A halin yanzu Javascript yana kashe a cikin burauzarka. Wasu fasalulluka na wannan gidan yanar gizon ba za su yi aiki ba idan an kashe JavaScript.
Yi rijistar takamaiman bayananka da takamaiman maganin da kake sha'awa kuma za mu daidaita bayanan da ka bayar tare da labarai daga babban rumbun adana bayanai kuma za mu aiko maka da kwafin PDF nan take ta imel.
作者 Ribeiro M., Barbosa C., Correia P., Torrao L., Neves Cardoso P., Moreira R., Falcao-Reis F., Falcao M., Pinheiro-Costa J.
Margarida Ribeiro,1,2,*Margarita Ribeiro, 1.2*Claudia Barbosa, shekaru 3*Claudia Barbosa, shekaru 3*2 Ilimin Halittar Likitanci – Faculty of Medicine na Jami'ar Porto, Porto, Portugal 3 Faculty of Medicine na Jami'ar Porto, Porto, Portugal;4Sashen Tiyata da Ilimin Jiki, Faculty of Medicine, Jami'ar Porto, Porto, Portugal4 Sashen Tiyata da Ilimin Jiki, Faculty of Medicine, Jami'ar Porto, Porto, Portugal *Waɗannan marubutan sun ba da gudummawa iri ɗaya ga wannan aikin.Hernâni Monteiro Porto, 4200-319, Portugal, imel [email protected] Manufa: Mun kimanta saman bayan corneal wanda aka daidaita don daidai wannan Mafi kyawun Sphere Back (BFSB) tsakanin ma'aunin sikelin lokaci (AdjEleBmax) da radius na BFSB (BFSBR). An yi amfani da matsakaicin tsayi da kansa azaman sabon sigar tomographic don yin rikodin ci gaban faɗaɗawa kuma idan aka kwatanta da sabbin sigogi masu inganci na ci gaban keratoconus (KK). Sakamako. Mun kimanta ma'aunin Kmax, D, radius na lanƙwasa na baya, da kuma ma'aunin yankewa mai kyau daga 3.0 mm mafi ƙanƙanta ma'ana a tsakiya (PRC), EleBmax, BFSBR, da AdjEleBmax a matsayin sigogi masu zaman kansu don yin rikodin ci gaban KC (wanda aka ayyana a matsayin masu canji biyu ko fiye), mun sami ƙwarewar 70%, 82%, 79%, 65%, 51%, da 63%, da 91%, 98%, 80%, 73%, 80%, da 84% takamaiman bayanai don gano ci gaban KC. . Yankin da ke ƙarƙashin lanƙwasa (AUC) ga kowane mai canji shine 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, bi da bi. Kammalawa: Idan aka kwatanta da EleBmax ba tare da wani gyara ba, AdjEleBmax yana da ƙwarewa mafi girma, AUC mafi girma da ingantaccen aiki tare da irin wannan ƙwarewa. AUC. Tunda siffar saman bayan ya fi lanƙwasa da lanƙwasa fiye da saman gaban, wanda zai iya taimakawa wajen gano canje-canje, muna ba da shawarar haɗa AdjEleBmax a cikin kimanta ci gaban KC tare da wasu masu canji don inganta amincin kimantawar asibiti da gano wuri. ci gaba. Kalmomi masu mahimmanci: keratoconus, cornea, ci gaba, mafi kyawun siffar ƙwallo mai siffar ƙwallo, matsakaicin tsayin saman bayan cornea.
