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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.
Mākarida Ribeiro,1,2,*Margarita Ribeiro, 1.2*Claudia Barbosa, 3 tau*Claudia Barbosa, 3 tau*2 Koiora Te Wāhanga Rongoā – Te Wāhanga Rongoā o Te Whare Wānanga o Porto, Porto, Potukara 3 Te Wāhanga Rongoā o Te Whare Wānanga o Porto, Porto, Potukara;4Tari Pokanga me te Hangarau Tinana, Wāhanga Rongoā, Te Whare Wānanga o Porto, Porto, Potukara4 Tari Pokanga me te Hangarau Tinana, Wāhanga Rongoā, Te Whare Wānanga o Porto, Porto, Potukara *I whai wāhi nui ēnei kaituhi ki tēnei mahi.Hernâni Monteiro Porto, 4200-319, Potukara, īmēra [email protected] Kaupapa: I arotakehia e mātou te mata o muri o te kornea i whakatikatikaina mō te Best Fit Sphere Back (BFSB) i waenga i ngā inenga tauine wā (AdjEleBmax) me te radius BFSB (BFSBR). Ko te teitei mōrahi tonu i whakamahia hei tawhā tomographic hou hei tuhi i te haere whakamua o te whakawhānui me te whakarite ki ngā tawhā pono hou o te haere whakamua o te keratoconus (KK). Ngā Hua. I arotakehia e mātou a Kmax, te taupū D, te radius piko o muri, me te pūwāhi tapahi pai mai i te pūwāhi angiangi rawa 3.0 mm i waenganui (PRC), EleBmax, BFSBR, me AdjEleBmax hei tawhā motuhake hei tuhi i te ahunga whakamua o te KC (i tautuhia hei taurangi e rua, neke atu rānei), i kitea e mātou he aro o te 70%, 82%, 79%, 65%, 51%, me te 63%, me te 91%, 98%, 80%, 73%, 80%, me te 84% ngā motuhaketanga mō te kite i te ahunga whakamua o te KC. . Ko te horahanga i raro i te pihi (AUC) mō ia taurangi he 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, ia. Whakatau: Ki te whakatauritea ki a EleBmax me te kore he whakatikatika, he teitei ake te motuhaketanga o AdjEleBmax, he teitei ake te AUC me te mahi pai ake me te aro rite. AUC. Nā te mea he porowhita ake te āhua o te mata o muri, he piko ake i te mata o mua, ā, ka āwhina pea tēnei ki te kite i ngā huringa, ka tūtohu mātou kia whakaurua a AdjEleBmax ki te aromatawai i te haere whakamua o te KC me ētahi atu taurangi hei whakapai ake i te pono o tā mātou aromatawai haumanu me te kite wawe. ngā haere whakamua. Ngā kupu matua: keratoconus, cornea, haere whakamua, te āhua tuara porowhita pai rawa atu, te teitei mōrahi o te mata o muri o te cornea.
