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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, shekara 3*Claudia Barbosa, shekara 3*2 Bio Faculty of Medicine - Faculty of Medicine na Jami'ar Porto, Porto, Portugal 3 Faculty of Medicine na Jami'ar Porto, Porto, Portugal;4 Sashen Tiyata da Ilimin Halitta, Faculty of Medicine, Jami'ar Porto, Porto, Portugal4 Sashen tiyata da ilimin halittar jiki, Faculty of Medicine, Jami'ar Porto, Porto, Portugal *Wadannan marubutan sun ba da gudummawa daidai ga wannan aikin.Hernâni Monteiro Porto, 4200-319, Portugal, imel [email protected] Manufa: Mun kimanta da corneal na baya surface gyara don guda Best Fit Sphere Back (BFSB) tsakanin ma'auni na lokaci (AdjEleBmax) da BFSB radius (BFSBR) Matsakaicin tsayi kanta an yi amfani da ita azaman sabon ma'auni don yin rikodin ci gaban dilatation kuma idan aka kwatanta da sabbin ingantattun sigogi na ci gaban keratoconus (KK).SakamakoMun kimanta Kmax, D index, na baya curvature radius, da manufa yanke yanke daga 3.0 mm thinnest point tsakiya (PRC), EleBmax, BFSBR, da AdjEleBmax a matsayin masu zaman kansu sigogi don rikodin ci gaban KC (wanda aka ayyana azaman biyu ko fiye masu canji), mun sami hankali. na 70%, 82%, 79%, 65%, 51%, and 63%, da 91%, 98%, 80%, 73%, 80%, da 84% ƙayyadaddun abubuwan gano ci gaban KC..Yankin da ke ƙarƙashin lanƙwasa (AUC) na kowane mai canzawa shine 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, bi da bi.Kammalawa: Idan aka kwatanta da EleBmax ba tare da wani daidaitawa ba, AdjEleBmax yana da ƙayyadaddun ƙayyadaddun ƙayyadaddun bayanai, mafi girma AUC da mafi kyawun aiki tare da hankali iri ɗaya.AUC.Tun da siffar bangon baya ya fi tsayi kuma mai lankwasa fiye da na baya, wanda zai iya taimakawa wajen gano canje-canje, muna ba da shawarar hada da AdjEleBmax a cikin kima na ci gaban KC tare da wasu masu canji don inganta amincin binciken mu na asibiti da kuma gano wuri.progressions.Mahimman kalmomi: keratoconus, cornea, ci gaba, mafi kyawun siffar dorsal dorsal, matsakaicin tsayi na baya na cornea.
Keratoconus (KK) shine ectasia na farko na farko na kowa.Yanzu ana la'akari da shi azaman na biyu (albeit asymmetric) cuta mai saurin ci gaba wanda ke haifar da sauye-sauyen tsari da yawa wanda ke biye da ɓacin rai da tabo.1,2 A asibiti, marasa lafiya suna gabatar da astigmatism na yau da kullun da myopia, photophobia, da / ko monocular diplopia tare da raunin hangen nesa, maximally gyara na gani acuity (BCVA) da kuma rage ingancin rayuwa.3,4 Abubuwan bayyanar RP yawanci suna farawa a cikin shekaru goma na biyu na rayuwa kuma suna ci gaba zuwa shekaru goma na huɗu, sannan ta hanyar kwantar da hankali na asibiti.Haɗari da ƙimar ci gaba ya fi girma a cikin mutanen da ke ƙasa da shekaru 19.5.6
Kodayake har yanzu babu tabbataccen magani, jiyya na yanzu don keratoconus ido yana da mahimman manufofi guda biyu: inganta aikin gani da dakatar da ci gaban dilation.7,8 Za a iya ganin tsohon a cikin tabarau, m ko rabin-tsage-tsalle na ruwan tabarau, zoben intracorneal, ko a cikin dashen corneal lokacin da cutar ta yi tsanani.9 Manufar ta ƙarshe ita ce tsattsauran ra'ayi na waɗannan jiyya na haƙuri, a halin yanzu ana iya samun su ta hanyar haɗin kai.Wannan aiki yana haifar da karuwa a cikin juriya na biomechanical da taurin kai kuma yana hana ci gaba.10-13 Ko da yake ana iya yin hakan a kowane mataki na cutar, ana samun mafi girman fa'ida a cikin matakan farko.14 Ya kamata a yi ƙoƙari don gano ci gaba da wuri da kuma hana ci gaba da lalacewa, da kuma guje wa jiyya maras dacewa ga sauran marasa lafiya, don haka rage haɗarin rikice-rikice irin su kamuwa da cuta, asarar ƙwayoyin endothelial, da kuma ciwo mai tsanani bayan tiyata.15.16
