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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, ane makore matatu*Claudia Barbosa, ane makore matatu*2 Bio Faculty of Medicine – Faculty of Medicine yeYunivhesiti yePorto, Porto, Portugal 3 Faculty of Medicine yeYunivhesiti yePorto, Porto, Portugal;4Dhipatimendi reKuvhiya neFiziyoloji, Dhipatimendi reMishonga, Yunivhesiti yePorto, Porto, Portugal4 Dhipatimendi reKuvhiya neFiziyoloji, Dhipatimendi reMishonga, Yunivhesiti yePorto, Porto, Portugal *Vanyori ava vakabatsira zvakaenzana mubasa iri.Hernâni Monteiro Porto, 4200-319, Portugal, email [email protected] Chinangwa: Takaongorora cornea posterior surface yakagadziriswa kuti ive neBest Fit Sphere Back (BFSB) yakafanana pakati pekuyera nguva (AdjEleBmax) uye BFSB radius (BFSBR). Kureba kwakanyanya kwakashandiswa se tomography parameter itsva kunyora kufambira mberi kwekuwedzera uye kuenzanisa neparamita dzakavimbika dze keratoconus progression (KK). Mhedzisiro. Takaongorora Kmax, D index, posterior curvature radius, uye ideal cutoff point kubva pa3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, uye AdjEleBmax sema parameter akazvimiririra ekunyora KC progression (yakatsanangurwa sema variable maviri kana anopfuura ), takawana sensitivities e70%, 82%, 79%, 65%, 51%, uye 63%, uye 91%, 98%, 80%, 73%, 80%, uye 84% specificities yekuona KC progression. . Nzvimbo iri pasi pecurve (AUC) ye variable yega yega yaive 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, zvichiteerana. Mhedziso: Kana tichienzanisa neEleBmax isina kugadziriswa, AdjEleBmax ine specificity yakakwira, AUC yakakwira uye performance iri nani ine sensitivity yakafanana. AUC. Sezvo chimiro chekumusoro kwemashure chakanyanya kutenderera uye chakakombama kupfuura chepamberi, izvo zvinogona kubatsira kuona shanduko, tinokurudzira kuisa AdjEleBmax mukuongorora kufambira mberi kweKC pamwe chete nezvimwe zvinhu kuti tivandudze kuvimbika kwekuongorora kwedu kwekiriniki uye kuona nekukurumidza. Mazwi akakosha: keratoconus, cornea, kufambira mberi, chimiro chakanakisa chedenderedzwa remusana, kureba kwakanyanya kwekumusoro kwemashure kwecornea.
Keratoconus (KK) ndiyo inonyanya kuoneka mu primary corneal ectasia. Iye zvino yava kuonekwa sechirwere chisingaperi chinokonzerwa nemativi maviri (kunyangwe chisina kuenzana) chinotungamira mukuchinja kwakawanda kwechimiro zvichiteverwa nekutetepa kwe stromal uye mavanga. 1,2 Pakurapa, varwere vanoonekwa vaine astigmatism isina kujairika uye myopia, photophobia, uye/kana monocular diplopia ine dambudziko rekuona, maximally corrected visual acuity (BCVA) uye hupenyu hwakaderera. 3,4 Zviratidzo zveRP zvinowanzotanga mumakore gumi echipiri ehupenyu uye zvinopfuurira kusvika kumakore gumi echina, zvichiteverwa nekugadzikana kwekiriniki. Njodzi uye mwero wekufambira mberi kwacho wakakwira muvanhu vari pasi pemakore gumi nemapfumbamwe ekuberekwa. 5.6
