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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.
UMargarida Ribeiro,1,2,*UMargarita Ribeiro, 1.2*UClaudia Barbosa, oneminyaka emi-3 ubudala*UClaudia Barbosa, oneminyaka emi-3 ubudala*2 I-Bio Faculty of Medicine – I-Faculty of Medicine kwiYunivesithi yasePorto, ePorto, ePortugal 3 I-Faculty of Medicine kwiYunivesithi yasePorto, ePorto, ePortugal;4Isebe lotyando kunye neFiziyoloji, iFakhalthi yezonyango, iYunivesithi yasePorto, ePorto, ePortugal4 ISebe lotyando kunye neFiziyoloji, iFakhalthi yezonyango, iYunivesithi yasePorto, ePorto, ePortugal *Aba babhali banegalelo elilinganayo kulo msebenzi.Hernâni Monteiro Porto, 4200-319, ePortugal, i-imeyile [email protected] Injongo: Sivavanye umphezulu ongasemva we-cornea ohlengahlengisiweyo kwi-Best Fit Sphere Back (BFSB) efanayo phakathi kokulinganisa ixesha (AdjEleBmax) kunye ne-BFSB radius (BFSBR). Ukuphakama okuphezulu ngokwako kusetyenziswe njengepharamitha entsha ye-tomographic ukurekhoda ukuqhubela phambili kokwandiswa kwaye kuthelekiswa neepharamitha zamva nje ezithembekileyo zokuqhubela phambili kwe-keratoconus (KK). Iziphumo. Sivavanye i-Kmax, i-D index, i-posterior curvature radius, kunye ne-cutoff point efanelekileyo ukusuka kwi-3.0 mm thinnest point centered (PRC), i-EleBmax, i-BFSBR, kunye ne-AdjEleBmax njengeeparameter ezizimeleyo zokurekhoda i-KC progression (echazwa njengee-variables ezimbini okanye ngaphezulu), sifumene ubuzwelo be-70%, 82%, 79%, 65%, 51%, kunye ne-63%, kunye ne-91%, 98%, 80%, 73%, 80%, kunye ne-84% specifics zokufumanisa i-KC progression. . Indawo engaphantsi kwe-curve (AUC) ye-variable nganye yayiyi-0.822, 0.927, 0.844, 0.690, 0.695, 0.754, ngokwahlukeneyo. Isiphelo: Xa kuthelekiswa ne-EleBmax ngaphandle kohlengahlengiso, i-AdjEleBmax inobuzwelo obuphezulu, i-AUC ephezulu kunye nokusebenza okungcono okunobuzwelo obufanayo. I-AUC. Ekubeni imilo yomphezulu ongasemva ifana kakhulu ne-aspherical kwaye igobile kunomphezulu ongaphambili, nto leyo enokunceda ekufumaneni utshintsho, sicebisa ukuba kufakwe i-AdjEleBmax kuvavanyo lokuqhubela phambili kwe-KC kunye nezinye izinto eziguquguqukayo ukuphucula ukuthembeka kovavanyo lwethu lweklinikhi kunye nokufunyanwa kwangethuba. Amagama angundoqo: keratoconus, cornea, progression, eyona milo iphambili ye-dorsal, ukuphakama okuphezulu komphezulu ongasemva we-cornea.
