Establishment and validation of nomogram model for intraocular hypertension after femtosecond laser in situ keratomileusis for high myopia_Chinese Journal of Ocular Fundus Diseases

Authors：

Wang Meihua ,  Li Weina , Huang Xueli , Zhou Hanying

Department of Ophthalmology, The 910th Hospital of the People's Liberation Army Coalition Security Force, Quanzhou 362000, China;

Corresponding author：

Li Weina, Email: pmrhgcj@163.com

Keywords：

High myopia; Femtosecond laser; LASIK; High intraocular pressure; Nomogram model

DOI：

10.3760/cma.j.cn511434-20220520-00313

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the risk factors of high intraocular pressure (IOP) after femtosecond laser in situ keratomileusis (FS-LASIK) in patients with high myopia, and construct and verify nomogram model. Methods A retrospective clinical study. From January 2019 to January 2021, 327 patients (654 eyes) with high myopia treated with FS-LASIK in the Department of Ophthalmology of the 910th Hospital of the People's Liberation Army Coalition Security Force were included in the study. The patients were categorized into high IOP group and non-high IOP group according to whether high IOP occurred after surgery, which were 60 cases and 120 eyes (18.35%, 60/327) and 267 cases and 534 eyes (81.65%, 267/327), respectively. The clinical data of patients in the two groups were analyzed and observed, and the indicators with differences were subjected to one-way and multifactorial logistic regression analyses, and the results of the regression analyses were visualized to obtain the column line graphs using R3.5.3 software, and the accuracy of the column line graphs was verified by the consistency index (C-index), the calibration curves, and the subject's work characteristic curves (ROC curves). Results Comparison of the number of cases of affected corneal thickness (χ²=7.424), corneal curvature (χ²=9.849), glucocorticoid treatment (χ²=7.222), intraoperative IOP fluctuation (χ²=11.475), corneal hysteresis (χ²=6.368), and the incidence of intraoperative complications (χ²=6.673) in the hypertensive IOP group and the nonvisualized IOP group were statistically significant (P＜0.05). Binary logistic regression analysis showed that corneal thickness ＞450 μm, corneal curvature≤38 D, glucocorticoid treatment, intraoperative IOP fluctuation, corneal hysteresis ≤8.0 mm Hg (1 mm Hg=0.133 kPa), and intraoperative complications were the risk factors for the occurrence of high IOP after FS-LASIK surgery in patients with high myopia (P＜0.05). The C-index of the column-line graph prediction model based on this was 0.722 (95% confidence interval 0.684-0.760), the calibration curve and the ideal curve were basically the same, and the area under the ROC curve was 0.709. Conclusions Corneal thickness＞450 μm, keratometric curvature ≤38 D, glucocorticoid treatment, intraoperative fluctuation of intraocular pressure, and corneal hysteresis ≤8.0 mm Hg are the risk factors for the development of hyperopic IOP in highly risk factors for the development of high IOP after FS-LASIK surgery in myopic patients. The column-line diagram model constructed on the basis of the risk factors hava good accuracy.

Citation： Wang Meihua, Li Weina, Huang Xueli, Zhou Hanying. Establishment and validation of nomogram model for intraocular hypertension after femtosecond laser in situ keratomileusis for high myopia. Chinese Journal of Ocular Fundus Diseases, 2023, 39(8): 675-680. doi: 10.3760/cma.j.cn511434-20220520-00313 Copy

