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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, 3 xyoos*Claudia Barbosa, 3 xyoos*2 Bio Kws Qhia Ntawv ntawm Tshuaj - Kws Qhia Ntawv ntawm Tshuaj ntawm University of Porto, Porto, Portugal 3 Kws Qhia Ntawv ntawm Tshuaj ntawm University of Porto, Porto, Portugal;4Lub Tsev Haujlwm Saib Xyuas Kev Phais thiab Lub Cev, Kws Qhia Ntawv Kho Mob, Tsev Kawm Ntawv Qib Siab Porto, Porto, Portugal4 Lub Tsev Haujlwm Saib Xyuas Kev Phais Mob thiab Lub Cev, Kws Qhia Ntawv Kho Mob, Tsev Kawm Ntawv Qib Siab Porto, Porto, Portugal *Cov kws sau ntawv no tau pab txhawb nqa txoj haujlwm no sib npaug zos.Hernâni Monteiro Porto, 4200-319, Portugal, email [email protected] Lub Hom Phiaj: Peb tau soj ntsuam qhov corneal posterior surface kho rau tib qho Best Fit Sphere Back (BFSB) ntawm kev ntsuas lub sijhawm (AdjEleBmax) thiab BFSB radius (BFSBR). Qhov siab tshaj plaws nws tus kheej tau siv ua tus parameter tshiab tomographic los sau cov kev nce qib ntawm dilatation thiab piv nrog cov kev ntsuas tshiab tshaj plaws ntawm keratoconus progression (KK). Cov txiaj ntsig. Peb tau soj ntsuam Kmax, D index, posterior curvature radius, thiab ideal cutoff point los ntawm 3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, thiab AdjEleBmax ua cov kev ntsuas ywj pheej los sau KC kev nce qib (txhais tias yog ob lossis ntau qhov hloov pauv), peb pom qhov rhiab heev ntawm 70%, 82%, 79%, 65%, 51%, thiab 63%, thiab 91%, 98%, 80%, 73%, 80%, thiab 84% qhov tshwj xeeb rau kev ntes KC kev nce qib. . Thaj chaw hauv qab nkhaus (AUC) rau txhua qhov hloov pauv yog 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, raws li. Xaus lus: Piv rau EleBmax yam tsis muaj kev hloov kho, AdjEleBmax muaj qhov tshwj xeeb siab dua, AUC siab dua thiab kev ua tau zoo dua nrog qhov rhiab heev zoo sib xws. AUC. Vim tias cov duab ntawm qhov chaw tom qab yog aspherical thiab nkhaus dua li qhov chaw pem hauv ntej, uas yuav pab nrhiav tau cov kev hloov pauv, peb xav kom suav nrog AdjEleBmax hauv kev ntsuam xyuas KC kev nce qib nrog rau lwm cov kev hloov pauv kom txhim kho kev ntseeg siab ntawm peb qhov kev ntsuam xyuas kev kho mob thiab kev kuaj pom thaum ntxov. kev nce qib. Cov lus tseem ceeb: keratoconus, cornea, kev nce qib, qhov zoo tshaj plaws spherical dorsal duab, qhov siab tshaj plaws ntawm qhov chaw tom qab ntawm cornea.