I-Keratoconus (KK) yeyona ectasia iphambili ye-cornea ectasia. Ngoku ithathwa njengesifo esiqhubekayo esihamba ngamacala amabini (nangona singalingani) esikhokelela kutshintsho oluninzi lwesakhiwo olulandelwa kukuncipha kwe-stromal kunye nokuqhekeka. 1,2 Ngokwezonyango, izigulane zibonakala zine-astigmatism engaqhelekanga kunye ne-myopia, i-photophobia, kunye/okanye i-monocular diplopia enombono ophazamisekileyo, i-maximally corrected visual acuity (BCVA) kunye nomgangatho wobomi ophantsi. 3,4 Iimpawu ze-RP zihlala ziqala kwishumi lesibini lobomi kwaye ziqhubekele kwishumi lesine, zilandelwe kukuzinza kweklinikhi. Umngcipheko kunye nesantya sokuqhubekela phambili siphezulu kubantu abangaphantsi kweminyaka eli-19 ubudala. 5.6
Nangona kungekho nyango luqinisekileyo, unyango lwangoku lwe-ocular keratoconus luneenjongo ezimbini ezibalulekileyo: ukuphucula ukusebenza kokubonwa kunye nokuthintela ukuqhubela phambili kokukhula. 7,8 Lokuqala lunokubonwa kwiiglasi, iilensi zoqhagamshelwano eziqinileyo okanye eziqinileyo, iiringi zangaphakathi kwe-cornea, okanye kwi-cornea transplants xa isifo sinzima kakhulu. 9 Injongo yokugqibela yi-grail engcwele yezi ndlela zonyango zezigulane, okwangoku zinokufezekiswa kuphela ngokudityaniswa. Olu tyando lukhokelela ekwandeni kokumelana kwe-biomechanical kunye nokuqina kwe-cornea kwaye luthintela ukuqhubela phambili. 10-13 Nangona oku kunokwenziwa nakweyiphi na inqanaba lesifo, inzuzo enkulu ifunyanwa kwizigaba zokuqala. 14 Kufuneka kwenziwe imizamo yokufumanisa ukuqhubela phambili kwangethuba kunye nokuthintela ukonakala okungakumbi, kunye nokuphepha unyango olungeyomfuneko lwabanye abaguli, ngaloo ndlela kunciphisa umngcipheko weengxaki ezixubeneyo ezifana nosulelo, ukulahleka kweeseli ze-endothelial, kunye nentlungu enzima emva kotyando. 15.16
Nangona izifundo ezininzi ezijolise ekuchazeni nasekufumaneni inkqubela phambili,17-19 akukabikho nkcazo ihambelanayo yenkqubela phambili yokwandiswa okanye indlela eqhelekileyo yokuyibhala phantsi.9,20,21 KwiGlobal Consensus on Keratoconus and Dilated Diseases (2015), inkqubela phambili yekeratoconus ichazwa njengotshintsho olulandelelanayo ubuncinane kwiiparameter ezimbini ze-topographic ezilandelayo: ukuqiniswa kwe-corneal anterior, ukuqiniswa kwe-posterior cornea, ukuncitshiswa kunye/okanye ubukhulu be-cornea Izinga lotshintsho liyanda ukusuka kumda ukuya kwinqanaba elincinci.9 Nangona kunjalo, inkcazo ecacileyo yenkqubela phambili isafuneka. Kwenziwe imizamo yokufumana ezona zinto zinamandla zokufumanisa nokuchaza inkqubela phambili. 19:22–24
Ngenxa yokuba imilo yomphezulu we-posterior cornea, ojikeleze kakhulu kwaye ugobile kunomphezulu ongaphambili, inokuba luncedo ekufumaneni utshintsho,25 injongo ephambili yolu phononongo yayikukuvavanya iimpawu ze-posterior cornea elevation angle ephezulu. ilungiselelwe indawo efanayo efanelekileyo. Umlinganiselo wexesha (BFSB) (AdjEleBmax) kunye ne-BFSB radius (BFSBR) zodwa zisebenze njengeeparameter ezintsha zokurekhoda inkqubela phambili yokwanda kwaye zithelekiswa neeparameter ezisetyenziswa kakhulu kwi-KC progression.
Amehlo ali-113 ezigulane ezingama-76 ezilandelelanayo ezifunyaniswe zine-keratoconus ahlolwe kolu phononongo lweqela elijonga emva kwiSebe le-Ophthalmology kwiSibhedlele esiPhakathi seYunivesithi yaseSão João, ePortugal. Olu phononongo luvunyiwe yikomiti yemigaqo yokuziphatha yengingqi yeCentro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto kwaye lwenziwa ngokuhambelana neSibhengezo saseHelsinki. Imvume ebhaliweyo enolwazi ifunyenwe kubo bonke abathathi-nxaxheba kwaye, ukuba umthathi-nxaxheba ungaphantsi kweminyaka eli-16 ubudala, kumzali kunye/okanye kumgcini osemthethweni.
Izigulana ezine-KC ezineminyaka eli-14 ukuya kwengama-30 ubudala zichongiwe kwaye zabandakanywa ngokulandelelana kulandelelwano lwethu lwamehlo kunye nolwe-cornea phakathi kuka-Okthobha-Disemba 2021.