Duk da bincike da yawa da ke da nufin ma'ana da gano ci gaba,17-19 har yanzu babu takamaiman ma'anar ci gaban dilatation ko daidaitacciyar hanyar rubuta shi.9,20,21 A cikin Yarjejeniya ta Duniya akan Keratoconus da Dilated Diseases (2015), ci gaban keratoconus an bayyana shi azaman canji na jeri a cikin akalla biyu daga cikin sigogin topographic masu zuwa: ƙwanƙwasa na baya na baya, haɓakar ƙwayar cuta ta baya, raguwa da / ko kauri. na cornea Adadin canji yana ƙaruwa daga kewaye zuwa mafi ƙanƙanta batu.9 Koyaya, ana buƙatar ƙarin takamaiman ma'anar ci gaba.An yi ƙoƙari don nemo mafi ƙarfi masu canji don ganowa da bayyana ci gaba.19:22–24
Ganin cewa siffar saman kusurwar baya, wanda ya fi aspherical da lankwasa fiye da na baya, na iya zama da amfani don gano canje-canje, 25 babban manufar wannan binciken shine a kimanta halayen matsakaicin matsakaicin tsayin kusurwa na baya.daidaita zuwa yankin da ya fi dacewa.Ma'aunin ma'auni na lokaci (BFSB) (AdjEleBmax) da kuma radius BFSB (BFSBR) su kaɗai sun yi aiki azaman sabbin sigogi don yin rikodin ci gaban dilation da kwatanta su zuwa mafi yawan abubuwan da aka yi amfani da su don ci gaban KC.
Dukkanin idanu na 113 na 76 marasa lafiya a jere da aka gano tare da keratoconus an bincikar su a cikin wannan binciken na baya-bayan nan a Sashen Ophthalmology a Asibitin Tsakiya na Jami'ar São João, Portugal.Kwamitin da'a na gida na Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto ya amince da binciken kuma an gudanar da shi daidai da sanarwar Helsinki.An sami izinin rubutaccen bayanin izini daga duk mahalarta kuma, idan ɗan takarar yana ƙasa da shekaru 16, daga iyaye da/ko mai kula da doka.
An gano marasa lafiya tare da KC masu shekaru 14 zuwa 30 kuma an haɗa su bi da bi a cikin ido da ido a cikin Oktoba-Disamba 2021.
Dukkanin majinyacin da aka zaɓa an bi su na tsawon shekara ɗaya ta hanyar ƙwararren ƙwanƙwasa kuma an gudanar da aƙalla ma'auni na Scheimpflug guda uku (Pentacam®; Oculus, Wetzlar, Jamus).Marasa lafiya sun daina sanya ruwan tabarau na lamba aƙalla awanni 48 kafin aunawa.ƙwararren likitan kashin baya ne ya yi duk ma'auni kuma an haɗa sikanin kawai tare da ingantaccen ingancin "Ok".Idan ba a yiwa ma'aunin ingancin hoto ta atomatik alamar "Ok", za a maimaita gwajin.An yi nazarin sikanin sikanin guda biyu don kowane ido don gano ci gaba, tare da kowane nau'i biyu ya rabu da watanni 12 ± 3.Idanun da ke da KC na subclinical kuma an haɗa su (a cikin waɗannan lokuta, ɗayan ido dole ne ya nuna alamun KC na asibiti).
Mun cire daga nazarin idanun KC waɗanda aka yi wa tiyatar ido a baya (crosslinking corneal, zoben corneal, ko dashen corneal) da kuma idanu tare da cututtukan da suka ci gaba sosai (kaurin corneal a thinnest <350 µm, hydrokeratosis, ko zurfin tabo na corneal) yayin da ƙungiyar ta ci gaba da kasawa. "Ok" bayan binciken ingancin ingancin ciki.