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4.	Liu M, Shi W, Liu X, et al. Postoperative corneal biomechanics and influencing factors during femtosecond-assisted laser in situ keratomileusis (FS-LASIK) and laser-assisted subepithelial keratomileusis (LASEK) for high myopia[J]. Lasers Med Sci, 2021, 36(8): 1709-1717. DOI: 10.1007/s10103-021-03320-2.
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8.	刘莛, 余婷, 潘娇, 等. 角膜曲率对飞秒激光小切口角膜基质透镜取出术后患者屈光状态影响的临床研究[J]. 中华眼科杂志, 2018, 54(1): 48-54. DOI: 10.3760/cma.j.issn.0412-4081.2018.01.009.Liu T, Yu T, Pan J, et al. Clinical study on the influence of corneal curvature on the refractive status of patients after femtosecond laser small-incision corneal stromal lens removal[J]. Chin J Ophthalmol, 2018, 54(1): 48-54. DOI: 10.3760/cma.j.issn.0412-4081.2018.01.009.
9.	王丽, 陶俊. 近视患者屈光度数与视网膜神经纤维层厚度、中央角膜厚度、角膜曲率和眼压的相关性[J]. 广西医学, 2018, 40(16): 1821-1824. DOI: 10.11675/j.issn.0253-4304.2018.16.14.Wang L, Tao J. Correlation of refractive error with retinal nerve fiber layer thickness, central corneal thickness, corneal curvature and intraocular pressure in myopic patients[J]. Guangxi Medicine, 2018, 40(16): 1821-1824. DOI: 10.11675/j.issn.0253-4304.2018.16.14.
10.	尹奕, 王艳玲. 准分子激光上皮下角膜磨镶术后使用糖皮质激素滴眼剂对眼压影响的分析[J]. 临床和实验医学杂志, 2020, 19(13): 1432-1436. DOI: 10.3969/j.issn.1671-4695.2020.13.026.Yin Y, Wang YL. Analysis of the effect of glucocorticoid drops on intraocular pressure after excimer laser subepithelial keratomileusis[J]. Journal of Clinical and Experimental Medicine, 2020, 19(13): 1432-1436. DOI: 10.3969/j.issn.1671-4695.2020.13.026.
11.	史清霞, 杨慧, 马秋霞. 准分子激光原位角膜磨镶术术后激素性高眼压患者24例的观察分析[J]. 山西医药杂志, 2020, 49(19): 2693-2694. DOI: 10.3969/j.issn.0253-9926.2020.19.059.Shi QX, Yang H, Ma QX. Observation and analysis of 24 patients with hormonal hypertension after excimer laser in situ keratomileusis[J]. Shanxi Med J, 2020, 49(19): 2693-2694. DOI: 10.3969/j.issn.0253-9926.2020.19.059.
12.	鲁占军, 梁晓瑜, 马瑞彤, 等. LASIK术后两种糖皮质激素滴眼液作用下眼压的变化[J]. 应用激光, 2018, 38(1): 136-141. DOI: 10.14128/j.cnki.al.20183801.136.Lu ZJ, Liang XY, Ma RT, et al. Changes of intraocular pressure under the effect of two glucocorticoid eye drops after LASIK[J]. Applied Laser, 2018, 38(1): 136-141. DOI: 10.14128/j.cnki.al.20183801.136.