Zonke izigulana ezikhethiweyo zalandelwa unyaka wonke yingcali ye-cornea kwaye zenziwa ubuncinane imilinganiselo emithathu ye-Scheimpflug tomographic (Pentacam®; Oculus, Wetzlar, eJamani). Izigulana zayeka ukunxiba iilensi zoqhagamshelwano ubuncinane iiyure ezingama-48 ngaphambi kokulinganisa. Zonke izilinganiso zenziwa yingcali yamathambo eqeqeshiweyo kwaye kuphela iiskeni ezine-check yomgangatho ethi "Kulungile" zafakwa. Ukuba uvavanyo lomgangatho womfanekiso oluzenzekelayo aluphawulwanga njengo "Kulungile", uvavanyo luya kuphindwa. Kuhlolwe iiskeni ezimbini kuphela kwiliso ngalinye ukuze kufunyanwe inkqubela phambili, apho isibini ngasinye sahlulwe ziinyanga ezili-12 ± 3. Amehlo ane-KC engaphantsi kweklinikhi nawo afakiwe (kwezi meko, elinye iliso kufuneka ukuba libonise iimpawu ezicacileyo ze-KC yeklinikhi).
Siwakhuphe kuhlalutyo amehlo e-KC awayekhe atyandwa amehlo ngaphambili (ukudityaniswa kwe-cornea, iiringi ze-cornea, okanye ukufakelwa kwe-cornea) kunye namehlo anesifo esiphucukileyo kakhulu (ubukhulu be-cornea kwi-thinnest <350 µm, i-hydrokeratosis, okanye amanxeba e-cornea anzulu) njengoko iqela lihlala lisilela "Kulungile" emva kokuhlolwa komgangatho we-scan yangaphakathi.
Idatha yedemografi, yeklinikhi kunye neyetomografi iqokelelwe ukuze ihlalutywe. Ukuze sibone ukuqhubela phambili kwe-KC, siqokelele iinguqu ezahlukeneyo zetomografi kuquka ukugoba okuphezulu kwe-corneal (Kmax), ukugoba okuphakathi kwe-corneal (Km), ukugoba okuthe tyaba kwe-corneal (K1), ukugoba okuphezulu kwe-corneal meridion (K2), i-corneal astigmatism (Astig = K2 – K1). ), umlinganiselo wobukhulu obuncinci (PachyMin), ukuphakama okuphezulu kwe-posterior corneal (EleBmax), i-posterior radius of curvature (PRC) 3.0 mm ephakathi kwindawo encinci, i-Belin/Ambrosio D-index (D-index), i-BFSBR kunye ne-EleBmax zilungiswe kwi-BFSB (AdjEleBmax). Njengoko kubonisiwe kumzobo 1, i-AdjEleBmax ifunyanwa emva kokuba sichonge ngesandla i-radius efanayo ye-BFSB kuzo zombini iimvavanyo zomatshini sisebenzisa ixabiso le-BFSR ukusuka kuqikelelo lwesibini.
Ilayisi. 1. Uthelekiso lwemifanekiso yePentacam® kwindawo ethe nkqo emva kunye nokuqhubela phambili kweklinikhi okwenyani kunye nexesha leenyanga ezili-13 phakathi kovavanyo. Kwiphaneli 1, i-EleBmax yayiyi-68 µm kuvavanyo lokuqala kunye ne-66 µm kwelesibini, ngoko ke bekungekho kuqhubela phambili kule parameter. Eyona radii yesphere ilungileyo enikezelwa ngokuzenzekelayo ngumatshini kuvavanyo ngalunye yi-5.99 mm kunye ne-5.90 mm, ngokulandelelana. Ukuba sicofa iqhosha le-BFS, kuya kuvela ifestile apho i-radius entsha ye-BFS ingachazwa ngesandla. Sichonge i-radius efanayo kuzo zombini iimvavanyo sisebenzisa ixabiso lesibini le-radius ye-BFS elilinganisiweyo (5.90mm). Kwiphaneli 2, ixabiso elitsha le-EleBmax (EleBmaxAdj) elilungisiweyo kwi-BFS efanayo kuvavanyo lokuqala yi-59 µm, ebonisa ukunyuka kwe-7 µm kuvavanyo lwesibini, ebonisa ukuqhubela phambili ngokwe-7 µm threshold yethu.
