Aims To establish and evaluate predictive models for glaucoma-related adverse events (GRAEs) following secondary intraocular lens (IOL) implantation in paediatric eyes. Methods 205 children (356 aphakic eyes) receiving secondary IOL implantation at Zhongshan Ophthalmic Center with a 3-year follow-up were enrolled. Cox proportional hazard model was used to identify predictors of GRAEs and developed nomograms. Model performance was evaluated with time-dependent receiver operating characteristic (ROC) curves, decision curve analysis, Kaplan-Meier curves and validated internally through C-statistics and calibration plot of the bootstrap samples. Results Older age at secondary IOL implantation (HR=1.5, 95% CI: 1.03 to 2.19), transient intraocular hypertension (HR=9.06, 95% CI: 2.97 to 27.67) and ciliary sulcus implantation (HR=14.55, 95% CI: 2.11 to 100.57) were identified as risk factors for GRAEs (all p<0.05). Two nomograms were established. At postoperatively 1, 2 and 3 years, model 1 achieved area under the ROC curves (AUCs) of 0.747 (95% CI: 0.776 to 0.935), 0.765 (95% CI: 0.804 to 0.936) and 0.748 (95% CI: 0.736 to 0.918), and the AUCs of model 2 were 0.881 (95% CI: 0.836 to 0.926), 0.895 (95% CI: 0.852 to 0.938) and 0.848 (95% CI: 0.752 to 0.945). Both models demonstrated fine clinical net benefit and performance in the interval validation. The Kaplan-Meier curves showing two distinct risk groups were well discriminated and robust in both models. An online risk calculator was constructed. Conclusion Two nomograms could sensitively and accurately identify children at high risk of GRAEs after secondary IOL implantation to help early identification and timely intervention. Data are available upon reasonable request.

中文翻译：

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预测儿科二次人工晶状体植入后发生青光眼相关不良事件的风险：一项为期 3 年的研究


目的 建立并评估儿科二次人工晶状体 (IOL) 植入后青光眼相关不良事件 (GRAE) 的预测模型。方法 选取在中山市眼科中心接受二次人工晶体植入术并随访3年的儿童205例（356眼）。 Cox 比例风险模型用于识别 GRAE 的预测因子并开发列线图。模型性能通过时间相关的受试者工作特征 (ROC) 曲线、决策曲线分析、Kaplan-Meier 曲线进行评估，并通过 C 统计量和自举样本的校准图进行内部验证。结果 二次IOL植入时年龄较大（HR=1.5，95% CI：1.03～2.19）、一过性高眼压（HR=9.06，95% CI：2.97～27.67）和睫状沟植入（HR=14.55，95% CI： 2.11 至 100.57）被确定为 GRAE 的危险因素（所有 p<0.05）。建立了两个列线图。术后 1 年、2 年和 3 年时，模型 1 的 ROC 曲线下面积 (AUC) 分别为 0.747（95% CI：0.776 至 0.935）、0.765（95% CI：0.804 至 0.936）和 0.748（95% CI：0.736）至0.918），模型2的AUC分别为0.881（95% CI：0.836至0.926）、0.895（95% CI：0.852至0.938）和0.848（95% CI：0.752至0.945）。两种模型在间隔验证中都表现出了良好的临床净效益和性能。卡普兰-迈耶曲线显示两个不同的风险组在两个模型中都得到了很好的区分和稳健。构建了在线风险计算器。结论 两种列线图能够灵敏、准确地识别二次IOL植入后GRAE高危儿童，有助于早期识别和及时干预。数据可根据合理要求提供。