糖尿病视网膜病变PRP术后黄斑水肿预测研究 ——基于 OCT图像的机器学习建模

左 慧懿, 黄 兰超, 黄 宝宇, 黄 里佳, 闭 福兰, 班胜 刚*
广西医科大学第一附属医院眼科

摘要


目的：基于OCT图像的机器学习方法，开发预测模型识别糖尿病性视网膜病变（DR）患者全视网膜激
光光凝术（PRP）后出现或加重黄斑水肿（ME）的风险，为个体化治疗提供参考。方法：回顾性纳入2024年3月
至2025年3月进行PRP治疗的重度非增殖期（NPDR）或增殖期糖尿病视网膜病变（PDR）患者180例，收集其
术前及术后 1 个月的临床资料与 OCT 图像，提取黄斑结构参数。构建随机森林（RF）、支持向量机（SVM）、极端
梯度提升（XGBoost）与梯度提升决策树（GBDT）四种机器学习模型，并进行交叉验证。利用SHAP方法评估特
征变量对最佳模型的影响及贡献。结果：PRP 术后黄斑中心凹厚度、黄斑体积及囊样水肿显著增加（P<0.01）。四
种模型中，GBDT模型表现最佳，预测准确度为0.761，AUC值为0.719。SHAP分析显示，年龄、HbA1c、糖尿病
病程为阳性风险因素，ELM/EZ损伤和黄斑中心凹厚度为风险降低因子。结论：PRP虽可控制DR进展，但可能
加重黄斑水肿。本研究构建的GBDT模型可有效预测PRP术后黄斑水肿高风险患者，为个体化治疗提供依据，具
有良好应用前景。

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参考


[1]Teo ZL, Tham YC, Yu M, et al. Global Prevalence of

Diabetic Retinopathy and Projection of Burden through 2045:

Systematic Review and Meta-analysis. Ophthalmology. 2021.

128(11): 1580-1591.

[2]TAN T E, WONG T Y. Diabetic retinopathy: Looking

forward to 2030[J]. Front Endocrinol (Lausanne), 2022, 13:

1077669.

[3]LIN K Y, HSIH W H, LIN Y B, et al. Update in the

epidemiology, risk factors, screening, and treatment of diabetic

retinopathy[J]. J Diabetes Investig, 2021,12(8):1322-1325.

[4]SINGH R, WALIA A, KAUR J, et al. Diabetic

Retinopathy - Pathophysiology to Treatment: A Review[J].

Curr Diabetes Rev, 2025,21(3):58-67.

[5] 黎晓新 .《我国糖尿病视网膜病变临床诊疗指南

（2022 年）——基于循证医学修订》更新点 [J]. 中华眼底

病杂志，2023，39（02）：91-94.

[6]REDDY S V, HUSAIN D. Panretinal Photocoagulation:

A Review of Complications[J]. Semin Ophthalmol, 2018, 33(1):

83-88.

[7]LI Y, FOO L L, WONG C W, et al. Pathologic

myopia: advances in imaging and the potential role of artificial

intelligence[J]. Br J Ophthalmol, 2023, 107(5): 600-606.

[8]HEMELINGS R, ELEN B, BLASCHKO M B, et

al. Pathological myopia classification with simultaneous

lesion segmentation using deep learning[J]. Comput Methods

Programs Biomed, 2021,199: 105920.

[9]PARRAVANO M, CENNAMO G, DI ANTONIO L, etal. Multimodal imaging in diabetic retinopathy and macular

edema: An update about biomarkers[J]. Surv Ophthalmol,

2024, 69(6): 893-904.

[10]SZETO S K, LAI T Y, VUJOSEVIC S, et al. Optical

coherence tomography in the management of diabetic macular

oedema[J]. Prog Retin Eye Res, 2024, 98:101220.

[11]SUCIU C I, SUCIU V I, NICOARA S D. Optical

Coherence Tomography (Angiography) Biomarkers in the

Assessment and Monitoring of Diabetic Macular Edema[J]. J

Diabetes Res, 2020,2020:6655021.

[ 1 2 ] H A M E D N , V A N D E R W O U D E L ,

ROOHIPOURMOALLAI R, et al. Effect of pattern scanning

laser on macular thickness in diabetic retinopathy[J]. Ther Adv

Ophthalmol, 2021,13:25158414211035860.

[13]SOMAN M, GANEKAL S, NAIR U, et al. Effect

of panretinal photocoagulation on macular morphology and

thickness in eyes with proliferative diabetic retinopathy without

clinically significant macular edema[J]. Clin Ophthalmol,

2012, 6: 2013-2017.

[14]CHONG D D, DAS N, SINGH R P. Diabetic

retinopathy: Screening, prevention, and treatment[J]. Cleve

Clin J Med, 2024,91(8):503-510.

[15] 张聪，徐丽 . 糖化血红蛋白水平与糖尿病视网膜

病变激光光凝术后黄斑水肿的相关性 [J]. 中国医科大学学

报，2020，49（11）：980-984.

[16]KOUR V, SWAIN J, SINGH J, et al. A Review on

Diabetic Retinopathy[J]. Curr Diabetes Rev, 2024, 20(6):

e201023222418.

[17]GHAMDI A. Clinical Predictors of Diabetic

Retinopathy Progression; A Systematic Review[J]. Curr

Diabetes Rev, 2020, 16(3): 242-247.

[18]SAXENA S, MEYER C H, AKDUMAN L. External

limiting membrane and ellipsoid zone structural integrity in

diabetic macular edema[J]. Eur J Ophthalmol, 2022,32(1):15-16.

[19]TATSUMI T. Current Treatments for Diabetic

Macular Edema[J]. Int J Mol Sci, 2023,24(11):9591.

[20]OHARA H, HARADA Y, HIYAMA T, et al.

Faricimab for Diabetic Macular Edema in Patients Refractory

to Ranibizumab or Aflibercept[J]. Medicina (Kaunas), 2023,

59(6): 1125.


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