Ukuze sihlalutye inkqubela phambili kunye nokuvavanya ukusebenza kakuhle kweenguqu ezintsha zophando, sisebenzise iiparameter ezisetyenziswa rhoqo njengeempawu zokuqhubela phambili (iKmax, iKm, iK2, iAstig, iPachyMin, iPRC, kunye neD-Index) kunye nemingcele echazwe kwiincwadi. Nangona kungekuko ngokweempirical). Itheyibhile 1 idwelisa amaxabiso amele inkqubela phambili yeparameter nganye yohlalutyo. Inkqubela phambili yeKC ichazwe xa ubuncinane ezimbini zenguqu ezifundweyo ziqinisekisa inkqubela phambili.
Itheyibhile 1 Iiparameter zeTomographic zamkelwe ngokubanzi njengeempawu zokuqhubela phambili kwenkqubela phambili ye-RP kunye nemida ehambelanayo echazwe kwiincwadi (nangona ingakhange iqinisekiswe)
Kolu phononongo, ukusebenza kwee-variables ezintathu kuvavanyiwe ukuqhubela phambili (i-EleBmax, i-BFSB, kunye ne-AdjEleBmax) ngokusekelwe ekubeni kukho ukuqhubela phambili kwezinye ii-variables ezimbini ubuncinane. Amanqaku okusika afanelekileyo kwezi-variables abalwe kwaye athelekiswa nezinye ii-variables.
Uhlalutyo lwezibalo lwenziwe kusetyenziswa isoftware yezibalo ye-SPSS (inguqulelo 27.0 ye-Mac OS; SPSS Inc., eChicago, IL, e-USA). Iimpawu zesampulu ziyashwankathelwa kwaye idatha iboniswe njengamanani kunye nobungakanani bezinto eziguquguqukayo zezigaba. Izinto eziguquguqukayo eziqhubekayo zichazwa njenge-mean kunye ne-standard deviation (okanye i-median kunye ne-interquartile range xa ​​usasazo lugobile). Utshintsho kwi-keratometric index lufunyenwe ngokuthabatha ixabiso lokuqala kumlinganiselo wesibini (oko kukuthi, ixabiso le-delta elihle libonisa ukunyuka kwexabiso leparameter ethile). Uvavanyo lwe-parametric kunye nolwe-non-parametric lwenziwe ukuvavanya usasazo lwezinto eziguquguqukayo ze-cornea ezihlelwe njenge-progressive okanye ezingezizo eziqhubekayo, kubandakanya uvavanyo lwe-t oluzimeleyo, uvavanyo lwe-Mann-Whitney U, uvavanyo lwe-chi-square, kunye novavanyo oluchanekileyo lukaFisher (ukuba luyimfuneko). Inqanaba lokubaluleka kwezibalo libekwe kwi-0.05. Ukuvavanya ukusebenza kakuhle kwe-Kmax, D-index, PRC, BFSBR, EleBmax, kunye ne-AdjEleBmax njengezibikezeli zokuqhubela phambili komntu ngamnye, sakhe ii-receiver performance curves (ROC) saza sabala amanqaku afanelekileyo okunqumla, uvakalelo, ukucacisa, okulungileyo (PPV), kunye neNegative Predictive Value (NPV). ) kunye nendawo engaphantsi kwe-curve (AUC) xa ubuncinane ii-variables ezimbini zidlula imida ethile (njengoko kuchaziwe ngaphambili) ukuze sihlele i-progression njengolawulo.
Amehlo ali-113 ezigulane ezingama-76 ezine-RP afakiwe kolu phononongo. Uninzi lwezigulane yayingamadoda (n=87, 77%) kwaye ubudala obuphakathi kuvavanyo lokuqala yayiyi-24.09 ± 3.93 iminyaka. Ngokuphathelele ukuhluzwa kwe-KC ngokusekelwe ekunyukeni kokuphambuka kwe-Belin/Ambrosio dilatation (index ye-BAD-D), uninzi (n=68, 60.2%) lwamehlo lwaluphakathi. Abaphandi bakhethe ngazwi linye ixabiso elinqunyiweyo le-7.0 baza bahlula phakathi kwe-keratoconus ethambileyo nephakathi ngokweencwadi26. Nangona kunjalo, lonke uhlalutyo lubandakanya isampuli yonke. Iimpawu zoluntu, zeklinikhi kunye ne-tomographic zesampuli, kubandakanya i-average, minimum, maximum, standard deviation (SD) kunye nokulinganisa ngama-95% confidence intervals (IC95%), kunye nokulinganisa kokuqala nokwesibini. Umahluko phakathi kwamaxabiso emva kweenyanga ezili-12 ± 3 unokufumaneka kwitheyibhile 2.
