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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 engu-3*UClaudia Barbosa, oneminyaka engu-3*2 I-Bio Faculty of Medicine – Faculty of Medicine yase-University of Porto, ePorto, ePortugal 3 Faculty of Medicine yase-University of Porto, ePorto, ePortugal;4 UMnyango Wezokuhlinzwa kanye Ne-Physiology, I-Faculty of Medicine, i-University of Porto, ePorto, ePortugal4 UMnyango Wokuhlinza kanye Ne-Physiology, I-Faculty of Medicine, i-University of Porto, ePorto, ePortugal *Laba babhali banegalelo elilinganayo kulo msebenzi.I-Hernâni Monteiro Porto, 4200-319, ePortugal, i-imeyili [email protected] Inhloso: Sihlole ubuso be-cornea posterior obulungiswe i-Best Fit Sphere Back (BFSB) efanayo phakathi kokulinganiswa kwesikali sesikhathi (AdjEleBmax) kanye ne-BFSB radius (BFSBR). Ukuphakama okuphezulu ngokwako kusetshenziswe njengepharamitha entsha ye-tomographic ukurekhoda ukuqhubeka kokwanda futhi kuqhathaniswa namapharamitha athembekile akamuva okuqhubekela phambili kwe-keratoconus (KK). Imiphumela. Sihlole i-Kmax, inkomba ye-D, i-posterior curvature radius, kanye ne-cutoff point efanele kusuka ku-3.0 mm thinnest point centered (PRC), i-EleBmax, i-BFSBR, kanye ne-AdjEleBmax njengemingcele ezimele yokurekhoda inqubekela phambili ye-KC (echazwa njengezinguquko ezimbili noma ngaphezulu), sithole ukuzwela okungu-70%, 82%, 79%, 65%, 51%, kanye no-63%, kanye no-91%, 98%, 80%, 73%, 80%, kanye no-84% ukucacisa ukuthola inqubekela phambili ye-KC. . Indawo engaphansi kwe-curve (AUC) ye-variable ngayinye yayingu-0.822, 0.927, 0.844, 0.690, 0.695, 0.754, ngokulandelana. Isiphetho: Uma kuqhathaniswa ne-EleBmax ngaphandle kokulungiswa, i-AdjEleBmax inokucaciswa okuphezulu, i-AUC ephezulu kanye nokusebenza okungcono okunokuzwela okufanayo. I-AUC. Njengoba ukuma kobuso obungemuva kufana nokuma okugobile futhi kugobile kunobuso obungaphambili, okungasiza ekuboneni izinguquko, siphakamisa ukuthi kufakwe i-AdjEleBmax ekuhlolweni kokuqhubeka kwe-KC kanye nezinye izinto eziguquguqukayo ukuze kuthuthukiswe ukuthembeka kokuhlolwa kwethu kwezokwelapha kanye nokutholwa kusenesikhathi. Amagama ayisihluthulelo: i-keratoconus, i-cornea, ukuqhubekela phambili, ukuma okuhle kakhulu kwe-dorsal okuyindilinga, ukuphakama okuphezulu kobuso obungemuva be-cornea.