Keratoconus (KK) ita ce cutar da ta fi yawa a cikin cornea ectasia. Yanzu ana ɗaukarta a matsayin cuta mai ci gaba ta hanyoyi biyu (kodayake ba ta da matsala) wacce ke haifar da canje-canje a tsarin jiki da yawa, sannan ta koma tabo. 1,2 A asibiti, marasa lafiya suna fuskantar rashin daidaituwar astigmatism da myopia, photophobia, da/ko monocular diplopia tare da raunin gani, ingantaccen gyaran gani (BCVA) da raguwar ingancin rayuwa. 3,4 Bayyanar RP yawanci tana farawa ne a cikin shekaru goma na biyu na rayuwa kuma ci gaba zuwa shekaru goma na huɗu, sannan kuma daidaita asibiti. Hadarin da ƙimar ci gaba ya fi yawa a cikin mutanen da ba su kai shekaru 19 ba. 5.6
Duk da cewa har yanzu babu maganin da ya dace, maganin da ake yi wa keratoconus na ido yana da manufofi biyu masu mahimmanci: inganta aikin gani da kuma dakatar da ci gaban faɗaɗawa. 7,8 Ana iya ganin na farko a cikin tabarau, ruwan tabarau masu tauri ko masu tauri, zoben ciki, ko kuma a cikin dashen cornea lokacin da cutar ta yi tsanani. 9 Manufar ta ƙarshe ita ce cikakkiyar kulawa ga waɗannan jiyya na marasa lafiya, a halin yanzu ana iya cimma ta ne kawai ta hanyar haɗa kai. Wannan aikin yana haifar da ƙaruwar juriyar biomechanical da tauri na cornea kuma yana hana ci gaba. 10-13 Kodayake ana iya yin wannan a kowane mataki na cutar, ana samun mafi girman fa'ida a matakan farko. 14 Ya kamata a yi ƙoƙari don gano ci gaba da wuri da kuma hana ci gaba da lalacewa, da kuma guje wa magani mara amfani ga wasu marasa lafiya, ta haka rage haɗarin rikitarwa kamar kamuwa da cuta, asarar ƙwayoyin endothelial, da kuma mummunan ciwon bayan tiyata. 15.16
Duk da bincike da dama da aka yi niyya don fayyace da gano ci gaba,17-19 har yanzu babu wani ma'anar ci gaban faɗaɗawa daidai gwargwado ko kuma wata hanya ta daidaita ta rubuta shi. 9,20,21 A cikin Yarjejeniyar Duniya kan Keratoconus da Cututtukan da suka Faru (2015), ci gaban keratoconus an bayyana shi a matsayin canji mai zuwa a cikin aƙalla sigogi biyu na yanayin ƙasa: tsayuwar cornea ta gaba, tsayuwar cornea ta baya, raguwa da/ko kauri na cornea Matsakaicin canji yana ƙaruwa daga kewaye zuwa mafi siriri. 9 Duk da haka, har yanzu ana buƙatar takamaiman ma'anar ci gaba. An yi ƙoƙari don nemo mafi ƙarfi masu canzawa don gano da bayyana ci gaba. 19:22–24
Ganin cewa siffar saman corneal na baya, wanda ya fi lanƙwasa da lanƙwasa fiye da saman gaba, na iya zama da amfani wajen gano canje-canje,25 babban manufar wannan binciken shine a kimanta halayen matsakaicin kusurwar tsayin corneal na baya. An daidaita shi zuwa yanki mafi dacewa. Ma'aunin sikelin lokaci (BFSB) (AdjEleBmax) da radius na BFSB (BFSBR) kaɗai sun yi aiki azaman sabbin sigogi don yin rikodin ci gaban faɗaɗawa kuma an kwatanta su da sigogin da aka fi amfani da su don ci gaban KC.
An duba jimillar idanu 113 na marasa lafiya 76 a jere da aka gano suna da keratoconus a cikin wannan binciken da aka yi a Sashen Kula da Ido a Babban Asibitin Jami'ar São João, Portugal. Kwamitin ɗa'a na yankin Centro Hospitalar Universitario de São João/Faculdade de Medicina da Universidade do Porto ne ya amince da binciken kuma an gudanar da shi bisa ga Sanarwar Helsinki. An sami izini a rubuce daga dukkan mahalarta kuma, idan mahalarta ba su kai shekara 16 ba, daga iyaye da/ko mai kula da shari'a.
An gano marasa lafiya da ke fama da cutar KC masu shekaru 14 zuwa 30 kuma an haɗa su a jere a cikin binciken ido da ido a tsakanin Oktoba-Disamba 2021.