An tattara bayanan alƙaluma, na asibiti da na hoto don bincike.Don gano ci gaban KC, mun tattara nau'ikan nau'ikan nau'ikan hoto da yawa ciki har da matsakaicin lanƙwasa na corneal (Kmax), ma'anar lanƙwasa na corneal (Km), lanƙwasa na corneal na corneal lebur (K1), steepest meridional corneal curvature (K2), astigmatism na corneal (Astig = K2 - K1). ).), ƙananan ma'aunin kauri (PachyMin), matsakaicin tsayi na baya na baya (EleBmax), radius na baya na curvature (PRC) 3.0 mm a tsakiya a kan bakin bakin ciki, Belin / Ambrosio D-index (D-index), BFSBR da EleBmax an daidaita su zuwa BFSB (AdjEleBmax).Kamar yadda aka nuna a cikin fig.1, AdjEleBmax yana samuwa bayan da hannu muka ƙayyade radius BFSB iri ɗaya a cikin gwaje-gwajen injin biyu ta amfani da ƙimar BFSR daga kimanta na biyu.
Shinkafa1. Kwatanta hotunan Pentacam® a cikin madaidaiciyar matsayi na baya tare da ci gaba na asibiti na gaskiya tare da tazara na watanni 13 tsakanin gwaje-gwaje.A cikin panel 1, EleBmax ya kasance 68 µm a jarrabawar farko da 66 µm a na biyu, don haka babu wani ci gaba a cikin wannan siga.Mafi kyawun radiyoyin sphere ta atomatik da injin ke bayarwa don kowane ƙima shine 5.99 mm da 5.90 mm, bi da bi.Idan muka danna maɓallin BFS, taga zai bayyana inda za'a iya bayyana sabon radius na BFS da hannu.Mun ƙaddara radius iri ɗaya a cikin gwaje-gwajen biyu ta amfani da ƙimar radius BFS da aka auna na biyu (5.90mm).A cikin kwamiti na 2, sabon darajar EleBmax (EleBmaxAdj) da aka gyara don BFS iri ɗaya a cikin ƙimar farko shine 59 µm, yana nuna haɓakar 7 µm a cikin kima na biyu, yana nuna ci gaba bisa ga madaidaicin 7 µm.
Don nazarin ci gaba da kimanta tasiri na sababbin masu canji na binciken, mun yi amfani da sigogi da aka saba amfani da su azaman alamun ci gaba (Kmax, km, K2, Astig, PachyMin, PRC, da D-Index) da kuma ƙofofin da aka bayyana a cikin wallafe-wallafen.ko da yake ba a zahiri ba).Tebu 1 yana lissafin ƙimar da ke wakiltar ci gaban kowane ma'aunin bincike.An bayyana ci gaban KC lokacin da aƙalla biyu daga cikin sauye-sauyen da aka yi nazari sun tabbatar da ci gaba.
Tebur 1 Ma'auni na Tomographic gabaɗaya ana karɓa azaman alamomin ci gaban ci gaban RP da madaidaitan ƙofofin da aka bayyana a cikin wallafe-wallafen (ko da yake ba a tabbatar ba)
A cikin wannan binciken, an gwada aikin masu canji guda uku don ci gaba (EleBmax, BFSB, da AdjEleBmax) dangane da kasancewar ci gaban aƙalla wasu masu canji guda biyu.An ƙididdige madaidaitan wuraren yanke yanke don waɗannan masu canji kuma an kwatanta su da sauran masu canji.