I-Keratoconus (KK) yisifo esivame kakhulu se-primary cornea ectasia. Manje ibhekwa njengesifo esiqhubekayo esiqhubekayo esihambisana nezinhlangothi ezimbili (nakuba singalingani) esiholela ezinguqukweni eziningi zesakhiwo ezilandelwa ukuncipha kwe-stromal kanye nezibazi. 1,2 Ngokwezokwelapha, iziguli ziba ne-astigmatism engajwayelekile kanye ne-myopia, i-photophobia, kanye/noma i-monocular diplopia enombono ophazamisekile, i-maximally corrected visual acuity (BCVA) kanye nekhwalithi yokuphila enciphile. 3,4 Ukubonakaliswa kwe-RP kuvame ukuqala eminyakeni eyishumi yesibili yokuphila futhi kuqhubekela eminyakeni eyishumi yesine, kulandelwe ukuzinza kwezokwelapha. Ingozi kanye nezinga lokuqhubeka liphezulu kubantu abangaphansi kweminyaka engu-19 ubudala. 5.6
Nakuba kungekho ikhambi eliqinisekile, ukwelashwa kwamanje kwe-keratoconus yamehlo kunemigomo emibili ebalulekile: ukuthuthukisa ukusebenza kokubona nokuvimba ukuqhubeka kokukhula. 7,8 Okokuqala kungabonakala ezingilazini, kuma-contact lens aqinile noma aqinile, emasongweni angaphakathi kwe-cornea, noma ekufakweni kwe-cornea lapho isifo sinzima kakhulu. 9 Umgomo wokugcina uwuphawu olungcwele lwalezi zindlela zokwelapha zeziguli, okwamanje ezingatholakala kuphela ngokuxhumanisa. Lokhu kusebenza kuholela ekwandeni kokumelana kwe-biomechanical kanye nokuqina kwe-cornea futhi kuvimbela ukuqhubeka okuqhubekayo. 10-13 Nakuba lokhu kungenziwa kunoma yisiphi isigaba sesifo, inzuzo enkulu itholakala ezigabeni zokuqala. 14 Kufanele kwenziwe imizamo yokuthola ukuqhubeka kusenesikhathi nokuvimbela ukuwohloka okuqhubekayo, nokugwema ukwelashwa okungadingekile kwezinye iziguli, ngaleyo ndlela kuncishiswe ingozi yezinkinga ezihambisanayo njengokutheleleka, ukulahlekelwa yiseli le-endothelial, kanye nobuhlungu obukhulu ngemva kokuhlinzwa. 15.16
Naphezu kwezifundo eziningana ezihlose ukuchaza nokuthola inqubekela phambili,17-19 akukabikho ncazelo ehambisanayo yenqubekela phambili yokwanda noma indlela ejwayelekile yokuyibhala phansi.9,20,21 Ku-Global Consensus on Keratoconus and Dilated Diseases (2015), inqubekela phambili ye-keratoconus ichazwa njengoshintsho olulandelanayo okungenani ezimbili zemingcele elandelayo ye-topographic: ukujiya kwe-corneal anterior, ukujiya kwe-cornea posterior, ukuncipha kanye/noma ukujiya kwe-cornea Izinga lokushintsha liyakhula kusukela ku-perimeter kuya endaweni encane kakhulu.9 Kodwa-ke, incazelo ecacile yenqubekela phambili isadingeka. Kwenziwe imizamo yokuthola iziguquguquki eziqinile kakhulu zokuthola nokuchaza inqubekela phambili. 19:22–24
Njengoba ukuma kobuso be-posterior cornea, obuyindilinga futhi obugobile kakhulu kunobuso bangaphambili, kungaba usizo ekutholeni izinguquko,25 inhloso eyinhloko yalolu cwaningo kwakuwukuhlola izici ze-posterior cornea elevation angle ephezulu. ivumelaniswe nendawo efanayo efaneleke kakhulu. Ukulinganiswa kwesikali sesikhathi (BFSB) (AdjEleBmax) kanye ne-BFSB radius (BFSBR) zodwa zisebenze njengemingcele emisha yokurekhoda ukuqhubeka kokwanda futhi zaqhathaniswa nemingcele esetshenziswa kakhulu ekuqhubekeni kwe-KC.
Amehlo angu-113 eziguli ezingu-76 ezilandelanayo ezitholakale zine-keratoconus ahlolwe kulolu cwaningo lweqembu elibheke emuva eMnyangweni Wezokwelapha Amehlo eSibhedlela Esiphakathi saseNyuvesi yaseSão João, ePortugal. Lolu cwaningo lwavunywa yikomidi lezokuziphatha lendawo le-Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto futhi lwenziwa ngokuhambisana neSimemezelo saseHelsinki. Imvume ebhaliwe enolwazi yatholakala kubo bonke abahlanganyeli, futhi uma umhlanganyeli engaphansi kweminyaka engu-16 ubudala, yatholakala kumzali kanye/noma kumgcini osemthethweni.
Iziguli ezine-KC ezineminyaka engu-14 kuya kwengu-30 zitholwe futhi zafakwa ngokulandelana ekulandeleni kwethu kwamehlo kanye ne-cornea phakathi kuka-Okthoba-Disemba 2021.