An bi duk waɗanda aka zaɓa zuwa asibiti na tsawon shekara ɗaya ta hanyar ƙwararren likitan ido, kuma an yi musu aƙalla ma'aunin tomografi na Scheimpflug guda uku (Pentacam®; Oculus, Wetzlar, Jamus). Marasa lafiya sun daina sanya ruwan tabarau na ido aƙalla awanni 48 kafin a auna. An yi duk ma'aunin ta hanyar ƙwararren likitan ido, kuma an haɗa da gwajin inganci na "OK". Idan ba a yiwa kimanta ingancin hoto ta atomatik alama a matsayin "OK" ba, za a maimaita gwajin. An yi nazarin gwaje-gwaje guda biyu kawai ga kowane ido don gano ci gaba, tare da raba kowane biyu da watanni 12 ± 3. An kuma haɗa da idanu masu KC na ƙananan ƙwayoyin cuta (a cikin waɗannan yanayi, ɗayan idon dole ne ya nuna alamun KC na asibiti).
Mun cire idanun KC waɗanda aka yi musu tiyatar ido a baya (haɗin gwiwar ido, zoben hanci, ko dashen hanci) da kuma idanu masu fama da cutar da ta yi tsanani (kauri a kusurwar ido wanda ya fi ƙasa da µ350 µm, hydrokeratosis, ko kuma tabon hanci mai zurfi) daga cikin binciken, saboda ƙungiyar ta kasa samun nasara a "OK" bayan an duba ingancin hoton ciki.
An tattara bayanai na alƙaluma, na asibiti da na tomographic don yin nazari. Domin gano ci gaban KC, mun tattara ma'aunin tomographic da yawa waɗanda suka haɗa da matsakaicin lanƙwasa cornea (Kmax), matsakaicin lanƙwasa cornea (Km), lanƙwasa cornea mai faɗi (K1), lanƙwasa cornea mai tsayi mafi tsayi (K2), astigmatism na cornea (Astig = K2 – K1).), mafi ƙarancin ma'aunin kauri (PachyMin), matsakaicin tsayin cornea na baya (EleBmax), radius na lanƙwasa na baya (PRC) 3.0 mm a tsakiya akan mafi siririn wuri, an daidaita Belin/Ambrosio D-index (D-index), BFSBR da EleBmax zuwa BFSB (AdjEleBmax). Kamar yadda aka nuna a cikin hoto na 1, ana samun AdjEleBmax bayan mun ƙayyade radius ɗin BFSB iri ɗaya da hannu a cikin gwaje-gwajen injina guda biyu ta amfani da ƙimar BFSR daga kimantawa na biyu.
Shinkafa. 1. Kwatanta hotunan Pentacam® a matsayi na baya mai miƙewa tare da ci gaban asibiti na gaske tare da tazara na watanni 13 tsakanin gwaje-gwaje. A cikin allon 1, EleBmax ya kasance 68 µm a gwajin farko da 66 µm a na biyu, don haka babu ci gaba a cikin wannan siga. Mafi kyawun radiyon zagaye da na'urar ta bayar ta atomatik don kowane kimantawa shine 5.99 mm da 5.90 mm, bi da bi. Idan muka danna maɓallin BFS, taga zai bayyana inda za a iya ayyana sabon radiyon BFS da hannu. Mun ƙayyade radiyo iri ɗaya a cikin gwaje-gwajen biyu ta amfani da ƙimar radius na BFS na biyu da aka auna (5.90mm). A cikin allon 2, sabon ƙimar EleBmax (EleBmaxAdj) da aka gyara don BFS iri ɗaya a kimantawa ta farko shine 59 µm, yana nuna ƙaruwar 7 µm a kimantawa ta biyu, yana nuna ci gaba bisa ga iyakar 7 µm ɗinmu.
Don yin nazarin ci gaba da kuma kimanta tasirin sabbin masu canjin bincike, mun yi amfani da sigogi da aka saba amfani da su azaman alamun ci gaba (Kmax, Km, K2, Astig, PachyMin, PRC, da D-Index) da kuma iyakokin da aka bayyana a cikin wallafe-wallafen. kodayake ba a zahiri ba). Tebur na 1 ya lissafa ƙimar da ke wakiltar ci gaban kowane sigar bincike. An ayyana ci gaban KC lokacin da aƙalla biyu daga cikin masu canjin da aka yi nazari suka tabbatar da ci gaba.
Tebur 1. Sigogi na Tomographic gabaɗaya ana karɓar su azaman alamun ci gaban ci gaban RP da matakan da suka dace da aka bayyana a cikin wallafe-wallafen (kodayake ba a tabbatar da su ba)
A cikin wannan binciken, an gwada aikin masu canji guda uku don ci gaba (EleBmax, BFSB, da AdjEleBmax) bisa ga kasancewar ci gaban aƙalla wasu masu canji guda biyu. An ƙididdige ma'aunin yankewa mafi kyau ga waɗannan masu canji kuma an kwatanta su da sauran masu canji.