An yi nazarin ƙididdiga ta amfani da software na ƙididdiga na SPSS (sigar 27.0 don Mac OS; SPSS Inc., Chicago, IL, Amurka).An taƙaita halayen samfuri kuma an gabatar da bayanai azaman lambobi da ma'auni na masu canji.Ana bayyana masu ci gaba da canji a matsayin ma'ana da daidaitattun karkata (ko tsaka-tsaki da kewayon tsaka-tsaki lokacin da aka karkatar da rarraba).An sami canjin ma'aunin keratometric ta hanyar cire ƙimar asali daga ma'auni na biyu (watau ƙimar delta mai kyau tana nuna haɓakar ƙimar wani siga).An yi gwaje-gwajen parametric da marasa daidaituwa don kimanta rarrabuwar sauye-sauyen lanƙwasa na corneal waɗanda aka rarraba a matsayin ci gaba ko mara ci gaba, gami da samfurin t-test mai zaman kansa, gwajin Mann-Whitney U-test, gwajin chi-square, da ainihin gwajin Fisher (idan ake bukata).An saita matakin mahimmancin ƙididdiga a 0.05.Don tantance tasirin Kmax, D-index, PRC, BFSBR, EleBmax, da AdjEleBmax a matsayin masu tsinkayar ci gaban mutum ɗaya, mun gina maɓallan aikin mai karɓa (ROC) kuma mun ƙididdige mahimman abubuwan yankewa, hankali, ƙayyadaddun, tabbatacce (PPV), da Hasashen Hasashen. Darajar (NPV).) da yanki a ƙarƙashin lanƙwasa (AUC) lokacin da aƙalla masu canji biyu suka wuce wasu ƙofofin (kamar yadda aka bayyana a baya) don rarraba ci gaba azaman sarrafawa.
An haɗa duka idanu na 113 na marasa lafiya 76 tare da RP a cikin binciken.Yawancin marasa lafiya maza ne (n = 87, 77%) kuma matsakaicin shekaru a farkon kima shine 24.09 ± 3.93 shekaru.Dangane da rarrabuwar kawuna na KC dangane da ƙaƙƙarfan jimillar Belin/Ambrosio dilatation dilatation (BAD-D index), yawancin (n=68, 60.2%) na idanu sun kasance matsakaici.Masu binciken gaba ɗaya sun zaɓi ƙimar yankewa na 7.0 kuma sun bambanta tsakanin keratoconus mai laushi da matsakaici bisa ga wallafe-wallafe26.Duk da haka, sauran nazarin ya haɗa da dukan samfurin.Halayen alƙaluma, na asibiti da na hoto na samfurin, gami da ma'ana, mafi ƙanƙanta, matsakaicin, daidaitaccen karkata (SD) da ma'auni tare da tazarar amincewa 95% (IC95%), da ma'auni na farko da na biyu.Bambanci tsakanin dabi'u bayan watanni 12 ± 3 ana iya samuwa a cikin tebur 2.
Tebur 2. Alkaluma, na asibiti da kuma halayen halayen marasa lafiya.Ana bayyana sakamakon a matsayin ma'anar ± daidaitaccen karkata don ci gaba da masu canji (* ana bayyana sakamakon a matsayin matsakaici ± IQR), 95% tazarar amincewa (95% CI), jinsi na maza da idon dama ana bayyana su azaman lamba da kashi
Tebur na 3 yana nuna adadin idanu da aka ware azaman masu ci gaba da la'akari da kowane ma'aunin hoto (Kmax, km, K2, Astig, PachyMin, PRC da D-Index) daban.Yin la'akari da ci gaba na KC, wanda aka bayyana ta hanyar canje-canjen da aka lura a cikin akalla nau'i biyu na nau'i-nau'i, 57 idanu (50.4%) sun nuna ci gaba.
Tebura 3 Lambobi da mitar idanu waɗanda aka keɓe azaman masu ci gaba, la'akari da kowane siga na hoto daban
Kmax, D-index, PRC, EleBmax, BFSB, da AdjEleBmax maki a matsayin masu tsinkaya masu zaman kansu na ci gaban KC an nuna su a cikin Table 4. Misali, idan muka ayyana ƙimar kofa don ƙara Kmax ta 1 diopter (D) don alamar ci gaba, ko da yake Wannan siga yana nuna azanci na 49 %, yana da ƙayyadaddun ƙayyadaddun 100% (duk shari'ar da aka gano a matsayin ci gaba akan wannan siga gaskiya ne).masu ci gaba a sama) tare da ƙimar tsinkaya mai kyau (PPV) na 100%, ƙimar tsinkaya mara kyau (NPV) na 66%, da yanki a ƙarƙashin madaidaicin (AUC) na 0.822.Koyaya, ƙididdige madaidaicin yanke don kmax shine 0.4, yana ba da hankali na 70%, ƙayyadaddun 91%, PPV na 89%, da NPV na 75%.