Zonke iziguli ezikhethiwe zalandelwa unyaka wonke nguchwepheshe we-cornea futhi zahlolwa okungenani kathathu nge-Scheimpflug tomographic (Pentacam®; Oculus, Wetzlar, Germany). Iziguli zayeka ukugqoka amalensi okuxhumana okungenani amahora angu-48 ngaphambi kokulinganiswa. Zonke izilinganiso zenziwa udokotela wamathambo oqeqeshiwe futhi kwafakwa kuphela ukuskena okune-quality check ethi “Kulungile”. Uma ukuhlolwa kwekhwalithi yesithombe okuzenzakalelayo kungaphawulwanga ngokuthi “Kulungile”, ukuhlolwa kuzophindwa. Kuhlaziywe ukuskena okubili kuphela kweso ngalinye ukuze kutholakale ukuqhubeka, kanti i-pair ngayinye ihlukaniswe izinyanga ezingu-12 ± 3. Amehlo ane-subclinical KC nawo afakiwe (kulezi zimo, elinye iso kumele ukuthi libonise izimpawu ezicacile ze-clinical KC).
Asizange siwakhiphe ekuhlaziyweni kwamehlo e-KC aseke ahlinzwa amehlo ngaphambilini (ukuhlanganiswa kwe-cornea, izindandatho ze-cornea, noma ukufakelwa kwe-cornea) kanye namehlo anesifo esithuthuke kakhulu (ubukhulu be-cornea ku-thinnest <350 µm, i-hydrokeratosis, noma izibazi ze-cornea ezijulile) njengoba iqembu lihlala lihluleka “Kulungile” ngemva kokuhlolwa kwekhwalithi yokuskena kwangaphakathi.
Idatha yabantu, yezokwelapha kanye neye-tomografi yaqoqwa ukuze ihlaziywe. Ukuze sithole ukuqhubeka kwe-KC, siqoqe izinto eziningana eziguquguqukayo ze-tomografi ezihlanganisa ukugoba okukhulu kwe-corneal (Kmax), ukugoba okumaphakathi kwe-corneal (Km), ukugoba okucaba kwe-corneal (K1), ukugoba okukhulu kwe-corneal meridion (K2), i-corneal astigmatism (Astig = K2 – K1). ), ukulinganisa ubuncane bokujiya (PachyMin), ukuphakama okuphezulu kwe-posterior corneal (EleBmax), i-posterior radius of curvature (PRC) engu-3.0 mm egxile endaweni encane kakhulu, i-Belin/Ambrosio D-index (D-index), i-BFSBR kanye ne-EleBmax zalungiswa ku-BFSB (AdjEleBmax). Njengoba kuboniswe ku-fig. 1, i-AdjEleBmax itholakala ngemuva kokuthi sithole ngesandla i-radius efanayo ye-BFSB kuzo zombili izivivinyo zomshini sisebenzisa inani le-BFSR kusukela ekulinganisweni kwesibili.
Ilayisi. 1. Ukuqhathaniswa kwezithombe ze-Pentacam® endaweni engemuva eqondile kanye nokuqhubekela phambili kweqiniso kwezokwelapha kanye nesikhawu sezinyanga ezingu-13 phakathi kokuhlolwa. Kuphaneli 1, i-EleBmax yayingu-68 µm ekuhlolweni kokuqala kanye no-66 µm kwesibili, ngakho-ke akukho ukuqhubekela phambili kule pharamitha. Ama-radii esphere amahle kakhulu anikezwa ngokuzenzakalelayo ngumshini ekuhlolweni ngakunye angama-5.99 mm kanye no-5.90 mm, ngokulandelana. Uma sichofoza inkinobho ye-BFS, kuzovela ifasitela lapho i-radius entsha ye-BFS ingachazwa khona ngesandla. Sithole i-radius efanayo kuzo zombili izivivinyo sisebenzisa inani le-radius yesibili elilinganisiwe ye-BFS (5.90mm). Kuphaneli 2, inani elisha le-EleBmax (EleBmaxAdj) elilungisiwe le-BFS efanayo ekuhlolweni kokuqala lingu-59 µm, okubonisa ukwanda okungu-7 µm ekuhlolweni kwesibili, okubonisa ukuqhubekela phambili ngokwesilinganiso sethu esingu-7 µm.