An gudanar da nazarin ƙididdiga ta amfani da software na ƙididdiga na SPSS (sigar 27.0 don Mac OS; SPSS Inc., Chicago, IL, Amurka). An taƙaita halayen samfura kuma an gabatar da bayanai azaman lambobi da rabo na masu canji na rukuni. Ana bayyana masu canji masu ci gaba a matsayin matsakaicin karkacewa da daidaito (ko kewayon matsakaici da tsaka-tsaki lokacin da aka karkatar da rarrabawa). An sami canjin ma'aunin keratometric ta hanyar cire ƙimar asali daga ma'auni na biyu (watau, ƙimar delta mai kyau tana nuna ƙaruwa a ƙimar wani takamaiman siga). An gudanar da gwaje-gwajen parametric da marasa parametric don kimanta rarrabawar masu canji na lanƙwasa corneal waɗanda aka rarraba a matsayin masu ci gaba ko marasa ci gaba, gami da gwajin t-samfurin mai zaman kansa, gwajin Mann-Whitney U, gwajin chi-square, da gwajin Fisher daidai (idan ana buƙata). An saita matakin mahimmancin ƙididdiga a 0.05. Domin tantance ingancin Kmax, D-index, PRC, BFSBR, EleBmax, da AdjEleBmax a matsayin masu hasashen ci gaban mutum ɗaya, mun gina lanƙwasa aikin mai karɓa (ROC) kuma mun ƙididdige wuraren yankewa masu kyau, hankali, takamaiman aiki, tabbatacce (PPV), da ƙimar hasashen da ba ta da kyau (NPV). ) da yanki a ƙarƙashin lanƙwasa (AUC) lokacin da aƙalla masu canji biyu suka wuce wasu ma'auni (kamar yadda aka bayyana a baya) don rarraba ci gaban a matsayin iko.
An haɗa jimillar idanu 113 na marasa lafiya 76 da ke da RP a cikin binciken. Yawancin marasa lafiya maza ne (n=87, 77%) kuma matsakaicin shekarun da aka yi gwajin farko shine shekaru 24.09 ± 3.93. Dangane da rarrabuwar KC bisa ga ƙaruwar jimillar karkacewar Belin/Ambrosio (BAD-D index), yawancin (n=68, 60.2%) na idanu sun kasance matsakaici. Masu binciken sun zaɓi ƙimar yankewa ta 7.0 gaba ɗaya kuma sun bambanta tsakanin keratoconus mai sauƙi da matsakaici bisa ga wallafe-wallafe26. Duk da haka, sauran binciken ya haɗa da cikakken samfurin. Halayen alƙaluma, na asibiti da na tomography na samfurin, gami da matsakaici, mafi ƙaranci, matsakaicin, daidaitaccen karkacewa (SD) da ma'auni tare da tazara na amincewa 95% (IC95%), da kuma ma'auni na farko da na biyu. Ana iya samun bambanci tsakanin ƙimar bayan watanni 12 ± 3 a cikin tebur na 2.
Tebur na 2. Halayen alƙaluma, na asibiti da kuma na tomography na marasa lafiya. An bayyana sakamakon a matsayin matsakaicin ± karkacewar daidaito ga masu ci gaba da canzawa (*sakamako ana bayyana shi azaman matsakaici ± IQR), tazara ta amincewa 95% (95% CI), jinsi na namiji da idon dama an bayyana su azaman lamba da kashi
Tebur na 3 ya nuna adadin idanu da aka rarraba a matsayin masu ci gaba idan aka yi la'akari da kowace ma'aunin tomographic (Kmax, Km, K2, Astig, PachyMin, PRC da D-Index) daban-daban. Idan aka yi la'akari da ci gaban KC, wanda aka bayyana ta hanyar canje-canje da aka lura a cikin aƙalla masu canjin tomographic guda biyu, idanu 57 (50.4%) sun nuna ci gaba.
