Development of a Nomogram to Predict Graft Survival After Penetrating Keratoplasty

被引:8
|
作者
Shiuey, Eric J.
Zhang, Qiang
Rapuano, Christopher J.
Ayres, Brandon D.
Hammersmith, Kristin M.
Nagra, Parveen K.
Syed, Zeba A.
机构
[1] Thomas Jefferson Univ, Sidney Kimmel Med Coll, Philadelphia, PA 19107 USA
[2] Wills Eye Hosp & Res Inst, Vickie & Jack Farber Vis Res Ctr, Biostat Consulting Core, Philadelphia, PA USA
[3] Wills Eye Hosp & Res Inst, Cornea Serv, Philadelphia, PA USA
基金
美国安德鲁·梅隆基金会;
关键词
RISK-FACTORS; CORNEAL ENDOTHELIUM; SILICONE OIL; FOLLOW-UP; FAILURE; REJECTION; HISTORY; MODEL;
D O I
10.1016/j.ajo.2021.01.030
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
PURPOSE: To develop a nomogram to predict the 3- and 5-year likelihood of graft survival after penetrating keratoplasty (PK) based on preoperative assessment and intraoperative plan. DESIGN: Retrospective clinical case-control study. METHODS: Data from 1,029 consecutive PKs in 903 eyes of 835 patients performed at a single tertiary center from May 2007 to September 2018 were extracted from electronic medical records and evaluated for corneal graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Thirty-seven variables were assessed by multivariable Cox models. A nomogram to predict the probability of graft survival was created. RESULTS: Mean recipient age was 57.1 +/- 22.0 years and mean follow-up was 4.22 +/- 3.05 years. Overall, 37.4% of grafts failed during follow-up. Eleven variables were significantly associated with graft failure, including active microbial infection at the time of PK (hazard ratio [HR] = 5.10, 95% confidence interval [CI] 3.53-7.37), intraocular silicone oil at the conclusion of the PK (HR = 4.28, 95% CI 2.38-7.71), history of systemic autoimmune disease (HR = 2.83, 95% CI 1.63-4.90), 4 quadrants of corneal neovascularization (HR = 2.76, 95% CI 1.56-4.86), any prior anterior segment surgery (HR = 2.41, 95% CI 1.55-3.75), and lens status as anterior chamber intraocular lens at the conclusion of surgery (HR = 2.35, 95% CI 1.30-4.26). The nomogram exhibited a concordance index of 0.76 (95% CI 0.74-0.78); internal calibration plots depicted strong correlation between prediction and observation of graft survival. CONCLUSIONS: PK graft prognosis may be predicted relatively accurately based on 11 variables. Although established from retrospective data, this nomogram would be valuable for data-driven patient counseling prior to corneal transplantation. ((C) 2021 The Authors. Published by Elsevier Inc.)
引用
收藏
页码:32 / 41
页数:10
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