Ko te Keratoconus (KK) te mate ectasia corneal tuatahi e tino kitea ana. Inaianei e kiia ana he mate e rua ngā taha (ahakoa he koretake) e ahu whakamua ana, e arahi ana ki ngā huringa hanganga maha, ā, ka whai muri ko te angiangi o te stromal me te whara. 1,2 I roto i te haumanu, ka puta mai ngā tūroro me te astigmatism koretake me te myopia, te photophobia, me/ranei te monocular diplopia me te tirohanga ngoikore, te tirohanga matakite kua whakatikatikahia (BCVA) me te kounga o te oranga kua heke. 3,4 Ko ngā whakaaturanga o te RP ka tīmata i te tekau tau tuarua o te oranga ka ahu whakamua ki te tekau tau tuawhā, ā, ka whai muri ko te pumau haumanu. He teitei ake te mōrearea me te tere o te ahu whakamua i roto i te hunga kei raro iho i te 19 tau te pakeke. 5.6
Ahakoa kāore anō kia kitea he rongoā tuturu, e rua ngā whāinga nui o te maimoatanga o nāianei mō te keratoconus ocular: te whakapai ake i te mahi tirohanga me te aukati i te haere whakamua o te whakawhānui. 7,8 Ka kitea pea te tuatahi i roto i ngā mōhiti, i ngā karaihe whakapā pakari, i ngā mowhiti intracorneal rānei, i roto rānei i ngā whakawhitinga corneal ina tino kino rawa te mate. 9 Ko te whāinga whakamutunga ko te kaupapa tapu o ēnei maimoatanga tūroro, e taea ana i tēnei wā mā te hononga whakawhiti anake. Ka hua ake tēnei mahi i te pikinga o te ātete koiora me te pakari o te cornea, ā, ka ārai i te haere whakamua. 10-13 Ahakoa ka taea tēnei i tētahi wāhanga o te mate, ko te painga nui ka puta i ngā wāhanga tōmua. 14 Me whakapau kaha ki te kite wawe i te haere whakamua me te aukati i te hekenga atu, me te karo i te maimoatanga koretake o ētahi atu tūroro, kia whakaitihia ai te mōrearea o ngā raruraru whakawhiti pērā i te mate, te ngaronga o ngā pūtau endothelial, me te mamae nui i muri i te pokanga. 15.16
Ahakoa ētahi rangahau e aro ana ki te tautuhi me te kite i te ahunga whakamua,17-19 kāore anō kia kitea he whakamāramatanga ōrite mō te ahunga whakamua o te whānui, kāore anō hoki he huarahi paerewa hei tuhi. 9,20,21 I roto i te Global Consensus on Keratoconus and Dilated Diseases (2015), ko te ahunga whakamua o te keratoconus e tautuhia ana ko te huringa ā-wāhanga i roto i te iti rawa e rua o ngā tawhā āhua whenua e whai ake nei: te pikinga o te kornea o mua, te pikinga o te kornea o muri, te angiangi me/te matotoru rānei o te kornea. Ka piki ake te tere o te huringa mai i te taha ki te pūwāhi angiangi rawa. 9 Heoi anō, me whai whakamāramatanga motuhake ake mō te ahunga whakamua. Kua whakapau kaha ki te kimi i ngā taurangi tino kaha hei kite me te whakamārama i te ahunga whakamua. 19:22–24
I te mea he pai pea te āhua o te mata o muri o te kornea, he porowhita ake, he piko ake i te mata o mua, mō te kite i ngā huringa,25 ko te whāinga matua o tēnei rangahau he aromatawai i ngā āhuatanga o te koki teitei mōrahi o te kornea o muri. i urutau ki te rohe tino tika. Ko te ine tauine wā (BFSB) (AdjEleBmax) me te radius BFSB (BFSBR) anake i mahi hei tawhā hou hei tuhi i te haere whakamua o te whānui, ā, i whakaritea ki ngā tawhā e whakamahia whānuitia ana mō te haere whakamua o te KC.
I tirotirohia ngā kanohi 113 katoa o ngā tūroro 76 i tātaritatia he keratoconus i roto i tēnei rangahau whakamuri i te Tari Ophthalmology i te Hōhipera Matua o te Whare Wānanga o São João, Potukara. I whakaaetia te rangahau e te komiti matatika ā-rohe o te Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto, ā, i whakahaerehia i runga anō i te Whakapuakitanga o Helsinki. I whiwhi whakaaetanga ā-tuhi mai i ngā kaiuru katoa, ā, mēnā kei raro iho i te 16 tau te pakeke o te kaiuru, mai i te matua me/ranei te kaitiaki ture.
I tautuhia ngā tūroro KC i waenga i te 14 ki te 30 tau te pakeke, ā, i whakaurua rātou ki roto i tā mātou tirotiro kanohi me te kornea i waenga i a Oketopa ki Tīhema 2021.