Itheyibhile 2. Iimpawu zedemografi, zeklinikhi kunye nezesimo seentsholongwane zezigulane. Iziphumo zibonakaliswa njenge-avareji ± ukuphambuka okuqhelekileyo kwiinguqu eziqhubekayo (*iziphumo zibonakaliswa njenge-median ± IQR), i-95% yokuzithemba phakathi kwexesha (95% CI), isini samadoda kunye neliso lasekunene zibonakaliswa njengenani kunye nepesenti
Itheyibhile 3 ibonisa inani lamehlo ahlelwe njengee-progressors eziqwalasela iparameter nganye ye-tomographic (i-Kmax, i-Km, i-K2, i-Astig, i-PachyMin, i-PRC kunye ne-D-Index) ngokwahlukeneyo. Xa kujongwa ukuqhubela phambili kwe-KC, okuchazwe lutshintsho olubonwe ubuncinane kwiinguqu ezimbini ze-tomographic, amehlo angama-57 (50.4%) abonise ukuqhubela phambili.
Itheyibhile 3 Inani kunye nokuphindaphinda kwamehlo ahlelwe njengee-progressors, kuthathelwa ingqalelo iparameter nganye ye-tomographic ngokwahlukeneyo
Amanqaku e-Kmax, D-index, PRC, EleBmax, BFSB, kunye ne-AdjEleBmax njengezinto ezizimelayo zokuqikelela ukuqhubela phambili kwe-KC ziboniswe kwiTheyibhile 4. Umzekelo, ukuba sichaza ixabiso elilinganiselweyo lokunyusa i-Kmax nge-1 diopter (D) ukuphawula ukuqhubela phambili, nangona le parameter ibonisa uvakalelo lwe-49%, inobume obuthile be-100% (zonke iimeko ezichongiweyo njengeziqhubela phambili kule parameter zaziyinyani). ii-progressors ezingentla) ezinexabiso eliqikelelweyo elilungileyo (PPV) le-100%, ixabiso eliqikelelweyo elingalunganga (NPV) le-66%, kunye nendawo engaphantsi kwe-curve (AUC) ye-0.822. Nangona kunjalo, i-cutoff efanelekileyo ebaliweyo ye-kmax yayiyi-0.4, inika uvakalelo lwe-70%, ubume obuthile be-91%, i-PPV ye-89%, kunye ne-NPV ye-75%.
Itheyibhile 4 Amanqaku e-Kmax, D-Index, PRC, BFSB, EleBmax, kunye ne-AdjEleBmax njengezinto ezibonisa ukuqhubela phambili kwe-KC (ezichazwa njengotshintsho olukhulu kwiinguqu ezimbini okanye ngaphezulu)
Ngokuphathelele isalathisi se-D, indawo efanelekileyo yokusika yi-0.435, uvakalelo yi-82%, ukucaciswa yi-98%, i-PPV yi-94%, i-NPV yi-84%, kwaye i-AUC yi-0.927. Siqinisekisile ukuba kumehlo angama-50 aqhubekileyo, zizigulane ezi-3 kuphela ezingakhange ziqhubeke kwezinye iiparameter ezimbini okanye ngaphezulu. Kumehlo angama-63 apho isalathisi se-D singakhange siphucuke khona, ali-10 (15.9%) abonise ukuqhubela phambili ubuncinane kwezinye iiparameter ezimbini.
Kwi-PRC, indawo efanelekileyo yokunquma ukuqhubela phambili yayikukwehla kwe-0.065 kunye nobuntununtunu be-79%, ukucaciswa kwe-80%, i-PPV ye-80%, i-NPV ye-79%, kunye ne-AUC ye-0.844.
Ngokuphathelele ukuphakama komphezulu ongasemva (i-EleBmax), umda ofanelekileyo wokumisela ukuqhubela phambili yayikukunyuka kwe-2.5 µm kunye novakalelo lwe-65% kunye nocaciso lwe-73%. Xa kuhlengahlengiswa kwi-BSFB yesibini elinganisiweyo, uvakalelo lweparameter entsha i-AdjEleBmax yayiyi-63% kwaye ucaciso luphuculwe yi-84% kunye nendawo efanelekileyo yokusika ye-6.5 µm. I-BFSB ngokwayo ibonise ucaciso olugqibeleleyo lwe-0.05 mm kunye novakalelo lwe-51% kunye nocaciso lwe-80%.