Keratoconus (KK) yog qhov mob pob qhov muag uas tshwm sim ntau tshaj plaws. Tam sim no nws suav hais tias yog ib qho mob uas mob ntev thiab mob ob sab (txawm tias tsis sib xws) ua rau muaj ntau yam kev hloov pauv ntawm cov qauv ua raws li stromal thinning thiab caws pliav. 1,2 Hauv kev kho mob, cov neeg mob muaj cov tsos mob astigmatism tsis zoo thiab myopia, photophobia, thiab/lossis monocular diplopia nrog kev pom tsis zoo, qhov pom kev zoo tshaj plaws (BCVA) thiab txo qis lub neej zoo. 3,4 Cov tsos mob ntawm RP feem ntau pib hauv kaum xyoo thib ob ntawm lub neej thiab nce mus rau kaum xyoo thib plaub, ua raws li kev ruaj khov hauv kev kho mob. Kev pheej hmoo thiab tus nqi ntawm kev nce qib siab dua rau cov neeg hnub nyoog qis dua 19 xyoo. 5.6
Txawm hais tias tseem tsis tau muaj kev kho mob tseeb, kev kho mob tam sim no rau qhov muag keratoconus muaj ob lub hom phiaj tseem ceeb: txhim kho kev ua haujlwm pom kev thiab tiv thaiv kev loj hlob ntawm kev nthuav dav. 7,8 Tus thawj yuav pom tau hauv cov tsom iav, cov iav sib cuag tawv lossis semi-rigid, cov nplhaib intracorneal, lossis hauv kev hloov corneal thaum tus kab mob hnyav dhau. 9 Lub hom phiaj tom kawg yog lub grail dawb huv ntawm cov neeg mob cov kev kho mob no, tam sim no tsuas yog ua tiav los ntawm kev sib txuas. Kev phais mob no ua rau muaj kev nce ntxiv ntawm kev tiv thaiv biomechanical thiab kev tawv ntawm lub cornea thiab tiv thaiv kev loj hlob ntxiv. 10-13 Txawm hais tias qhov no tuaj yeem ua tiav ntawm txhua theem ntawm tus kab mob, qhov txiaj ntsig zoo tshaj plaws tau txais hauv cov theem thaum ntxov. 14 Yuav tsum tau ua kom pom kev loj hlob thaum ntxov thiab tiv thaiv kev puas tsuaj ntxiv, thiab kom tsis txhob kho lwm tus neeg mob tsis tsim nyog, yog li txo qhov kev pheej hmoo ntawm kev sib kis xws li kev kis kab mob, kev poob ntawm cov hlwb endothelial, thiab mob hnyav tom qab phais. 15.16
Txawm hais tias muaj ntau txoj kev tshawb fawb uas tsom mus rau kev txhais thiab nrhiav pom kev nce qib,17-19 tseem tsis tau muaj kev txhais lus sib xws ntawm kev nce qib ntawm qhov muag lossis txoj hauv kev sau tseg nws. 9,20,21 Hauv Global Consensus on Keratoconus and Dilated Diseases (2015), kev nce qib ntawm keratoconus yog txhais tias yog kev hloov pauv sib law liag hauv tsawg kawg yog ob qho ntawm cov yam ntxwv hauv qab no: kev nce qib ntawm lub qhov muag pem hauv ntej, kev nce qib ntawm lub qhov muag tom qab, kev nyias nyias thiab / lossis tuab ntawm lub qhov muag Tus nqi ntawm kev hloov pauv nce ntxiv los ntawm qhov chaw mus rau qhov nyias tshaj plaws. 9 Txawm li cas los xij, kev txhais lus tshwj xeeb ntxiv ntawm kev nce qib tseem xav tau. Kev siv zog tau ua los nrhiav cov hloov pauv muaj zog tshaj plaws los nrhiav thiab piav qhia txog kev nce qib. 19: 22–24
Muab hais tias qhov zoo li ntawm qhov chaw sab nraub qaum ntawm lub qhov muag, uas yog aspherical thiab nkhaus dua li qhov chaw sab pem hauv ntej, tej zaum yuav pab tau rau kev ntes cov kev hloov pauv,25 lub hom phiaj tseem ceeb ntawm txoj kev tshawb fawb no yog los ntsuam xyuas cov yam ntxwv ntawm lub kaum sab xis siab tshaj plaws ntawm lub qhov muag tom qab. Kev ntsuas lub sijhawm (BFSB) (AdjEleBmax) thiab BFSB radius (BFSBR) ib leeg ua haujlwm ua cov kev ntsuas tshiab los sau cov kev nce qib ntawm kev nthuav dav thiab piv rau cov kev ntsuas feem ntau siv rau kev nce qib ntawm KC.
Tag nrho muaj 113 lub qhov muag ntawm 76 tus neeg mob uas tau kuaj pom tias muaj keratoconus tau raug kuaj xyuas hauv kev tshawb fawb rov qab no ntawm Department of Ophthalmology ntawm Central Hospital ntawm University of São João, Portugal. Kev tshawb fawb no tau txais kev pom zoo los ntawm pawg neeg saib xyuas kev coj ncaj ncees hauv zos ntawm Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto thiab tau ua raws li Daim Ntawv Tshaj Tawm ntawm Helsinki. Kev pom zoo ua ntawv tau txais los ntawm txhua tus neeg koom nrog thiab, yog tias tus neeg koom nrog hnub nyoog qis dua 16 xyoo, los ntawm niam txiv thiab/lossis tus saib xyuas raug cai.
Cov neeg mob uas muaj KC hnub nyoog 14 txog 30 xyoo tau raug txheeb xyuas thiab suav nrog hauv peb qhov kev soj ntsuam qhov muag thiab lub qhov muag thaum lub Kaum Hli-Kaum Ob Hlis 2021.
