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E hoʻopaʻa inoa i kāu mau kikoʻī kikoʻī a me ka lāʻau lapaʻau kikoʻī āu e makemake ai a e hoʻohālikelike mākou i ka ʻike āu e hāʻawi ai me nā ʻatikala mai kā mākou waihona ʻikepili nui a leka uila iā ʻoe i kahi kope PDF koke.
作者 Ribeiro M., Barbosa C., Correia P., Torrao L., Neves Cardoso P., Moreira R., Falcao-Reis F., Falcao M., Pinheiro-Costa J.
ʻO Margarida Ribeiro,1,2,*ʻO Margarita Ribeiro, 1.2*ʻO Claudia Barbosa, 3 makahiki*ʻO Claudia Barbosa, 3 makahiki*2 Bio Ke Kula Lapaʻau – Ke Kula Lapaʻau o ke Kulanui o Porto, Porto, Pokukala 3 Ke Kula Lapaʻau o ke Kulanui o Porto, Porto, Pokukala;4Keʻena ʻoki kino a me ka Physiology, Ke Kula Lapaʻau, Ke Kulanui o Porto, Porto, Pokukala4 Ke Keʻena ʻoki kino a me ka Physiology, Faculty of Medicine, University of Porto, Porto, Pokukala *Ua kōkua like kēia mau mea kākau i kēia hana.ʻO Hernâni Monteiro Porto, 4200-319, Pokukala, leka uila [email protected] Kumu: Ua loiloi mākou i ka ʻili hope o ka corneal i hoʻoponopono ʻia no ka Best Fit Sphere Back (BFSB) like ma waena o nā ana manawa (AdjEleBmax) a me ka radius BFSB (BFSBR) Ua hoʻohana ʻia ke kiʻekiʻe loa iā ia iho ma ke ʻano he parameter tomographic hou e hoʻopaʻa i ka holomua o ka dilatation a hoʻohālikelike ʻia me nā palena hilinaʻi hou loa o ka holomua keratoconus (KK). Nā hopena. Ua loiloi mākou iā Kmax, D index, posterior curvature radius, a me kahi ʻoki kūpono mai 3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, a me AdjEleBmax ma ke ʻano he mau palena kūʻokoʻa e hoʻopaʻa i ka holomua o KC (i wehewehe ʻia he ʻelua a ʻoi aku paha mau loli), ua loaʻa iā mākou nā ʻike o 70%, 82%, 79%, 65%, 51%, a me 63%, a me 91%, 98%, 80%, 73%, 80%, a me 84% nā kikoʻī no ka ʻike ʻana i ka holomua o KC. . ʻO ka wahi ma lalo o ke piʻo (AUC) no kēlā me kēia loli he 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, kēlā me kēia. Hopena: Ke hoʻohālikelike ʻia me EleBmax me ka ʻole o kekahi hoʻoponopono, ʻoi aku ka kiʻekiʻe o ka kikoʻī o AdjEleBmax, ʻoi aku ka nui o ka AUC a me ka hana maikaʻi me ka ʻike like. AUC. ʻOiai ʻoi aku ka aspherical a me ka piʻo o ke ʻano o ka ʻili hope ma mua o ka ʻili mua, kahi e kōkua ai i ka ʻike ʻana i nā loli, manaʻo mākou e hoʻokomo iā AdjEleBmax i ka loiloi o ka holomua o KC me nā mea hoʻololi ʻē aʻe e hoʻomaikaʻi i ka hilinaʻi o kā mākou loiloi lapaʻau a me ka ʻike mua ʻana. nā holomua.Nā huaʻōlelo koʻikoʻi: keratoconus, cornea, ka holomua, ke ʻano dorsal spherical maikaʻi loa, ke kiʻekiʻe loa o ka ʻili hope o ka cornea.