I tirotirohia ngā tūroro katoa i tīpakohia mō te tau kotahi e te tohunga kornea, ā, i whai i te iti rawa kia toru ngā inenga tomographic Scheimpflug (Pentacam®; Oculus, Wetzlar, Tiamana). I mutu te mau o ngā tūroro i ngā karaihe whakapā i te iti rawa 48 hāora i mua i ngā inenga. I mahia ngā inenga katoa e te tohunga wheua kua whakangungua, ā, ko ngā matawai anake me te tirotiro kounga o "OK" i whakaurua. Mena kāore te aromatawai kounga whakaahua aunoa i tohua hei "OK", ka tuaruatia te whakamātautau. E rua noa ngā matawai mō ia kanohi i tātarihia hei kite i te ahunga whakamua, me te wehenga o ia takirua e 12 ± 3 marama. I whakaurua hoki ngā kanohi me te KC iti-haumanu (i ēnei take, me whakaatu e te kanohi kē atu ngā tohu mārama o te KC haumanu).
I tangohia mai i te tātari ngā kanohi KC kua oti kē te pokanga kanohi (te hononga whakawhiti o te kornea, ngā mowhiti kornea, te whakawhitinga kornea rānei) me ngā kanohi he mate tino kino (te matotoru o te kornea i te mea angiangi rawa <350 µm, te hydrokeratosis, te whara hohonu rānei o te kornea) nā te mea ka rahua tonu te rōpū ki te "OK" i muri i ngā tirotiro kounga matawai ā-roto.
I kohia ngā raraunga taupori, haumanu me te tomografi hei tātari. Hei kite i te ahunga whakamua o te KC, i kohia e mātou ētahi taurangi tomografi tae atu ki te piko mōrahi o te kornea (Kmax), te piko toharite o te kornea (Km), te piko papatahi o te kornea meridional (K1), te piko tino pari o te kornea meridional (K2), te astigmatism o te kornea (Astig = K2 – K1). ), te ine matotoru iti rawa (PachyMin), te teitei mōrahi o te kornea o muri (EleBmax), te radius piko o muri (PRC) 3.0 mm i waenganui i te pūwāhi angiangi rawa, i whakatikatikaina te Belin/Ambrosio D-index (D-index), BFSBR me te EleBmax ki te BFSB (AdjEleBmax). E ai ki te pikitia 1, ka whiwhihia te AdjEleBmax i muri i tā mātou whakatau ā-ringa i te radius BFSB kotahi i roto i ngā whakamātautau mīhini e rua mā te whakamahi i te uara BFSR mai i te whakatau tata tuarua.
Rice. 1. Te whakataurite i ngā whakaahua Pentacam® i te tūranga poutū o muri me te ahunga whakamua haumanu pono me te wā 13-marama i waenga i ngā whakamātautau. I te röpü 1, ko te EleBmax he 68 µm i te whakamātautau tuatahi me te 66 µm i te tuarua, nō reira kāore he ahunga whakamua i roto i tēnei tawhā. Ko ngā radius porowhita pai rawa atu i homai aunoa e te mīhini mō ia aromatawai ko te 5.99 mm me te 5.90 mm, ia. Mena ka pāwhiritia e tātou te pātene BFS, ka puta he matapihi ka taea te tautuhi ā-ringa i tētahi radius BFS hou. I whakatauhia e mātou te radius kotahi i roto i ngā whakamātautau e rua mā te whakamahi i te uara radius BFS tuarua i inehia (5.90mm). I te röpü 2, ko te uara hou o EleBmax (EleBmaxAdj) i whakatikatikaina mō te BFS kotahi i te aromatawai tuatahi ko te 59 µm, e tohu ana i te pikinga 7 µm i te aromatawai tuarua, e tohu ana i te ahunga whakamua e ai ki tā mātou paepae 7 µm.