Tag nrho cov neeg mob uas tau xaiv tau raug saib xyuas ib xyoos los ntawm tus kws kho mob tshwj xeeb rau lub qhov muag thiab tau ua tsawg kawg peb qhov kev ntsuas Scheimpflug tomographic (Pentacam®; Oculus, Wetzlar, Lub Tebchaws Yelemees). Cov neeg mob tsum tsis txhob hnav cov iav sib cuag tsawg kawg 48 teev ua ntej kev ntsuas. Txhua qhov kev ntsuas tau ua los ntawm tus kws kho pob txha uas tau kawm tiav thiab tsuas yog cov scans nrog kev kuaj xyuas zoo ntawm "OK" xwb. Yog tias kev ntsuas qhov zoo ntawm daim duab tsis tau cim tias "OK", qhov kev xeem yuav rov ua dua. Tsuas yog ob qhov scans rau txhua lub qhov muag tau raug soj ntsuam kom pom kev nce qib, nrog rau txhua khub sib cais los ntawm 12 ± 3 lub hlis. Cov qhov muag uas muaj KC subclinical kuj tau raug suav nrog (hauv cov xwm txheej no, lwm lub qhov muag yuav tsum tau qhia meej txog KC hauv kev kho mob).
Peb tsis suav nrog cov qhov muag KC uas tau phais qhov muag ua ntej lawm (corneal crosslinking, corneal rings, lossis corneal transplant) thiab cov qhov muag uas muaj kab mob hnyav heev (corneal thickness at thinnest <350 µm, hydrokeratosis, lossis deep corneal scarring) vim tias pawg no pheej ua tsis tau zoo tom qab kev kuaj xyuas qhov zoo ntawm kev luam theej duab sab hauv.
Cov ntaub ntawv txog pej xeem, kev kho mob, thiab kev thaij duab tau sau los tshuaj xyuas. Yuav kom paub txog kev nce qib ntawm KC, peb tau sau ntau yam kev hloov pauv ntawm kev thaij duab suav nrog qhov siab tshaj plaws ntawm lub qhov muag (Kmax), qhov nruab nrab ntawm lub qhov muag (Km), qhov nkhaus ntawm lub qhov muag tiaj tus (K1), qhov nkhaus ntawm lub qhov muag ntxhab tshaj plaws (K2), qhov tsis pom kev zoo ntawm lub qhov muag (Astigmatism = K2 – K1). ), qhov ntsuas qhov tuab tsawg kawg nkaus (PachyMin), qhov siab tshaj plaws ntawm lub qhov muag tom qab (EleBmax), qhov nkhaus tom qab (PRC) 3.0 hli uas nyob nruab nrab ntawm qhov nyias tshaj plaws, Belin/Ambrosio D-index (D-index), BFSBR thiab EleBmax tau hloov kho rau BFSB (AdjEleBmax). Raws li pom hauv daim duab 1, AdjEleBmax tau txais tom qab peb txiav txim siab tib lub vojvoog BFSB hauv ob qho kev sim tshuab siv tus nqi BFSR los ntawm qhov kwv yees thib ob.
Mov. 1. Kev sib piv ntawm cov duab Pentacam® hauv txoj hauj lwm ntsug tom qab nrog kev nce qib tiag tiag nrog lub sijhawm 13 lub hlis ntawm kev kuaj mob. Hauv vaj huam sib luag 1, EleBmax yog 68 µm ntawm kev kuaj mob thawj zaug thiab 66 µm ntawm qhov thib ob, yog li tsis muaj kev nce qib hauv qhov ntsuas no. Lub voj voog zoo tshaj plaws uas lub tshuab tau muab rau txhua qhov kev ntsuam xyuas yog 5.99 mm thiab 5.90 mm, raws li. Yog tias peb nyem rau ntawm lub pob BFS, lub qhov rais yuav tshwm sim qhov twg lub voj voog BFS tshiab tuaj yeem txhais tau manually. Peb tau txiav txim siab tib lub voj voog hauv ob qho kev xeem siv tus nqi voj voog BFS thib ob ntsuas (5.90mm). Hauv vaj huam sib luag 2, tus nqi tshiab ntawm EleBmax (EleBmaxAdj) kho rau tib lub BFS hauv kev ntsuam xyuas thawj zaug yog 59 µm, qhia txog kev nce 7 µm hauv kev ntsuam xyuas thib ob, qhia txog kev nce qib raws li peb qhov 7 µm threshold.