ʻO Keratoconus (KK) ka ectasia corneal mua maʻamau. I kēia manawa ua manaʻo ʻia he maʻi bilateral (ʻoiai asymmetric) e holomua mau ana e alakaʻi ana i nā loli kūkulu he nui i ukali ʻia e ka lahilahi stromal a me ka scarring. 1,2 Ma ke ʻano lapaʻau, hōʻike nā maʻi me ka astigmatism irregular a me ka myopia, photophobia, a/a i ʻole monocular diplopia me ka ʻike maka ʻole, ka maximally corrected visual acuity (BCVA) a me ka emi ʻana o ke ʻano o ke ola. 3,4 Hoʻomaka pinepine nā hōʻike o RP i ka lua o nā makahiki o ke ola a holomua i ka ʻehā o nā makahiki, a ukali ʻia e ka hoʻopaʻa ʻana o ke kauka. ʻOi aku ka kiʻekiʻe o ka pilikia a me ka wikiwiki o ka holomua i nā poʻe ʻōpio ma mua o 19 mau makahiki. 5.6
ʻOiai ʻaʻohe lāʻau lapaʻau paʻa, ʻelua mau pahuhopu koʻikoʻi ka lāʻau lapaʻau o kēia manawa no ke keratoconus ocular: ka hoʻomaikaʻi ʻana i ka hana ʻike a me ka hoʻōki ʻana i ka holomua o ka dilation. 7,8 Hiki ke ʻike ʻia ka mea mua i nā aniani, nā aniani pili paʻa a semi-rigid paha, nā apo intracorneal, a i ʻole i nā hoʻoili corneal ke koʻikoʻi loa ka maʻi. 9 ʻO ka pahuhopu hope loa ka grail hemolele o kēia mau lāʻau lapaʻau maʻi, i hiki ke hoʻokō ʻia ma o ka crosslinking. Ke alakaʻi nei kēia hana i ka hoʻonui ʻana i ke kūʻē biomechanical a me ka paʻakikī o ka cornea a pale i ka holomua hou aʻe. 10-13 ʻOiai hiki ke hana ʻia kēia i kēlā me kēia pae o ka maʻi, loaʻa ka pōmaikaʻi nui loa i nā pae mua. 14 Pono e hana ʻia nā hoʻoikaika e ʻike mua i ka holomua a pale i ka hōʻino hou ʻana, a e pale aku i ka mālama pono ʻole ʻana i nā maʻi ʻē aʻe, no laila e hōʻemi ana i ka pilikia o nā pilikia cross-complications e like me ka maʻi, ka nalowale o nā cell endothelial, a me ka ʻeha postoperative koʻikoʻi. 15.16
ʻOiai kekahi mau haʻawina i manaʻo ʻia e wehewehe a ʻike i ka holomua,17-19 ʻaʻohe wehewehe kūlike o ka holomua o ka dilatation a i ʻole ke ala maʻamau o ka palapala ʻana iā ia. 9,20,21 Ma ka Global Consensus on Keratoconus and Dilated Diseases (2015), ua wehewehe ʻia ka holomua o keratoconus ma ke ʻano he loli kaʻina ma ka liʻiliʻi ʻelua o nā ʻano topographic: anterior corneal steepening, posterior corneal steepening, thinning and/or thickness of the cornea. Hoʻonui ka wikiwiki o ka loli mai ka perimeter a i ka thinnest point. 9 Eia nō naʻe, pono mau kahi wehewehe kikoʻī o ka holomua. Ua hana ʻia nā hoʻoikaika e ʻike i nā loli ikaika loa e ʻike a wehewehe i ka holomua. 19:22–24
No ka mea, ʻo ke ʻano o ka ʻili o ka corneal hope, ʻoi aku ka aspherical a me ka piʻo ma mua o ka ʻili mua, he mea pono paha ia no ka ʻike ʻana i nā loli,25 ʻo ka pahuhopu nui o kēia noiʻi ʻana, ʻo ia ke loiloi i nā ʻano o ke kihi kiʻekiʻe o ka corneal hope loa. i hoʻololi ʻia i ka wahi kūpono loa. ʻO ke ana ʻana o ka manawa (BFSB) (AdjEleBmax) a me ka radius BFSB (BFSBR) wale nō i lawelawe ma ke ʻano he mau palena hou e hoʻopaʻa i ka holomua o ka dilation a hoʻohālikelike iā lākou i nā palena i hoʻohana pinepine ʻia no ka holomua KC.
Ua nānā ʻia he 113 mau maka o 76 mau maʻi i ʻike ʻia me keratoconus ma kēia noiʻi cohort retrospective ma ka ʻOihana Ophthalmology ma ka Halemai Waena o ke Kulanui o São João, Pokukala. Ua ʻāpono ʻia ke aʻo ʻana e ke komite loina kūloko o ka Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto a ua mālama ʻia e like me ka Hōʻike o Helsinki. Ua loaʻa ka ʻae ʻia i kākau ʻia mai nā mea komo a pau, a inā ʻaʻole i piha ka mea komo i ka 16 mau makahiki, mai ka makua a me/a i ʻole ke kahu kānāwai.
Ua ʻike ʻia nā maʻi me KC i piha i nā makahiki 14 a 30 a ua hoʻokomo ʻia i loko o kā mākou nānā ʻana i ka maka a me ka cornea i ka wā ma waena o ʻOkakopa a me Kekemapa 2021.
Ua ukali ʻia nā mea maʻi i koho ʻia no hoʻokahi makahiki e kahi loea corneal a ua hana ʻia ma ka liʻiliʻi he ʻekolu mau ana tomographic Scheimpflug (Pentacam®; Oculus, Wetzlar, Kelemānia). Ua hoʻōki nā mea maʻi i ke komo ʻana i nā aniani hoʻopili ma ka liʻiliʻi he 48 mau hola ma mua o nā ana. Ua hana ʻia nā ana āpau e kahi orthopedist i aʻo ʻia a ua hoʻokomo wale ʻia nā scan me ka nānā ʻana i ka maikaʻi o "OK". Inā ʻaʻole i hōʻailona ʻia ka loiloi maikaʻi kiʻi ʻakomi ʻo "OK", e hana hou ʻia ka hoʻāʻo. ʻElua wale nō scan no kēlā me kēia maka i kālailai ʻia e ʻike i ka holomua, me kēlā me kēia pālua i hoʻokaʻawale ʻia e 12 ± 3 mau mahina. Ua hoʻokomo pū ʻia nā maka me ka subclinical KC (i kēia mau hihia, pono e hōʻike ka maka ʻē aʻe i nā hōʻailona maopopo o ka clinical KC).