Hei tātari i te ahunga whakamua me te aromatawai i te whai huatanga o ngā taurangi rangahau hou, i whakamahia e mātou ngā tawhā e whakamahia whānuitia ana hei tohu ahunga whakamua (Kmax, Km, K2, Astig, PachyMin, PRC, me te D-Index) me ngā paepae kua whakaahuatia i roto i ngā tuhinga. Ahakoa ehara i te mea he wheako). Kei te Ripanga 1 ngā uara e tohu ana i te ahunga whakamua o ia tawhā tātari. I tautuhia te ahunga whakamua o te KC ina whakaū te iti rawa e rua o ngā taurangi i rangahauhia i te ahunga whakamua.
Ripanga 1 Ngā tawhā tātaitai e whakaaetia whānuitia ana hei tohu mō te haere whakamua o te haere whakamua o te RP me ngā paepae e rite ana i whakaahuatia i roto i ngā tuhinga (ahakoa kāore anō kia whakaūtia)
I roto i tēnei rangahau, i whakamātauria te mahi a ngā taurangi e toru mō te ahunga whakamua (EleBmax, BFSB, me AdjEleBmax) i runga i te aroaro o te ahunga whakamua o ētahi atu taurangi e rua, neke atu rānei. I tatauhia ngā pūwāhi tapahi pai mō ēnei taurangi, ā, i whakaritea ki ētahi atu taurangi.
I whakahaerehia te tātari tatauranga mā te whakamahi i te pūmanawa tatauranga SPSS (putanga 27.0 mō Mac OS; SPSS Inc., Chicago, IL, USA). Ka whakarāpopototia ngā āhuatanga tauira, ā, ka whakaatuhia ngā raraunga hei tau me ngā ōwehenga o ngā taurangi kāwai. Ka whakaahuahia ngā taurangi tonu hei toharite me te paerewa rerekētanga (te awhe waenga me te awhe interquartile rānei ina he piko te tohatoha). I whiwhihia te huringa o te taupū keratometric mā te tango i te uara taketake mai i te inenga tuarua (arā, ko te uara delta pai e tohu ana i te pikinga o te uara o tētahi tawhā motuhake). I whakahaerehia ngā whakamātautau tawhā me ngā whakamātautau kore-tawhā hei aromatawai i te tohatoha o ngā taurangi piko o te kornea kua whakarōpūtia hei ahunga whakamua, hei kore-whakahaere rānei, tae atu ki te whakamātautau-t tauira-motuhake, te whakamātautau-U Mann-Whitney, te whakamātautau chi-square, me te whakamātautau tika a Fisher (mēnā e tika ana). I whakatakotoria te taumata o te hiranga tatauranga ki te 0.05. Hei aromatawai i te whai huatanga o Kmax, D-index, PRC, BFSBR, EleBmax, me AdjEleBmax hei matapae ahunga whakamua takitahi, i hangaia e mātou ngā ānau mahi a te kaiwhiwhi (ROC) me te tatau i ngā pūwāhi tapahi pai, te aro, te motuhake, te pai (PPV), me te Uara Matapae Kino (NPV). ) me te horahanga i raro i te ānau (AUC) ina neke atu i te rua ngā taurangi i ētahi paepae (e ai ki te whakaahuatanga o mua) hei whakarōpū i te ahunga whakamua hei mana whakahaere.
I whakaurua ki te rangahau he 113 ngā kanohi o ngā tūroro 76 me te RP. Ko te nuinga o ngā tūroro he tāne (n=87, 77%), ā, ko te tau toharite i te aromatawai tuatahi he 24.09 ± 3.93 tau. Mō te wehewehenga KC i runga i te pikinga o te whānui o te Belin/Ambrosio (taupū BAD-D), ko te nuinga (n=68, 60.2%) o ngā kanohi he taurite. I whiriwhiria e ngā kairangahau he uara tapahi o te 7.0, ā, i wehewehea i waenga i te keratoconus ngawari me te taurite e ai ki ngā tuhinga26. Heoi, ko te toenga o te tātaritanga kei roto ko te tauira katoa. Ko ngā āhuatanga taupori, haumanu me te tomographic o te tauira, tae atu ki te tau toharite, te iti rawa, te mōrahi, te paerewa rerekētanga (SD) me ngā inenga me ngā wā whakawhirinaki 95% (IC95%), tae atu ki ngā inenga tuatahi me te tuarua. Ka kitea te rerekētanga i waenga i ngā uara i muri i te 12 ± 3 marama i te ripanga 2.