Txhawm rau txheeb xyuas kev nce qib thiab ntsuas qhov ua tau zoo ntawm cov kev hloov pauv tshiab ntawm kev kawm, peb siv cov kev ntsuas uas feem ntau siv ua cov cim qhia kev nce qib (Kmax, Km, K2, Astig, PachyMin, PRC, thiab D-Index) nrog rau cov kev txwv uas tau piav qhia hauv cov ntaub ntawv. Txawm hais tias tsis yog empirically). Rooj 1 teev cov nqi sawv cev rau kev nce qib ntawm txhua qhov kev ntsuas kev tshuaj xyuas. Kev nce qib ntawm KC tau txhais thaum tsawg kawg yog ob ntawm cov kev hloov pauv uas tau kawm tau lees paub kev nce qib.
Rooj 1 Cov kev ntsuas tomographic feem ntau lees txais ua cov cim ntawm kev nce qib ntawm RP kev nce qib thiab cov kev txwv sib xws piav qhia hauv cov ntaub ntawv (txawm hais tias tsis tau lees paub)
Hauv kev tshawb fawb no, kev ua tau zoo ntawm peb qhov hloov pauv tau raug sim rau kev nce qib (EleBmax, BFSB, thiab AdjEleBmax) raws li qhov muaj kev nce qib ntawm tsawg kawg yog ob lwm qhov hloov pauv. Cov ntsiab lus txiav tawm zoo tagnrho rau cov hloov pauv no tau suav thiab piv nrog lwm cov hloov pauv.
Kev tshuaj xyuas cov ntaub ntawv tau ua tiav los ntawm kev siv SPSS statistical software (version 27.0 rau Mac OS; SPSS Inc., Chicago, IL, USA). Cov yam ntxwv ntawm cov qauv tau muab sau ua ke thiab cov ntaub ntawv tau nthuav tawm ua cov lej thiab cov feem pua ​​ntawm cov categorical variables. Cov variables txuas ntxiv tau piav qhia tias yog qhov nruab nrab thiab qhov sib txawv ntawm tus qauv (lossis median thiab interquartile range thaum qhov kev faib tawm yog skewed). Qhov kev hloov pauv ntawm keratometric index tau txais los ntawm kev rho tawm tus nqi qub ntawm qhov kev ntsuas thib ob (piv txwv li, tus nqi delta zoo qhia txog kev nce ntxiv ntawm tus nqi ntawm ib qho parameter tshwj xeeb). Kev xeem parametric thiab non-parametric tau ua los ntsuas qhov kev faib tawm ntawm cov corneal curvature variables uas tau muab faib ua progressive lossis non-progressive, suav nrog independent-sample t-test, Mann-Whitney U-test, chi-square test, thiab Fisher's exact test (yog xav tau). Qib ntawm qhov tseem ceeb ntawm cov ntaub ntawv tau teeb tsa ntawm 0.05. Txhawm rau ntsuam xyuas qhov ua tau zoo ntawm Kmax, D-index, PRC, BFSBR, EleBmax, thiab AdjEleBmax ua cov kev kwv yees kev nce qib ntawm tus kheej, peb tau tsim cov kab nkhaus kev ua tau zoo ntawm tus txais (ROC) thiab xam cov ntsiab lus txiav zoo tagnrho, kev rhiab heev, qhov tshwj xeeb, qhov zoo (PPV), thiab qhov tsis zoo kwv yees tus nqi (NPV). ) thiab thaj chaw hauv qab kab nkhaus (AUC) thaum tsawg kawg yog ob qho hloov pauv tshaj qhov txwv (raws li tau piav qhia ua ntej) los faib qhov kev nce qib ua kev tswj hwm.
Tag nrho muaj 113 lub qhov muag ntawm 76 tus neeg mob uas muaj RP tau suav nrog hauv kev tshawb fawb. Feem ntau ntawm cov neeg mob yog txiv neej (n = 87, 77%) thiab lub hnub nyoog nruab nrab ntawm thawj qhov kev ntsuam xyuas yog 24.09 ± 3.93 xyoo. Hais txog KC stratification raws li kev nce ntxiv tag nrho Belin / Ambrosio dilatation deviation (BAD-D index), feem ntau (n = 68, 60.2%) ntawm cov qhov muag yog nruab nrab. Cov kws tshawb fawb tau xaiv qhov txiav tawm ntawm 7.0 thiab sib txawv ntawm qhov sib txawv me me thiab nruab nrab keratoconus raws li cov ntaub ntawv 26. Txawm li cas los xij, qhov seem ntawm kev tshuaj xyuas suav nrog tag nrho cov qauv. Cov yam ntxwv ntawm cov pej xeem, kev kho mob thiab tomographic ntawm cov qauv, suav nrog qhov nruab nrab, qhov tsawg kawg nkaus, qhov siab tshaj plaws, qhov sib txawv ntawm tus qauv (SD) thiab kev ntsuas nrog 95% kev ntseeg siab (IC95%), nrog rau thawj thiab thib ob kev ntsuas. Qhov sib txawv ntawm cov nqi tom qab 12 ± 3 lub hlis tuaj yeem pom hauv lub rooj 2.