Ua hoʻokaʻawale mākou mai ka loiloi i nā maka KC i hana mua ʻia i ke ʻoki maka (corneal crosslinking, corneal rings, a i ʻole corneal transplant) a me nā maka me ka maʻi holomua loa (ka mānoanoa o ka corneal ma ka lahilahi <350 µm, hydrokeratosis, a i ʻole ka ʻeha hohonu o ka corneal) ʻoiai ʻaʻole i hiki mau ka hui ke "OK" ma hope o nā nānā ʻana i ka maikaʻi o ka scan kūloko.
Ua hōʻiliʻili ʻia nā ʻikepili demographic, clinical a me tomographic no ka nānā ʻana. No ka ʻike ʻana i ka holomua o KC, ua hōʻiliʻili mākou i kekahi mau loli tomographic e pili ana i ka curvature corneal kiʻekiʻe loa (Kmax), ka curvature corneal awelika (Km), ka curvature corneal meridional pālahalaha (K1), ka curvature corneal meridional steepest (K2), ka astigmatism corneal (Astig = K2 - K1). ), ke ana ʻana o ka mānoanoa liʻiliʻi loa (PachyMin), ke kiʻekiʻe corneal posterior kiʻekiʻe loa (EleBmax), ka radius posterior o ke curvature (PRC) 3.0 mm i kikowaena ʻia ma kahi lahilahi loa, ua hoʻoponopono ʻia ʻo Belin/Ambrosio D-index (D-index), BFSBR a me EleBmax i BFSB (AdjEleBmax). E like me ka mea i hōʻike ʻia ma ke kiʻi 1, loaʻa ʻo AdjEleBmax ma hope o ko mākou hoʻoholo lima ʻana i ka radius BFSB like i nā hoʻāʻo mīkini ʻelua me ka hoʻohana ʻana i ka waiwai BFSR mai ka lua o ka manaʻo.
ʻO ka laiki. 1. Hoʻohālikelike o nā kiʻi Pentacam® ma ke kūlana hope kū pololei me ka holomua maoli o ke kino me kahi manawa 13 mahina ma waena o nā hoʻokolohua. Ma ka panela 1, ʻo EleBmax he 68 µm i ka hoʻokolohua mua a me 66 µm i ka lua, no laila ʻaʻohe holomua i kēia palena. ʻO nā radii sphere maikaʻi loa i hāʻawi ʻia e ka mīkini no kēlā me kēia loiloi he 5.99 mm a me 5.90 mm, kēlā me kēia. Inā kaomi mākou i ke pihi BFS, e ʻike ʻia kahi puka makani kahi e hiki ai ke wehewehe lima ʻia kahi radius BFS hou. Ua hoʻoholo mākou i ka radius like i nā hoʻokolohua ʻelua me ka hoʻohana ʻana i ka waiwai radius BFS lua i ana ʻia (5.90mm). Ma ka panela 2, ʻo ka waiwai hou o EleBmax (EleBmaxAdj) i hoʻoponopono ʻia no ka BFS like i ka loiloi mua he 59 µm, e hōʻike ana i ka piʻi ʻana o 7 µm i ka loiloi ʻelua, e hōʻike ana i ka holomua e like me kā mākou paepae 7 µm.
No ke kālailai ʻana i ka holomua a me ka loiloi ʻana i ka pono o nā loli hou o ke aʻo ʻana, ua hoʻohana mākou i nā palena i hoʻohana pinepine ʻia e like me nā māka holomua (Kmax, Km, K2, Astig, PachyMin, PRC, a me D-Index) a me nā paepae i wehewehe ʻia ma ka palapala. ʻoiai ʻaʻole ma ke ʻano empirical). Papa inoa ka Papa 1 i nā waiwai e hōʻike ana i ka holomua o kēlā me kēia palena loiloi. Ua wehewehe ʻia ka holomua o KC i ka wā i hōʻoia ai ʻelua o nā loli i aʻo ʻia i ka holomua.
Papa 1 Nā ʻōkuhi Tomographic i ʻae ʻia ma ke ʻano he mau māka o ka holomua o ka holomua RP a me nā paepae pili i wehewehe ʻia ma ka palapala (ʻoiai ʻaʻole i hōʻoia ʻia)
Ma kēia haʻawina, ua hoʻāʻo ʻia ka hana o ʻekolu mau loli no ka holomua (EleBmax, BFSB, a me AdjEleBmax) ma muli o ke alo o ka holomua o ʻelua mau loli ʻē aʻe. Ua helu ʻia nā kiko ʻoki kūpono no kēia mau loli a ua hoʻohālikelike ʻia me nā loli ʻē aʻe.
