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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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.
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6.	中華醫學會眼科學分會青光眼學組. 中國高眼壓癥診斷治療和隨訪專家共識(2020年)[J]. 中華眼科雜志, 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.
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8.	劉莛, 余婷, 潘嬌, 等. 角膜曲率對飛秒激光小切口角膜基質透鏡取出術后患者屈光狀態影響的臨床研究[J]. 中華眼科雜志, 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.	王麗, 陶俊. 近視患者屈光度數與視網膜神經纖維層厚度、中央角膜厚度、角膜曲率和眼壓的相關性[J]. 廣西醫學, 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, 王艷玲. 準分子激光上皮下角膜磨鑲術后使用糖皮質激素滴眼劑對眼壓影響的分析[J]. 臨床和實驗醫學雜志, 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, 楊慧, 馬秋霞. 準分子激光原位角膜磨鑲術術后激素性高眼壓患者24例的觀察分析[J]. 山西醫藥雜志, 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.	魯占軍, 梁曉瑜, 馬瑞彤, 等. LASIK術后兩種糖皮質激素滴眼液作用下眼壓的變化[J]. 應用激光, 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.	康楊, 胡琦, 李雪, 等. 利用眼反應分析儀評估FS-LASIK和LASEK術后角膜生物力學穩定性[J]. 國際眼科雜志, 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, 尹鴻芝, 魏勝蘭, 等. 飛秒激光LASIK術后角膜生物力學各指標和眼壓的改變[J]. 眼科新進展, 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.	張力蘋, 劉喜娟, 林卉, 等. 晚期胃癌生存預后因素及列線圖預測模型的建立與驗證[J]. 南方醫科大學學報, 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.	張冬, 解戰兵. 高原地區急性腦梗死患者靜脈溶栓后出血轉化的因素分析及列線圖預測模型構建[J]. 國際神經病學神經外科學雜志, 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.	劉慧穎. 飛秒激光制瓣LASIK術后淚膜及視力的影響因素分析[J]. 國際眼科雜志, 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. 劉靈琳, 吳崢崢, 李冬鋒, 等. 成都和綿陽地區青少年近視患病率及影響因素分析[J]. 國際眼科雜志, 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. 董彥會. 2000—2050年全球近視和高度近視的患病率及趨勢研究[J]. 中華預防醫學雜志, 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. 中華醫學會眼科學分會青光眼學組. 中國高眼壓癥診斷治療和隨訪專家共識(2020年)[J]. 中華眼科雜志, 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. 單保生, 李建橋. 眼高壓癥患者角膜中央厚度對非接觸眼壓計測量值的影響[J]. 山東大學基礎醫學院學報, 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. 劉莛, 余婷, 潘嬌, 等. 角膜曲率對飛秒激光小切口角膜基質透鏡取出術后患者屈光狀態影響的臨床研究[J]. 中華眼科雜志, 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. 王麗, 陶俊. 近視患者屈光度數與視網膜神經纖維層厚度、中央角膜厚度、角膜曲率和眼壓的相關性[J]. 廣西醫學, 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, 王艷玲. 準分子激光上皮下角膜磨鑲術后使用糖皮質激素滴眼劑對眼壓影響的分析[J]. 臨床和實驗醫學雜志, 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, 楊慧, 馬秋霞. 準分子激光原位角膜磨鑲術術后激素性高眼壓患者24例的觀察分析[J]. 山西醫藥雜志, 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. 魯占軍, 梁曉瑜, 馬瑞彤, 等. LASIK術后兩種糖皮質激素滴眼液作用下眼壓的變化[J]. 應用激光, 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. 康楊, 胡琦, 李雪, 等. 利用眼反應分析儀評估FS-LASIK和LASEK術后角膜生物力學穩定性[J]. 國際眼科雜志, 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, 尹鴻芝, 魏勝蘭, 等. 飛秒激光LASIK術后角膜生物力學各指標和眼壓的改變[J]. 眼科新進展, 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. 張力蘋, 劉喜娟, 林卉, 等. 晚期胃癌生存預后因素及列線圖預測模型的建立與驗證[J]. 南方醫科大學學報, 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. 張冬, 解戰兵. 高原地區急性腦梗死患者靜脈溶栓后出血轉化的因素分析及列線圖預測模型構建[J]. 國際神經病學神經外科學雜志, 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. 劉慧穎. 飛秒激光制瓣LASIK術后淚膜及視力的影響因素分析[J]. 國際眼科雜志, 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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