Tebur 3 Adadi da yawan idanu da aka rarraba a matsayin masu ci gaba, la'akari da kowace siga ta tomographic daban-daban
An nuna maki Kmax, D-index, PRC, EleBmax, BFSB, da AdjEleBmax a matsayin masu hasashen ci gaban KC a cikin Jadawali na 4. Misali, idan muka ayyana ƙimar iyaka don ƙara Kmax da diopter 1 (D) don nuna ci gaba, kodayake wannan sigar tana nuna ƙarfin ji na 49%, tana da takamaiman 100% (duk shari'o'in da aka gano a matsayin ci gaba akan wannan sigar a zahiri gaskiya ne). masu ci gaba a sama) tare da ƙimar hasashen mai kyau (PPV) na 100%, ƙimar hasashen mara kyau (NPV) na 66%, da yanki a ƙarƙashin lanƙwasa (AUC) na 0.822. Duk da haka, yankewar da aka ƙididdige don kmax shine 0.4, yana ba da ƙarfin ji na 70%, takamaiman 91%, PPV na 89%, da NPV na 75%.
Tebur 4 Maki Kmax, D-Index, PRC, BFSB, EleBmax, da AdjEleBmax a matsayin masu hasashen ci gaban KC (wanda aka ayyana a matsayin babban canji a cikin masu canji biyu ko fiye)
Dangane da ma'aunin D, matakin yankewa mafi dacewa shine 0.435, ƙarfin ji shine 82%, takamaiman shine 98%, PPV shine 94%, NPV shine 84%, kuma AUC shine 0.927. Mun tabbatar da cewa daga cikin idanu 50 da suka ci gaba, marasa lafiya 3 ne kawai ba su ci gaba akan wasu sigogi 2 ko fiye ba. Daga cikin idanu 63 waɗanda ma'aunin D bai inganta ba, 10 (15.9%) sun nuna ci gaba a cikin aƙalla wasu sigogi biyu.
Ga PRC, maƙasudin da ya dace don ayyana ci gaba shine raguwar 0.065 tare da saurin amsawa na 79%, takamaiman 80%, PPV na 80%, NPV na 79%, da AUC na 0.844.
Dangane da ɗaga saman baya (EleBmax), madaidaicin matakin tantance ci gaba shine ƙaruwar 2.5 µm tare da ƙarfin ji na 65% da kuma takamaiman kashi 73%. Lokacin da aka daidaita shi da BSFB na biyu da aka auna, ƙarfin ji na sabon sigar AdjEleBmax ya kasance 63% kuma ƙimar ji na ta inganta da 84% tare da madaidaicin wurin yankewa na 6.5 µm. BFSB da kanta ta nuna cikakkiyar yankewa na 0.05 mm tare da ƙarfin ji na 51% da kuma takamaiman kashi 80%.
A hoto na 2, an nuna lanƙwasa na ROC ga kowanne daga cikin ma'aunin tomographic da aka kiyasta (Kmax, D-Index, PRC, EleBmax, BFSB da AdjEleBmax). Mun ga cewa D-index gwaji ne mafi inganci tare da AUC mafi girma (0.927) sannan PRC da Kmax suka biyo baya. AUC EleBmax shine 0.690. Lokacin da aka daidaita shi don BFSB, wannan saitin (AdjEleBmax) ya inganta aikinsa ta hanyar faɗaɗa AUC zuwa 0.754. BFSB kanta tana da AUC na 0.690.
Hoto na 2. Lanƙwasa aikin mai karɓar bayanai (ROC) yana nuna cewa amfani da ma'aunin D don tantance ci gaban keratoconus ya cimma manyan matakan hankali da takamaiman bayanai, sai PRC da Kmax. Har yanzu ana ɗaukar AdjEleBmax a matsayin mai ma'ana kuma gabaɗaya ya fi Elebmax kyau ba tare da daidaita BFSB ba.
Takaitattun bayanai: Kmax, matsakaicin lanƙwasa na cornea; D-index, Belin/Ambrosio D-index; PRC, radius na lanƙwasa na baya daga 3.0 mm a tsakiya akan mafi siririn wuri; BFSB, mafi dacewa da baya mai siffar ƙwallo; Tsawo; AdjELEBmax, kusurwar tsayi mafi girma. an daidaita saman bayan cornea zuwa ga mafi kyawun lanƙwasa na ƙwallo.