Ua hana ʻia ka loiloi helu me ka hoʻohana ʻana i ka polokalamu helu SPSS (mana 27.0 no Mac OS; SPSS Inc., Chicago, IL, USA). Hōʻuluʻulu ʻia nā ʻano laʻana a hōʻike ʻia ka ʻikepili ma ke ʻano he mau helu a me nā ʻāpana o nā loli mahele. Ua wehewehe ʻia nā loli hoʻomau e like me ka awelika a me ka maʻamau deviation (a i ʻole ka median a me ka interquartile range ke skewed ka hoʻolaha). Ua loaʻa ka loli o ka helu kuhikuhi keratometric ma ka unuhi ʻana i ka waiwai mua mai ka lua o ke ana (ʻo ia hoʻi, ʻo ka waiwai delta maikaʻi e hōʻike ana i ka piʻi ʻana o ka waiwai o kahi palena kikoʻī). Ua hana ʻia nā hoʻāʻo Parametric a me nā non-parametric e loiloi i ka hoʻolaha ʻana o nā loli curvature corneal i hoʻokaʻawale ʻia he holomua a ʻaʻole holomua, me ka hoʻāʻo kūʻokoʻa-laʻana t-test, Mann-Whitney U-test, hoʻāʻo chi-square, a me ka hoʻāʻo pololei a Fisher (inā pono). Ua hoʻonohonoho ʻia ka pae o ke koʻikoʻi helu ma 0.05. No ka loiloi ʻana i ka pono o Kmax, D-index, PRC, BFSBR, EleBmax, a me AdjEleBmax ma ke ʻano he mau wānana holomua pākahi, ua kūkulu mākou i nā piʻo hana hoʻokipa (ROC) a ua helu i nā kiko ʻoki kūpono, ka ʻike, ke kikoʻī, ka maikaʻi (PPV), a me ka Negative Predictive Value (NPV). ) a me ka wahi ma lalo o ke piʻo (AUC) i ka wā e ʻoi aku ai ʻelua mau loli ma mua o kekahi mau paepae (e like me ka mea i wehewehe ʻia ma mua) e hoʻokaʻawale i ka holomua ma ke ʻano he kaohi.
Ua hoʻokomo ʻia he 113 mau maka o 76 mau maʻi me RP i loko o ke aʻo ʻana. ʻO ka hapa nui o nā maʻi he kāne (n = 87, 77%) a ʻo ka awelika makahiki i ka loiloi mua ʻana he 24.09 ± 3.93 mau makahiki. E pili ana i ka stratification KC ma muli o ka hoʻonui ʻia ʻana o ka Belin/Ambrosio dilatation deviation deviation (BAD-D index), ʻo ka hapa nui (n = 68, 60.2%) o nā maka he waena. Ua koho like nā mea noiʻi i kahi waiwai ʻoki o 7.0 a hoʻokaʻawale ma waena o ke keratoconus māmā a me ke waena e like me ka palapala26. Eia nō naʻe, ʻo ke koena o ka loiloi e pili ana i ka laʻana holoʻokoʻa. ʻO nā ʻano demographic, clinical a me tomographic o ka laʻana, me ka awelika, ka liʻiliʻi loa, ka nui loa, ka maʻamau deviation (SD) a me nā ana me 95% mau waena hilinaʻi (IC95%), a me nā ana mua a me ka lua. Hiki ke loaʻa ka ʻokoʻa ma waena o nā waiwai ma hope o 12 ± 3 mau mahina ma ka papa 2.
Papa 2. Nā ʻano demographic, clinical a me tomographic o nā maʻi. Hōʻike ʻia nā hopena ma ke ʻano he mean ± standard deviation no nā loli hoʻomau (*hōʻike ʻia nā hopena ma ke ʻano he median ± IQR), 95% interval confidence (95% CI), hōʻike ʻia ke kāne kāne a me ka maka ʻākau ma ke ʻano he helu a me ka pakeneka
Hōʻike ka Papa 3 i ka helu o nā maka i hoʻokaʻawale ʻia he mau mea holomua e noʻonoʻo ana i kēlā me kēia ʻano tomographic (Kmax, Km, K2, Astig, PachyMin, PRC a me D-Index) ma ke kaʻawale. Ma ka noʻonoʻo ʻana i ka holomua o KC, i wehewehe ʻia e nā loli i ʻike ʻia ma ka liʻiliʻi he ʻelua mau loli tomographic, ua hōʻike ʻo 57 mau maka (50.4%) i ka holomua.
