Development and Validation of a Nomogram for Predicting Second Surgery in Patients with Concomitant Esotropia

Area of Science:

• Ophthalmology
• Medical Statistics
• Surgical Outcomes

Background:

• Concomitant esotropia (CE) often requires surgical intervention.
• Predicting the risk of subsequent surgeries is crucial for managing CE patients.
• A validated predictive tool for CE surgery outcomes was lacking.

Purpose of the Study:

• To develop and validate a nomogram for predicting the risk of a second surgery in patients with concomitant esotropia (CE).
• To identify key prognostic factors influencing the need for re-operation in CE patients.
• To provide a clinical tool for better prognostic evaluation of CE surgical outcomes.

Main Methods:

• Retrospective cohort study of 357 patients with CE who underwent surgery.
• Development of a predictive nomogram using multivariate Cox proportional hazards regression.
• Internal validation using concordance index (C-index) and calibration curves on training (70%) and validation (30%) sets.

Main Results:

• Six independent prognostic factors identified: age at surgery, age at onset, amblyopia, deviation angles, surgical amount, and post-operative deviation angles.
• The nomogram demonstrated favorable discrimination and accuracy in both training (C-index=0.84) and validation (C-index=0.80) sets.
• The nomogram effectively estimates the risk of second surgery for surgically treated CE.

Conclusions:

• The developed nomogram serves as a valuable predictive tool for prognostic evaluation in concomitant esotropia surgery.
• This tool can assist clinicians in assessing the likelihood of requiring a second surgery for CE patients.
• The nomogram contributes to improved patient management and surgical planning for CE.