Idan aka yi la'akari da EleBmax, BFSB, da AdjEleBmax, bi da bi, mun tabbatar da cewa idanu 53 (46.9%), 40 (35.3%), da 45 (39.8%) sun nuna ci gaba ga kowane siga da aka ware, bi da bi. Daga cikin waɗannan idanu, 16 (30.2%), 11 (27.5%), da 9 (45%), bi da bi, ba su da ci gaba na gaskiya kamar yadda aka bayyana ta aƙalla wasu siga biyu. Daga cikin idanu 60 da EleBmax ba ta ɗauke su a matsayin ci gaba ba, idanu 20 (33%) sun kasance masu ci gaba akan wasu siga 2 ko fiye. An ɗauki idanu ashirin da takwas (38.4%) da 21 (30.9%) a matsayin marasa ci gaba bisa ga BFSB da AdjEleBmax kaɗai, bi da bi, suna nuna ci gaba na gaskiya.
Muna da niyyar bincika ingancin BFSB kuma, mafi mahimmanci, matsakaicin tsayin corneal na baya (AdjEleBmax) wanda BFSB ya daidaita a matsayin sabon siga don annabta da gano ci gaban KC da kuma kwatanta su da sauran sigogin tomography waɗanda aka saba amfani da su azaman alamun ci gaba. An yi kwatancen da iyakokin da aka ruwaito a cikin wallafe-wallafen (kodayake ba a tabbatar da su ba), wato Kmax da D-Index.20
Lokacin da muka saita EleBmax zuwa radius na BFSB (AdjEleBmax), mun lura da ƙaruwa mai yawa a cikin takamaiman bayanai - 73% don sigar da ba a daidaita ba da 84% don sigar da aka gyara - ba tare da shafar ƙimar hankali ba (65% da 63%). Mun kuma kimanta radius na BFSB da kansa a matsayin wani mai yuwuwar hasashen ci gaban faɗaɗawa. Duk da haka, ƙwarewar (51% vs 63%), takamaiman bayanai (80% vs 84%) da AUC (0.69 vs 0.75) na wannan sigar sun yi ƙasa da na AdjEleBmax.
Kmax sanannen ma'auni ne don hasashen ci gaban KC. 27 Babu wata yarjejeniya kan wace iyaka ta yankewa ta fi dacewa. 12,28 A cikin bincikenmu, mun yi la'akari da ƙaruwar 1D ko fiye a matsayin ma'anar ci gaba. A wannan matakin, mun lura cewa duk marasa lafiya da aka gano suna ci gaba an tabbatar da su ta hanyar aƙalla wasu sigogi biyu, suna nuna takamaiman 100%. Duk da haka, ƙarfinsa ya yi ƙasa sosai (49%), kuma ba a iya gano ci gaban a cikin idanu 29 ba. Duk da haka, a cikin bincikenmu, madaidaicin matakin Kmax shine 0.4 D, ƙarfinsa shine 70%, kuma takamaiman 91% ne, wanda ke nufin cewa tare da raguwar takamaiman ƙwararraki (daga 100% zuwa 91%), mun inganta. Jin daɗin ya kasance daga 49% zuwa 70%. Duk da haka, mahimmancin wannan sabon matakin a asibiti abin tambaya ne. A cewar binciken Kreps kan maimaita ma'aunin Pentacam®, maimaituwan Kmax ya kasance 0.61 a cikin ciwon daji mai sauƙi da kuma 1.66 a cikin caesarean colpitis matsakaici,19 wanda ke nufin cewa ƙimar yankewa ta ƙididdiga a cikin wannan samfurin ba ta da mahimmanci a asibiti domin yana bayyana yanayi mai kwanciyar hankali. lokacin da aka yi amfani da mafi girman ci gaba ga wasu samfura. A gefe guda kuma, Kmax yana siffanta lanƙwasa cornea na gaba mafi tsayi na ƙaramin yanki 29 kuma ba zai iya sake haifar da canje-canjen da ke faruwa a cikin cornea na gaba, cornea na baya, da sauran yankunan pachymetry ba. 30-32 Idan aka kwatanta da sabbin sigogi na baya, AdjEleBmax ya nuna mafi girman jin daɗi (63% vs. 49%). An gano idanu 20 masu ci gaba daidai ta amfani da wannan sigar kuma an rasa su ta amfani da Kmax (idan aka kwatanta da idanu 12 masu ci gaba da aka gano ta amfani da Kmax maimakon AdjEleBmax). Wannan binciken yana goyan bayan gaskiyar cewa saman bayan cornea yana da tsayi kuma ya fi faɗaɗa a tsakiya idan aka kwatanta da saman gaba, wanda zai iya taimakawa wajen gano canje-canje. 25, 32, 33
