710）
角膜水平直径	1.452	0.243	5.979	<0.001	4.272（2.653~6.877）
常数项	-4.796	1.417	5.174	0.002	0.008