Rooj 2. Cov yam ntxwv ntawm cov neeg mob, kev kho mob thiab tomographic. Cov txiaj ntsig tau qhia ua qhov nruab nrab ± tus qauv sib txawv rau cov hloov pauv tas mus li (* cov txiaj ntsig tau qhia ua nruab nrab ± IQR), 95% kev ntseeg siab (95% CI), poj niam txiv neej thiab qhov muag sab xis tau qhia ua tus lej thiab feem pua
Rooj 3 qhia txog tus naj npawb ntawm cov qhov muag uas tau muab faib ua cov neeg nce qib los ntawm kev xav txog txhua qhov ntsuas tomographic (Kmax, Km, K2, Astig, PachyMin, PRC thiab D-Index) sib cais. Xav txog qhov kev nce qib ntawm KC, txhais los ntawm kev hloov pauv pom hauv tsawg kawg yog ob qhov hloov pauv tomographic, 57 lub qhov muag (50.4%) tau pom tias muaj kev nce qib.
Rooj 3 Tus lej thiab zaus ntawm cov qhov muag raug faib ua cov neeg nce qib, suav nrog txhua qhov kev ntsuas tomographic sib cais
Cov qhab nia Kmax, D-index, PRC, EleBmax, BFSB, thiab AdjEleBmax ua cov lus kwv yees ywj pheej ntawm KC kev nce qib tau qhia nyob rau hauv Rooj 4. Piv txwv li, yog tias peb txhais tus nqi threshold rau kev nce Kmax los ntawm 1 diopter (D) los cim kev nce qib, txawm hais tias qhov parameter no qhia txog kev rhiab heev ntawm 49%, nws muaj qhov tshwj xeeb ntawm 100% (txhua qhov xwm txheej tau txheeb xyuas tias yog kev nce qib ntawm qhov parameter no qhov tseeb). cov neeg nce qib saum toj no) nrog tus nqi kwv yees zoo (PPV) ntawm 100%, tus nqi kwv yees tsis zoo (NPV) ntawm 66%, thiab thaj tsam hauv qab nkhaus (AUC) ntawm 0.822. Txawm li cas los xij, qhov kev txiav tawm zoo tagnrho rau kmax yog 0.4, muab qhov rhiab heev ntawm 70%, qhov tshwj xeeb ntawm 91%, PPV ntawm 89%, thiab NPV ntawm 75%.
Rooj 4 Kmax, D-Index, PRC, BFSB, EleBmax, thiab AdjEleBmax cov qhab nia ua cov lus kwv yees cais ntawm KC kev nce qib (txhais tias yog kev hloov pauv tseem ceeb hauv ob lossis ntau qhov hloov pauv)
Hais txog qhov ntsuas D, qhov chaw txiav zoo tshaj plaws yog 0.435, qhov rhiab heev yog 82%, qhov tshwj xeeb yog 98%, PPV yog 94%, NPV yog 84%, thiab AUC yog 0.927. Peb tau lees paub tias ntawm 50 lub qhov muag uas tau nce qib, tsuas yog 3 tus neeg mob tsis tau nce qib ntawm 2 lossis ntau dua lwm yam. Ntawm 63 lub qhov muag uas qhov ntsuas D tsis tau zoo dua, 10 (15.9%) tau qhia txog kev nce qib hauv tsawg kawg yog ob yam kev ntsuas ntxiv.
Rau PRC, qhov chaw txiav zoo tshaj plaws los txhais kev nce qib yog qhov txo qis ntawm 0.065 nrog qhov rhiab heev ntawm 79%, qhov tshwj xeeb ntawm 80%, PPV ntawm 80%, NPV ntawm 79%, thiab AUC ntawm 0.844.