Table 4 Kmax, D-Index, PRC, BFSB, EleBmax, da AdjEleBmax maki a matsayin keɓaɓɓen tsinkaya na ci gaban KC (wanda aka ayyana azaman babban canji a cikin masu canji biyu ko fiye)
Dangane da ma'aunin D, madaidaicin yanke yanke shine 0.435, hankali shine 82%, takamaiman shine 98%, PPV shine 94%, NPV shine 84%, kuma AUC shine 0.927.Mun tabbatar da cewa daga cikin idanu 50 da suka ci gaba, marasa lafiya 3 kawai ba su ci gaba ba akan 2 ko fiye da wasu sigogi.Daga cikin idanu 63 da D index bai inganta ba, 10 (15.9%) ya nuna ci gaba a cikin akalla wasu sigogi biyu.
Don PRC, maƙasudin yanke yanke don ayyana ci gaba shine raguwar 0.065 tare da hankali na 79%, ƙayyadaddun 80%, PPV na 80%, NPV na 79%, da AUC na 0.844.
Dangane da hawan saman baya (EleBmax), madaidaicin ƙofa don tantance ci gaba shine haɓakar 2.5 µm tare da azanci na 65% da ƙayyadaddun 73%.Lokacin da aka daidaita zuwa BSFB na biyu da aka auna, ƙwarewar sabon siga AdjEleBmax ya kasance 63% kuma ƙayyadaddun ƙayyadaddun ya inganta ta 84% tare da madaidaicin yanke yanke na 6.5 µm.BFSB da kanta ya nuna cikakkiyar yankewar 0.05 mm tare da azanci na 51% da takamaiman 80%.
A kan fig.2 yana nuna madaidaicin ROC don kowane ƙididdige ma'aunin tomographic (Kmax, D-Index, PRC, EleBmax, BFSB da AdjEleBmax).Mun ga cewa D-index shine gwaji mafi inganci tare da mafi girma AUC (0.927) wanda PRC da Kmax suka biyo baya.AUC EleBmax shine 0.690.Lokacin da aka kunna don BFSB, wannan saitin (AdjEleBmax) ya inganta aikinsa ta hanyar faɗaɗa AUC zuwa 0.754.BFSB kanta tana da AUC na 0.690.
Hoto 2. Ƙididdigar aikin mai karɓa (ROC) yana nuna cewa yin amfani da alamar D don ƙayyade ci gaban keratoconus ya sami babban matakan hankali da ƙayyadaddun bayanai, sannan PRC da Kmax suka biyo baya.AdjEleBmax har yanzu ana ɗaukar ma'ana kuma gabaɗaya ya fi Elebmax ba tare da kunna BFSB ba.
Taƙaitaccen bayani: Kmax, matsakaicin curvature na corneal;D-index, Belin/Ambrosio D-index;PRC, radius na baya na curvature daga 3.0 mm a tsakiya akan mafi bakin ciki;BFSB, wanda ya fi dacewa da baya mai siffar zobe;Tsayi;AdjELEBmax, matsakaicin kusurwar haɓakawa.an daidaita saman baya na cornea zuwa dorsum mafi dacewa.
Idan akai la'akari da EleBmax, BFSB, da AdjEleBmax, bi da bi, mun tabbatar da cewa 53 (46.9%), 40 (35.3%), da 45 (39.8%) idanu sun nuna ci gaba ga kowane keɓaɓɓen siga, bi da bi.Daga cikin waɗannan idanu, 16 (30.2%), 11 (27.5%), da 9 (45%), bi da bi, ba su da ci gaba na gaskiya kamar yadda aka ayyana ta aƙalla wasu sigogi biyu.Daga cikin idanu 60 da ba a la'akari da ci gaba ta hanyar EleBmax, 20 (33%) idanu sun kasance masu ci gaba a kan 2 ko fiye da wasu sigogi.An yi la'akari da idanu ashirin da takwas (38.4%) da 21 (30.9%) ba su da ci gaba bisa ga BFSB da AdjEleBmax kadai, bi da bi, suna nuna ci gaba na gaskiya.