A cewar wasu bincike, D-index siga ce da aka ware wacce ke da mafi girman hankali (82%), takamaiman aiki (95%) da AUC (0.927). 34 A gaskiya, wannan ba abin mamaki bane, tunda wannan ma'aunin sigogi ne da yawa. PRC ita ce ta biyu mafi saurin aiki (79%) sai AdjEleBmax (63%). Kamar yadda aka ambata a baya, mafi girman hankali, ƙarancin rashin tabbas na ƙarya kuma mafi kyawun sigogin tantancewa suna haɓaka. 35 Saboda haka, muna ba da shawarar amfani da AdjEleBmax (tare da yankewa na 7 µm don ci gaba maimakon 6.5 µm tunda sikelin dijital da aka gina a cikin Pentacam® bai haɗa da wurare na adadi don wannan sigar ba) maimakon EleBmax mara gyara, wanda za a haɗa tare da sauran masu canji a cikin kimantawa. ci gaban keratoconus don inganta amincin kimantawar asibiti da gano ci gaba da wuri.
Duk da haka, bincikenmu yana fuskantar wasu ƙuntatawa. Na farko, mun yi amfani da sigogin hoton tomographic shapeflug kawai don fayyace da kimanta ci gaban, amma wasu hanyoyi a halin yanzu suna samuwa don wannan manufa, kamar nazarin biomechanical, wanda zai iya gabatowa duk wani canje-canje na yanayin ƙasa ko tomographic. 36 Na biyu, muna amfani da ma'auni ɗaya na duk sigogin da aka gwada kuma, a cewar Ivo Guber et al., matsakaici akan hotuna da yawa yana haifar da ƙarancin matakan hayaniyar aunawa. 28 Duk da cewa ma'auni tare da Pentacam® sun kasance masu kyau a cikin idanu na yau da kullun, sun kasance ƙasa a cikin idanu masu rashin daidaituwa na cornea da cornea ectasia. 37 A cikin wannan binciken, mun haɗa da idanu kawai tare da ingantaccen ingantaccen binciken Pentacam®, wanda ke nufin cewa an kawar da cutar da ta ci gaba. 17 Na uku, mun ayyana masu ci gaba na gaske a matsayin suna da aƙalla sigogi biyu bisa ga wallafe-wallafen amma ba a tabbatar da su ba tukuna. A ƙarshe, kuma wataƙila mafi mahimmanci, bambancin a cikin ma'aunin Pentacam® yana da mahimmanci a asibiti wajen tantance ci gaban keratoconus. 18,26 A cikin samfurin idanunmu 113, lokacin da aka raba su bisa ga ma'aunin BAD-D, yawancin idanu (n=68, 60.2%) sun kasance matsakaici, sauran kuma ba su da lafiya ko kuma suna da sauƙi. Duk da haka, idan aka yi la'akari da ƙaramin girman samfurin, mun riƙe cikakken binciken ba tare da la'akari da tsananin KTC ba. Mun yi amfani da ƙimar iyaka wacce ta fi dacewa da dukkan samfurinmu, amma mun yarda cewa wannan na iya ƙara hayaniya (canzawa) ga ma'aunin kuma ya haifar da damuwa game da sake maimaita ma'auni. Saurin maimaita ma'auni ya dogara da tsananin KTC, kamar yadda Kreps, Gustafsson et al. 18,26 suka nuna. Saboda haka, muna ba da shawarar sosai cewa nazarin gaba ya yi la'akari da matakai daban-daban na cutar kuma ya kimanta wuraren da suka dace don ci gaba mai dacewa.