Kunyangwe pasina mushonga chaiwo, kurapwa kuri kuitwa pari zvino kwemaziso ekeratoconus kune zvinangwa zviviri zvakakosha: kuvandudza mashandiro ekuona uye kumisa kufambira mberi kwekukura. 7,8 Yekutanga inogona kuonekwa mumagirazi, magirazi ekuonana akaomarara kana kuti akaomarara, mhete dzemukati memusoro, kana mukuisirwa cornea kana chirwere chacho chakanyanya kuoma. 9 Chinangwa chekupedzisira ndicho chinhu chitsvene chekurapa uku kwevarwere, pari zvino chinongowanikwa chete kuburikidza nekubatanidza cornea. Kuvhiya uku kunotungamira mukuwedzera kwekusagadzikana kwebiomechanical uye kuomarara kwecornea uye kudzivirira kufambira mberi. 10-13 Kunyangwe izvi zvichigona kuitwa padanho ripi zvaro rechirwere, kubatsirwa kukuru kunowanikwa mumatanho ekutanga. 14 Kuedza kunofanirwa kuitwa kuti paonekwe kufambira mberi nekukurumidza uye kudzivirira kuora kwakanyanya, uye kudzivirira kurapwa kusingakoshi kwevamwe varwere, nokudaro zvichideredza njodzi yezvinetso zvakasiyana-siyana zvakaita sehutachiona, kurasikirwa nemasero e endothelial, uye kurwadziwa kwakanyanya mushure mekuvhiyiwa. 15.16
Pasinei nezvidzidzo zvakati wandei zvakanangana nekutsanangura nekuona kufambira mberi,17-19 hapasati pave netsananguro yakatsiga yekufambira mberi kwekuwedzera kana nzira yakajairika yekunyora.9,20,21 MuGlobal Consensus on Keratoconus and Dilated Diseases (2015), kufambira mberi kwekeratoconus kunotsanangurwa sekuchinja kwakatevedzana mune zvingangoita zviviri zvezvinotevera: anterior corneal steepening, posterior cornea steepening, kutetepa uye/kana ukobvu hwecornea. Mwero wekuchinja unowedzera kubva pamuganhu kusvika panzvimbo yakatetepa.9 Zvisinei, tsananguro chaiyo yekufambira mberi ichiri kudiwa. Kuedza kwakaitwa kuti pave nezvinoshanduka zvakasimba kuti zvionekwe uye kutsanangura kufambira mberi.19:22–24
Zvichienderana nekuti chimiro cheposterior cornea pamusoro, iyo iri aspherical uye yakakombama kupfuura pamusoro wepamberi, chingave chinobatsira pakuona shanduko,25 chinangwa chikuru chechidzidzo ichi chaive chekuongorora hunhu hwemaximum posterior cornea elevation angle. yakagadziriswa kune imwe nzvimbo yakakodzera. Kuyerwa kwenguva (BFSB) (AdjEleBmax) uye BFSB radius (BFSBR) chete zvakashanda sema parameter matsva ekurekodha kufambira mberi kwe dilation uye zvakaenzaniswa nema parameter anoshandiswa zvakanyanya pakufambira mberi kweKC.
Maziso evarwere 76 vakatevedzana vakaonekwa vaine keratoconus akaongororwa muongororo iyi yeboka rezvekumashure paDhipatimendi reOphthalmology paCentral Hospital yeYunivhesiti yeSão João, Portugal. Chidzidzo ichi chakatenderwa nekomiti yetsika dzemunharaunda yeCentro Hospitalar Universitarário de São João/Faculdade de Medicina da Universidade do Porto uye chakaitwa zvichienderana neDeclaration of Helsinki. Mvumo yakanyorwa yakawanikwa kubva kune vese vatori vechikamu uye, kana vatori vechikamu vari pasi pemakore gumi nematanhatu, kubva kumubereki uye/kana muchengeti wepamutemo.
Varwere vane KC vane makore ari pakati pe14 ne30 vakaonekwa uye vakaverengerwa muongororo yedu yemaziso ne corneal pakati paGumiguru-Zvita 2021.
Varwere vese vakasarudzwa vakateverwa kwegore rimwe nachiremba we cornea uye vakaongororwa katatu keScheimpflug tomographic (Pentacam®; Oculus, Wetzlar, Germany). Varwere vakarega kupfeka ma contact lenses maawa makumi mana nemasere vasati vaongororwa. Kuongororwa kwese kwakaitwa nachiremba wemapfupa akadzidziswa uye kuskena chete nekutarisa kwehunhu hwe "OK" ndiko kwakabatanidzwa. Kana kuongororwa kwehunhu hwemufananidzo otomatiki kusina kunyorwa kuti "OK", bvunzo yacho ichadzokororwa. Kuskena kuviri chete kweziso rega rega kwakaongororwa kuti kuone kufambira mberi, uye peya yega yega yakaparadzaniswa nemwedzi gumi nemaviri ± mitatu. Maziso ane subclinical KC akaverengerwawo (muzviitiko izvi, rimwe ziso rinofanira kunge rakaratidza zviratidzo zvakajeka zve clinical KC).