Papa 3 Ka helu a me ke alapine (frequency) o nā maka i hoʻokaʻawale ʻia e like me nā mea holomua, e noʻonoʻo ana i kēlā me kēia ʻāpana tomographic ma ke kaʻawale
Hōʻike ʻia nā helu Kmax, D-index, PRC, EleBmax, BFSB, a me AdjEleBmax ma ke ʻano he mau wānana kūʻokoʻa o ka holomua o KC ma ka Papa 4. No ka laʻana, inā mākou e wehewehe i kahi waiwai paepae no ka hoʻonui ʻana iā Kmax ma 1 diopter (D) e hōʻailona i ka holomua, ʻoiai ke hōʻike nei kēia parameter i kahi ʻike o 49%, he kikoʻī kona o 100% (nā hihia āpau i ʻike ʻia he holomua ma kēia parameter he ʻoiaʻiʻo nō). nā mea holomua ma luna) me kahi waiwai wānana maikaʻi (PPV) o 100%, kahi waiwai wānana maikaʻi ʻole (NPV) o 66%, a me kahi ʻāpana ma lalo o ke piʻo (AUC) o 0.822. Eia nō naʻe, ʻo ka ʻoki kūpono i helu ʻia no kmax he 0.4, e hāʻawi ana i kahi ʻike o 70%, kahi kikoʻī o 91%, kahi PPV o 89%, a me kahi NPV o 75%.
Papa 4 Nā helu Kmax, D-Index, PRC, BFSB, EleBmax, a me AdjEleBmax ma ke ʻano he mau wānana hoʻokaʻawale o ka holomua o KC (i wehewehe ʻia he loli koʻikoʻi i ʻelua a ʻoi aku paha mau loli)
Ma ke ʻano o ka helu kuhikuhi D, ʻo ke kiko ʻoki kūpono loa he 0.435, ʻo ka ʻike he 82%, ʻo ka kikoʻī he 98%, ʻo ka PPV he 94%, ʻo ka NPV he 84%, a ʻo ka AUC he 0.927. Ua hōʻoia mākou o nā maka he 50 i holomua, ʻo 3 wale nō mau maʻi i holomua ʻole ma 2 a ʻoi aku paha mau palena ʻē aʻe. No nā maka he 63 i hoʻomaikaʻi ʻole ʻia ai ka helu kuhikuhi D, 10 (15.9%) i hōʻike i ka holomua ma ka liʻiliʻi he ʻelua mau palena ʻē aʻe.
No PRC, ʻo ke kiko ʻoki kūpono e wehewehe i ka holomua he emi ʻana o 0.065 me ka ʻike o 79%, kikoʻī o 80%, PPV o 80%, NPV o 79%, a me AUC o 0.844.
E pili ana i ke kiʻekiʻe o ka ʻili hope (EleBmax), ʻo ka paepae kūpono no ka hoʻoholo ʻana i ka holomua he piʻi ʻana o 2.5 µm me ka ʻike o 65% a me ka kikoʻī o 73%. I ka hoʻoponopono ʻia ʻana i ka lua o ka BSFB i ana ʻia, ʻo ka ʻike o ka palena hou ʻo AdjEleBmax he 63% a ua hoʻomaikaʻi ʻia ka kikoʻī ma 84% me kahi kiko ʻoki kūpono o 6.5 µm. Ua hōʻike ka BFSB ponoʻī i kahi ʻoki kūpono o 0.05 mm me ka ʻike o 51% a me ka kikoʻī o 80%.
Ma ke kiʻi 2 e hōʻike ana i nā piʻo ROC no kēlā me kēia o nā palena tomographic i manaʻo ʻia (Kmax, D-Index, PRC, EleBmax, BFSB a me AdjEleBmax). ʻIke mākou he hoʻāʻo ʻoi aku ka maikaʻi o ka D-index me kahi AUC kiʻekiʻe (0.927) i ukali ʻia e PRC a me Kmax. ʻO AUC EleBmax he 0.690. I ka wā i hoʻonohonoho ʻia ai no BFSB, ua hoʻomaikaʻi kēia hoʻonohonoho (AdjEleBmax) i kāna hana ma ka hoʻonui ʻana i ka AUC i 0.754. Loaʻa iā BFSB iho kahi AUC o 0.690.
Kiʻi 2. Nā piʻo hana a ka mea hoʻokipa (ROC) e hōʻike ana ua loaʻa i ka hoʻohana ʻana o ka helu kuhikuhi D e hoʻoholo i ka holomua o keratoconus nā pae kiʻekiʻe o ka ʻike a me ke kikoʻī, ukali ʻia e PRC a me Kmax. Manaʻo ʻia ʻo AdjEleBmax he kūpono a ʻoi aku ka maikaʻi ma mua o Elebmax me ka ʻole o ka hoʻonohonoho ʻana o BFSB.
Nā pōkole: Kmax, ke kūlou ʻana o ka cornea kiʻekiʻe loa; D-index, Belin/Ambrosio D-index; PRC, ke kaʻina o ke kūlou ʻana mai 3.0 mm i kau ʻia ma kahi lahilahi loa; BFSB, kūpono loa no ke kua poepoe; Kiʻekiʻe; AdjELEBmax, ke kihi kiʻekiʻe loa. ua hoʻoponopono ʻia ka ʻili hope o ka cornea i ka dorsum poepoe kūpono loa.