13.	Chaurasia SS, Luengo Gimeno F, Tan K, et al. In vivo real-time intraocular pressure variations during LASIK flap creation[J]. Invest Ophthalmol Vis Sci, 2010, 51(9): 4641-4645. DOI: 10.1167/iovs.10-5228.
14.	Aoki S , Murata H , Matsuura M , et al. The effect of air pulse-driven whole eye motion on the association between corneal hysteresis and glaucomatous visual field progression[J/OL]. Sci Rep, 2018, 8(1): 2969[2018-02-14]. https://pubmed.ncbi.nlm.nih.gov/29445204/.
15.	康杨, 胡琦, 李雪, 等. 利用眼反应分析仪评估FS-LASIK和LASEK术后角膜生物力学稳定性[J]. 国际眼科杂志, 2018, 18(11): 2116-2118. DOI: 10.3980/j.issn.1672-5123.2018.11.43.Kang Y, Hu Q, Li X, et al. Assessment of corneal biomechanical stability after FS-LASIK and LASEK using ocular response analyzer[J]. Int Eye Sci, 2018, 18(11): 2116-2118. DOI: 10.3980/j.issn.1672-5123.2018.11.43.
16.	李福生, 尹鸿芝, 魏胜兰, 等. 飞秒激光LASIK术后角膜生物力学各指标和眼压的改变[J]. 眼科新进展, 2013, 33(2): 175-177. DOI: 10.13389/j.cnki.rao.2013.02.020.Li FS, Yin HZ, Wei SL, et al. Changes in corneal biomechanics and intraocular pressure after femtosecond laser LASIK[J]. Rec Adv Ophthalmol, 2013, 33(2): 175-177. DOI: 10.13389/j.cnki.rao.2013.02.020.
17.	张力苹, 刘喜娟, 林卉, 等. 晚期胃癌生存预后因素及列线图预测模型的建立与验证[J]. 南方医科大学学报, 2021, 41(4): 621-627. DOI: 10.12122/j.issn.1673-4254.2021.04.21.Zhang LP, Liu XJ, Lin H, et al. Establishment and validation of survival prognostic factors and column-line diagram prediction model for advanced gastric cancer[J]. J South Med Univ, 2021, 41(4): 621-627. DOI: 10.12122/j.issn.1673-4254.2021.04.21.
18.	张冬, 解战兵. 高原地区急性脑梗死患者静脉溶栓后出血转化的因素分析及列线图预测模型构建[J]. 国际神经病学神经外科学杂志, 2021, 48(5): 461-465. DOI: 10.16636/j.cnki.jinn.1673-2642.2021.05.011.Zhang D, Xie ZB. Factor analysis of hemorrhage conversion after intravenous thrombolysis in patients with acute cerebral infarction in plateau area and construction of predictive model of column line diagram[J]. Journal of International Neurology and Neurosurgery, 2021, 48(5): 461-465. DOI: 10.16636/j.cnki.jinn.1673-2642.2021.05.011.
19.	刘慧颖. 飞秒激光制瓣LASIK术后泪膜及视力的影响因素分析[J]. 国际眼科杂志, 2017, 17(1): 47-49. DOI: 10.3980/j.issn.1672-5123.2017.1.11.Liu HY. Analysis of factors affecting tear film and visual acuity after femtosecond laser flap LASIK[J]. Int Eye Sci, 2017, 17(1): 47-49. DOI: 10.3980/j.issn.1672-5123.2017.1.11.