Hatina kubvisa muongororo yemaziso eKC akambovhiyiwa maziso (corneal crosslinking, corneal rings, kana transplant cornea) uye maziso ane chirwere chakanyanya kukura (corneal thinnest <350 µm, hydrokeratosis, kana deep cornea scarring) sezvo boka iri richiramba richikundikana "OK" mushure mekuongororwa kwemukati mekuongorora kwemhando.
Data rehuwandu hwevanhu, rekiriniki uye rematomografi rakaunganidzwa kuti riongororwe. Kuti tione kufambira mberi kweKC, takaunganidza zvinhu zvakasiyana-siyana zvinosanganisira maximum corneal curvature (Kmax), mean corneal curvature (Km), flat meridial corneal curvature (K1), steepest meridial corneal curvature (K2), corneal astigmatism (Astig = K2 – K1). ), minimum thickness measurement (PachyMin), maximum posterior corneal height (EleBmax), posterior radius of curvature (PRC) 3.0 mm centered on thinnest point, Belin/Ambrosio D-index (D-index), BFSBR neEleBmax zvakagadziriswa kuBFSB (AdjEleBmax). Sezvakaratidzwa mumufananidzo 1, AdjEleBmax inowanikwa mushure mekunge tawana nemaoko BFSB radius yakafanana mumiedzo yese yemuchina tichishandisa BFSR value kubva kuestimate yechipiri.
Mupunga. 1. Kuenzanisa mifananidzo yePentacam® iri panzvimbo yakatwasuka nekumashure kwakanyatsogadzirwa nekufambira mberi kwekiriniki nemwedzi gumi nemitatu pakati pebvunzo. Mupanera 1, EleBmax yaive 68 µm pabvunzo yekutanga uye 66 µm payechipiri, saka pakanga pasina kufambira mberi muparameter iyi. Mahara esphere akanakisa anopiwa otomatiki nemuchina pakuongorora kwega kwega i5.99 mm uye 5.90 mm, zvichiteerana. Kana tikadzvanya bhatani reBFS, hwindo richaonekwa apo radius itsva yeBFS inogona kutsanangurwa nemaoko. Takaona radius imwechete mumiedzo yese tichishandisa chiyero chechipiri cheBFS chakayerwa (5.90mm). Mupanera 2, kukosha kutsva kweEleBmax (EleBmaxAdj) kwakagadziriswa kweBFS imwechete mukuongorora kwekutanga i59 µm, zvichiratidza kuwedzera kwe7 µm mukuongorora kwechipiri, zvichiratidza kufambira mberi zvichienderana nechiyero chedu che7 µm.
Kuti tiongorore kufambira mberi uye kuongorora kushanda kwezviyero zvitsva zvekudzidza, takashandisa maparamita anowanzo shandiswa sezviratidzo zvekufambira mberi (Kmax, Km, K2, Astig, PachyMin, PRC, uye D-Index) pamwe chete nematanho akatsanangurwa mumabhuku. kunyangwe zvisiri zvekuyedza). Tafura 1 inonyora mavalues ​​​​anomiririra kufambira mberi kweparamita yega yega yekuongorora. Kufambira mberi kweKC kwakatsanangurwa apo zvingangoita zviviri zvezviyero zvakadzidzwa zvakasimbisa kufambira mberi.
Tafura 1. Ma parameter eTomographic anowanzo gamuchirwa sezviratidzo zvekufambira mberi kwekufambira mberi kweRP uye zvipingamupinyi zvinoenderana zvinotsanangurwa mumabhuku (kunyange zvisati zvasimbiswa)
Muchidzidzo ichi, kushanda kwezviyero zvitatu kwakaedzwa kuti zvionekwe kuti zvinofambira mberi sei (EleBmax, BFSB, uye AdjEleBmax) zvichibva pakuvapo kwekufambira mberi kwezviyero zviviri. Mapoinzi akakodzera ezvikamu izvi akaverengerwa uye akaenzaniswa nezvimwe.
