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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, wazaka 3*Claudia Barbosa, wazaka 3*2 Bio Faculty of Medicine – Faculty of Medicine ya University of Porto, Porto, Portugal 3 Faculty of Medicine ya University of Porto, Porto, Portugal;4Dipatimenti ya Opaleshoni ndi Physiology, Faculty of Medicine, University of Porto, Porto, Portugal4 Dipatimenti ya Opaleshoni ndi Physiology, Faculty of Medicine, University of Porto, Porto, Portugal *Olemba awa adathandiziranso ntchito imeneyi.Hernâni Monteiro Porto, 4200-319, Portugal, imelo [email protected] Cholinga: Tinayesa malo ozungulira cornea omwe adasinthidwa kuti agwirizane ndi Best Fit Sphere Back (BFSB) yomweyi pakati pa miyeso ya nthawi (AdjEleBmax) ndi BFSB radius (BFSBR). Kutalika kwakukulu komweko kunagwiritsidwa ntchito ngati chizindikiro chatsopano cha tomographic kuti alembe kupita patsogolo kwa kukula ndikuyerekeza ndi magawo odalirika a keratoconus progression (KK). Zotsatira. Tinayesa Kmax, D index, posterior curvature radius, ndi cutoff point yoyenera kuchokera ku 3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, ndi AdjEleBmax ngati magawo odziyimira pawokha kuti tilembe kupita patsogolo kwa KC (kutanthauzidwa ngati zosintha ziwiri kapena zingapo), tinapeza kuti 70%, 82%, 79%, 65%, 51%, ndi 63%, ndi 91%, 98%, 80%, 73%, 80%, ndi 84% zenizeni zodziwira kupita patsogolo kwa KC. . Malo omwe ali pansi pa curve (AUC) pa variable iliyonse anali 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, motsatana. Kutsiliza: Poyerekeza ndi EleBmax popanda kusintha kulikonse, AdjEleBmax ili ndi specificity yapamwamba, AUC yapamwamba komanso magwiridwe antchito abwino okhala ndi sensitivity yofanana. AUC. Popeza mawonekedwe a pamwamba pa diso ndi ozungulira komanso opindika kuposa pamwamba pa diso, zomwe zingathandize kuzindikira kusintha, tikupangira kuti tiphatikizepo AdjEleBmax poyesa kupita patsogolo kwa KC pamodzi ndi zinthu zina kuti tiwongolere kudalirika kwa kuwunika kwathu kwachipatala komanso kuzindikira koyambirira. Mawu ofunikira: keratoconus, cornea, kupita patsogolo, mawonekedwe abwino kwambiri a dorsal dorsal, kutalika kwakukulu kwa pamwamba pa diso la cornea.
Keratoconus (KK) ndiye matenda ofala kwambiri a primary corneal ectasia. Tsopano akuonedwa kuti ndi matenda a bilateral (ngakhale asymmetric) omwe amakula nthawi zonse omwe amachititsa kusintha kwa kapangidwe kake kutsatiridwa ndi kuchepa kwa stromal ndi zipsera. 1,2 Mwachipatala, odwala amakhala ndi astigmatism yosakhazikika komanso myopia, photophobia, ndi/kapena monocular diplopia yokhala ndi vuto la masomphenya, maximally corrected visual acuity (BCVA) komanso moyo wawo umakhala wochepa. 3,4 Zizindikiro za RP nthawi zambiri zimayamba m'zaka khumi zachiwiri za moyo ndipo zimapita ku zaka khumi zachinayi, kutsatiridwa ndi kukhazikika kwachipatala. Chiwopsezo ndi kuchuluka kwa kupita patsogolo kumakhala kwakukulu mwa anthu osakwana zaka 19. 5.6