Hais txog qhov siab ntawm qhov chaw tom qab (EleBmax), qhov zoo tshaj plaws rau kev txiav txim siab qhov kev nce qib yog qhov nce ntawm 2.5 µm nrog qhov rhiab heev ntawm 65% thiab qhov tshwj xeeb ntawm 73%. Thaum kho rau qhov thib ob ntsuas BSFB, qhov rhiab heev ntawm qhov parameter tshiab AdjEleBmax yog 63% thiab qhov tshwj xeeb tau txhim kho los ntawm 84% nrog qhov chaw txiav zoo tagnrho ntawm 6.5 µm. BFSB nws tus kheej tau qhia txog qhov txiav zoo meej ntawm 0.05 hli nrog qhov rhiab heev ntawm 51% thiab qhov tshwj xeeb ntawm 80%.
Hauv daim duab 2 qhia cov kab ROC rau txhua qhov kev kwv yees tomographic parameters (Kmax, D-Index, PRC, EleBmax, BFSB thiab AdjEleBmax). Peb pom tias D-index yog qhov kev sim zoo dua nrog AUC siab dua (0.927) ua raws li PRC thiab Kmax. AUC EleBmax yog 0.690. Thaum kho rau BFSB, qhov chaw no (AdjEleBmax) tau txhim kho nws cov kev ua tau zoo los ntawm kev nthuav dav AUC mus rau 0.754. BFSB nws tus kheej muaj AUC ntawm 0.690.
Daim Duab 2. Cov kab nkhaus ua tau zoo ntawm tus txais (ROC) qhia tias kev siv D index los txiav txim siab qhov kev nce qib ntawm keratoconus tau ua tiav qib siab ntawm kev nkag siab thiab kev tshwj xeeb, ua raws li PRC thiab Kmax. AdjEleBmax tseem suav tias yog qhov tsim nyog thiab feem ntau zoo dua li Elebmax yam tsis muaj BFSB tuning.
Cov Lus Luv: Kmax, qhov siab tshaj plaws ntawm lub qhov muag; D-index, Belin/Ambrosio D-index; PRC, qhov nkhaus rov qab los ntawm 3.0 hli uas nyob nruab nrab ntawm qhov chaw nyias tshaj plaws; BFSB, zoo tshaj plaws rau lub nraub qaum kheej kheej; Qhov Siab; AdjELEBmax, lub kaum sab xis siab tshaj plaws. qhov chaw tom qab ntawm lub qhov muag raug kho kom haum rau lub nraub qaum kheej kheej uas haum tshaj plaws.
Xav txog EleBmax, BFSB, thiab AdjEleBmax, raws li, peb tau lees paub tias 53 (46.9%), 40 (35.3%), thiab 45 (39.8%) lub qhov muag tau qhia txog kev nce qib rau txhua qhov kev ntsuas cais tawm, raws li. Ntawm cov qhov muag no, 16 (30.2%), 11 (27.5%), thiab 9 (45%), raws li, tsis muaj kev nce qib tiag tiag raws li tau txhais los ntawm tsawg kawg yog ob qho kev ntsuas ntxiv. Ntawm 60 lub qhov muag uas tsis suav tias yog kev nce qib los ntawm EleBmax, 20 (33%) lub qhov muag tau nce qib ntawm 2 lossis ntau dua lwm yam kev ntsuas. Nees nkaum yim (38.4%) thiab 21 (30.9%) lub qhov muag tau suav tias tsis nce qib raws li BFSB thiab AdjEleBmax ib leeg, raws li, qhia txog kev nce qib tiag tiag.
Peb npaj siab yuav tshawb nrhiav qhov ua tau zoo ntawm BFSB thiab, qhov tseem ceeb tshaj, BFSB-kho qhov siab tshaj plaws tom qab corneal qhov siab (AdjEleBmax) ua ib qho parameter tshiab los kwv yees thiab ntes KC kev nce qib thiab piv rau lwm cov parameter tomographic uas feem ntau siv ua cov cim qhia txog kev nce qib. Kev sib piv tau ua nrog cov thresholds tau tshaj tawm hauv cov ntaub ntawv (txawm hais tias tsis tau lees paub), uas yog Kmax thiab D-Index.20
Thaum teeb tsa EleBmax rau BFSB radius (AdjEleBmax), peb pom tias muaj kev nce ntxiv ntawm qhov tshwj xeeb - 73% rau qhov tsis tau kho thiab 84% rau qhov kho qhov tshwj xeeb - yam tsis cuam tshuam rau qhov rhiab heev (65% thiab 63%). Peb kuj tau soj ntsuam BFSB radius nws tus kheej ua lwm qhov kev kwv yees ntawm kev nce qib ntawm kev nthuav dav. Txawm li cas los xij, qhov rhiab heev (51% vs 63%), qhov tshwj xeeb (80% vs 84%) thiab AUC (0.69 vs 0.75) ntawm qhov parameter no qis dua li ntawm AdjEleBmax.
