Influencing factors and prediction model construction of posterior capsular opacification after intraocular lens implantation treated with Nd: YAG laser.

OBJECTIVE

To explore the influencing factors of posterior capsular opacification (Posterior Capsular Opacification, PCO) after intraocular lens implantation treated with Nd: YAG(Neodymium: Yttrium-Aluminum-Garnet) laser and to establish a predictive model to evaluate its risk.

METHODS

From January 2018 to June 2023, the data of 312 patients with posterior capsule opacification and Nd: YAG laser treatment in our hospital were retrospectively analyzed. All patients were randomly divided into training group (218 cases) and verification group (94 cases) at the ratio of 7:3. In the training set, the independent risk factors of posterior capsule opacification before operation were identified by multivariate Logistic regression analysis, and the nomogram prediction model was constructed. By drawing ROC (receiver operating characteristic) curve and calibration curve, the prediction effectiveness of the model is evaluated, and the verification is carried out in the verification set, and its clinical application value is explored by Decision Curve Analysis (DCA).

RESULTS

Among 312 patients, 84 (22.92%) developed PCO. The logistic results showed that age ≥ 60 years, extracapsular excision surgery, multifocal intraocular lens, axial length ≥ 24 mm, preoperative visual acuity < 0.3, high laser energy, and large posterior capsule incision aperture were associated with the occurrence of PCO (P < 0.05). The C-index indexes of the nomograph model were 0.870 and 0.842 in the training set and verification set, respectively, and the average was absolute. In the Hosmer-Lemeshow test, the χ values of the training set and the verification set are 4.007(P = 0.856) and 2.841(P = 0.943), respectively. The ROC curve shows that the AUC(Area Under Curve) values of the training set and the verification set are 0.870 (95% CI: 0.810-0.929) and 0.843 (95% CI: 0.732-0.954) respectively, and the combination of sensitivity and specificity is 0.792, 0.810, 0.765 and 0.792 respectively.

CONCLUSION

The nomogram prediction model based on Nd: YAG laser treatment of PCO risk factors after intraocular lens implantation has high accuracy and calibration, which can provide a key reference for formulating preventive measures, help to reduce the incidence of PCO and improve the prognosis of patients.