Ngakhale kuti palibe mankhwala enieni omwe alipo, chithandizo cha keratoconus cha maso chili ndi zolinga ziwiri zofunika: kukonza magwiridwe antchito a maso ndikuletsa kukula kwa kukula. 7,8 Choyamba chikhoza kuwoneka m'magalasi, magalasi olumikizana olimba kapena osasunthika, mphete zamkati mwa cornea, kapena m'ma transplantation a cornea pamene matendawa ali oopsa kwambiri. 9 Cholinga chomaliza ndi njira yopatulika ya mankhwala awa a odwala, omwe pakadali pano amatha kupezeka kudzera mu crosslinking. Opaleshoniyi imapangitsa kuti cornea ikule bwino komanso kulimba kwake kukhale kotetezeka. 10-13 Ngakhale izi zitha kuchitika pagawo lililonse la matendawa, phindu lalikulu limapezeka m'magawo oyamba. 14 Kuyesetsa kuzindikira kupita patsogolo msanga ndikupewa kuwonongeka kwina, komanso kupewa chithandizo chosafunikira kwa odwala ena, potero kuchepetsa chiopsezo cha zovuta zina monga matenda, kutayika kwa maselo a endothelial, ndi ululu waukulu pambuyo pa opaleshoni. 15.16
Ngakhale kuti maphunziro angapo cholinga chake chinali kufotokoza ndi kuzindikira kupita patsogolo, 17-19 palibe tanthauzo lokhazikika la kupita patsogolo kwa kukula kapena njira yokhazikika yolembera. 9,20,21 Mu Global Consensus on Keratoconus and Dilated Diseases (2015), kupita patsogolo kwa keratoconus kumatanthauzidwa ngati kusintha kotsatizana m'magawo awiri otsatirawa: kukwera kwa cornea anterior, kukwera kwa cornea posterior, kupyapyala ndi/kapena makulidwe a cornea Kuchuluka kwa kusintha kumawonjezeka kuchokera kuzungulira mpaka pamalo owonda kwambiri. 9 Komabe, tanthauzo lenileni la kupita patsogolo likufunikanso. Kuyesetsa kwachitika kuti papezeke zinthu zolimba kwambiri kuti zizindikire ndikufotokozera kupita patsogolo. 19:22–24
Popeza mawonekedwe a pamwamba pa cornea ya kumbuyo, yomwe ndi yozungulira komanso yokhota kuposa pamwamba, ingakhale yothandiza pozindikira kusintha,25 cholinga chachikulu cha kafukufukuyu chinali kuwunika mawonekedwe a ngodya yayikulu kwambiri ya posterior cornea elevation. idasinthidwa kukhala malo omwewo oyenera. Muyeso wa nthawi (BFSB) (AdjEleBmax) ndi BFSB radius (BFSBR) zokha zidagwira ntchito ngati magawo atsopano olembera kupita patsogolo kwa dilation ndikuziyerekeza ndi magawo omwe amagwiritsidwa ntchito kwambiri pa kupita patsogolo kwa KC.
Maso okwana 113 a odwala 76 otsatizana omwe adapezeka ndi keratoconus adawunikidwa mu kafukufukuyu wofufuza za m'mbuyo ku Dipatimenti ya Ophthalmology ku Chipatala Chapakati cha Yunivesite ya São João, ku Portugal. Kafukufukuyu adavomerezedwa ndi komiti ya makhalidwe abwino ya Centro Hospitalar Universitarário de São João/Faculdade de Medicina da Universidade do Porto ndipo adachitika motsatira Chikalata cha Helsinki. Chilolezo cholembedwa chochokera kwa ophunzira onse chinaperekedwa ndipo, ngati wophunzirayo ali ndi zaka zosakwana 16, kuchokera kwa kholo ndi/kapena womusamalira mwalamulo.
Odwala omwe ali ndi KC azaka zapakati pa 14 ndi 30 adazindikirika ndipo adaphatikizidwa motsatizana mu kafukufuku wathu wa maso ndi cornea kuyambira Okutobala mpaka Disembala 2021.
Odwala onse osankhidwa anatsatiridwa kwa chaka chimodzi ndi katswiri wa cornea ndipo anayesedwa katatu ndi Scheimpflug tomographic (Pentacam®; Oculus, Wetzlar, Germany). Odwalawo anasiya kuvala ma contact lens osachepera maola 48 musanayambe kuyeza. Miyeso yonse inachitidwa ndi dokotala wodziwa bwino mafupa ndipo ma scan okha ndi omwe anayesedwa kuti "Chabwino" anaphatikizidwa. Ngati kuwunika kwa chithunzi chokha sikunalembedwe kuti "Chabwino", mayesowo adzabwerezedwanso. Ma scan awiri okha pa diso lililonse adawunikidwa kuti azindikire kupita patsogolo, ndipo awiriawiri aliwonse adalekanitsidwa ndi miyezi 12 ± 3. Maso omwe ali ndi subclinical KC nawonso adaphatikizidwa (m'mikhalidwe iyi, diso linalo liyenera kuti linawonetsa zizindikiro zomveka bwino za clinical KC).