Kuongororwa kwenhamba kwakaitwa uchishandisa SPSS statistical software (vhezheni 27.0 yeMac OS; SPSS Inc., Chicago, IL, USA). Hunhu hwemuenzaniso hunopfupikiswa uye data rinopihwa senhamba uye huwandu hwezvinhu zvakasiyana-siyana. Zvinhu zvinoramba zvichienderera mberi zvinotsanangurwa se mean uye standard deviation (kana median uye interquartile range kana distribution yakatsveyama). Shanduko mu keratometric index yakawanikwa nekubvisa kukosha kwekutanga kubva pakuyera kwechipiri (kureva, positive delta value inoratidza kuwedzera kwekukosha kweparameter yakati). Miedzo ye parametric ne non-parametric yakaitwa kuti iongorore kugoverwa kwe corneal curvature variables dzakarongwa se progressive kana non-progressive, kusanganisira independent-sample t-test, Mann-Whitney U-test, chi-square test, uye Fisher's exact test (kana zvichidikanwa). Level of statistical significance yakaiswa pa 0.05. Kuti tiongorore kushanda kweKmax, D-index, PRC, BFSBR, EleBmax, uye AdjEleBmax sezviratidziro zvekufambira mberi kwemunhu, takagadzira macurve ekushanda kwemugamuchiri (ROC) uye takaverenga ma cutoff points akakodzera, sensitivity, specificity, positive (PPV), uye Negative Predictive Value (NPV). ) uye nzvimbo iri pasi pecurve (AUC) kana zvinhu zviviri zvichipfuura mamwe ma thresholds (sezvakatsanangurwa kare) kuti tigadzire kufambira mberi sekutonga.
Maziso 113 evarwere 76 vane RP akabatanidzwa muchidzidzo ichi. Vazhinji vevarwere vaive varume (n=87, 77%) uye avhareji yezera pakutanga yaive makore 24.09 ± 3.93. Nezvekupatsanurwa kweKC zvichibva pakuwedzera kwehuwandu hweBelin/Ambrosio dilatation deviation (BAD-D index), ruzhinji (n=68, 60.2%) rwemaziso rwaive pakati nepakati. Vaongorori vakasarudza pamwe chete cut-off value ye7.0 uye vakasiyanisa pakati pe mild ne modern keratoconus zvichienderana nemabhuku26. Zvisinei, zvimwe zvese zvekuongorora zvinosanganisira sampuro yese. Hunhu hwedemographic, clinical uye tomographic yesample, kusanganisira avhareji, minimum, maximum, standard deviation (SD) uye zviyero zvine 95% confidence intervals (IC95%), pamwe nekuyera kwekutanga nechechipiri. Musiyano uripo pakati pemakoshero mushure memwedzi 12 ± 3 unogona kuwanikwa mutafura 2.
Tafura 2. Hunhu hwehuwandu hwevanhu, kliniki uye tomography yevarwere. Mhedzisiro inoratidzwa seavhareji ± kutsauka kwakajairika kwezviratidzo zvinoenderera mberi (*mhedzisiro inoratidzwa sepakati ± IQR), 95% nguva yekuvimba (95% CI), murume nemurume uye ziso rekurudyi zvinoratidzwa senhamba neperesenti
Tafura 3 inoratidza huwandu hwemaziso akarongwa semaprogressor tichitarisa parameter yega yega ye tomographic (Kmax, Km, K2, Astig, PachyMin, PRC uye D-Index) zvakasiyana. Tichifunga nezvekufambira mberi kweKC, kwakatsanangurwa nekuchinja kwakaonekwa mune zvingangoita zviviri zve tomographic variables, maziso 57 (50.4%) akaratidza kufambira mberi.
Tafura 3 Nhamba uye kuwanda kwemaziso akarongwa semaprogressor, tichifunga nezve tomography parameter yega yega zvakasiyana
Kmax, D-index, PRC, EleBmax, BFSB, uye AdjEleBmax scores sezviratidziro zvakazvimiririra zvekufambira mberi kweKC zvinoratidzwa muTafura 4. Semuenzaniso, kana tikatsanangura chiyero chekuwedzera Kmax ne 1 diopter (D) kuratidza kufambira mberi, kunyangwe parameter iyi ichiratidza kunzwisisika kwe49%, ine specificity ye100% (zviitiko zvese zvakaonekwa seprogressive pane iyi parameter zvaive zvechokwadi). progressors dziri pamusoro) ine positive predictive value (PPV) ye100%, negative predictive value (NPV) ye66%, uye nzvimbo iri pasi pecurve (AUC) ye0.822. Zvisinei, cutoff yakaverengerwa ye kmax yaive 0.4, ichipa kunzwisisika kwe70%, specificity ye91%, PPV ye89%, uye NPV ye75%.