Ukuze sihlaziye ukuqhubekela phambili nokuhlola ukusebenza kahle kweziguquguquko ezintsha zocwaningo, sisebenzise amapharamitha avame ukusetshenziswa njengezimpawu zokuqhubekela phambili (i-Kmax, i-Km, i-K2, i-Astig, i-PachyMin, i-PRC, kanye ne-D-Index) kanye nemingcele echazwe ezincwadini. Nakuba kungenjalo ngokwesayensi). Ithebula 1 libala amanani amele inqubekela phambili yepharamitha ngayinye yokuhlaziya. Ukuqhubekela phambili kwe-KC kwachazwa lapho okungenani ezimbili zeziguquguquko ezifundwe ziqinisekisa ukuqhubekela phambili.
Ithebula 1 Amapharamitha e-Tomographic avame ukwamukelwa njengezimpawu zokuqhubeka kokuqhubeka kwe-RP kanye nemikhawulo ehambisanayo echazwe ezincwadini (nakuba kungaqinisekiswanga)
Kulolu cwaningo, ukusebenza kweziguquguquko ezintathu kuhlolwe ukuqhubekela phambili (i-EleBmax, i-BFSB, kanye ne-AdjEleBmax) ngokusekelwe ekubeni khona kokuqhubekela phambili okungenani kwezinye iziguquguquko ezimbili. Amaphuzu okuqeda afanele alezi ziguquguquko abalwa futhi aqhathaniswa nezinye iziguquguquko.
Ukuhlaziywa kwezibalo kwenziwe kusetshenziswa isofthiwe yezibalo ye-SPSS (inguqulo 27.0 ye-Mac OS; SPSS Inc., eChicago, IL, e-USA). Izici zesampula ziyafingqwa futhi idatha yethulwa njengezinombolo kanye nezilinganiso zezinguquko zezigaba. Izinguquko eziqhubekayo zichazwa njengokuphambuka okuphakathi kanye nokujwayelekile (noma ububanzi obuphakathi kanye nobubanzi be-interquartile lapho ukusatshalaliswa kugobile). Ushintsho kunkomba ye-keratometric lutholakale ngokususa inani lokuqala esilinganisweni sesibili (okungukuthi, inani le-delta elihle libonisa ukwanda kwenani lepharamitha ethile). Ukuhlolwa kwe-parametric kanye nokungekho kwe-parametric kwenziwe ukuhlola ukusatshalaliswa kwezinguquko ze-corneal curvature ezihlukaniswe njengezinto eziqhubekayo noma ezingaqhubeki, kufaka phakathi ukuhlolwa kwe-t-independent-sample, ukuhlolwa kwe-Mann-Whitney U, ukuhlolwa kwe-chi-square, kanye nokuhlolwa okuqondile kukaFisher (uma kudingeka). Izinga lokubaluleka kwezibalo libekwe ku-0.05. Ukuze sihlole ukusebenza kahle kwe-Kmax, D-index, PRC, BFSBR, EleBmax, kanye ne-AdjEleBmax njengezibikezeli zokuqhubekela phambili ngazinye, sakhe ama-receiver performance curves (ROC) futhi sabala amaphuzu afanele okunqamula, ukuzwela, ukucacisa, okuhle (PPV), kanye ne-Negative Predictive Value (NPV). ) kanye nendawo ngaphansi kwe-curve (AUC) lapho okungenani iziguquguquki ezimbili zidlula imingcele ethile (njengoba kuchaziwe ngaphambili) ukuze sihlukanise i-progression njengokulawula.
Amehlo angu-113 eziguli ezingu-76 ezine-RP afakiwe ocwaningweni. Iningi leziguli kwakungabesilisa (n=87, 77%) kanti ubudala obumaphakathi ekuhlolweni kokuqala babuyiminyaka engu-24.09 ± 3.93. Ngokuphathelene nokuhlukaniswa kwe-KC okusekelwe ekuguqukeni okuphelele kwe-Belin/Ambrosio dilatation (inkomba ye-BAD-D), iningi (n=68, 60.2%) lamehlo laliphakathi nendawo. Abacwaningi bakhethe ngazwi linye inani elinqunyiwe elingu-7.0 futhi bahlukanisa phakathi kwe-keratoconus emnene nephakathi nendawo ngokwezincwadi26. Kodwa-ke, okunye ukuhlaziywa kufaka phakathi isampula yonke. Izici zezibalo zabantu, zemitholampilo nezesimo sesampula, kufaka phakathi isilinganiso, ubuncane, ubukhulu, ukuphambuka okujwayelekile (SD) kanye nezilinganiso ezinezikhawu zokuzethemba ezingu-95% (IC95%), kanye nezilinganiso zokuqala nezesibili. Umehluko phakathi kwamanani ngemuva kwezinyanga ezingu-12 ± 3 ungatholakala kuthebula 2.
