Nomogram for predicting significant rotation after plate-haptic toric intraocular lens implantation in a Chinese population

PURPOSE: To identify independent risk factors associated with significant postoperative rotation (≥10 degrees) of plate-haptic toric intraocular lenses (IOLs) and to develop and externally validate a predictive nomogram. SETTING: 2 independent eye centers in China. DESIGN: Prospective observational study with a training cohort and an external validation cohort. METHODS: 805 eyes from 805 cataract patients with regular corneal astigmatism (≥0.75 diopter) who underwent phacoemulsification and plate-haptic toric IOL implantation between August 2021 and December 2024 were included. Patients from 1 center formed the training cohort, while patients from the second center served as the external validation cohort. Least absolute shrinkage and selection operator regression followed by multivariate logistic regression was used to identify predictors of significant toric IOL rotation (≥10 degrees at 2 weeks postoperatively). A predictive nomogram was developed and validated through receiver operating characteristic analysis, calibration curve, and decision curve analysis (DCA). RESULTS: Age (odds ratio [OR] = 1.04, P = .002), anterior chamber depth (ACD) (OR = 7.71, P < .001), lens thickness (LT) (OR = 5.13, P < .001), and white-to-white (WTW) (OR = 2.36, P = .002) were identified as independent predictors. The nomogram demonstrated good discriminative performance with an area under the curve of 0.809 in the training cohort and 0.848 in the validation cohort. Calibration and DCA analyses confirmed the accuracy and clinical utility of the model. CONCLUSIONS: A validated nomogram based on age, ACD, LT, and WTW provides a useful tool for individualized preoperative risk assessment of significant toric IOL rotation, aiding surgical decision-making.