Sitinaphatikizepo maso a KC omwe adachitidwa opaleshoni ya maso kale (kulumikizana kwa corneal, mphete za corneal, kapena kuikidwa kwa cornea) ndi maso omwe ali ndi matenda opitilira muyeso (kukhuthala kwa cornea pa thinnest <350 µm, hydrokeratosis, kapena zipsera zakuya za cornea) chifukwa gululo limalephera "Chabwino" pambuyo pofufuza momwe zinthu zilili mkati mwa scan.
Deta ya anthu, yachipatala ndi ya tomographic inasonkhanitsidwa kuti iwunikidwe. Kuti tipeze kupita patsogolo kwa KC, tinasonkhanitsa zinthu zingapo za tomographic kuphatikizapo maximum corneal curvature (Kmax), mean corneal curvature (Km), flat meridial corneal curvature (K1), steepest meridial corneal curvature (K2), corneal astigmatism (Astig = K2 - K1). ), muyeso wocheperako wa makulidwe (PachyMin), maximum posterior corneal height (EleBmax), posterior radius of curvature (PRC) 3.0 mm pakati pa thinnest point, Belin/Ambrosio D-index (D-index), BFSBR ndi EleBmax zinasinthidwa kukhala BFSB (AdjEleBmax). Monga momwe tawonetsera pachithunzi 1, AdjEleBmax imapezeka titapeza pamanja BFSB radius yomweyo m'mayeso onse awiri a makina pogwiritsa ntchito BFSR value kuchokera ku chiyerekezo chachiwiri.
1. Kuyerekeza zithunzi za Pentacam® pamalo oyima kumbuyo ndi kupita patsogolo kwenikweni kwachipatala ndi nthawi ya miyezi 13 pakati pa mayeso. Mu gulu 1, EleBmax inali 68 µm pa mayeso oyamba ndi 66 µm pa yachiwiri, kotero panalibe kupita patsogolo mu parameter iyi. Ma radii abwino kwambiri ozungulira omwe amaperekedwa ndi makina pakuwunika kulikonse ndi 5.99 mm ndi 5.90 mm, motsatana. Ngati tidina batani la BFS, zenera lidzawonekera pomwe radius yatsopano ya BFS ingatanthauzidwe pamanja. Tinapeza radius yomweyo m'mayeso onse awiri pogwiritsa ntchito mtengo wachiwiri wa BFS radius (5.90mm). Mu gulu 2, mtengo watsopano wa EleBmax (EleBmaxAdj) wokonzedwa wa BFS yomweyo mu kuyesa koyamba ndi 59 µm, kusonyeza kuwonjezeka kwa 7 µm mu kuyesa kwachiwiri, kusonyeza kupita patsogolo malinga ndi malire athu a 7 µm.
Kuti tifufuze kupita patsogolo ndikuwunika momwe zinthu zatsopano zophunzirira zimagwirira ntchito, tidagwiritsa ntchito magawo omwe amagwiritsidwa ntchito kwambiri ngati zizindikiro zoyendera patsogolo (Kmax, Km, K2, Astig, PachyMin, PRC, ndi D-Index) komanso malire omwe afotokozedwa m'mabuku. Ngakhale kuti si zoona zenizeni). Gome 1 limalemba ma values ​​​​omwe akuyimira kupita patsogolo kwa gawo lililonse losanthula. Kupita patsogolo kwa KC kunatanthauzidwa pamene zinthu ziwiri zomwe zaphunziridwazo zatsimikizira kupita patsogolo.
Gome 1 Magawo a Tomographic nthawi zambiri amavomerezedwa ngati zizindikiro za kupita patsogolo kwa kupita patsogolo kwa RP ndi malire ofanana omwe afotokozedwa m'mabuku (ngakhale sanatsimikizidwe)
Mu kafukufukuyu, magwiridwe antchito a zinthu zitatu adayesedwa kuti aone ngati zikuyenda bwino (EleBmax, BFSB, ndi AdjEleBmax) kutengera kupezeka kwa zinthu zina ziwiri kapena kuposerapo. Magawo oyenera a zinthuzi adawerengedwa ndikuyerekezeredwa ndi zinthu zina.