1. 刘灵琳, 吴峥峥, 李冬锋, 等. 成都和绵阳地区青少年近视患病率及影响因素分析[J]. 国际眼科杂志, 2019, 19(7): 1196-1200. DOI: 10.3980/j.issn.1672-5123.2019.7.26.Liu LL, Wu ZZ, Li DF, et al. Prevalence and influencing factors of myopia between adolescents in Chengdu and Mianyang Area[J]. Int Eye Sci, 2019, 19(7): 1196-1200. DOI: 10.3980/j.issn.1672-5123.2019.7.26.
2. 董彦会. 2000—2050年全球近视和高度近视的患病率及趋势研究[J]. 中华预防医学杂志, 2017, 51(4): 294. DOI: 10.3760/cma.j.issn.0253-9624.2017.04.004.Dong YH. A study on the prevalence and trend of myopia and high myopia worldwide from 2000 to 2050[J]. Chin J Pre Med, 2017, 51(4): 294. DOI: 10.3760/cma.j.issn.0253-9624.2017.04.004.
3. Vega-Estrada A, Alio JL. Femtosecond-assisted laser in situ keratomileusis for high myopia correction: long-term follow-up outcomes[J]. Eur J Ophthalmol, 2020, 30(3): 446-454. DOI: 10.1177/1120672119834478.
4. Liu M, Shi W, Liu X, et al. Postoperative corneal biomechanics and influencing factors during femtosecond-assisted laser in situ keratomileusis (FS-LASIK) and laser-assisted subepithelial keratomileusis (LASEK) for high myopia[J]. Lasers Med Sci, 2021, 36(8): 1709-1717. DOI: 10.1007/s10103-021-03320-2.
5. Xu Z, Gui S, Huang J, et al. Effect of femtosecond laser in situ keratomileusis on the choriocapillaris perfusion and choroidal thickness in myopic patients[J]. Curr Eye Res, 2020, 46(1): 1-7. DOI: 10.1080/02713683.2020.1833350.
6. 中华医学会眼科学分会青光眼学组. 中国高眼压症诊断治疗和随访专家共识(2020年)[J]. 中华眼科杂志, 2020, 56(1): 21-24. DOI: 10.3760/cma.j.issn.0412-4081.2020.01.008.Glaucoma Group of the Ophthalmology Branch of the Chinese Medical Association. Expert consensus on the diagnosis, treatment and follow-up of high intraocular pressure in China (2020)[J]. Chin J Ophthalmol, 2020, 56(1): 21-24. DOI: 10.3760/cma.j.issn.0412-4081.2020.01.008.
7. 单保生, 李建桥. 眼高压症患者角膜中央厚度对非接触眼压计测量值的影响[J]. 山东大学基础医学院学报, 2002, 16(6): 367-368. DOI: 10.3969/j.issn.1673-3770.2002.06.021.San BS, Li JQ. Effect of central corneal thickness on non-contact tonometer measurements in patients with ocular hypertension[J]. J Preclin Med Shandong Univ, 2002, 16(6): 367-368. DOI: 10.3969/j.issn.1673-3770.2002.06.021.
8. 刘莛, 余婷, 潘娇, 等. 角膜曲率对飞秒激光小切口角膜基质透镜取出术后患者屈光状态影响的临床研究[J]. 中华眼科杂志, 2018, 54(1): 48-54. DOI: 10.3760/cma.j.issn.0412-4081.2018.01.009.Liu T, Yu T, Pan J, et al. Clinical study on the influence of corneal curvature on the refractive status of patients after femtosecond laser small-incision corneal stromal lens removal[J]. Chin J Ophthalmol, 2018, 54(1): 48-54. DOI: 10.3760/cma.j.issn.0412-4081.2018.01.009.
9. 王丽, 陶俊. 近视患者屈光度数与视网膜神经纤维层厚度、中央角膜厚度、角膜曲率和眼压的相关性[J]. 广西医学, 2018, 40(16): 1821-1824. DOI: 10.11675/j.issn.0253-4304.2018.16.14.Wang L, Tao J. Correlation of refractive error with retinal nerve fiber layer thickness, central corneal thickness, corneal curvature and intraocular pressure in myopic patients[J]. Guangxi Medicine, 2018, 40(16): 1821-1824. DOI: 10.11675/j.issn.0253-4304.2018.16.14.
10. 尹奕, 王艳玲. 准分子激光上皮下角膜磨镶术后使用糖皮质激素滴眼剂对眼压影响的分析[J]. 临床和实验医学杂志, 2020, 19(13): 1432-1436. DOI: 10.3969/j.issn.1671-4695.2020.13.026.Yin Y, Wang YL. Analysis of the effect of glucocorticoid drops on intraocular pressure after excimer laser subepithelial keratomileusis[J]. Journal of Clinical and Experimental Medicine, 2020, 19(13): 1432-1436. DOI: 10.3969/j.issn.1671-4695.2020.13.026.