Tafura 4 Kmax, D-Index, PRC, BFSB, EleBmax, uye AdjEleBmax mamakisi sezviratidzo zvega zvekufambira mberi kweKC (zvinotsanangurwa sekuchinja kukuru muzvikamu zviviri kana kupfuura)
Panyaya yeD index, nzvimbo yakakodzera yekubvisa chirwere i0.435, kunzwa kwechirwere i82%, specificity i98%, PPV i94%, NPV i84%, uye AUC i0.927. Takasimbisa kuti pamaziso makumi mashanu akaenderera mberi, varwere vatatu chete ndivo vasina kufambira mberi pane mamwe ma parameter maviri kana kupfuura. Pamaziso makumi matanhatu nematatu ayo D index isina kuvandudzika, gumi (15.9%) akaratidza kufambira mberi mune mamwe ma parameter maviri.
Kune PRC, nzvimbo yakanakisisa yekugumisa kufambira mberi kwaive kudzikira kwe0.065 nekunzwisisa kwe79%, hunyanzvi hwe80%, PPV ye80%, NPV ye79%, uye AUC ye0.844.
Nezvekukwirira kwepamusoro penzvimbo (EleBmax), chiyero chakanaka chekuona kufambira mberi kwacho chaive kuwedzera kwe2.5 µm nekunzwa kwe65% uye hunyanzvi hwe73%. Pakagadziriswa kuBSFB yechipiri yakayerwa, kunzwisisika kweparameter itsva yeAdjEleBmax kwaive 63% uye hunyanzvi hwacho hwakawedzera ne84% nepfungwa yakanaka ye6.5 µm. BFSB pachayo yakaratidza kudzika kwakakwana kwe0.05 mm nekunzwa kwe51% uye hunyanzvi hwe80%.
Pamufananidzo wechipiri panoratidza maROC curves ega ega e estimated tomographic parameters (Kmax, D-Index, PRC, EleBmax, BFSB uye AdjEleBmax). Tinoona kuti D-index ibvunzo inoshanda zvakanyanya ine AUC yakakwira (0.927) ichiteverwa nePRC neKmax. AUC EleBmax i0.690. Payakagadziriswa BFSB, iyi setting (AdjEleBmax) yakavandudza mashandiro ayo nekuwedzera AUC kusvika 0.754. BFSB pachayo ine AUC ye0.690.
Mufananidzo 2. Makori ekushanda kwemugamuchiri (ROC) anoratidza kuti kushandiswa kweD index kuona kufambira mberi kwekeratoconus kwakawana mwero wepamusoro wekunzwa uye kujekesa, zvichiteverwa nePRC neKmax. AdjEleBmax ichiri kuonekwa seyakanaka uye kazhinji iri nani pane Elebmax isina BFSB tuning.
Zvidimbu: Kmax, kukombama kwakanyanya kwe cornea; D-index, Belin/Ambrosio D-index; PRC, nharaunda yekumashure yekukombama kubva pa3.0 mm yakatarisana nenzvimbo yakatetepa; BFSB, yakakodzera musana wakatenderera; Kureba; AdjELEBmax, kona yepamusoro yekukwira. Nzvimbo yekumashure ye cornea inogadziriswa kune dorsum yakatenderera yakakodzera.
Tichifunga nezveEleBmax, BFSB, uye AdjEleBmax, zvakateerana, takasimbisa kuti maziso 53 (46.9%), 40 (35.3%), uye 45 (39.8%) akaratidza kufambira mberi kwechikamu chimwe nechimwe chakaparadzaniswa, zvichiteerana. Pamaziso aya, 16 (30.2%), 11 (27.5%), uye 9 (45%), zvakateerana, haana kufambira mberi kwechokwadi sezvakatsanangurwa nemamwe maparamita maviri. Pamaziso makumi matanhatu asina kutariswa seanofambira mberi neEleBmax, maziso makumi maviri (33%) aive afambira mberi pane mamwe maparamita maviri kana kupfuura. Makumi maviri nemasere (38.4%) uye 21 (30.9%) maziso akatariswa seasina kufambira mberi zvichienderana neBFSB neAdjEleBmax chete, zvichiratidza kufambira mberi kwechokwadi.