Kmax yog ib qho parameter uas paub zoo rau kev kwv yees qhov kev nce qib ntawm KC. 27 Tsis muaj kev pom zoo rau qhov kev txwv txiav twg tsim nyog dua. 12,28 Hauv peb txoj kev tshawb fawb, peb tau xav txog kev nce ntawm 1D lossis ntau dua ua lub ntsiab lus ntawm kev nce qib. Ntawm qhov ntsuas no, peb tau pom tias txhua tus neeg mob uas tau txheeb xyuas tias muaj kev nce qib tau lees paub los ntawm tsawg kawg yog ob qho kev ntsuas ntxiv, qhia txog qhov tshwj xeeb ntawm 100%. Txawm li cas los xij, nws qhov kev nkag siab qis heev (49%), thiab kev nce qib tsis tuaj yeem pom hauv 29 lub qhov muag. Txawm li cas los xij, hauv peb txoj kev tshawb fawb, qhov zoo tagnrho Kmax threshold yog 0.4 D, qhov rhiab heev yog 70%, thiab qhov tshwj xeeb yog 91%, uas txhais tau tias nrog qhov txo qis hauv qhov tshwj xeeb (los ntawm 100% txog 91%), peb tau txhim kho. Qhov rhiab heev ntawm 49% txog 70%. Txawm li cas los xij, qhov tseem ceeb ntawm kev kho mob ntawm qhov ntsuas tshiab no yog qhov tsis ntseeg. Raws li kev tshawb fawb Kreps txog kev rov ua dua ntawm Pentacam® kev ntsuas, qhov rov ua dua ntawm Kmax yog 0.61 hauv mob qog noj ntshav me me thiab 1.66 hauv caesarean colpitis nruab nrab,19 uas txhais tau tias tus nqi txiav tawm hauv cov qauv no tsis tseem ceeb hauv kev kho mob vim nws txhais tau tias muaj qhov xwm txheej ruaj khov. thaum qhov kev nce qib siab tshaj plaws tau siv rau lwm cov qauv. Kmax, ntawm qhov tod tes, piav qhia txog qhov nkhaus ntawm lub qhov muag pem hauv ntej ntawm thaj chaw me me 29 thiab tsis tuaj yeem rov ua dua cov kev hloov pauv uas tshwm sim hauv lub qhov muag pem hauv ntej, lub qhov muag tom qab, thiab lwm qhov chaw ntawm pachymetry. 30-32 Piv rau cov kev ntsuas tom qab tshiab, AdjEleBmax tau qhia txog kev nkag siab siab dua (63% vs. 49%). 20 lub qhov muag nce qib tau txheeb xyuas kom raug siv cov kev ntsuas no thiab plam siv Kmax (piv rau 12 lub qhov muag nce qib pom siv Kmax es tsis txhob AdjEleBmax). Qhov kev tshawb pom no txhawb nqa qhov tseeb tias qhov chaw tom qab ntawm lub qhov muag pem hauv ntej yog ntxhab dua thiab nthuav dav dua hauv nruab nrab piv rau qhov chaw pem hauv ntej, uas yuav pab nrhiav kev hloov pauv. 25, 32, 33
Raws li lwm cov kev tshawb fawb, D-index yog ib qho parameter cais nrog qhov rhiab heev tshaj plaws (82%), qhov tshwj xeeb (95%) thiab AUC (0.927). 34 Qhov tseeb, qhov no tsis yog qhov xav tsis thoob, vim qhov no yog ntau tus parameter index. PRC yog qhov thib ob hloov pauv rhiab heev tshaj plaws (79%) ua raws li AdjEleBmax (63%). Raws li tau hais ua ntej, qhov siab dua qhov rhiab heev, qhov tsawg dua qhov tsis zoo cuav thiab qhov zoo dua cov kev tshuaj ntsuam xyuas tsim. 35 Yog li ntawd, peb pom zoo kom siv AdjEleBmax (nrog qhov txiav ntawm 7 µm rau kev nce qib es tsis yog 6.5 µm txij li thaum lub ntsuas digital ua rau hauv Pentacam® tsis suav nrog cov chaw lej rau qhov parameter no) es tsis txhob siv EleBmax tsis raug, uas yuav suav nrog nrog lwm cov hloov pauv hauv kev ntsuam xyuas. kev nce qib ntawm keratoconus los txhim kho kev ntseeg siab ntawm peb qhov kev ntsuam xyuas kev kho mob thiab kev kuaj pom thaum ntxov ntawm kev nce qib.