11. 史清霞, 杨慧, 马秋霞. 准分子激光原位角膜磨镶术术后激素性高眼压患者24例的观察分析[J]. 山西医药杂志, 2020, 49(19): 2693-2694. DOI: 10.3969/j.issn.0253-9926.2020.19.059.Shi QX, Yang H, Ma QX. Observation and analysis of 24 patients with hormonal hypertension after excimer laser in situ keratomileusis[J]. Shanxi Med J, 2020, 49(19): 2693-2694. DOI: 10.3969/j.issn.0253-9926.2020.19.059.
12. 鲁占军, 梁晓瑜, 马瑞彤, 等. LASIK术后两种糖皮质激素滴眼液作用下眼压的变化[J]. 应用激光, 2018, 38(1): 136-141. DOI: 10.14128/j.cnki.al.20183801.136.Lu ZJ, Liang XY, Ma RT, et al. Changes of intraocular pressure under the effect of two glucocorticoid eye drops after LASIK[J]. Applied Laser, 2018, 38(1): 136-141. DOI: 10.14128/j.cnki.al.20183801.136.
13. Chaurasia SS, Luengo Gimeno F, Tan K, et al. In vivo real-time intraocular pressure variations during LASIK flap creation[J]. Invest Ophthalmol Vis Sci, 2010, 51(9): 4641-4645. DOI: 10.1167/iovs.10-5228.
14. Aoki S , Murata H , Matsuura M , et al. The effect of air pulse-driven whole eye motion on the association between corneal hysteresis and glaucomatous visual field progression[J/OL]. Sci Rep, 2018, 8(1): 2969[2018-02-14]. https://pubmed.ncbi.nlm.nih.gov/29445204/.
15. 康杨, 胡琦, 李雪, 等. 利用眼反应分析仪评估FS-LASIK和LASEK术后角膜生物力学稳定性[J]. 国际眼科杂志, 2018, 18(11): 2116-2118. DOI: 10.3980/j.issn.1672-5123.2018.11.43.Kang Y, Hu Q, Li X, et al. Assessment of corneal biomechanical stability after FS-LASIK and LASEK using ocular response analyzer[J]. Int Eye Sci, 2018, 18(11): 2116-2118. DOI: 10.3980/j.issn.1672-5123.2018.11.43.
16. 李福生, 尹鸿芝, 魏胜兰, 等. 飞秒激光LASIK术后角膜生物力学各指标和眼压的改变[J]. 眼科新进展, 2013, 33(2): 175-177. DOI: 10.13389/j.cnki.rao.2013.02.020.Li FS, Yin HZ, Wei SL, et al. Changes in corneal biomechanics and intraocular pressure after femtosecond laser LASIK[J]. Rec Adv Ophthalmol, 2013, 33(2): 175-177. DOI: 10.13389/j.cnki.rao.2013.02.020.
17. 张力苹, 刘喜娟, 林卉, 等. 晚期胃癌生存预后因素及列线图预测模型的建立与验证[J]. 南方医科大学学报, 2021, 41(4): 621-627. DOI: 10.12122/j.issn.1673-4254.2021.04.21.Zhang LP, Liu XJ, Lin H, et al. Establishment and validation of survival prognostic factors and column-line diagram prediction model for advanced gastric cancer[J]. J South Med Univ, 2021, 41(4): 621-627. DOI: 10.12122/j.issn.1673-4254.2021.04.21.
18. 张冬, 解战兵. 高原地区急性脑梗死患者静脉溶栓后出血转化的因素分析及列线图预测模型构建[J]. 国际神经病学神经外科学杂志, 2021, 48(5): 461-465. DOI: 10.16636/j.cnki.jinn.1673-2642.2021.05.011.Zhang D, Xie ZB. Factor analysis of hemorrhage conversion after intravenous thrombolysis in patients with acute cerebral infarction in plateau area and construction of predictive model of column line diagram[J]. Journal of International Neurology and Neurosurgery, 2021, 48(5): 461-465. DOI: 10.16636/j.cnki.jinn.1673-2642.2021.05.011.
19. 刘慧颖. 飞秒激光制瓣LASIK术后泪膜及视力的影响因素分析[J]. 国际眼科杂志, 2017, 17(1): 47-49. DOI: 10.3980/j.issn.1672-5123.2017.1.11.Liu HY. Analysis of factors affecting tear film and visual acuity after femtosecond laser flap LASIK[J]. Int Eye Sci, 2017, 17(1): 47-49. DOI: 10.3980/j.issn.1672-5123.2017.1.11.

Chinese Journal of Ocular Fundus Diseases

Establishment and validation of nomogram model for intraocular hypertension after femtosecond laser in situ keratomileusis for high myopia

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