Abstract

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.