Clinical predictive model for poor visual function recovery in patients after refractive cataract surgery
10.3760/cma.j.cn115455-20240909-00780
- VernacularTitle:屈光性白内障术后患者视功能恢复不良的临床预测模型
- Author:
Yalong XU
1
;
Gaoqiang MENG
;
Li MENG
Author Information
1. 西北大学附属西安爱尔古城眼科医院青光眼白内障科，西安 710000
- Publication Type:Journal Article
- Keywords:
Cataractextraction;
Refractive;
Visual function recovery;
Predictive model
- From:
Chinese Journal of Postgraduates of Medicine
2025;48(9):802-809
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the factors influencing poor visual function recovery in patients after refractive cataract surgery, and to provide an effective clinical predictive model for improving and preventing poor postoperative visual function in such patients.Methods:A retrospective study was conducted on 314 patients who underwent refractive cataract surgery in Xi'an Ai'ergucheng Eye Hospital Affiliated to Northwest University from January 2021 to June 2024. The best corrected visual acuity (BCVA) was used to evaluate the postoperative visual function of patients. Patients were divided into a good visual function recovery group of 252 cases and a poor visual function recovery group of 62 cases based on their visual function recovery. The differences in general clinical data, surgical-related information and aqueous humor cytokines between the two groups were compared. Correlation tests and Logistic regression analysis were used to identify factors closely associated with poor visual function recovery in patients after refractive cataract surgery. The predictive efficacy of these factors for poor visual function recovery was evaluated using the receiver operating characteristic (ROC) curve, area under the curve (AUC) and decision curve.Results:The age, proportion of diabetes, proportion of severe cataracts, preoperative fasting blood glucose (FBG) and preoperative glycosylated hemoglobin (HbA 1c) levels in the poor visual function recovery group were significantly higher than those in the good visual function recovery group: 66 (64, 68) years old vs. 64 (61, 66) years old, 32.3% (20/62) vs. 17.9% (45/252), 48.4% (30/62) vs. 32.1% (81/252), (5.73 ± 0.94) mmol/L vs. (5.29 ± 0.84) mmol/L, (6.39 ± 0.76)% vs. (5.86 ± 0.64)%, and the differences were statistically significant ( P<0.05). The operation time, proportion of intraoperative vitreous leakage and phacoemulsification time in the poor visual function recovery group were significantly higher than those in the good visual function recovery group: (34.23 ± 4.13) min vs. (32.55 ± 2.20) min, 45.2% (28/62) vs. 26.2% (66/252), (19.81 ± 2.96) min vs. (18.62 ± 1.49) min, and the differences were statistically significant ( P<0.05). The levels of aqueous humor interleukin (IL)-1β and vascular endothelial growth factor (VEGF)-A in the poor visual function recovery group were significantly higher than those in the good visual function recovery group: (20.17 ± 3.71) ng/L vs. (18.54 ± 2.16) ng/L, (130.11 ± 15.54) ng/L vs. (122.35 ± 6.74) ng/L, and the differences were statistically significant ( P<0.05). Spearman correlation analysis, univariate and multivariate Logistic regression analysis confirmed that age ( OR = 1.762, 95% CI 1.430 to 2.172), preoperative FBG ( OR = 2.272, 95% CI 1.387 to 3.721), preoperative HbA 1c ( OR = 2.823, 95% CI 1.517 to 5.254), diabetes ( OR = 5.413, 95% CI 1.162 to 25.222), intraoperative vitreous leakage ( OR = 4.751, 95% CI 1.877 to 8.309) and aqueous humor IL-1β ( OR = 1.195, 95% CI 1.031 to 1.386) were important risk factors for poor visual function recovery after refractive cataract surgery ( P<0.05). ROC and decision curve analysis found that the combined application of these risk factors had a high predictive efficacy for poor visual function recovery in patients after refractive cataract surgery, with an AUC (95% CI) of 0.885 (0.839 to 0.931) ( P<0.05). Conclusions:Older age, higher preoperative FBG and HbA 1c levels, diabetes, intraoperative vitreous overflow and higher levels of aqueous humor IL-1β are important factors contributing to poor visual function recovery in patients undergoing refractive cataract surgery. The model constructed based on these indicators has a high predictive efficacy for postoperative visual function recovery in patients undergoing refractive cataract surgery.