Kusanthula kwa ziwerengero kunachitika pogwiritsa ntchito pulogalamu ya ziwerengero ya SPSS (mtundu 27.0 wa Mac OS; SPSS Inc., Chicago, IL, USA). Makhalidwe a zitsanzo amafupikitsidwa ndipo deta imaperekedwa ngati manambala ndi magawo a zosintha zamagulu. Zosintha zopitilira zimafotokozedwa ngati kusiyana kwapakati ndi kokhazikika (kapena kusiyana kwapakati ndi pakati pa ma quartile pamene kugawa kwasokonekera). Kusintha kwa index ya keratometric kunapezeka pochotsa mtengo woyambirira kuchokera muyeso wachiwiri (mwachitsanzo, mtengo wabwino wa delta umasonyeza kuwonjezeka kwa mtengo wa parameter inayake). Mayeso a parametric ndi non-parametric adachitidwa kuti ayese kugawa kwa zosintha za corneal curvature zomwe zimagawidwa ngati zopitilira kapena zosapitilira, kuphatikiza mayeso odziyimira pawokha a t, mayeso a Mann-Whitney U, mayeso a chi-square, ndi mayeso enieni a Fisher (ngati pakufunika). Mlingo wa kufunika kwa ziwerengero unayikidwa pa 0.05. Kuti tiwone momwe Kmax, D-index, PRC, BFSBR, EleBmax, ndi AdjEleBmax imagwirira ntchito ngati zoneneratu za kupita patsogolo kwa munthu payekha, tinapanga ma curve ogwirira ntchito olandila (ROC) ndikuwerengera mfundo zabwino zodulira, kukhudzidwa, kutsimikizika, zabwino (PPV), ndi Negative Predictive Value (NPV). ) ndi malo omwe ali pansi pa curve (AUC) pomwe zosintha ziwiri zosachepera zimadutsa malire ena (monga tafotokozera kale) kuti tigawa kupita patsogolo ngati kulamulira.
Odwala 76 omwe anali ndi RP onse anaphatikizidwa mu kafukufukuyu. Odwala ambiri anali amuna (n=87, 77%) ndipo zaka zapakati pa mayeso oyamba zinali 24.09 ± 3.93. Ponena za kugawa kwa KC kutengera kuwonjezeka kwa kupotoka konse kwa Belin/Ambrosio (BAD-D index), ambiri (n=68, 60.2%) a maso anali apakati. Ofufuzawo anasankha mogwirizana mtengo wodulidwa wa 7.0 ndipo anasiyanitsa pakati pa keratoconus yofatsa ndi yocheperako malinga ndi mabuku26. Komabe, kusanthula konseko kumaphatikizapo chitsanzo chonse. Makhalidwe a anthu, azachipatala ndi tomographic a chitsanzocho, kuphatikiza pakati, osachepera, apamwamba, kupotoka kokhazikika (SD) ndi miyeso yokhala ndi 95% confidence intervals (IC95%), komanso miyeso yoyamba ndi yachiwiri. Kusiyana pakati pa miyeso pambuyo pa miyezi 12 ± 3 kungapezeke mu tebulo 2.
Gome 2. Makhalidwe a anthu, matenda ndi mawonekedwe a odwala. Zotsatira zake zimafotokozedwa ngati apakati ± kupotoka kokhazikika kwa zinthu zosalekeza (*zotsatira zake zimafotokozedwa ngati apakati ± IQR), 95% nthawi yodzidalira (95% CI), amuna ndi diso lamanja zimafotokozedwa ngati chiwerengero ndi peresenti
Gome 3 likuwonetsa chiwerengero cha maso omwe agawidwa ngati ma progressor poganizira parameter iliyonse ya tomographic (Kmax, Km, K2, Astig, PachyMin, PRC ndi D-Index) padera. Poganizira kupita patsogolo kwa KC, komwe kumatanthauzidwa ndi kusintha komwe kwawonedwa m'masinthidwe awiri a tomographic, maso 57 (50.4%) adawonetsa kupita patsogolo.
