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
Processing time: 128 Days and 18.1 Hours
ARTICLE HIGHLIGHTS
Research background

Pars plana vitrectomy (PPV) can effectively treat diabetic retinopathy (DR); however, some patients are prone to neovascular glaucoma (NVG) after surgery, affecting treatment efficacy. An in-depth understanding of the risk factors for NVG formation and the construction of an effective prediction model are important for clinical intervention to reduce the occurrence of NVG.

Research motivation

Previous studies on NVG risk factors did not include inflammatory factors in their analysis, and there is a lack of a quick and effective clinical risk prediction model. A thorough understanding of the risk factors for NVG and the construction of an effective risk assessment model can promote the clinical identification of high-risk patients and guide interventions.

Research objectives

To analyze the risk factors (including inflammatory factors) for NVG after PPV in patients with DR, build a nomogram model based on this, and evaluate the effectiveness of the model.

Research methods

Binary logistic regression was performed to analyze the risk factors for NVG in patients with DR after PPV. The R language (R 4.0.3) software was used to construct the nomogram, and its accuracy and effectiveness were evaluated using receiver operating characteristic (ROC) and calibration curves.

Research results

Risk factors for NVG after PPV in DR include posterior capsule defect during combined cataract surgery, preoperative VEGF, HbAlc, aqueous fluid IL-6, and aqueous fluid IL-10, and the column nomogram model constructed based on this had good differentiation [AUC: 0.962 (95% confidence interval, 95%CI): 0.932-0.991), sensitivity: 91.5%, and specificity: 82.3%]. The external validation of the model was also good [AUC: 0.878 (95%CI: 0.746-0.982), sensitivity: 66.7%, specificity: 95.7%].

Research conclusions

NVG influencing factors in patients with DR after surgery are related to many factors, including posterior capsular defects, preoperative VEGF, HbAlc, aqueous fluid IL-6, and aqueous fluid IL-10. The nomogram built based on risk factors had a high prediction accuracy and clinical applicability and is expected to expand the scope of application and reduce the occurrence of NVG.

Research perspectives

This study confirmed that the constructed column diagram is suitable for DR after PPV at our hospital. Future research should aim to expand the sample size to multiple centers to enhance the reliability of the results and facilitate the popularization and application of the model.