Kumfanekiso wesi-2 ubonisa ii-ROC curves zeparameter nganye ye-tomographic estimated (Kmax, D-Index, PRC, EleBmax, BFSB kunye ne-AdjEleBmax). Sibona ukuba i-D-index luvavanyo olusebenza ngakumbi olune-AUC ephezulu (0.927) elandelwa yi-PRC kunye ne-Kmax. I-AUC EleBmax yi-0.690. Xa ilungiselelwe i-BFSB, olu seto (AdjEleBmax) luphucule ukusebenza kwalo ngokwandisa i-AUC ukuya kwi-0.754. I-BFSB ngokwayo ine-AUC ye-0.690.
Umfanekiso 2. Ii-Receiver performance curves (ROC) ezibonisa ukuba ukusetyenziswa kwe-D index ukumisela inkqubela phambili ye-keratoconus kufikelele kumanqanaba aphezulu obuntununtunu kunye nokucaciswa, kulandele i-PRC kunye ne-Kmax. I-AdjEleBmax isathathwa njengefanelekileyo kwaye ngokubanzi ingcono kune-Elebmax ngaphandle kokulungiswa kwe-BFSB.
Izifinyezo: I-Kmax, ukugoba okuphezulu kwe-cornea; i-D-index, i-Belin/Ambrosio D-index; i-PRC, i-back radius ye-curvature ukusuka kwi-3.0 mm ephakathi kwindawo encinci; i-BFSB, ifanelekile kakhulu kumqolo ongqukuva; Ukuphakama; i-AdjELEBmax, i-engile ephezulu yokuphakama. Umphezulu ongasemva we-cornea ulungelelaniswe ne-dorsum engqukuva efanelekileyo.
Ukuqwalasela i-EleBmax, i-BFSB, kunye ne-AdjEleBmax, ngokwahlukeneyo, siqinisekisile ukuba amehlo angama-53 (46.9%), angama-40 (35.3%), kunye nama-45 (39.8%) abonise ukuqhubela phambili kwiparameter nganye eyahlukileyo, ngokwahlukeneyo. Kula mehlo, ali-16 (30.2%), ali-11 (27.5%), kunye nama-9 (45%), ngokwahlukeneyo, ayengenalo ukuqhubela phambili okwenyani njengoko kuchaziwe ubuncinane kwezinye iiparameter ezimbini. Kumehlo angama-60 angathathwa njengokuqhubela phambili yi-EleBmax, amehlo angama-20 (33%) ayeqhubela phambili kwezinye iiparameter ezimbini okanye ngaphezulu. Amehlo angama-28 (38.4%) kunye nama-21 (30.9%) athathwa njengongaqhubekiyo ngokwe-BFSB kunye ne-AdjEleBmax yodwa, ngokwahlukeneyo, ebonisa ukuqhubela phambili okwenyani.
Sijonge ukuphanda ukusebenza kakuhle kwe-BFSB, kwaye okubaluleke ngakumbi, ukuphakama okuphezulu kwe-posterior cornea (AdjEleBmax) okuhlengahlengisiweyo yi-BFSB njengepharamitha entsha yokuqikelela nokufumanisa inkqubela phambili ye-KC kunye nokuzithelekisa nezinye iiparameter ze-tomographic ezisetyenziswa rhoqo njengeempawu zenkqubela phambili. Uthelekiso lwenziwe ngemida echazwe kwiincwadi (nangona ingaqinisekiswanga), ezizezi i-Kmax kunye ne-D-Index.20
Xa sibeka i-EleBmax kwi-radius ye-BFSB (i-AdjEleBmax), sibone ukwanda okukhulu kokucacileyo - i-73% kwi-parameter engalungiswanga kunye ne-84% kwi-parameter elungisiweyo - ngaphandle kokuchaphazela ixabiso lokuziva (65% kunye ne-63%). Sikwavavanye i-radius ye-BFSB ngokwayo njengenye into enokubangela inkqubela phambili yokwanda. Nangona kunjalo, ukuva (51% vs 63%), ukuva (80% vs 84%) kunye ne-AUC (0.69 vs 0.75) yale parameter yayingaphantsi kuneye-AdjEleBmax.