Gome 3 Chiwerengero ndi kuchuluka kwa maso omwe amagawidwa ngati ma progressor, poganizira gawo lililonse la tomographic padera
Kmax, D-index, PRC, EleBmax, BFSB, ndi AdjEleBmax scores monga zoneneratu zodziyimira pawokha za kupita patsogolo kwa KC zikuwonetsedwa mu Gome 4. Mwachitsanzo, ngati titafotokoza mtengo wowonjezera wa Kmax ndi 1 diopter (D) kuti tizindikire kupita patsogolo, ngakhale kuti gawoli likuwonetsa kukhudzidwa kwa 49%, lili ndi kutsimikizika kwa 100% (zochitika zonse zomwe zadziwika kuti zikupita patsogolo pa gawoli zinali zoona). opitilira pamwambapa) okhala ndi kutsimikizika kwabwino (PPV) kwa 100%, kutsimikizika kwa negative (NPV) kwa 66%, ndi dera lomwe lili pansi pa curve (AUC) kwa 0.822. Komabe, kuwerengera koyenera kwa kmax kunali 0.4, kupereka kukhudzidwa kwa 70%, kutsimikizika kwa 91%, PPV ya 89%, ndi NPV ya 75%.
Gome 4 Kmax, D-Index, PRC, BFSB, EleBmax, ndi AdjEleBmax scores monga zodziwira za kupita patsogolo kwa KC (zomwe zimatanthauzidwa ngati kusintha kwakukulu mu zosintha ziwiri kapena zingapo)
Ponena za D index, malo abwino odulira ndi 0.435, kukhudzidwa ndi 82%, kudziwika ndi 98%, PPV ndi 94%, NPV ndi 84%, ndipo AUC ndi 0.927. Tatsimikiza kuti mwa maso 50 omwe adapita patsogolo, odwala atatu okha ndi omwe sanapite patsogolo pa magawo ena awiri kapena kuposerapo. Mwa maso 63 omwe D index sinapite patsogolo, 10 (15.9%) adawonetsa kupita patsogolo m'magawo ena osachepera awiri.
Kwa PRC, njira yabwino kwambiri yodziwira kupita patsogolo inali kuchepa kwa 0.065 ndi kukhudzidwa kwa 79%, kudziwika kwa 80%, PPV ya 80%, NPV ya 79%, ndi AUC ya 0.844.
Ponena za kukwera kwa pamwamba (EleBmax), malire oyenera odziwira kupita patsogolo anali kuwonjezeka kwa 2.5 µm ndi kukhudzidwa kwa 65% ndi kutsimikizika kwa 73%. Atasinthidwa ku BSFB yachiwiri yoyesedwa, kukhudzidwa kwa gawo latsopano la AdjEleBmax kunali 63% ndipo kutsimikizika kunakula ndi 84% ndi mfundo yoyenera yodulidwa ya 6.5 µm. BFSB yokha inawonetsa kudulidwa kwangwiro kwa 0.05 mm ndi kukhudzidwa kwa 51% ndi kutsimikizika kwa 80%.
Pa chithunzi 2 chikuwonetsa ma curve a ROC a chilichonse mwa magawo oyerekeza a tomographic (Kmax, D-Index, PRC, EleBmax, BFSB ndi AdjEleBmax). Tikuwona kuti D-index ndi mayeso ogwira mtima kwambiri okhala ndi AUC yapamwamba (0.927) kutsatiridwa ndi PRC ndi Kmax. AUC EleBmax ndi 0.690. Atasinthidwa kuti agwirizane ndi BFSB, makonda awa (AdjEleBmax) adasintha magwiridwe antchito ake pokulitsa AUC kufika pa 0.754. BFSB yokha ili ndi AUC ya 0.690.
Chithunzi 2. Ma curve a magwiridwe antchito a Receiver (ROC) akuwonetsa kuti kugwiritsa ntchito D index kuti adziwe kupita patsogolo kwa keratoconus kunapeza milingo yayikulu ya sensitivity ndi specificity, kutsatiridwa ndi PRC ndi Kmax. AdjEleBmax imaonedwabe kuti ndi yoyenera komanso nthawi zambiri ndi yabwino kuposa Elebmax popanda BFSB tuning.