A ƙarshe, gano ci gaba da wuri yana da matuƙar muhimmanci domin samar da magani cikin lokaci don dakatar da ci gaba (ta hanyar haɗin gwiwa)38 da kuma taimakawa wajen kiyaye gani da ingancin rayuwa ga marasa lafiyarmu. 34 Babban burin aikinmu shine mu nuna cewa EleBmax, wanda aka daidaita zuwa radius ɗin BFS iri ɗaya tsakanin ma'aunin lokaci, yana da aiki mafi kyau fiye da EleBmax kanta. Wannan sigar tana nuna takamaiman aiki da inganci idan aka kwatanta da EleBmax, tana ɗaya daga cikin sigogi mafi mahimmanci (sabili da haka mafi kyawun ingancin tantancewa) kuma don haka alama ce mai yuwuwar ci gaba da wuri. Ana ba da shawarar sosai don ƙirƙirar fihirisa masu sigogi da yawa. Nazarin gaba da ya haɗa da nazarin ci gaban multivariate ya kamata ya haɗa da AdjEleBmax.
Marubutan ba sa samun wani tallafi na kuɗi don bincike, marubuta da/ko buga wannan labarin.
Margarida Ribeiro da Claudia Barbosa marubuta ne na wannan binciken. Marubutan ba su bayar da rahoton cewa babu wani rikici na sha'awa a cikin wannan aikin ba.
1. Krachmer JH, Feder RS, Belin MV Keratoconus da sauran cututtukan da ke rage kumburi a ido. Nazarin ido na rayuwa. 1984;28(4):293–322. Ma'aikatar Cikin Gida: 10.1016/0039-6257(84)90094-8
2. Rabinovich Yu.S. Keratoconus. Likitan ido na tsira. 1998;42(4):297–319. doi: 10.1016/S0039-6257(97)00119-7
3. Tambe DS, Ivarsen A., Hjortdal J. An cire tiyatar keratectomy ta hanyar amfani da hasken rana don cire keratoconus. Wannan matsalar ita ce maganin ido. 2015;6(2):260–268. Ofishin gida: 10.1159/000431306
4. Kymes SM, Walline JJ, Zadnik K, Sterling J, Gordon MO, Haɗin gwiwa na Kimantawa Mai Dogon Lokaci na Nazarin Keratoconus G. Canje-canje a cikin ingancin rayuwa ga marasa lafiya da keratoconus. Ni Jay Oftalmol. 2008;145(4):611–617. doi: 10.1016 / j.ajo.2007.11.017
5. McMahon TT, Edrington TB, Schotka-Flynn L., Olafsson HE, Davis LJ, Shekhtman KB Canjin tsayi a lanƙwasa na cornea a cikin keratoconus. cornea. 2006;25(3):296–305. doi:10.1097/01.ico.0000178728.57435.df
[PubMed] 6. Ferdy AS, Nguyen V., Gor DM, Allan BD, Rozema JJ, Watson SL Ci gaban halitta na keratoconus: bita mai tsari da kuma nazarin meta na idanu 11,529. ilimin ido. 2019;126(7):935–945. doi:10.1016/j.ophtha.2019.02.029
7. Andreanos KD, Hashemi K., Petrelli M., Drutsas K., Georgalas I., Kimionis GD Algorithm don maganin keratoconus. Oftalmol Ter. 2017;6(2):245–262. doi: 10.1007/s40123-017-0099-1
8. Madeira S, Vasquez A, Beato J, da sauransu. Haɗakar ƙwayar corneal collagen ta hanzarta haɗuwa tsakanin ƙwayoyin corneal idan aka kwatanta da haɗakar gargajiya a cikin marasa lafiya da keratoconus: nazarin kwatantawa. Asibitin ido. 2019;13:445–452. doi:10.2147/OPTH.S189183
9. Gomez JA, Tan D., Rapuano SJ da sauransu. Yarjejeniyar duniya kan keratoconus da cutar da ta faɗaɗa. cornea. 2015;34(4):359–369. doi:10.1097/ICO.00000000000000408
10. Cunha AM, Sardinha T, Torrão L, Moreira R, Falcão-Reis F, Pinheiro-Costa J. Transepithelial accelerated corneal collagen giciye: sakamakon shekaru biyu. Clinical ophthalmology. 2020; 14:2329–2337. doi: 10.2147/OPTH.S252940
11. Wollensak G, Spoerl E, Seiler T. Riboflavin/UV collagen cross-linking don maganin keratoconus. Ni Jay Oftalmol. 2003;135(5):620–627. doi: 10.1016/S0002-9394(02)02220-1