I-Kmax yiparameter eyaziwayo yokuqikelela ukuqhubela phambili kwe-KC. 27 Akukho mvumelwano malunga nokuba yeyiphi imida yokuphela efanelekileyo ngakumbi. 12,28 Kuphononongo lwethu, siqwalasele ukunyuka kwe-1D okanye ngaphezulu njengenkcazo yokuqhubela phambili. Kulo mda, siqaphele ukuba zonke izigulane ezichongiweyo njengeziqhubela phambili ziqinisekiswe ubuncinane ngezinye iiparameter ezimbini, nto leyo ebonisa ukuba zichanekile kwi-100%. Nangona kunjalo, uvakalelo lwayo lwaluphantsi kakhulu (49%), kwaye ukuqhubela phambili alukwazanga ukubonwa emehlweni angama-29. Nangona kunjalo, kuphononongo lwethu, umda ofanelekileyo we-Kmax yayingu-0.4 D, uvakalelo lwaluyi-70%, kwaye uvakalelo lwaluyi-91%, oko kuthetha ukuba ngokuncipha okuthelekisekayo (ukusuka kwi-100% ukuya kwi-91%), siphucukile. Uvakalelo lwaluphakathi kwe-49% ukuya kwi-70%. Nangona kunjalo, ukubaluleka kweklinikhi kwalo mda mtsha kuyathandabuzeka. Ngokwesifundo seKreps malunga nokuphindaphinda kwemilinganiselo yePentacam®, ukuphindaphinda kweKmax yayiyi-0.61 kumhlaza we-catarrhal ophantsi kunye ne-1.66 kwi-caesarean colpitis ephakathi,19 oko kuthetha ukuba ixabiso lokunqunyulwa kwezibalo kule sampulu alibalulekanga ngokwezonyango njengoko lichaza imeko ezinzileyo. xa inkqubela ephezulu enokwenzeka isetyenziswa kwezinye iisampuli. IKmax, kwelinye icala, ichaza ukugoba kwe-corneal yangaphambili okubukhali kakhulu kwindawo encinci 29 kwaye ayinakuphinda ivelise utshintsho olwenzeka kwi-cornea yangaphambili, i-cornea yangasemva, kunye nezinye iindawo ze-pachymetry. 30-32 Xa kuthelekiswa neeparameter ezintsha zangasemva, i-AdjEleBmax ibonise uvakalelo oluphezulu (63% vs. 49%). Amehlo angama-20 aqhubekekayo achongiwe ngokuchanekileyo kusetyenziswa le parameter kwaye aphoswa kusetyenziswa iKmax (xa kuthelekiswa namehlo ali-12 aqhubekekayo afunyenwe kusetyenziswa iKmax endaweni ye-AdjEleBmax). Olu fumaniso luxhasa inyani yokuba umphezulu ongasemva we-cornea uqinile kwaye wande ngakumbi embindini xa kuthelekiswa nomphezulu ongaphambili, onokunceda ukubona utshintsho. 25,32,33
Ngokwezinye izifundo, i-D-index yiparameter eyodwa enobuntununtunu obuphezulu (82%), ubunyani (95%) kunye ne-AUC (0.927). 34 Enyanisweni, oku akumangalisi, kuba le yi-multi-parameter index. I-PRC yayiyeyona variable yesibini ebucayi kakhulu (79%) ilandelwa yi-AdjEleBmax (63%). Njengoko bekutshiwo ngaphambili, okukhona ubuthathaka buphezulu, kokukhona zimbalwa izinto ezimbi ezingalunganga kwaye kokukhona ziphuhliswa ngcono iiparameter zovavanyo. 35 Ke ngoko, sicebisa ukusebenzisa i-AdjEleBmax (ene-cutoff ye-7 µm yokuqhubela phambili endaweni ye-6.5 µm kuba isikali sedijithali esakhelwe kwi-Pentacam® asibandakanyi iindawo zedesimali zale parameter) endaweni ye-EleBmax engalungiswanga, eya kubandakanywa kunye nezinye izinto eziguquguqukayo kuvavanyo. Ukuqhubela phambili kwe-keratoconus ukuphucula ukuthembeka kovavanyo lwethu lweklinikhi kunye nokufumanisa kwangethuba ukuqhubela phambili.
