Objective: To develop and validate a predictive model for assessing the risk of early postoperative high intraocular pressure (HIOP) following posterior chamber intraocular lens implantation. Methods: The clinical data of patients who underwent posterior chamber intraocular lens implantation at the Second Affiliated Hospital of Zhejiang University School of Medicine between May 2023 and April 2024 were retrospectively reviewed. Patients were divided into a modeling group and a validation group with a 7∶3 ratio using computerized random allocation. The modeling group was further categorized into normal intraocular pressure and HIOP groups based on the occurrence of early postoperative HIOP. Multivariate logistic regression analysis was employed to establish a risk prediction model. Receiver operating characteristic (ROC) curve analysis was conducted using R software to assess the predictive ability and accuracy of the model, along with calibration and decision curve analysis (DCA) curve plotting. Results: A total of 239 patients (478 eyes) were enrolled. The modeling group consisted of 168 patients (82 males and 86 females) (336 eyes), with an average age of (25.5±5.1) years. The validation group consisted of 71 patients (36 males and 35 females) (142 eyes), with an average age of (24.7±5.7) years. The early postoperative HIOP incidence rate after posterior chamber intraocular lens implantation was 32.4% (109/336), while it was 26.8% (38/142) in the validation group. The multivariate logistic regression analysis indicated that preoperative refractive diopter (OR=0.873, 95%CI: 0.782-0.976, P=0.017), corneal endothelial cell count (OR=0.996, 95%CI: 0.995-0.997, P<0.001), corneal thickness (OR=1.015, 95%CI: 1.006-1.024, P=0.001), and preoperative intraocular pressure (OR=1.470, 95%CI: 1.283-1.686, P<0.001) were associated factors for early HIOP. The Hosmer-Lemeshow test showed that the χ2 value was 8.444 (P=0.391), and the area under the ROC curve (AUC) was 0.888 (95%CI: 0.852-0.925). The Youden index reached its maximum value of 0.646, with a sensitivity of 0.862 and specificity of 0.784. AUC of validation group was 0.921 (95%CI: 0.870-0.972), with a maximum Youden index of 0.765, sensitivity of 0.842 and specificity of 0.923. Conclusions: The risk prediction model constructed based on preoperative refractive diopter, corneal endothelial cell count, corneal thickness, and preoperative intraocular pressure demonstrates good predictive performance for early postoperative HIOP following posterior chamber intraocular lens implantation.
目的： 构建晶状体眼后房型人工晶状体植入术后早期高眼压风险预测模型并验证其效能。 方法： 回顾性纳入2023年5月至2024年4月在浙江大学医学院附属第二医院行晶状体眼后房型人工晶状体植入术的患者。通过计算机随机分配方式，按照7∶3的比例分为建模组和验证组。建模组根据是否发生术后早期高眼压，分为正常眼压组和高眼压组。采用多因素logistic回归建立高眼压风险预测模型并绘制列线图，分别采用受试者工作特征（ROC）曲线、校准曲线和决策曲线（DCA）对模型的预测价值进行评估。 结果： 最终共纳入患者239例478眼；建模组168例336眼，男82例，女86例，年龄（25.5±5.1）岁；验证组71例142眼，男36例，女35例，年龄（24.7±5.7）岁。晶状体眼后房型人工晶状体植入术后早期高眼压发生率建模组为32.4%（109/336），验证组为26.8%（38/142）。多因素logistic回归分析结果显示，术前屈光度数（OR=0.873，95%CI：0.782~0.976，P=0.017）、术前角膜内皮计数（OR=0.996，95%CI：0.995~0.997，P<0.001）、术前角膜厚度（OR=1.015，95%CI：1.006~1.024，P=0.001）及术前眼压（OR=1.470，95%CI：1.283~1.686，P<0.001）是术后早期高眼压的相关因素；由此建立的预测模型Hosmer-Lemeshow检验结果显示，χ2=8.444，P=0.391；ROC曲线下面积为0.888（95%CI：0.852~0.925），约登指数最大时（0.646），灵敏度为0.862，特异度为0.784。验证组ROC曲线下面积0.921（95%CI：0.870~0.972），约登指数最大时（0.765），灵敏度为0.842，特异度为0.923。 结论： 术前屈光度数、角膜内皮计数、角膜厚度、眼压是晶状体眼后房型人工晶状体植入术后早期高眼压的相关因素，由此建立的预测模型具有较好的预测效能。.