Ithebula 2. Izici zezibalo zabantu, zezokwelapha kanye nezesimo sesiguli. Imiphumela ivezwa njengesilinganiso ± ukuphambuka okujwayelekile kweziguquguquki eziqhubekayo (*imiphumela ivezwa njengesilinganiso ± IQR), isikhawu sokuzethemba esingu-95% (95% CI), ubulili besilisa kanye neso lesokudla kuvezwa njengenombolo kanye nephesenti
Ithebula 3 likhombisa inani lamehlo ahlukaniswe njengama-progressor uma kucatshangelwa ipharamitha ngayinye ye-tomographic (i-Kmax, i-Km, i-K2, i-Astig, i-PachyMin, i-PRC kanye ne-D-Index) ngokwehlukana. Uma kucatshangelwa ukuqhubeka kwe-KC, okuchazwe yizinguquko ezibonwe okungenani eziguquguquki ezimbili ze-tomographic, amehlo angu-57 (50.4%) abonise ukuqhubeka.
Ithebula 3 Inombolo kanye nemvamisa yamehlo ahlukaniswe njengama-progressor, kucatshangelwa ipharamitha ngayinye ye-tomographic ngokwehlukana
Amaphuzu e-Kmax, D-index, i-PRC, i-EleBmax, i-BFSB, kanye ne-AdjEleBmax njengezibikezeli ezizimele zokuqhubekela phambili kwe-KC aboniswe kuThebula 4. Isibonelo, uma sichaza inani lomkhawulo lokukhulisa i-Kmax nge-1 diopter (D) ukuze kuphawulwe ukuqhubekela phambili, yize le pharamitha ibonisa ukuzwela okungu-49%, inokucaciswa okungu-100% (zonke izimo ezikhonjwe njengeziqhubekayo kule pharamitha empeleni zaziyiqiniso). ama-progressors angenhla) anenani elibikezelayo elihle (PPV) elingu-100%, inani elibikezelayo elibi (NPV) elingu-66%, kanye nendawo engaphansi kwejika (AUC) elingu-0.822. Kodwa-ke, i-cutoff efanelekile ebaliwe ye-kmax yayingu-0.4, enikeza ukuzwela okungu-70%, ukucaciswa okungu-91%, i-PPV engu-89%, kanye ne-NPV engu-75%.
Ithebula 4 I-Kmax, i-D-Index, i-PRC, i-BFSB, i-EleBmax, kanye ne-AdjEleBmax amaphuzu njengezibikezeli ezihlukile zokuqhubekela phambili kwe-KC (ezichazwa njengoshintsho olubalulekile eziguquguqukweni ezimbili noma ngaphezulu)
Ngokuphathelene nenkomba ye-D, iphuzu elifanele lokuvala lingu-0.435, ukuzwela kungu-82%, ukucacisa kungu-98%, i-PPV ingu-94%, i-NPV ingu-84%, kanye ne-AUC ingu-0.927. Siqinisekisile ukuthi emehlweni angu-50 aqhubekela phambili, iziguli ezintathu kuphela ezingazange ziqhubekele phambili kwezinye izilinganiso ezimbili noma ngaphezulu. Kumehlo angu-63 lapho inkomba ye-D ingazange ithuthuke khona, ayi-10 (15.9%) abonise ukuqhubekela phambili okungenani kwezinye izilinganiso ezimbili.
Ku-PRC, iphuzu elifanele lokunquma inqubekela phambili kwakuwukwehla okungu-0.065 ngokuzwela okungu-79%, ukucaciswa okungu-80%, i-PPV engu-80%, i-NPV engu-79%, kanye ne-AUC engu-0.844.
Ngokuphathelene nokuphakama kobuso obungemuva (i-EleBmax), umkhawulo ofanele wokunquma ukuqhubekela phambili kwakuwukukhuphuka okungu-2.5 µm ngokuzwela okungu-65% kanye nokucaciswa okungu-73%. Lapho kulungiselelwa i-BSFB yesibili elinganisiwe, ukuzwela kwepharamitha entsha i-AdjEleBmax kwaba ngu-63% kanti ukucaciswa kwathuthuka ngo-84% ngephuzu elifanele lokunqunywa elingu-6.5 µm. I-BFSB ngokwayo ibonise ukunqunywa okuphelele okungu-0.05 mm ngokuzwela okungu-51% kanye nokucaciswa okungu-80%.