Ripanga 2. Ngā āhuatanga taupori, haumanu me te tomografi o ngā tūroro. Ka whakaatuhia ngā hua hei toharite ± paerewa rerekētanga mō ngā taurangi tonu (*ka whakaatuhia ngā hua hei waenga ± IQR), 95% te wā whakawhirinaki (95% CI), ko te ira tāne me te kanohi matau ka whakaatuhia hei tau me te ōrau
E whakaatu ana te Ripanga 3 i te maha o ngā kanohi kua whakarōpūtia hei hunga ahu whakamua i runga i te whakaaro ki ia tawhā tomographic (Kmax, Km, K2, Astig, PachyMin, PRC me te D-Index) motuhake. I te whakaaro ki te ahunga whakamua o te KC, i tautuhia e ngā huringa i kitea i roto i te iti rawa e rua ngā taurangi tomographic, 57 ngā kanohi (50.4%) i whakaatu i te ahunga whakamua.
Ripanga 3 Te maha me te auau o ngā kanohi kua whakarōpūtia hei ahunga whakamua, me te whai whakaaro motuhake ki ia tawhā tomographic
Kei te Ripanga 4 ngā kaute Kmax, D-index, PRC, EleBmax, BFSB, me AdjEleBmax hei matapae motuhake mō te ahunga whakamua o KC. Hei tauira, ki te tautuhia e tātou he uara paepae mō te whakanui ake i te Kmax mā te 1 diopter (D) hei tohu i te ahunga whakamua, ahakoa he 49% te aro o tēnei tawhā, he 100% tōna motuhaketanga (ko ngā take katoa i tautuhia he ahunga whakamua i runga i tēnei tawhā he pono). (ngā kaihaere whakamua i runga ake nei) me te uara matapae pai (PPV) o te 100%, he uara matapae kino (NPV) o te 66%, me te horahanga i raro i te pihi (AUC) o te 0.822. Heoi, ko te tapahi pai i tatauhia mō te kmax he 0.4, e homai ana he aro o te 70%, he motuhaketanga o te 91%, he PPV o te 89%, me te NPV o te 75%.
Ripanga 4 Ko ngā kaute Kmax, D-Index, PRC, BFSB, EleBmax, me AdjEleBmax hei tohu motuhake mō te haere whakamua o te KC (kua tautuhia hei huringa nui i roto i ngā taurangi e rua, neke atu rānei)
Mō te taupū D, ko te pūwāhi tapahi pai ko te 0.435, ko te aro o te mate he 82%, ko te motuhaketanga he 98%, ko te PPV he 94%, ko te NPV he 84%, ā, ko te AUC he 0.927. I whakaū mātou o ngā kanohi 50 i ahu whakamua, e 3 noa iho ngā tūroro kāore i ahu whakamua i runga i te 2, neke atu rānei, o ētahi atu tawhā. O ngā kanohi 63 kāore i pai ake te taupū D, 10 (15.9%) i whakaatu i te ahunga whakamua i roto i te iti rawa e rua atu tawhā.
Mō te PRC, ko te pūwāhi tapahi pai rawa atu hei tautuhi i te ahunga whakamua he hekenga o te 0.065 me te tairongo o te 79%, te motuhaketanga o te 80%, te PPV o te 80%, te NPV o te 79%, me te AUC o te 0.844.
Mō te teitei o te mata o muri (EleBmax), ko te paepae pai mō te whakatau i te ahunga whakamua he pikinga o te 2.5 µm me te aro o te 65% me te motuhaketanga o te 73%. I te whakatikatikaina ki te BSFB tuarua i inehia, ko te aro o te tawhā hou AdjEleBmax he 63%, ā, i pai ake te motuhaketanga mā te 84% me te pūwāhi tapahi pai o te 6.5 µm. I whakaatu te BFSB i te tapahi tino pai o te 0.05 mm me te aro o te 51% me te motuhaketanga o te 80%.
