Shiuey et al reported a nomogram for predicting corneal graft survival after placement by penetrating keratoplasty. These can help to identify a patient who may require more aggressive management. The authors are from Thomas Jefferson University and Wills Eye Hospital in Philadelphia.
Patient selection: status post penetrating keratoplasty
Parameters:
(1) age at transplant in years, from 0 to 100
(2) systemic autoimmune disease
(3) glaucoma
(4) prior anterior segment surgery
(5) prior glaucoma surgery
(6) active microbial infection
(7) number of quadrants showing neovascularization
(8) silicone oil present at conclusion of surgery
(9) anterior synechiae
(10) final lens status
(12) concurrent lensectomy or intraocular lens removal
points for age =
= MAX(0,65-(0.65 * (age)))
|
Parameter
|
Finding
|
Poins
|
|
autoimmune disease
|
no
|
0
|
|
|
yes
|
64
|
|
glaucoma
|
no
|
0
|
|
|
yes
|
31
|
|
prior anterior segment surgery
|
no
|
0
|
|
|
yes
|
54
|
|
prior glaucoma surgery
|
no
|
0
|
|
|
yes
|
34
|
|
active infection
|
no
|
0
|
|
|
yes
|
100
|
|
number of quadrants
|
0
|
0
|
|
|
1
|
17
|
|
|
2
|
20
|
|
|
3
|
35
|
|
|
4
|
62
|
|
silicone oil
|
no
|
0
|
|
|
yes
|
89
|
|
anterior synechiae
|
no
|
0
|
|
|
yes
|
25
|
|
final lens status
|
phakic
|
0
|
|
|
PCIOL (posterior chamber intraocular lens)
|
27
|
|
|
aphakic
|
37
|
|
|
ACIOL (anterior chamber intraocular lens)
|
52
|
|
lens removal
|
no
|
0
|
|
|
yes
|
40
|
where:
• If glaucoma surgery performed, then glaucoma should be positive.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 616
• The higher the score the lower the chances of graft survival.
|
Total Score
|
Value of X
|
|
<= 163
|
2.876 - (0.0196 * (score))
|
|
> 163
|
(-0.0002441 * ((score)^2)) + (0.06237 * (score)) - 4.106
|
5-year probability of graft survival =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.76.
