Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2024; 15(4): 654-663
Published online Apr 15, 2024. doi: 10.4239/wjd.v15.i4.654
Construction and validation of a neovascular glaucoma nomogram in patients with diabetic retinopathy after pars plana vitrectomy
Yi Shi, Yan-Xin Zhang, Ming-Fei Jiao, Xin-Jun Ren, Bo-Jie Hu, Ai-Hua Liu, Xiao-Rong Li
Yi Shi, Ming-Fei Jiao, Bo-Jie Hu, Xiao-Rong Li, Surgical Retina, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Yan-Xin Zhang, Ai-Hua Liu, Glaucoma, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Xin-Jun Ren, Ocular Trauma, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Co-first authors: Yi Shi and Yan-Xin Zhang.
Co-corresponding authors: Ai-Hua Liu and Xiao-Rong Li.
Author contributions: Shi Y and Zhang YX designed and performed the research and wrote the paper; Liu AH and Li XR designed the research and supervised the report; Jiao MF, Ren XJ, and Hu BJ contributed to the analysis; all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Shi Y and Zhang YX contributed equally to this work and are co-first authors; Liu AH and Li XR contributed equally to this work and are co- corresponding authors. The reasons for designating Liu AH and Li XR as co-corresponding authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-corresponding authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives. Third, Liu AH and Li XR contributed efforts of equal substance throughout the research process. The choice of these researchers as co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study.
Supported by the Tianjin Key Medical Discipline (Specialty) Construction Project, No. TJYXZDXK-037A.
Institutional review board statement: The study was reviewed and approved by the Tianjin Medical University Eye Hospital [Approval No. 2021KL(L)-54].
Informed consent statement: The requirement of informed consent was exempted.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Statistical data used in this study can be obtained from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Rong Li, MD, Chief Physician, Surgical Retina, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No. 251 Fukang Road, Nankai District, Tianjin 300384, China. lixiaorong_tmu@163.com
Received: December 5, 2023
Peer-review started: December 5, 2023
First decision: December 21, 2023
Revised: December 30, 2023
Accepted: February 6, 2024
Article in press: February 6, 2024
Published online: April 15, 2024
Abstract
BACKGROUND

Neovascular glaucoma (NVG) is likely to occur after pars plana vitrectomy (PPV) for diabetic retinopathy (DR) in some patients, thus reducing the expected benefit. Understanding the risk factors for NVG occurrence and building effective risk prediction models are currently required for clinical research.

AIM

To develop a visual risk profile model to explore factors influencing DR after surgery.

METHODS

We retrospectively selected 151 patients with DR undergoing PPV. The patients were divided into the NVG (NVG occurrence) and No-NVG (No NVG occurrence) groups according to the occurrence of NVG within 6 months after surgery. Independent risk factors for postoperative NVG were screened by logistic regression. A nomogram prediction model was established using R software, and the model’s prediction accuracy was verified internally and externally, involving the receiver operator characteristic curve and correction curve.

RESULTS

After importing the data into a logistic regression model, we concluded that a posterior capsular defect, preoperative vascular endothelial growth factor ≥ 302.90 pg/mL, glycosylated hemoglobin ≥ 9.05%, aqueous fluid interleukin 6 (IL-6) ≥ 53.27 pg/mL, and aqueous fluid IL-10 ≥ 9.11 pg/mL were independent risk factors for postoperative NVG in patients with DR (P < 0.05). A nomogram model was established based on the aforementioned independent risk factors, and a computer simulation repeated sampling method was used to internally and externally verify the nomogram model. The area under the curve (AUC), sensitivity, and specificity of the model were 0.962 [95% confidence interval (95%CI): 0.932-0.991], 91.5%, and 82.3%, respectively. The AUC, sensitivity, and specificity of the external validation were 0.878 (95%CI: 0.746-0.982), 66.7%, and 95.7%, respectively.

CONCLUSION

A nomogram constructed based on the risk factors for postoperative NVG in patients with DR has a high prediction accuracy. This study can help formulate relevant preventive and treatment measures.

Keywords: Diabetic retinopathy, Retinopathy, Neovascular, Glaucoma, Risk factors, Nomogram

Core Tip: The primary treatment for diabetic retinopathy (DR) is pars plana vitrectomy (PPV); however, neovascular glaucoma (NVG) is likely to occur after surgery. This affects the prognosis of surgery. Risk factors for NVG after PPV have been studied; however, whether inflammatory factors in the aqueous humor are related to the risk of NVG formation is unknown. We explored the risk factors (including inflammatory factors) for NVG and built a histogram model based on these factors, which confirmed the effectiveness and applicability of this model in assessing NVG after PPV in patients with DR.