Kei te pikitia 2 ngā ānau ROC mō ia o ngā tawhā tomographic kua whakatauhia (Kmax, D-Index, PRC, EleBmax, BFSB me AdjEleBmax). Ka kite tātou he whakamātautau whai hua ake te D-index me te AUC teitei ake (0.927) ā, ka whai ake ko te PRC me te Kmax. Ko te AUC EleBmax he 0.690. I te wā i whakaritea ai mō te BFSB, i whakapai ake tēnei tautuhinga (AdjEleBmax) i tana mahi mā te whakawhānui i te AUC ki te 0.754. Ko te AUC o te BFSB tonu he 0.690.
Pikitia 2. Ngā ānau mahi a te kaiwhiwhi (ROC) e whakaatu ana i te whakamahinga o te tohu D hei whakatau i te haere whakamua o te keratoconus i eke ki ngā taumata teitei o te aro me te motuhaketanga, ā, i whai ake ko te PRC me te Kmax. E kiia ana he whaitake tonu te AdjEleBmax, ā, he pai ake i te Elebmax me te kore he whakatikatika BFSB.
Ngā Whakarāpopototanga: Kmax, te piko mōrahi o te kornea; D-index, Belin/Ambrosio D-index; PRC, te radius piko o muri mai i te 3.0 mm e pokapū ana ki te pūwāhi angiangi rawa; BFSB, he pai rawa atu mō te tuara porowhita; Teitei; AdjELEBmax, te koki teitei mōrahi. kua whakatikatikaina te mata o muri o te kornea ki te tuara porowhita tino pai.
I te whakaaro ki a EleBmax, BFSB, me AdjEleBmax, ia, i whakaū mātou e 53 (46.9%), 40 (35.3%), me te 45 (39.8%) ngā kanohi i whakaatu i te ahunga whakamua mō ia tawhā motuhake. O ēnei kanohi, 16 (30.2%), 11 (27.5%), me te 9 (45%), ia, kāore he ahunga whakamua pono e ai ki te tautuhia e te iti rawa e rua atu tawhā. O ngā kanohi 60 kāore i kiia he ahunga whakamua e EleBmax, 20 (33%) ngā kanohi i ahu whakamua i runga i te 2, neke atu rānei, o ētahi atu tawhā. E rua tekau mā waru (38.4%) me te 21 (30.9%) ngā kanohi i kiia kāore e ahu whakamua e ai ki a BFSB me AdjEleBmax anake, ia, e whakaatu ana i te ahunga whakamua pono.
E whai ana mātou ki te tirotiro i te whai huatanga o te BFSB, me te mea nui ake, te teitei teitei o muri o te kornea kua whakatikatikaina e te BFSB (AdjEleBmax) hei tawhā hou hei matapae me te kite i te ahunga whakamua o te KC, me te whakarite i ēnei ki ētahi atu tawhā tomographic e whakamahia whānuitia ana hei tohu mō te ahunga whakamua. I whakaritea ngā whakataurite ki ngā paepae i kōrerotia i roto i ngā tuhinga (ahakoa kāore i whakamanahia), arā, ko te Kmax me te D-Index.20
I te whakatakoto i te EleBmax ki te radius BFSB (AdjEleBmax), i kite mātou i te pikinga nui o te motuhaketanga – 73% mō te tawhā kāore i whakatikatikaina me te 84% mō te tawhā kua whakatikatikaina – me te kore e pā ki te uara aro (65% me te 63%). I arotakehia hoki e mātou te radius BFSB tonu hei tohu pea mō te haere whakamua o te whakawhānui. Heoi, ko te aro (51% vs 63%), te motuhaketanga (80% vs 84%) me te AUC (0.69 vs 0.75) o tēnei tawhā he iti iho i ērā o AdjEleBmax.