Ma ka noʻonoʻo ʻana iā EleBmax, BFSB, a me AdjEleBmax, kēlā me kēia, ua hōʻoia mākou he 53 (46.9%), 40 (35.3%), a me 45 (39.8%) mau maka i hōʻike i ka holomua no kēlā me kēia palena i hoʻokaʻawale ʻia, kēlā me kēia. No kēia mau maka, 16 (30.2%), 11 (27.5%), a me 9 (45%), kēlā me kēia, ʻaʻohe holomua maoli e like me ka mea i wehewehe ʻia e ʻelua mau palena ʻē aʻe. No nā maka 60 i manaʻo ʻole ʻia he holomua e EleBmax, 20 (33%) mau maka i holomua ma 2 a ʻoi aku paha mau palena ʻē aʻe. Ua manaʻo ʻia he iwakāluakūmāwalu (38.4%) a me 21 (30.9%) mau maka he holomua ʻole e like me BFSB a me AdjEleBmax wale nō, kēlā me kēia, e hōʻike ana i ka holomua maoli.
Manaʻo mākou e noiʻi i ka pono o BFSB a, ʻoi aku ka nui, ʻo ke kiʻekiʻe kiʻekiʻe o ka posterior corneal i hoʻoponopono ʻia e BFSB (AdjEleBmax) ma ke ʻano he parameter hou e wānana a ʻike i ka holomua o KC a hoʻohālikelike iā lākou me nā parameter tomographic ʻē aʻe i hoʻohana pinepine ʻia e like me nā māka o ka holomua. Ua hana ʻia nā hoʻohālikelike me nā paepae i hōʻike ʻia ma ka palapala (ʻoiai ʻaʻole i hōʻoia ʻia), ʻo ia hoʻi ʻo Kmax a me D-Index.20
I ke kau ʻana iā EleBmax i ka radius BFSB (AdjEleBmax), ua ʻike mākou i kahi piʻi nui o ka specificity - 73% no ka parameter i hoʻoponopono ʻole ʻia a me 84% no ka parameter i hoʻoponopono ʻia - me ka ʻole o ka hoʻopilikia ʻana i ka waiwai sensitivity (65% a me 63%). Ua loiloi pū mākou i ka radius BFSB ponoʻī ma ke ʻano he mea wānana hiki ke hoʻonui i ka hoʻonui ʻana o ka dilatation. Eia nō naʻe, ʻoi aku ka haʻahaʻa o ka sensitivity (51% vs 63%), specificity (80% vs 84%) a me AUC (0.69 vs 0.75) o kēia parameter ma mua o AdjEleBmax.
He ʻano kaulana ʻo Kmax no ka wānana ʻana i ka holomua o KC. 27 ʻAʻohe manaʻo like ma ka palena ʻoki i ʻoi aku ka kūpono. 12,28 I kā mākou noiʻi ʻana, ua noʻonoʻo mākou i ka piʻi ʻana o 1D a ʻoi aku paha ma ke ʻano he wehewehe ʻana o ka holomua. Ma kēia paepae, ua ʻike mākou ua hōʻoia ʻia nā maʻi āpau i ʻike ʻia e holomua ana e ʻelua mau ʻano ʻē aʻe, e hōʻike ana i kahi kikoʻī o 100%. Eia nō naʻe, ua haʻahaʻa loa kona ʻike (49%), a ʻaʻole hiki ke ʻike ʻia ka holomua i 29 mau maka. Eia nō naʻe, i kā mākou noiʻi ʻana, ʻo ka paepae Kmax kūpono he 0.4 D, ʻo 70% ka ʻike, a ʻo 91% ka kikoʻī, ʻo ia hoʻi me ka emi ʻana o ka kikoʻī (mai 100% a 91%), ua hoʻomaikaʻi mākou. Loaʻa ka ʻike mai 49% a 70%. Eia nō naʻe, he mea kānalua ka pilina lapaʻau o kēia paepae hou. Wahi a ke aʻo ʻana a Kreps e pili ana i ka hana hou ʻana o nā ana ʻo Pentacam®, ʻo ka hana hou ʻana o Kmax he 0.61 i ka maʻi ʻaʻai catarrhal akahai a me 1.66 i ka colpitis caesarean moderate,19 ʻo ia hoʻi, ʻaʻole koʻikoʻi ke ʻano o ka waiwai ʻoki helu ma kēia laʻana no ka mea e wehewehe ana i kahi kūlana paʻa. ke hoʻopili ʻia ka holomua kiʻekiʻe loa i nā laʻana ʻē aʻe. ʻO Kmax, ma ka ʻaoʻao ʻē aʻe, ke ʻano o ka curvature corneal anterior ʻoi loa o ka ʻāpana liʻiliʻi 29 a ʻaʻole hiki ke hana hou i nā loli e hana ʻia ana ma ka cornea anterior, cornea posterior, a me nā wahi ʻē aʻe o ka pachymetry. 30-32 Ke hoʻohālikelike ʻia me nā palena posterior hou, ua hōʻike ʻo AdjEleBmax i ka ʻike kiʻekiʻe (63% vs. 49%). Ua ʻike pololei ʻia he 20 mau maka holomua me ka hoʻohana ʻana i kēia palena a ua hala me ka hoʻohana ʻana iā Kmax (hoʻohālikelike ʻia me 12 mau maka holomua i ʻike ʻia me ka hoʻohana ʻana iā Kmax ma kahi o AdjEleBmax). Kākoʻo kēia ʻike i ka ʻoiaʻiʻo ʻoi aku ka ʻoi aku o ka ʻili hope o ka cornea a ʻoi aku ka hoʻonui ʻia ma ke kikowaena i hoʻohālikelike ʻia me ka ʻili mua, kahi e kōkua ai i ka ʻike ʻana i nā loli. 25,32,33
