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                  [1]李琳,孟紫薇,張利民,等.散光矯正型人工晶狀體植入術后軸向旋轉的預測研究[J].眼科新進展,2023,43(7):536-541.[doi:10.13389/j.cnki.rao.2023.0108]
                   LI Lin,MENG Ziwei,ZHANG Limin,et al.Predictors of axial rotation after astigmatism-correcting intraocular lens implantation[J].Recent Advances in Ophthalmology,2023,43(7):536-541.[doi:10.13389/j.cnki.rao.2023.0108]
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                  散光矯正型人工晶狀體植入術后軸向旋轉的預測研究/HTML
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                  《眼科新進展》[ISSN:1003-5141/CN:41-1105/R]

                  卷:
                  43卷
                  期數:
                  2023年7期
                  頁碼:
                  536-541
                  欄目:
                  應用研究
                  出版日期:
                  2023-07-05

                  文章信息/Info

                  Title:
                  Predictors of axial rotation after astigmatism-correcting intraocular lens implantation
                  作者:
                  李琳孟紫薇張利民虹霏朱丹
                  010000 內蒙古自治區呼和浩特市, 內蒙古醫科大學附屬醫院眼科
                  Author(s):
                  LI LinMENG ZiweiZHANG LiminHONG FeiZHU Dan
                  Department of Ophthalmology,the Affiliated Hospital of Mongolia Medical College,Hohhot 010000,Inner Mongolia Autonomous Regions,China
                  關鍵詞:
                  散光矯正人工晶狀體植入術后軸向旋轉白內障
                  Keywords:
                  astigmatism correction intraocular lens implantation postoperative axial rotation cataract
                  分類號:
                  R776
                  DOI:
                  10.13389/j.cnki.rao.2023.0108
                  文獻標志碼:
                  A
                  摘要:
                  目的 研究散光矯正型人工晶狀體(TIOL)植入術后軸向旋轉的預測因素。
                  方法 選取2019年9月至2022年6月我院收治的100例(200眼)行TIOL植入術的白內障患者,將患者隨機分為模型建立組(60例120眼)、外部驗證組(40例80眼),比較模型建立組、外部驗證組術后發生軸向旋轉(發生組)與未發生軸向旋轉(未發生組)患者各項臨床資料及數據的差異,采用Lasso回歸和Logistic回歸分析術后軸向旋轉的預測因素,R語言建立預測模型,并對所建立模型進行評價和外部驗證。
                  結果 模型建立組:發生組患者眼軸長度、撕囊口直徑均高于未發生組,植入張力環患者少于未發生組,前囊膜混濁分級與未發生組差異顯著,以上差異均有統計學意義(均為P<0.05)。外部驗證組:發生組患者眼軸長度、撕囊口直徑均高于未發生組,前囊膜混濁分級與未發生組差異顯著,以上差異均有統計學意義(均為P<0.05)。其余指標兩組間差異均無統計學意義(均為P>0.05)。Lasso回歸分析篩選出具有預測價值的4個術后軸向旋轉因素:眼軸長度、撕囊口直徑、前囊膜混濁分級、植入張力環,其系數分別為1.988、2.076、1.553、-0.762。Logistic回歸分析結果顯示,眼軸長度、撕囊口直徑、前囊膜混濁分級4級是術后軸向旋轉的相關危險因素,植入張力環是術后軸向旋轉的相關保護因素(均為P<0.05)。針對模型建立組繪制的預測術后軸向旋轉列線圖模型的預測風險能力指數(C-index)為0.945,提示列線圖預測能力較好。繪制模型建立組、外部驗證組的校準曲線,結果顯示,兩者校準度分別為0.905、0.926,提示模型與實際觀察結果有較好的一致性。繪制決策分析曲線(DCA)評價模型的臨床效用,結果顯示,術后軸向旋轉的列線圖預測模型具有明顯的正向凈收益。
                  結論 眼軸長度、撕囊口直徑、前囊膜混濁分級4級是白內障TIOL術后軸向旋轉的相關危險因素,植入張力環是術后軸向旋轉的相關保護因素,4項相關危險因素均可作為術后軸向旋轉的預測因素,為臨床早期預測和干預提供參考。
                  Abstract:
                  Objective To investigate the predictors of axial rotation after astigmatism-correcting toric intraocular lens (TIOL) implantation.
                  Methods One hundred cataract patients (200 eyes) admitted to our hospital for TIOL implantation from September 2019 to June 2022 were selected and randomly divided into the model building group (60 patients,120 eyes) and the external validation group (40 patients,80 eyes),to analyze the clinical data of patients with axial rotation (occurrence group) and without axial rotation (non-occurrence group) after surgery in the two groups.Lasso and logistic regression were used to explore the predictors of postoperative axial rotation.A prediction model was developed in R language and then was evaluated and validated externally.
                  Results Model building group: The axial length (AL) and the diameter of the capsulorhexis opening in the occurrence group were higher than those in the non-occurrence group,the number of patients implanted with tension rings was less than that in the non-occurrence group,and the anterior capsule opacification (ACO) grade was significantly different from that in the non-occurrence group (all P<0.05).External validation group: The AL and the diameter of the capsulorhexis opening in the occurrence group were higher than those in the non-occurrence group,and the ACO grade was significantly different from that in the non-occurrence group (all P<0.05).No significant differences were found in the rest indicators between the two groups (all P>0.05).Four factors were identified as having predictive value for postoperative axial rotation through Lasso regression analysis,namely,AL,diameter of the capsulorhexis opening,ACO grade,and tension ring implantation,with correlation coefficients of 1.988,2.076,1.553,and -0.762,respectively.Logistic regression analysis results showed that AL,diameter of the capsulorhexis opening,and ACO grade 4 were risk factors for postoperative axial rotation,while the tension ring implantation was a protective factor for postoperative axial rotation (all P<0.05).The concordance index (C-index) of the nomogram drawn for the predication of postoperative axial rotation in the model building group was 0.945,indicating that the nomogram had good predictive effects.Calibration curves for the model building group and the external validation group showed that the calibration degrees of the two groups were 0.905 and 0.926,respectively,indicating good consistency between the model and the actual observations.A decision curve was drawn to evaluate the clinical effects of the model,and the results showed that the nomogram prediction model for postoperative axial rotation had significant positive net benefits.
                  Conclusion AL,diameter of the capsulorhexis opening,and ACO grade 4 are risk factors associated with axial rotation after TIOL,and tension ring implantation is a protective factor associated with axial rotation after TIOL.These four factors can all be used as predictors of preoperative axial rotation,providing references for early clinical prediction and intervention.

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                  更新日期/Last Update: 2023-07-05
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