Construction of a nomogram for predicting the risk of postoperative vitreous re-hemorrhage in patients with proliferative diabetic retinopathy
Objective To explore the risk factors of postoperative vitreous re-hemorrhage in patients with proliferative diabetic retinopathy(PDR),and to construct a nomogram to predict the risk factors.Methods Clinical data of 182 eyes in 182 PDR patients who underwent pars plana vitrectomy(PPV)or anti-vascular endothelial growth factor(VEGF)combined with panretinal laser photocoagulation from January 2020 to June 2023 were retrospectively collected.Patients with vitreous re-hemorrhage were included in the study group,and those without re-hemorrhage were included in the control group.The data of the two groups were compared and the possible influencing factors for re-hemorrhage were analyzed.The risk factors obtained from the analysis were included in the construction of a nomogram.Results There were 31 cases of vitreous re-hemorrhage in 182 PDR patients,with an incidence of 17.03％.There were 151 cases without vitreous re-hemorrhage,accounting for 82.97％.Univariate analysis showed that the proportion of chronic kidney disease(CKD)and optic disc neovascularization(NVD)in the study group was significantly higher than that of the control group,and the level of preoperative glycosylated hemoglobin(HbA1c)was significantly higher in the study group(P＜0.05).There were no significant differences in other baseline data between the two groups(P＞0.05).The results of multivariate Logistic analysis showed that CKD,NVD,and high preoperative HbA1c were all risk factors for postoperative vitreous re-hemorrhage in PDR patients who underwent PPV or anti-VEGF combined with panretinal laser photocoagulation(OR＞1,P＜0.05).Based on the results of multivariate Logistic regression analysis,a nomogram was constructed.Bootstrap self sampling method and C-index(C-index=0.958)were used to the internal validation of the nomogram,yielding good accuracy and discrimination.The calibration curve fitted the ideal curve well.Conclusion The risk factors of vitreous re-hemorrhage after PPV or anti-VEGF combined with panretinal laser photocoagulation in PDR patients include CKD,NVD and high preoperative HbA1c.The nomogram established on this basis has a good predictive effect on the risk of vitreous re-hemorrhage after PDR.
diabetic retinopathypars plana vitrectomyanti-vascular endothelial growth factor therapypanretinal laser photocoagulationvitreous hemorrhagenomogram model
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