Txawm li cas los xij, peb txoj kev tshawb fawb ntsib qee qhov kev txwv. Ua ntej, peb tsuas yog siv cov duab tomographic shapeflug los txhais thiab ntsuas kev nce qib, tab sis lwm txoj hauv kev tam sim no muaj rau tib lub hom phiaj, xws li kev tshuaj xyuas biomechanical, uas yuav ua ntej txhua qhov kev hloov pauv topographic lossis tomographic. 36 Qhov thib ob, peb siv ib qho kev ntsuas ntawm txhua qhov kev sim thiab, raws li Ivo Guber et al., qhov nruab nrab ntawm ntau daim duab ua rau muaj suab nrov qis dua. 28 Txawm hais tias kev ntsuas nrog Pentacam® tau rov ua dua zoo hauv qhov muag ib txwm muaj, lawv qis dua hauv qhov muag nrog corneal irregularities thiab corneal ectasia. 37 Hauv kev tshawb fawb no, peb tsuas yog suav nrog qhov muag nrog Pentacam® high-quality scan validation, uas txhais tau tias kab mob siab heev tau raug tshem tawm. 17 Qhov thib peb, peb txhais cov neeg nce qib tiag tiag raws li muaj tsawg kawg yog ob qhov kev ntsuas raws li cov ntaub ntawv tab sis tseem tsis tau lees paub. Thaum kawg, thiab tej zaum qhov tseem ceeb dua, qhov sib txawv ntawm Pentacam® kev ntsuas yog qhov tseem ceeb hauv kev kho mob hauv kev ntsuas kev nce qib ntawm keratoconus. 18,26 Hauv peb cov qauv ntawm 113 lub qhov muag, thaum faib ua pawg raws li qhov qhab nia BAD-D, feem ntau (n = 68, 60.2%) lub qhov muag yog qhov nruab nrab, nrog rau cov seem subclinical lossis me me. Txawm li cas los xij, muab qhov me me ntawm cov qauv, peb khaws cia qhov kev tshuaj xyuas tag nrho tsis hais txog qhov hnyav ntawm KTC. Peb tau siv tus nqi qis tshaj plaws rau peb cov qauv tag nrho, tab sis peb lees paub tias qhov no yuav ntxiv suab nrov (variability) rau qhov kev ntsuas thiab tsa kev txhawj xeeb txog kev ntsuas rov ua dua. Qhov rov ua dua ntawm kev ntsuas nyob ntawm qhov hnyav ntawm KTC, raws li qhia los ntawm Kreps, Gustafsson et al. 18,26. Yog li ntawd, peb xav kom cov kev tshawb fawb yav tom ntej coj mus rau hauv tus account cov theem sib txawv ntawm tus kab mob thiab ntsuas cov ntsiab lus txiav tawm zoo tagnrho rau kev nce qib tsim nyog.
Xaus lus, kev kuaj pom thaum ntxov ntawm kev nce qib yog qhov tseem ceeb tshaj plaws kom muab kev kho mob raws sijhawm kom tiv thaiv kev nce qib (los ntawm kev sib txuas)38 thiab pab khaws cia qhov muag thiab lub neej zoo hauv peb cov neeg mob. 34 Lub hom phiaj tseem ceeb ntawm peb txoj haujlwm yog los qhia tias EleBmax, kho rau tib lub vojvoog BFS ntawm kev ntsuas lub sijhawm, muaj kev ua tau zoo dua li EleBmax nws tus kheej. Cov txheej txheem no qhia txog kev tshwj xeeb thiab kev ua tau zoo dua piv rau EleBmax, nws yog ib qho ntawm cov txheej txheem rhiab heev tshaj plaws (thiab yog li ntawd qhov kev tshuaj ntsuam zoo tshaj plaws) thiab yog li ntawd muaj peev xwm ua tau biomarker thaum ntxov. Nws raug pom zoo kom tsim cov ntsuas ntau yam. Cov kev tshawb fawb yav tom ntej uas cuam tshuam nrog kev tshuaj xyuas kev nce qib ntau yam yuav tsum suav nrog AdjEleBmax.
Cov kws sau ntawv tsis tau txais kev txhawb nqa nyiaj txiag rau kev tshawb fawb, kev sau ntawv thiab / lossis kev tshaj tawm tsab xov xwm no.
Margarida Ribeiro thiab Claudia Barbosa yog cov neeg sau ntawv ua ke hauv kev tshawb fawb. Cov kws sau ntawv tsis qhia tias muaj kev tsis sib haum xeeb hauv txoj haujlwm no.
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