Tine chinangwa chekuongorora kushanda kweBFSB uye, chinonyanya kukosha, BFSB-adjusted maximum posterior corneal height (AdjEleBmax) senzira itsva yekufanotaura nekuona kufambira mberi kweKC uye kuenzanisa nemamwe ma parameter anowanzo shandiswa sezviratidzo zvekufambira mberi. Kuenzanisa kwakaitwa nematanho akataurwa mumabhuku (kunyange asina kusimbiswa), anoti Kmax neD-Index.20
Pakuisa EleBmax kuBFSB radius (AdjEleBmax), takaona kuwedzera kukuru kwespecificity - 73% yeparamita isina kugadziriswa uye 84% yeparamita yakagadziriswa - pasina kukanganisa sensitivity value (65% na 63%). Takaongororawo BFSB radius pachayo seimwe nzira inogona kuratidza kufambira mberi kwekuwedzera. Zvisinei, sensitivity (51% vs 63%), specificity (80% vs 84%) uye AUC (0.69 vs 0.75) yeparamita iyi yaive yakaderera pane yeAdjEleBmax.
Kmax iparamita inozivikanwa yekufanotaura kufambira mberi kweKC. 27 Hapana kubvumirana pamusoro pekuti ndeipi muganho wekupedzisira wakakodzera. 12,28 Mukudzidza kwedu, takafunga nezvekuwedzera kwe1D kana kupfuura setsanangudzo yekufambira mberi. Pamuganho uyu, takaona kuti varwere vese vakaonekwa sevari kufambira mberi vakasimbiswa nemamwe maparamita maviri, zvichiratidza kuti chaiyo ye100%. Zvisinei, kunzwa kwayo kwaive kwakaderera (49%), uye kufambira mberi kwaisagona kuonekwa mumaziso makumi maviri nemapfumbamwe. Zvisinei, mukudzidza kwedu, muganho wakakodzera weKmax waive 0.4 D, kunzwa kwaive 70%, uye specificity yaive 91%, zvinoreva kuti nekudzikira kwechokwadi (kubva pa100% kusvika pa91%), takavandudzika. Kunzwa kwaive kubva pa49% kusvika pa70%. Zvisinei, kukosha kwekiriniki kwemuganho mutsva uyu kunopokana. Sekureva kweongororo yaKreps pamusoro pekudzokororwa kwekuyerwa kwePentacam®, kudzokororwa kweKmax kwaive 0.61 mukenza yecatarrhal isina kusimba uye 1.66 mucolpitis yepakati,19 zvinoreva kuti kukosha kwechikamu chekuverenga mumuenzaniso uyu hakuna kukosha mukiriniki sezvo kunotsanangura mamiriro akagadzikana. apo kufambira mberi kwakanyanya kunogoneka kunoshandiswa kune mamwe masampuli. Kmax, kune rumwe rutivi, inoratidza kutenderera kwakanyanya kwekona yekumusoro kwenzvimbo diki 29 uye haigone kudzokorora shanduko dzinoitika mukona yekumusoro, kona yekumusoro, nedzimwe nzvimbo dzepachymetry. 30-32 Zvichienzaniswa nemaparamita matsva epashure, AdjEleBmax yakaratidza kunzwa kwakanyanya (63% vs. 49%). Maziso makumi maviri epashure akaonekwa nemazvo achishandisa iyi parameter uye akapotsa achishandisa Kmax (zvichienzaniswa nemaziso gumi nemaviri epashure akaonekwa achishandisa Kmax pachinzvimbo cheAdjEleBmax). Kuwanikwa uku kunotsigira chokwadi chekuti pamusoro pekona yekumusoro kwekona yakatetepa uye yakakura pakati zvichienzaniswa nepamusoro pekumusoro, izvo zvinogona kubatsira kuona shanduko. 25, 32, 33
Sekureva kwezvimwe zvidzidzo, D-index iparameter yakaparadzana ine sensitivity yepamusoro (82%), specificity (95%) uye AUC (0.927). 34 Kutaura zvazviri, izvi hazvishamisi, sezvo iyi iri multi-parameter index. PRC ndiyo yaive yechipiri most sensitivity variable (79%) ichiteverwa neAdjEleBmax (63%). Sezvambotaurwa, kana sensitivity yakakwira, false negatives shoma uye zviri nani kuti screening parameters ikure. 35 Saka, tinokurudzira kushandisa AdjEleBmax (ine cutoff ye7 µm yekufambira mberi pane 6.5 µm sezvo digital scale yakavakwa muPentacam® isingasanganisire decimal places yeiyi parameter) pachinzvimbo cheEleBmax isina kugadziriswa, iyo ichabatanidzwa pamwe chete nedzimwe variables mukuongorora. kufambira mberi kwekeratoconus kuvandudza kuvimbika kwekuongorora kwedu kwekiriniki uye kuona kufambira mberi kwekutanga.