Nangona kunjalo, uphando lwethu lujongene nemida ethile. Okokuqala, sisebenzise kuphela iiparameter ze-tomographic shapeflug imaging ukuchaza nokuvavanya inkqubela phambili, kodwa ezinye iindlela ezikhoyo ngoku ngenjongo efanayo, njengohlalutyo lwe-biomechanical, olunokwandulela naluphi na utshintsho lwe-topographic okanye lwe-tomographic. 36 Okwesibini, sisebenzisa umlinganiselo omnye wazo zonke iiparameter ezivavanyiweyo kwaye, ngokutsho kuka-Ivo Guber et al., umyinge kwimifanekiso emininzi ubangela amanqanaba aphantsi engxolo yokulinganisa. 28 Ngelixa ukulinganisa ngePentacam® kwakuphindwaphindwa kakuhle emehlweni aqhelekileyo, ayephantsi emehlweni aneengxaki ze-cornea kunye ne-cornea ectasia. 37 Kolu phononongo, siquke kuphela amehlo ane-Pentacam® eyakhelwe ngaphakathi yokuqinisekiswa kweskeni ephezulu, nto leyo ethetha ukuba isifo esiphambili sasuswa. 17 Okwesithathu, sichaza ii-progressors zokwenyani njengezineeparameter ezimbini ubuncinane ngokusekelwe kuncwadi kodwa azikaqinisekiswa. Okokugqibela, kwaye mhlawumbi okubaluleke ngakumbi, umahluko kwimilinganiselo yePentacam® ubaluleke kakhulu ekuvavanyeni inkqubela phambili ye-keratoconus. 18,26 Kwisampulu yethu yamehlo ali-113, xa ahlulwe ngokwe-BAD-D score, uninzi lwamehlo (n=68, 60.2%) ayephakathi, amanye ayengaphantsi kwe-subclinical okanye athambileyo. Nangona kunjalo, ngenxa yobungakanani besampulu encinci, sigcine uhlalutyo lulonke nokuba i-KTC inzima kangakanani na. Sisebenzise ixabiso elilinganiselweyo elilungele yonke isampulu yethu, kodwa siyavuma ukuba oku kunokongeza ingxolo (ukuguquguquka) kumlinganiselo kwaye kuphakamise inkxalabo malunga nokuphindaphinda komlinganiselo. Ukuphindaphinda komlinganiselo kuxhomekeke kubunzima be-KTC, njengoko kubonisiwe nguKreps, Gustafsson et al. 18,26. Ke ngoko, sicebisa ngamandla ukuba izifundo ezizayo ziqwalasele amanqanaba ahlukeneyo esi sifo kwaye zivavanye amanqaku afanelekileyo okuphela kwesifo ukuze kuqhubekeke kakuhle.
Ukuqukumbela, ukufunyanwa kwangoko kokuqhubela phambili kubaluleke kakhulu ukuze kubonelelwe ngonyango olukhawulezileyo lokumisa ukuqhubela phambili (ngokusebenzisa i-cross-linking)38 kwaye kuncedwe ukugcina umbono kunye nomgangatho wobomi kwizigulane zethu.34 Injongo ephambili yomsebenzi wethu kukubonisa ukuba i-EleBmax, elungelelaniswe kwi-BFS radius efanayo phakathi kokulinganiswa kwexesha, isebenza ngcono kune-EleBmax ngokwayo. Le parameter ibonisa ukucaca okuphezulu kunye nokusebenza kakuhle xa kuthelekiswa ne-EleBmax, yenye yezona parameters zibuthathaka (kwaye ke ngoko yeyona ndlela ilungileyo yokuvavanya) kwaye ngaloo ndlela yi-biomarker enokubakho yokuqhubela phambili kwangoko. Kucetyiswa kakhulu ukwenza ii-indexes ze-multi-parameter. Izifundo zexesha elizayo ezibandakanya uhlalutyo lokuqhubela phambili lwe-multivariate kufuneka zibandakanye i-AdjEleBmax.
Ababhali abafumani nkxaso-mali yophando, ukubhala kunye/okanye ukupapashwa kweli nqaku.
UMargarida Ribeiro kunye noClaudia Barbosa ngababhali abasebenzisana nabo kolu phando. Ababhali baxela ukuba akukho kungqubana kwezimvo kulo msebenzi.
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