Mafupikitsidwe: Kmax, kupindika kwakukulu kwa cornea; D-index, Belin/Ambrosio D-index; PRC, utali wa kumbuyo wopindika kuchokera pa 3.0 mm pakati pa mfundo yopyapyala kwambiri; BFSB, yoyenera bwino kumbuyo kozungulira; Kutalika; AdjELEBmax, ngodya yapamwamba kwambiri. pamwamba pa cornea pasinthidwa kukhala durumu yoyenera kwambiri.
Poganizira za EleBmax, BFSB, ndi AdjEleBmax, motsatana, tatsimikiza kuti maso 53 (46.9%), 40 (35.3%), ndi 45 (39.8%) adawonetsa kupita patsogolo kwa chizindikiro chilichonse chosiyana, motsatana. Mwa maso awa, 16 (30.2%), 11 (27.5%), ndi 9 (45%), motsatana, analibe kupita patsogolo kwenikweni monga momwe tafotokozera ndi magawo ena osachepera awiri. Mwa maso 60 omwe EleBmax sanawonedwe kuti akupita patsogolo, maso 20 (33%) anali kupita patsogolo pa magawo ena awiri kapena kuposerapo. Maso makumi awiri mphambu asanu ndi atatu (38.4%) ndi 21 (30.9%) adawonedwa kuti sakupita patsogolo malinga ndi BFSB ndi AdjEleBmax okha, motsatana, kusonyeza kupita patsogolo kwenikweni.
Tikufuna kufufuza momwe BFSB imagwirira ntchito komanso, chofunika kwambiri, kutalika kwa cornea komwe kumasinthidwa ndi BFSB (AdjEleBmax) ngati njira yatsopano yodziwira ndi kuzindikira kupita patsogolo kwa KC ndikuyerekeza ndi magawo ena a tomographic omwe amagwiritsidwa ntchito kwambiri ngati zizindikiro za kupita patsogolo. Kuyerekeza kunachitika ndi malire omwe adanenedwa m'mabuku (ngakhale sanatsimikizidwe), omwe ndi Kmax ndi D-Index.20
Poika EleBmax ku BFSB radius (AdjEleBmax), tinaona kuwonjezeka kwakukulu kwa specificity - 73% pa ​​parameter yosasinthidwa ndi 84% pa parameter yosinthidwa - popanda kukhudza sensitivity value (65% ndi 63%). Tinayesanso BFSB radius yokha ngati china chomwe chingasonyeze kupita patsogolo kwa dilatation. Komabe, sensitivity (51% vs 63%), specificity (80% vs 84%) ndi AUC (0.69 vs 0.75) ya parameter iyi zinali zochepa kuposa za AdjEleBmax.
Kmax ndi njira yodziwika bwino yodziwira kupita patsogolo kwa KC. 27 Palibe mgwirizano pa malire omalizira omwe ndi oyenera kwambiri. 12,28 Mu kafukufuku wathu, tinaganizira za kuwonjezeka kwa 1D kapena kuposerapo ngati tanthauzo la kupita patsogolo. Pa mlingo uwu, tinaona kuti odwala onse omwe adadziwika kuti akupita patsogolo adatsimikiziridwa ndi magawo ena awiri osachepera, zomwe zikusonyeza kuti ndi 100%. Komabe, kukhudzidwa kwake kunali kochepa (49%), ndipo kupita patsogolo sikunathe kuzindikirika m'maso 29. Komabe, mu kafukufuku wathu, malire abwino a Kmax anali 0.4 D, kukhudzidwa kunali 70%, ndipo kutsimikizika kunali 91%, zomwe zikutanthauza kuti ndi kuchepa pang'ono kwa kutsimikizika (kuchokera 100% mpaka 91%), tinasintha. Kukhudzidwa kunayambira 49% mpaka 70%. Komabe, kufunika kwachipatala kwa mlingo watsopanowu n'kokayikitsa. Malinga ndi kafukufuku wa Kreps wokhudza kubwerezabwereza kwa muyeso wa Pentacam®, kubwerezabwereza kwa Kmax kunali 0.61 mu khansa yofatsa ya catarrhal ndi 1.66 mu colpitis yapakati ya caesarean, 19 zomwe zikutanthauza kuti chiwerengero cha ziwerengero mu chitsanzo ichi sichili chofunikira kwambiri chifukwa chimafotokoza mkhalidwe wokhazikika. pamene kupita patsogolo kwakukulu komwe kungagwiritsidwe ntchito ku zitsanzo zina. Kmax, kumbali ina, imadziwika ndi kupindika kwa cornea ya anterior kwambiri ya dera laling'ono 29 ndipo silingathe kubwerezanso kusintha komwe kumachitika mu anterior cornea, posterior cornea, ndi madera ena a pachymetry. 