He tawhā rongonui a Kmax mō te matapae i te haere whakamua o te KC. 27 Kāore he whakaae whānui mō te rohe tapahi e tika ana. 12,28 I roto i tā mātou rangahau, i whakaarohia e mātou te pikinga o te 1D, neke atu rānei, hei whakamāramatanga mō te haere whakamua. I tēnei paepae, i kitea e mātou ko ngā tūroro katoa i tautuhia kei te haere whakamua kua whakaūtia e te iti rawa e rua atu tawhā, e kī ana he motuhaketanga o te 100%. Heoi, he iti noa iho tōna aro (49%), ā, kāore i taea te kite i te haere whakamua i roto i te 29 kanohi. Heoi, i roto i tā mātou rangahau, ko te paepae Kmax pai ko te 0.4 D, ko te aro he 70%, ā, ko te motuhaketanga he 91%, ko te tikanga me te hekenga whanaunga o te motuhaketanga (mai i te 100% ki te 91%), i pai ake mātou. I ahu mai te aro i te 49% ki te 70%. Heoi, he ruarua te hiranga haumanu o tēnei paepae hou. E ai ki te rangahau a Kreps mō te auautanga o ngā inenga Pentacam®, ko te auautanga o Kmax he 0.61 i roto i te mate pukupuku catarrhal ngawari me te 1.66 i roto i te caesarean colpitis ngawari,19 ko te tikanga kāore te uara tapahi tatauranga i roto i tēnei tauira i te hiranga haumanu nā te mea e tautuhi ana i tētahi āhuatanga pumau. ina whakamahia te ahunga whakamua mōrahi ki ētahi atu tauira. Ko Kmax, i tētahi atu ringa, e tohu ana i te piko o mua o te cornea o te rohe iti 29 ā, kāore e taea te whakaputa anō i ngā huringa e puta ana i roto i te cornea o mua, te cornea o muri, me ētahi atu wāhi o te pachymetry. 30-32 Ki te whakatauritea ki ngā tawhā hou o muri, i whakaatu a AdjEleBmax i te aro nui ake (63% vs. 49%). 20 ngā kanohi ahu whakamua i tautuhia tika mā te whakamahi i tēnei tawhā, ā, i ngaro mā te whakamahi i a Kmax (ki te whakatauritea ki te 12 ngā kanohi ahu whakamua i kitea mā te whakamahi i a Kmax hei utu mō AdjEleBmax). E tautoko ana tēnei kitenga i te meka he pari ake te mata o muri o te cornea, ā, he whānui ake i waenganui ki te mata o mua, ka āwhina pea tēnei ki te kite i ngā huringa. 25,32,33
E ai ki ētahi atu rangahau, ko te D-index he tawhā motuhake me te aro nui rawa atu (82%), te motuhaketanga (95%) me te AUC (0.927). 34 Inaa, ehara tēnei i te mea miharo, nā te mea he taupū maha-tawhā tēnei. Ko te PRC te tuarua o ngā taurangi tino aro nui (79%) i muri mai ko AdjEleBmax (63%). E ai ki te kōrero i mua ake nei, ko te teitei ake o te aro, ko te iti ake o ngā hua kino teka, ā, ko te pai ake o te whanaketanga o ngā tawhā tirotiro. 35 Nō reira, ka tūtohu mātou kia whakamahia te AdjEleBmax (me te tapahi o te 7 µm mō te ahunga whakamua kaua ki te 6.5 µm nā te mea kāore te tauine mamati i hangaia ki roto i te Pentacam® e whakauru ana i ngā wāhi ira mō tēnei tawhā) hei utu mō te EleBmax kāore i whakatikatikaina, ka whakaurua me ētahi atu taurangi ki te aromatawai. te ahunga whakamua o te keratoconus hei whakapai ake i te pono o tā mātou aromatawai haumanu me te kitenga wawe o te ahunga whakamua.