Wahi a nā haʻawina ʻē aʻe, ʻo ka D-index kahi palena i hoʻokaʻawale ʻia me ka ʻike kiʻekiʻe loa (82%), ka kikoʻī (95%) a me AUC (0.927). 34 ʻOiaʻiʻo, ʻaʻole kēia he mea kupanaha, ʻoiai he helu kuhikuhi multi-parameter kēia. ʻO PRC ka lua o ka loli koʻikoʻi loa (79%) i ukali ʻia e AdjEleBmax (63%). E like me ka mea i ʻōlelo ʻia ma mua, ʻo ke kiʻekiʻe o ka ʻike, ʻo ka liʻiliʻi o nā mea maikaʻi ʻole wahaheʻe a ʻoi aku ka maikaʻi o ka hoʻomohala ʻana o nā palena nānā. 35 No laila, paipai mākou e hoʻohana iā AdjEleBmax (me ka ʻoki ʻana o 7 µm no ka holomua ma mua o 6.5 µm ʻoiai ʻaʻole i hoʻokomo ka unahi kikohoʻe i kūkulu ʻia i loko o ka Pentacam® i nā wahi decimal no kēia palena) ma kahi o ka EleBmax i hoʻoponopono ʻole ʻia, e hoʻokomo pū ʻia me nā loli ʻē aʻe i ka loiloi. holomua o keratoconus e hoʻomaikaʻi i ka hilinaʻi o kā mākou loiloi lapaʻau a me ka ʻike mua ʻana o ka holomua.
Eia nō naʻe, ke kū nei kā mākou noiʻi i kekahi mau palena. ʻO ka mea mua, ua hoʻohana wale mākou i nā ʻano kiʻi ʻano tomographic e wehewehe a loiloi i ka holomua, akā loaʻa nā ʻano hana ʻē aʻe no ke kumu like, e like me ka loiloi biomechanical, hiki ke hele mua i nā loli topographic a tomographic paha. 36 ʻO ka lua, hoʻohana mākou i hoʻokahi ana o nā ʻano āpau i hoʻāʻo ʻia a, e like me Ivo Guber et al., ʻo ka awelika ma luna o nā kiʻi he nui e hopena i nā pae walaʻau ana haʻahaʻa. 28 ʻOiai ua hiki ke hana hou ʻia nā ana me Pentacam® i nā maka maʻamau, ua haʻahaʻa lākou i nā maka me nā corneal irregularities a me ka corneal ectasia. 37 Ma kēia noiʻi, ua hoʻokomo wale mākou i nā maka me ka hōʻoia scan kiʻekiʻe Pentacam® i kūkulu ʻia, ʻo ia hoʻi ua kāpae ʻia ka maʻi holomua. 17 ʻO ke kolu, wehewehe mākou i nā mea holomua maoli me ka liʻiliʻi o ʻelua mau ʻano e pili ana i ka palapala akā ʻaʻole i hōʻoia ʻia. ʻO ka hope, a ʻoi aku paha ka nui, ʻo ka loli o nā ana Pentacam® he mea nui ia i ka loiloi ʻana i ka holomua o keratoconus. 18,26 I loko o kā mākou laʻana o 113 mau maka, i ka wā i hoʻokaʻawale ʻia e like me ka helu BAD-D, ʻo ka hapa nui (n = 68, 60.2%) mau maka he waena, me ke koena subclinical a akahai paha. Eia nō naʻe, no ka liʻiliʻi o ka nui o ka laʻana, ua mālama mākou i ka loiloi holoʻokoʻa me ka nānā ʻole i ke koʻikoʻi o KTC. Ua hoʻohana mākou i kahi waiwai paepae i ʻoi aku ka maikaʻi no kā mākou laʻana holoʻokoʻa, akā ke ʻae nei mākou e hoʻohui paha kēia i ka walaʻau (variability) i ke ana a hoʻāla i nā hopohopo e pili ana i ka hana hou ʻana o ke ana. ʻO ka hana hou ʻana o nā ana e pili ana i ke koʻikoʻi o KTC, e like me ka mea i hōʻike ʻia e Kreps, Gustafsson et al. 18,26. No laila, ke paipai ikaika nei mākou e noʻonoʻo nā haʻawina e hiki mai ana i nā pae like ʻole o ka maʻi a loiloi i nā wahi ʻoki kūpono no ka holomua kūpono.