30-32 Poyerekeza ndi magawo atsopano a posterior, AdjEleBmax inasonyeza kukhudzidwa kwakukulu (63% vs. 49%). Maso 20 opita patsogolo adazindikirika bwino pogwiritsa ntchito parameter iyi ndipo adaphonya pogwiritsa ntchito Kmax (poyerekeza ndi maso 12 opita patsogolo omwe adapezeka pogwiritsa ntchito Kmax m'malo mwa AdjEleBmax). Kupeza kumeneku kumathandizira mfundo yakuti pamwamba pa cornea ndi poterera ndipo pakukula kwambiri pakati poyerekeza ndi pamwamba, zomwe zingathandize kuzindikira kusintha. 25,32,33
Malinga ndi kafukufuku wina, D-index ndi gawo lokhalokha lomwe lili ndi kukhudzika kwakukulu (82%), kutsimikizika (95%) ndi AUC (0.927). 34 Kwenikweni, izi sizodabwitsa, popeza iyi ndi index ya multi-parameter. PRC inali yachiwiri yosinthika kwambiri (79%) kutsatiridwa ndi AdjEleBmax (63%). Monga tanenera kale, kukhudzika kwakukulu, kutsika kwa zolakwika zochepa komanso magawo owunikira amakula bwino. 35 Chifukwa chake, tikupangira kugwiritsa ntchito AdjEleBmax (yokhala ndi cutoff ya 7 µm pakupitilira m'malo mwa 6.5 µm popeza sikelo ya digito yomangidwa mu Pentacam® sikuphatikiza malo a decimal a parameter iyi) m'malo mwa EleBmax yosakonzedwa, yomwe idzaphatikizidwa pamodzi ndi zosintha zina poyesa. kupita patsogolo kwa keratoconus kuti tiwongolere kudalirika kwa kuwunika kwathu kwachipatala komanso kuzindikira koyambirira kwa kupita patsogolo.
Komabe, kafukufuku wathu akukumana ndi zofooka zina. Choyamba, tidagwiritsa ntchito magawo ojambulira a tomographic shapeflug kuti tifotokoze ndikuyesa kupita patsogolo, koma njira zina zilipo pakadali pano, monga kusanthula kwa biomechanical, komwe kungayambitse kusintha kulikonse kwa topographic kapena tomographic. 36 Chachiwiri, timagwiritsa ntchito muyeso umodzi wa magawo onse oyesedwa ndipo, malinga ndi Ivo Guber et al., avareji pazithunzi zingapo imabweretsa phokoso lochepa. 28 Ngakhale kuti miyeso ndi Pentacam® inali yobwerezedwanso bwino m'maso abwinobwino, inali yotsika m'maso yokhala ndi zolakwika za cornea ndi cornea ectasia. 37 Mu kafukufukuyu, tidaphatikiza maso okha omwe ali ndi Pentacam® yomangidwa mkati yotsimikizira bwino kwambiri, zomwe zikutanthauza kuti matenda apamwamba sanathe. 17 Chachitatu, timafotokoza ma progressor enieni ngati omwe ali ndi magawo awiri kutengera mabuku koma sanatsimikizidwebe. Pomaliza, ndipo mwina chofunika kwambiri, kusiyana kwa miyeso ya Pentacam® ndikofunikira kwambiri pakuwunika kupita patsogolo kwa keratoconus. 18,26 Mu chitsanzo chathu cha maso 113, pamene adagawidwa motsatira BAD-D score, maso ambiri (n=68, 60.2%) anali ochepa, ndipo otsalawo anali osawoneka bwino kapena ochepa. Komabe, poganizira kukula kwa chitsanzo chochepa, tinasunga kusanthula konse mosasamala kanthu za kuopsa kwa KTC. Tagwiritsa ntchito mtengo wocheperako womwe ndi wabwino kwambiri pa chitsanzo chathu chonse, koma tikuvomereza kuti izi zitha kuwonjezera phokoso (kusintha) pa muyeso ndikubweretsa nkhawa za kubwerezabwereza kwa muyeso. Kubwerezabwereza kwa muyeso kumadalira kuopsa kwa KTC, monga momwe Kreps, Gustafsson et al. 18,26 akusonyezera. Chifukwa chake, tikulimbikitsa kwambiri kuti maphunziro amtsogolo aziganizira magawo osiyanasiyana a matendawa ndikuwunika malo oyenera oti apitirire patsogolo.