Heoi, kei te pāngia tā mātou rangahau e ētahi herenga. Tuatahi, i whakamahia noa e mātou ngā tawhā whakaahua tomography shapeflug hei tautuhi me te aromatawai i te ahunga whakamua, engari kei te wātea ētahi atu tikanga mō te kaupapa kotahi, pērā i te tātari koiora-mīhini, e taea ai te mua i ngā huringa topographic, tomographic rānei. 36 Tuarua, ka whakamahia e mātou he inenga kotahi o ngā tawhā katoa i whakamatautauria, ā, e ai ki a Ivo Guber et al., ko te toharite i runga i ngā whakaahua maha ka hua ake he iti ake ngā taumata haruru ine. 28 Ahakoa he pai te whakaputa i ngā inenga me Pentacam® i roto i ngā kanohi noa, he iti ake i roto i ngā kanohi he koretake te kornea me te ectasia kornea. 37 I roto i tēnei rangahau, i whakaurua noa e mātou ngā kanohi me te whakamana matawai kounga teitei Pentacam®, ko te tikanga kua whakakorehia te mate matatau. 17 Tuatoru, ka tautuhia e mātou ngā ahunga whakamua pono he iti rawa ngā tawhā e rua i runga i ngā tuhinga engari kāore anō kia whakaūtia. Hei whakamutunga, ā, he mea nui ake pea, ko te rerekētanga o ngā inenga Pentacam® he mea nui ki te haumanu i roto i te aromatawai i te ahunga whakamua o te keratoconus. 18,26 I roto i tā mātou tauira o ngā kanohi 113, i te wā i whakarōpūhia ai i runga i te kaute BAD-D, ko te nuinga (n=68, 60.2%) he kanohi taurite, ko te toenga he iti noa iho te mate, he ngawari rānei. Heoi, i te iti o te rahi o te tauira, i puritia e mātou te tātaritanga whānui ahakoa te kaha o te KTC. Kua whakamahia e mātou he uara paepae e pai ana mō tā mātou tauira katoa, engari e whakaae ana mātou ka tāpirihia pea he haruru (rerekētanga) ki te ine me te whakaara ake i ngā āwangawanga mō te taea te whakaputa anō i te ine. Ko te taea te whakaputa anō i ngā inenga e whakawhirinaki ana ki te kaha o te KTC, e whakaaturia ana e Kreps, Gustafsson et al. 18,26. Nō reira, e tino taunaki ana mātou kia whakaarohia e ngā rangahau ā muri ake nei ngā wāhanga rerekē o te mate me te aromatawai i ngā pūwāhi tapahi pai mō te ahunga whakamua tika.
Hei whakamutunga, he mea tino nui te kitenga wawe i te whanaketanga kia taea ai te whakarato maimoatanga wā tika hei aukati i te whanaketanga (mā te hononga whakawhiti)38 me te āwhina ki te tiaki i te tirohanga me te kounga o te oranga o ā mātou tūroro.34 Ko te whāinga matua o tā mātou mahi he whakaatu he pai ake te mahi a EleBmax, i whakaritea ki te radius BFS kotahi i waenga i ngā inenga wā, i a EleBmax tonu. He nui ake te motuhaketanga me te whai huatanga o tēnei tawhā ki te whakataurite ki a EleBmax, ko tētahi o ngā tawhā tino tairongo (nō reira ko te pai o te tirotiro) ā, nō reira he tohu koiora whanaketanga wawe pea. He tino taunaki kia waihangahia he taupū maha-tawhā. Me whakauru ngā rangahau ā muri ake nei e uru ana ki te tātari whanaketanga maha-taurangi ki a AdjEleBmax.
Kāore ngā kaituhi e whiwhi tautoko pūtea mō te rangahau, te kaituhi me/ranei te whakaputanga o tēnei tuhinga.
Ko Margarida Ribeiro rāua ko Claudia Barbosa ngā kaituhi o te rangahau. Kāore he taupatupatu pānga o ngā kaituhi i roto i tēnei mahi.
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