Zvisinei, chidzidzo chedu chakatarisana nezvimwe zvipingamupinyi. Chekutanga, takashandisa chete tomographic shapeflug imaging parameters kutsanangura nekuongorora kufambira mberi, asi dzimwe nzira dziripo parizvino nechinangwa chimwe chete, senge biomechanical analysis, iyo inogona kutangira chero shanduko dze topographic kana tomographic. 36 Chechipiri, tinoshandisa chiyero chimwe chete che parameters dzese dzakaedzwa uye, sekureva kwaIvo Guber et al., avhareji yemifananidzo yakawanda inoguma nemazinga eruzha rwekuyerwa akaderera. 28 Kunyange zvazvo zviyero nePentacam® zvaive zvakanaka kudzokororwa mumaziso akajairwa, zvaive zvakaderera mumaziso aine corneal irregularities uye corneal ectasia. 37 Muchidzidzo ichi, takangosanganisira maziso ane Pentacam® yakavakirwa mukati memhando yepamusoro yekuongorora, izvo zvaireva kuti chirwere chakafambira mberi chakabviswa. 17 Chechitatu, tinotsanangura progressors dzechokwadi sedzine parameters mbiri zvichibva pane zvinyorwa asi zvisati zvasimbiswa. Chekupedzisira, uye pamwe chinonyanya kukosha, kusiyana kwekuyerwa kwePentacam® kwakakosha mukuongorora kufambira mberi kwekeratoconus. 18,26 Mumuenzaniso wedu wemaziso 113, paakaiswa muzvikamu zvichienderana neBAD-D score, maziso mazhinji (n=68, 60.2%) aive pakati nepakati, mamwe ese ari pasi pekiriniki kana kuti ari mudiki. Zvisinei, tichifunga nezvehukuru hwemuenzaniso mudiki, takachengeta ongororo yese pasinei nekuoma kweKTC. Takashandisa chiyero chakanakira sampuli yedu yese, asi tinobvuma kuti izvi zvinogona kuwedzera ruzha (kushanduka) pakuyera uye kumutsa kunetseka nezvekuoma kwekuyerwa. Kudzokororwa kwekuyera kunoenderana nekuoma kweKTC, sezvakaratidzwa naKreps, Gustafsson et al. 18,26. Saka, tinokurudzira zvakasimba kuti zvidzidzo zveramangwana zviongorore matanho akasiyana echirwere uye zviongorore nzvimbo dzakakodzera dzekufambira mberi kwakakodzera.
Mukupedzisa, kuona kufambira mberi kwechirwere pakutanga kwakakosha zvikuru kuitira kupa kurapwa panguva yakakodzera kumisa kufambira mberi kwechirwere (kuburikidza nekubatanidza)38 uye kubatsira kuchengetedza kuona uye hupenyu hwakanaka muvarwere vedu.34 Chinangwa chikuru chebasa redu ndechekuratidza kuti EleBmax, yakagadziriswa kune BFS radius yakafanana pakati pekuyerwa kwenguva, ine mashandiro ari nani kupfuura EleBmax pachayo. Iyi parameter inoratidza kunyatsojeka uye kushanda zvakanaka kana ichienzaniswa neEleBmax, ndeimwe yeparameter inonyanya kunzwisisika (uye nekudaro ndiyo inonyanya kushanda zvakanaka pakuongorora chirwere) uye nokudaro inogona kuva biomarker yekutanga kwechirwere. Zvinokurudzirwa zvikuru kugadzira multi-parameter indexes. Zvidzidzo zveramangwana zvinosanganisira multivariate progression analysis zvinofanira kusanganisira AdjEleBmax.
Vanyori havagamuchire rutsigiro rwemari yekutsvaga, kunyora uye/kana kuburitswa kwechinyorwa chino.
Margarida Ribeiro naClaudia Barbosa vanyori vezvidzidzo izvi. Vanyori vacho vanoti hapana kupesana pakati pezvido zvavo mubasa iri.
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