Gu Xiaoxun, Zhang Miao, Liu Zhenzhen, Ruan Xiaoting, Tan Xuhua, Zhang Enen, Chen Xiaoyun, Luo Lixia, Liu Yizhi
From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China (Gu, M. Zhang, Z. Liu, Ruan, Tan, E. Zhang, Chen, Luo, Y. Liu); Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Xi'an, China (Gu).
J Cataract Refract Surg. 2023 Apr 1;49(4):385-391. doi: 10.1097/j.jcrs.0000000000001115. Epub 2022 Dec 21.
To explore the risk factors and construct nomogram models to predict the risks of clinically significant intraocular lens (IOL) tilt and decentration after cataract surgery in patients with age-related cataract.
Zhongshan Ophthalmic Center, Guangzhou, China.
Prospective cohort study.
207 patients (207 eyes) who underwent phacoemulsification combined with IOL implantation were enrolled in the study. Casia2 was used to measure the tilt and decentration of crystalline lenses and IOLs before and 3 months after surgery. Univariate and multivariate logistic regression analyses were used to determine the risk factors of clinically significant IOL tilt and decentration, and nomogram prediction models were constructed according to the results of the multivariate logistic regression analysis.
Two hundred and seven patients were included in analysis. 24 eyes (11.59%) and 16 eyes (7.73%) had clinically significant IOL tilt and decentration at 3 months after cataract surgery. Multivariate logistic regression analysis revealed that preoperative crystalline lens tilt and decentration were the risk factors for clinically significant IOL tilt (odds ratio [OR], 3.519, P < .001) and decentration (OR, 410.22, P = .001), respectively. Axial length was another association factor for clinically significant IOL decentration (OR, 2.155, P = .019). The risk models demonstrated good calibrations and discriminations for the predictions of clinically significant IOL tilt (receiver operating characteristic [ROC] area = 0.833, cutoff value = 6.5) and decentration (ROC area = 0.757, cutoff value = 0.08).
The good performances of our models suggested that they may be useful risk prediction tools for postoperative IOL tilt and decentration. The measurement of preoperative crystalline lens tilt and decentration should be one of the routine examinations before cataract surgery, especially for toric and multifocal IOLs.
探讨年龄相关性白内障患者白内障手术后发生具有临床意义的人工晶状体（IOL）倾斜和偏心的危险因素，并构建列线图模型以预测其风险。
中国广州中山眼科中心。
前瞻性队列研究。
纳入207例行超声乳化白内障吸除联合IOL植入术的患者（207只眼）。采用Casia2测量手术前及术后3个月晶状体和IOL的倾斜和偏心情况。采用单因素和多因素logistic回归分析确定具有临床意义的IOL倾斜和偏心的危险因素，并根据多因素logistic回归分析结果构建列线图预测模型。
207例患者纳入分析。白内障手术后3个月，24只眼（11.59%）发生具有临床意义的IOL倾斜，16只眼（7.73%）发生具有临床意义的IOL偏心。多因素logistic回归分析显示，术前晶状体倾斜和偏心分别是具有临床意义的IOL倾斜（比值比[OR]，3.519，P <.001）和偏心（OR，410.22，P =.001）的危险因素。眼轴长度是具有临床意义的IOL偏心的另一个相关因素（OR，2.155，P =.019）。风险模型在预测具有临床意义的IOL倾斜（受试者操作特征曲线[ROC]面积 = 0.833，截断值 = 6.5）和偏心（ROC面积 = 0.757，截断值 = 0.08）方面显示出良好的校准度和区分度。
我们模型的良好性能表明它们可能是预测术后IOL倾斜和偏心的有用风险预测工具。术前测量晶状体倾斜和偏心应成为白内障手术前的常规检查项目之一，尤其是对于散光和多焦点IOL。