I ka hopena, ʻo ka ʻike mua ʻana i ka holomua he mea nui loa ia e hāʻawi i ka lāʻau lapaʻau kūpono e hoʻōki i ka holomua (ma o ke keʻa ʻana)38 a kōkua i ka mālama ʻana i ka ʻike a me ke ʻano o ke ola i kā mākou mau maʻi.34 ʻO ka pahuhopu nui o kā mākou hana, ʻo ia ke hōʻike ʻana he ʻoi aku ka maikaʻi o ka hana a EleBmax, i hoʻonohonoho ʻia i ka radius BFS like ma waena o nā ana manawa, ma mua o EleBmax ponoʻī. Hōʻike kēia parameter i ke kikoʻī kiʻekiʻe a me ka pono i hoʻohālikelike ʻia me EleBmax, ʻo ia kekahi o nā palena koʻikoʻi loa (a no laila ʻo ka pono o ka nānā ʻana) a no laila he biomarker holomua mua. Manaʻo nui ʻia e hana i nā helu kuhikuhi multi-parameter. Pono nā haʻawina e hiki mai ana e pili ana i ka loiloi holomua multivariate e hoʻokomo iā AdjEleBmax.
ʻAʻole loaʻa i nā mea kākau kekahi kākoʻo kālā no ka noiʻi, ka mea kākau a/a i ʻole ka paʻi ʻana o kēia ʻatikala.
ʻO Margarida Ribeiro lāua ʻo Claudia Barbosa nā mea kākau pū i ke aʻo ʻana. ʻAʻole hōʻike nā mea kākau i kahi hakakā hoihoi ma kēia hana.
1. Krachmer JH, Feder RS, Belin MV Keratoconus a me nā maʻi lahilahi corneal non-inflammatory e pili ana. Survival ophthalmology. 1984;28(4):293–322. Ke Kuhina Kalaiaina: 10.1016/0039-6257(84)90094-8
2. Rabinovich Yu.S. Keratoconus. ʻO ka ophthalmology ola. 1998;42(4):297–319. doi: 10.1016/S0039-6257(97)00119-7
3. Tambe DS, Ivarsen A., Hjortdal J. Keratectomy photorefractive no keratoconus. He ophthalmol ka hihia. 2015;6(2):260–268. Keʻena home: 10.1159/000431306
4. ʻO Kymes SM, Walline JJ, Zadnik K, Sterling J, Gordon MO, Collaborative Longitudinal Evaluation of the Keratoconus G Study. Nā loli i ke ʻano o ke ola i nā poʻe maʻi me keratoconus. ʻO wau ʻo 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 Ka loli lōʻihi i ke kūlou ʻana o ka cornea i 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 Ka holomua kūlohelohe o keratoconus: kahi loiloi ʻōnaehana a me ka meta-analysis o 11,529 mau maka. ophthalmology. 2019;126(7):935–945. doi:10.1016/j.ophtha.2019.02.029
7. ʻO Andreanos KD, Hashemi K., Petrelli M., Drutsas K., Georgalas I., Kimionis GD Algorithm no ka mālama ʻana i keratoconus. Oftalmol Ter. 2017;6(2):245–262. doi: 10.1007/s40123-017-0099-1
8. Madeira S, Vasquez A, Beato J, et al. ʻO ka hoʻopili wikiwiki ʻana o ka transepithelial o ka collagen corneal e kūʻē i ka crosslinking maʻamau i nā poʻe maʻi me keratoconus: he haʻawina hoʻohālikelike. Clinical ophthalmology. 2019;13:445–452. doi:10.2147/OPTH.S189183
9. Gomez JA, Tan D., Rapuano SJ et al. ʻO ka ʻaelike honua ma ke keratoconus a me ka maʻi dilated. cornea. 2015;34(4):359–369. doi:10.1097/ICO.0000000000000408
10. Cunha AM, Sardinha T, Torrão L, Moreira R, Falcão-Reis F, Pinheiro-Costa J. Transepithelial accelerated corneal collagen cross-linking: elua makahiki hopena. Ophthalmology lapaau. 2020;14:2329–2337. doi: 10.2147/OPTH.S252940
11. Wollensak G, Spoerl E, Seiler T. Hoʻopili ʻana o Riboflavin/UV-induced collagen no ka mālama ʻana i keratoconus. ʻO wau ʻo Jay Oftalmol. 2003;135(5):620–627. doi: 10.1016/S0002-9394(02)02220-1