Ku-fig. 2 kukhombisa ama-ROC curve epharamitha ngayinye ye-tomographic elinganisiwe (i-Kmax, i-D-Index, i-PRC, i-EleBmax, i-BFSB kanye ne-AdjEleBmax). Sibona ukuthi i-D-index iyisivivinyo esisebenza kahle kakhulu esine-AUC ephezulu (0.927) elandelwa yi-PRC kanye ne-Kmax. I-AUC EleBmax ingu-0.690. Lapho ilungiselwe i-BFSB, lesi silungiselelo (i-AdjEleBmax) sithuthukise ukusebenza kwaso ngokwandisa i-AUC ibe ngu-0.754. I-BFSB ngokwayo ine-AUC engu-0.690.
Umfanekiso 2. Ama-Receiver performance curves (ROC) abonisa ukuthi ukusetshenziswa kwe-D index ukunquma ukuqhubeka kwe-keratoconus kufinyelele amazinga aphezulu okuzwela kanye nokucaciswa, kulandelwe yi-PRC kanye ne-Kmax. I-AdjEleBmax isabhekwa njengenengqondo futhi ngokuvamile 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-rediyasi yangemuva yokugoba kusuka ku-3.0 mm igxile endaweni encane kakhulu; i-BFSB, efaneleka kakhulu umhlane oyindilinga; Ukuphakama; I-AdjELEBmax, i-engeli yokuphakama ephezulu. Ubuso obungemuva be-cornea bulungiswa ku-dorsum eyindilinga efaneleka kakhulu.
Uma sibheka i-EleBmax, i-BFSB, kanye ne-AdjEleBmax, ngokulandelana, siqinisekisile ukuthi amehlo angu-53 (46.9%), angu-40 (35.3%), kanye nangu-45 (39.8%) abonise ukuqhubekela phambili kwepharamitha ngayinye ehlukanisiwe, ngokulandelana. Kula mehlo, angu-16 (30.2%), angu-11 (27.5%), kanye nangu-9 (45%), ngokulandelana, ayengenalo ukuqhubekela phambili kweqiniso njengoba kuchazwe okungenani amanye amapharamitha amabili. Kula mehlo angu-60 angabhekwanga njengokuqhubekela phambili yi-EleBmax, amehlo angu-20 (33%) ayeqhubekela phambili kwamanye amapharamitha amabili noma ngaphezulu. Amehlo angamashumi amabili nesishiyagalombili (38.4%) kanye nangu-21 (30.9%) abhekwa njengangaqhubeki phambili ngokusho kwe-BFSB kanye ne-AdjEleBmax kuphela, ngokulandelana, abonisa ukuqhubekela phambili kweqiniso.
Sihlose ukuphenya ukusebenza kahle kwe-BFSB kanye, okubaluleke kakhulu, ukuphakama okuphezulu kwe-posterior corneal okulungisiwe yi-BFSB (AdjEleBmax) njengepharamitha entsha yokubikezela nokuthola ukuqhubeka kwe-KC bese siqhathanisa nezinye ipharamitha ze-tomographic ezivame ukusetshenziswa njengezimpawu zokuqhubekela phambili. Ukuqhathaniswa kwenziwe ngemingcele ebikwe ezincwadini (nakuba ingaqinisekiswanga), okuyi-Kmax kanye ne-D-Index.20
Lapho sibeka i-EleBmax ku-radius ye-BFSB (i-AdjEleBmax), sibone ukwanda okukhulu kokucaciswa - 73% kupharamitha engalungisiwe kanye no-84% kupharamitha elungisiwe - ngaphandle kokuthinta inani lokuzwela (65% no-63%). Siphinde sahlola i-radius ye-BFSB ngokwayo njengenye indlela engaba khona yokubikezela ukuqhubekela phambili kokwanda. Kodwa-ke, ukuzwela (51% vs 63%), ukucaciswa (80% vs 84%) kanye ne-AUC (0.69 vs 0.75) yale pharamitha kwakuphansi kunaleyo ye-AdjEleBmax.
