Nomogram for predicting implant exposure risk following enucleation or evisceration with vicryl-meshed hydroxyapatite implants

AIMS: To develop and validate a nomogram predicting the risk of implant exposure in patients receiving vicryl-meshed hydroxyapatite (HA) orbital implants following enucleation or evisceration. METHODS: This is a retrospective study at the University Hospital of Cologne, which included 336 patients with primary vicryl-meshed HA implants. Univariate and multivariate logistic regression analyses identified independent risk factors for implant exposure. A nomogram was constructed, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA). RESULTS: Independent risk factors for implant exposure included previous ocular trauma (OR 2.08; 95% CI 1.01 to 4.31; p=0.048), diabetes mellitus (OR 4.17; 95% CI 1.81 to 9.63; p<0.001), autoimmune disease (OR 4.69; 95% CI 1.15 to 19.09; p=0.031), chemotherapy or radiotherapy (OR 4.25; 95% CI 1.09 to 16.58; p=0.037), hormone therapy (OR 2.35; 95% CI 1.04 to 5.30; p=0.039) and previous ocular surgery (OR 2.65; 95% CI 1.33 to 5.27; p=0.005). The nomogram demonstrated moderate discriminative ability (AUC 0.725 for both training and validation sets) and good calibration, with potential clinical utility supported by DCA. CONCLUSION: This nomogram provides a practical tool for identifying patients at higher risk of exposure following vicryl-meshed HA implantation and may inform individualised preventive strategies. As this is a single-centre study, its applicability is currently limited to this implant type and wrapping technique, and external validation in other centres and populations is needed to confirm its generalisability.