糖尿病性白内障患者术后发生角膜水肿的预测模型

Predictive model of corneal edema in patients with diabetic cataract

摘要:

目的：探讨糖尿病性白内障患者术后发生角膜水肿的危险因素并构建预测模型。

方法：选取2017-01/2019-12本院收治的糖尿病性白内障患者312例，均采取择期超声乳化白内障摘除联合人工晶状体(IOL)植入手术。根据术后1wk内是否出现角膜水肿分为角膜水肿组(n=62)和非角膜水肿组(n=250)。比较两组患者性别、年龄、吸烟史、饮酒史、糖尿病病程、高血压病史、青光眼病史、角膜营养不良、慢性葡萄膜炎、晶状体核硬度Emery分级、术前前房深度、术中超声能量和有效超声时间、IOL材料和植入位置、术后角膜内皮细胞数量。采用逐步Logistic回归分析确定糖尿病性白内障患者术后发生角膜水肿的危险因素，确定危险因素后构建危险评分体系，绘制ROC曲线分析危险评分模型对术后角膜水肿的预测价值。

结果：纳入的312例糖尿病性白内障患者中62例(19.9%)发生术后角膜水肿。根据逐步Logistic回归分析，年龄>60岁(OR=2.657，95% CI：1.135～6.220)、糖尿病病程>10a(OR=6.932，95% CI：1.911～25.145)、高血压病史(OR=2.783，95% CI：1.037～14.510)、青光眼病史(OR=3.679，95% CI：1.128～11.999)、慢性葡萄膜炎(OR=2.601，95% CI：1.099～6.156)、晶状体核硬度Ⅳ～Ⅴ级(OR=8.658，95% CI：2.595～28.887)、术前浅前房(OR=3.431，95% CI：1.679～7.011)、术后角膜内皮细胞数量(OR=3.026，95% CI：1.137～8.053)是糖尿病性白内障患者术后发生角膜水肿的危险因素。根据上述危险因素构建危险评分体系，年龄>60岁、高血压病史、青光眼病史、慢性葡萄膜炎、术前浅前房、术后角膜内皮细胞丢失≥10%分别对应1分，糖尿病病程>10a和晶状体核硬度Ⅳ～Ⅴ级分别对应2分，总分0～10分。危险评分模型预测糖尿病性白内障患者术后角膜水肿的ROC曲线下面积为0.848(95% CI：0.772～0.934)，以8.94分为最佳临界值，此时的敏感度和特异度分别为85.3%和80.2%。

结论：年龄>60岁、糖尿病病程>10a、高血压病史、青光眼病史、慢性葡萄膜炎、晶状体核硬度Ⅳ～Ⅴ级、术前浅前房、术后角膜内皮细胞丢失是糖尿病性白内障患者术后发生角膜水肿的危险因素，根据上述危险因素构建的危险评分模型对术后角膜水肿有较好预测价值。

Abstract:

AIM: To build up prediction model of corneal edema after cataract surgery in patients with diabetic.

METHODS: During January 2017 to December 2019, 312 patients with diabetic cataract underwent elective phacoemulsification cataract extraction combined with intraocular lens(IOL)implantation were enrolled. The patients were divided into corneal edema group(n=62)and non-corneal edema group(n=250)according to corneal edema status within 1wk after surgery. The gender, age, smoking history, drinking history, diabetes history, hypertension history, glaucoma history, corneal dystrophy, chronic uveitis, lens core hardness Emery classification, preoperative anterior chamber depth, intraoperative ultrasound energy and effective ultrasound time, IOL material and implant location, number of corneal endothelium after surgery were compared between the two groups. Stepwise Logistic regression analysis was used to determine the risk factors and a risk scoring system was constructed base on the determined risk factors. The ROC curve was drawn to analyze the predictive value of the risk score model for postoperative corneal edema.

RESULTS: Of the 312 diabetic cataract patients included, 62 cases(19.9%)had postoperative corneal edema. According to stepwise Logistic regression analysis, age >60 years(OR=2.657, 95% CI: 1.135-6.220), duration of diabetes >10 years(OR=6.932, 95% CI: 1.911-25.145), hypertension history(OR=2.783, 95% CI: 1.037-14.510),glaucoma history(OR=3.679, 95% CI: 1.128-11.999), chronic uveitis(OR=2.601, 95% CI: 1.099-6.156), lens nucleus hardness grade IV to V(OR=8.658, 95% CI: 2.595-28.887), preoperative shallow anterior chamber(OR=3.431, 95% CI:1.679-7.011), postoperative corneal endothelial cell count(OR=3.026, 95% CI: 1.137-8.053)were the risk factor for postoperative corneal edema in patients with diabetic cataract. The risk scoring system was constructed according to the above risk factors: age >60 years old, history of hypertension, history of glaucoma, chronic uveitis, corneal endothelial cell number loss≥10%, shallow anterior chamber corresponding to 1 point, duration of diabetes >10 years and lens hardness Ⅳ-V corresponds to 2 points, with a total score of 0-10 points. The risk score model predicts that the area under the ROC curve of postoperative corneal edema in diabetic cataract patients was 0.848(95% CI: 0.772-0.934)at cut-off value of 8.94, and the sensitivity and specificity were 85.3% and 80.2%, respectively.

CONCLUSION: Age>60 years old, course of diabetes >10 years, history of hypertension, history of glaucoma, chronic uveitis, lens nucleus hardness Ⅳ-Ⅴ, preoperative shallow anterior chamber, postoperative corneal endothelial cell loss is the postoperative occurrence of diabetic cataract patients. The risk factors of corneal edema, the risk scoring model constructed based on the above risk factors has good predictive value for postoperative corneal edema.