I-Kmax iyipharamitha eyaziwayo yokubikezela ukuqhubeka kwe-KC. 27 Akukho ukuvumelana ngokuthi yimuphi umkhawulo wokuvala ofaneleka kakhulu. 12,28 Esifundweni sethu, sicabangele ukwanda kwe-1D noma ngaphezulu njengencazelo yokuqhubekela phambili. Kulesi silinganiso, sibonile ukuthi zonke iziguli ezikhonjwe njengezithuthukayo ziqinisekiswe okungenani ezinye izilinganiso ezimbili, okuphakamisa ukucaciswa okungu-100%. Kodwa-ke, ukuzwela kwayo kwakuphansi kakhulu (49%), futhi ukuqhubekela phambili kwakungenakutholakala emehlweni angu-29. Kodwa-ke, esifundweni sethu, umkhawulo ofanele we-Kmax wawungu-0.4 D, ukuzwela kwakungu-70%, kanti ukucaciswa kwakungu-91%, okusho ukuthi ngokuncipha okulinganiselwe kokucaciswa (kusuka ku-100% kuya ku-91%), sithuthukile. Ukuzwela kwakusukela ku-49% kuya ku-70%. Kodwa-ke, ukubaluleka kwezokwelapha kwalesi silinganiso esisha kuyangabazeka. Ngokusho kocwaningo lwe-Kreps mayelana nokuphindaphinda kwezilinganiso ze-Pentacam®, ukuphindaphinda kwe-Kmax kwakungu-0.61 kumdlavuza we-catarrhal omnene kanye no-1.66 ku-caesarean colpitis olinganiselayo,19 okusho ukuthi inani lokunqunywa kwezibalo kulesi sampula alibalulekile ngokwezokwelapha njengoba lichaza isimo esizinzile. lapho inqubekela phambili enkulu engenzeka isetshenziswa kwamanye amasampula. I-Kmax, ngakolunye uhlangothi, ichaza ukugoba okukhulu kakhulu kwe-cornea yangaphambili yesifunda esincane 29 futhi ayikwazi ukuphinda ikhiqize izinguquko ezenzeka ku-cornea yangaphambili, i-cornea yangemuva, nezinye izindawo ze-pachymetry. 30-32 Uma kuqhathaniswa namapharamitha amasha angemuva, i-AdjEleBmax ibonise ukuzwela okuphezulu (63% vs. 49%). Amehlo angu-20 aqhubekayo ahlonzwe kahle kusetshenziswa le pharamitha futhi aphuthelwa kusetshenziswa i-Kmax (uma kuqhathaniswa namehlo angu-12 aqhubekayo atholakale kusetshenziswa i-Kmax esikhundleni se-AdjEleBmax). Lokhu okutholakele kusekela iqiniso lokuthi ubuso bangemuva be-cornea buphakeme futhi bunwebe kakhulu phakathi uma kuqhathaniswa nobuso bangaphambili, okungasiza ekuboneni izinguquko. 25,32,33
Ngokusho kwezinye izifundo, i-D-index iyipharamitha ehlukanisiwe enozwela oluphezulu kakhulu (82%), ukucaciswa (95%) kanye ne-AUC (0.927). 34 Empeleni, lokhu akumangazi, ngoba lokhu kuyinkomba yamapharamitha amaningi. I-PRC yayiyi-variable yesibili ebucayi kakhulu (79%) ilandelwa yi-AdjEleBmax (63%). Njengoba kushiwo ngaphambili, lapho ukuzwela kuphakeme, kuncane okungalungile futhi kuthuthuka kangcono amapharamitha okuhlola. 35 Ngakho-ke, sincoma ukusebenzisa i-AdjEleBmax (ene-cutoff engu-7 µm yokuqhubekela phambili kune-6.5 µm njengoba isikali sedijithali esakhelwe ku-Pentacam® singafaki izindawo zamadesimali zale pharamitha) esikhundleni se-EleBmax engalungiswanga, ezofakwa kanye nezinye izinto eziguquguqukayo ekuhlolweni. ukuqhubeka kwe-keratoconus ukuthuthukisa ukuthembeka kokuhlolwa kwethu kwezokwelapha kanye nokutholwa kokuqala kokuqhubekela phambili.