Pomaliza, kuzindikira msanga kupita patsogolo ndikofunikira kwambiri kuti tipereke chithandizo chanthawi yake kuti tiletse kupita patsogolo (kudzera mu cross-linking)38 ndikuthandizira kusunga masomphenya ndi moyo wabwino mwa odwala athu.34 Cholinga chachikulu cha ntchito yathu ndikuwonetsa kuti EleBmax, yolumikizidwa ku BFS radius yomweyo pakati pa kuyeza nthawi, ili ndi magwiridwe antchito abwino kuposa EleBmax yokha. Gawoli likuwonetsa kutsimikizika kwakukulu komanso kugwira ntchito bwino poyerekeza ndi EleBmax, ndi limodzi mwa magawo ofunikira kwambiri (ndipo motero ndi luso labwino kwambiri lowunikira) motero ndi chizindikiro cha kukula koyambirira. Ndikofunikira kwambiri kupanga ma index a multi-parameter. Maphunziro amtsogolo okhudzana ndi kusanthula kupita patsogolo kwa multivariate ayenera kuphatikizapo AdjEleBmax.
Olembawo salandira thandizo lililonse la ndalama pa kafukufuku, kulemba ndi/kapena kufalitsa nkhaniyi.
Margarida Ribeiro ndi Claudia Barbosa ndi olemba nawo kafukufukuyu. Olembawo sananene kuti pali kusiyana kulikonse pakati pa chidwi ndi ntchito imeneyi.
1. Krachmer JH, Feder RS, Belin MV Keratoconus ndi matenda ena ofanana ndi amenewa omwe si otupa a corneal thinning. Survival ophthalmology. 1984;28(4):293–322. Unduna wa Zamkati: 10.1016/0039-6257(84)90094-8
2. Rabinovich Yu.S. Keratoconus. Survival ophthalmology. 1998;42(4):297–319. doi: 10.1016/S0039-6257(97)00119-7
3. Tambe DS, Ivarsen A., Hjortdal J. Kuchotsa khungu losagwira ntchito pogwiritsa ntchito njira yochotsera khungu la khungu la khungu. Vutoli ndi la maso. 2015;6(2):260–268. Ofesi ya kunyumba: 10.1159/000431306
4. Kymes SM, Walline JJ, Zadnik K, Sterling J, Gordon MO, Kuwunika Kogwirizana kwa Kafukufuku wa Keratoconus G. Kusintha kwa moyo wa odwala omwe ali ndi keratoconus. Ndine 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 Kusintha kwa nthawi yayitali pakupindika kwa cornea mu 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 Kupita patsogolo kwachilengedwe kwa keratoconus: kuwunikanso mwadongosolo ndi kusanthula kwa meta kwa maso 11,529. ophthalmology. 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 yochizira keratoconus. Oftalmol Ter. 2017;6(2):245–262. doi: 10.1007/s40123-017-0099-1
8. Madeira S, Vasquez A, Beato J, ndi ena. Kulumikizana kwa Transepithelial kwa corneal collagen motsutsana ndi kulumikizana kwachikhalidwe mwa odwala omwe ali ndi keratoconus: kafukufuku wofananiza. Clinical ophthalmology. 2019;13:445–452. doi:10.2147/OPTH.S189183
9. Gomez JA, Tan D., Rapuano SJ ndi ena. Mgwirizano wapadziko lonse pa matenda a keratoconus ndi dilated disease. 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: zotsatira za zaka ziwiri. Clinical ophthalmology. 2020; 14:2329–2337. doi: 10.2147/OPTH.S252940
11. Wollensak G, Spoerl E, Seiler T. Riboflavin/UV-induced collagen cross-linking yochizira keratoconus. Ine ndine Jay Oftalmol. 2003;135(5):620–627. doi: 10.1016/S0002-9394(02)02220-1