Kodwa-ke, ucwaningo lwethu lubhekene nemikhawulo ethile. Okokuqala, sisebenzise amapharamitha okudweba i-tomographic shapeflug kuphela ukuchaza nokuhlola ukuqhubeka, kodwa ezinye izindlela ziyatholakala njengamanje ngenhloso efanayo, njengokuhlaziywa kwe-biomechanical, okungase kwandulele noma yiziphi izinguquko ze-topographic noma i-tomographic. 36 Okwesibili, sisebenzisa isilinganiso esisodwa sazo zonke ipharamitha ezivivinyiwe futhi, ngokusho kuka-Ivo Guber et al., isilinganiso phezu kwezithombe eziningi siphumela emazingeni omsindo ophansi wokulinganisa. 28 Ngenkathi izilinganiso nge-Pentacam® zaziphindaphindwa kahle emehlweni avamile, zaziphansi emehlweni anezinkinga ze-cornea kanye ne-cornea ectasia. 37 Kulolu cwaningo, sifake kuphela amehlo anokuqinisekiswa kwe-scan kwekhwalithi ephezulu kwe-Pentacam® eyakhelwe ngaphakathi, okusho ukuthi isifo esithuthukile sachithwa. 17 Okwesithathu, sichaza ama-progressor eqiniso njenganemingcele okungenani emibili ngokusekelwe ezincwadini kodwa angakaqinisekiswa. Okokugcina, futhi mhlawumbe okubaluleke kakhulu, ukuhlukahluka kwezilinganiso ze-Pentacam® kubaluleke kakhulu emtholampilo ekuhloleni ukuqhubeka kwe-keratoconus. 18,26 Kusampula yethu yamehlo angu-113, lapho ehlukaniswe ngokwezinga le-BAD-D, iningi lamehlo (n=68, 60.2%) lalilincane, kanti amanye ayengaphansi kwe-subclinical noma alula. Kodwa-ke, uma sibheka usayizi wesampula omncane, sigcine ukuhlaziywa okuphelele kungakhathaliseki ukuthi i-KTC ibukhali kangakanani. Sisebenzise inani elilinganiselwe elifanele isampula yethu yonke, kodwa siyavuma ukuthi lokhu kungangeza umsindo (ukuguquguquka) ekulinganisweni futhi kuphakamise ukukhathazeka mayelana nokuphindaphinda kokulinganisa. Ukuphindaphinda kokulinganisa kuncike ebunzimeni be-KTC, njengoba kuboniswe nguKreps, Gustafsson et al. 18,26. Ngakho-ke, sincoma kakhulu ukuthi izifundo zesikhathi esizayo zicabangele izigaba ezahlukene zesifo futhi zihlole amaphuzu okuphela afanele ukuze kuthuthukiswe ngendlela efanele.
Ekuphetheni, ukutholakala kokuqala kokuqhubeka kubaluleke kakhulu ukuze kuhlinzekwe ukwelashwa ngesikhathi esifanele ukuze kumiswe ukuqhubekela phambili (ngokusebenzisa ukuxhumanisa)38 futhi kusize ekulondolozeni umbono kanye nekhwalithi yokuphila ezigulini zethu.34 Umgomo oyinhloko womsebenzi wethu ukukhombisa ukuthi i-EleBmax, ehlelwe ku-BFS radius efanayo phakathi kokulinganiswa kwesikhathi, isebenza kangcono kune-EleBmax uqobo. Le pharamitha ikhombisa ukucaca okuphezulu kanye nokusebenza kahle uma kuqhathaniswa ne-EleBmax, ingenye yemingcele ebucayi kakhulu (ngakho-ke ukusebenza kahle kokuhlola okungcono kakhulu) futhi ngaleyo ndlela i-biomarker yokuqhubekela phambili okungenzeka. Kunconywa kakhulu ukudala izinkomba zamapharamitha amaningi. Izifundo zesikhathi esizayo ezihilela ukuhlaziywa kokuqhubekela phambili kwe-multivariate kufanele zifake i-AdjEleBmax.
Ababhali abatholi noma yiluphi uxhaso lwezezimali ngocwaningo, ubunikazi bombhali kanye/noma ukushicilelwa kwalesi sihloko.
UMargarida Ribeiro noClaudia Barbosa bangababhali abasebenzisana nabo ocwaningweni. Ababhali babika ukuthi akukho ukungqubuzana kwezintshisekelo kulo msebenzi.
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