Muna da niyyar bincika ingancin BFSB kuma, mafi mahimmanci, BFSB-daidaita matsakaicin tsayi na baya (AdjEleBmax) azaman siga na sabon labari don tsinkaya da gano ci gaban KC da kwatanta su da sauran sigogin hoto da aka saba amfani da su azaman alamun ci gaba.An yi kwatancen tare da ƙofofin da aka ruwaito a cikin wallafe-wallafen (ko da yake ba a inganta ba), wato Kmax da D-Index.20
A lokacin da kafa eleBMAX zuwa radius na BFSB (Adjolebmax), mun lura da babban sigogi - kashi 63% don ƙimar m - 65% da 63%).Mun kuma ƙididdige radius na BFSB kanta a matsayin wani mai iya hasashen ci gaban dilatation.Koyaya, hankali (51% vs 63%), takamaiman (80% vs 84%) da AUC (0.69 vs 0.75) na wannan siga sun kasance ƙasa da na AdjEleBmax.
Kmax sanannen siga ne don hasashen ci gaban KC.27 Babu ijma'i akan wanne iyaka yanke yanke ya fi dacewa.12,28 A cikin bincikenmu, mun yi la'akari da karuwa na 1D ko fiye a matsayin ma'anar ci gaba.A wannan bakin kofa, mun lura cewa duk marasa lafiya da aka gano suna ci gaba an tabbatar da su ta hanyar aƙalla wasu sigogi biyu, suna nuna takamaiman 100%.Duk da haka, hankalinsa ya kasance kaɗan (49%), kuma ba a iya gano ci gaba a cikin idanu 29 ba.Koyaya, a cikin bincikenmu, madaidaicin madaidaicin Kmax shine 0.4 D, hankali shine 70%, kuma ƙayyadaddun ƙayyadaddun shine 91%, wanda ke nufin cewa tare da raguwar dangi a takamaiman (daga 100% zuwa 91%), mun inganta.Hankali ya bambanta daga 49% zuwa 70%.Koyaya, mahimmancin asibiti na wannan sabon kofa yana da tambaya.Dangane da binciken Kreps akan maimaita ma'aunin Pentacam®, maimaitawar Kmax ya kasance 0.61 a cikin ciwon daji na catarrhal mai laushi da 1.66 a cikin matsakaicin caesarean colpitis,19 wanda ke nufin ƙimar yanke ƙididdiga a cikin wannan samfurin ba ta da mahimmanci a asibiti kamar yadda ya bayyana. wani barga yanayi.lokacin da aka yi amfani da matsakaicin yiwuwar ci gaba zuwa wasu samfurori.Kmax, a gefe guda, yana siffanta mafi girman lanƙwasa na baya na ƙananan yanki na 29 kuma ba zai iya sake haifar da canje-canjen da ke faruwa a cikin cornea na baya, na baya, da sauran wurare na pachymetry.30-32 Idan aka kwatanta da sababbin sigogi na baya, AdjEleBmax ya nuna mafi girman hankali (63% vs. 49%).An gano idanu masu ci gaba 20 daidai ta amfani da wannan siga kuma an rasa ta amfani da Kmax (idan aka kwatanta da idanu masu ci gaba 12 da aka gano ta amfani da Kmax maimakon AdjEleBmax).Wannan binciken yana goyan bayan gaskiyar cewa gefen baya na cornea ya fi tsayi kuma ya fi girma a tsakiya idan aka kwatanta da na baya, wanda zai iya taimakawa wajen gano canje-canje.25,32,33
Dangane da sauran karatun, D-index shine keɓaɓɓen siga tare da mafi girman hankali (82%), takamaiman (95%) da AUC (0.927).34 A haƙiƙa, wannan ba abin mamaki ba ne, tun da wannan maƙasudin ma'auni ne da yawa.PRC ita ce ta biyu mafi m (79%) sannan AdjEleBmax (63%) ya biyo baya.Kamar yadda aka ambata a baya, mafi girman hankali, ƙarancin ƙarancin ƙarya kuma mafi kyawun sigogin nunawa suna haɓaka.35 Saboda haka, muna ba da shawarar yin amfani da AdjEleBmax (tare da yanke na 7 µm don ci gaba maimakon 6.5 µm tun da ma'aunin dijital da aka gina a cikin Pentacam® bai ƙunshi wurare na ƙima don wannan ma'auni ba) maimakon EleBmax da ba a gyara ba, wanda za a haɗa tare da shi. sauran masu canji a kima.ci gaban keratoconus don inganta amincin ƙididdigar mu na asibiti da farkon gano ci gaba.
Koyaya, nazarinmu yana fuskantar wasu gazawa.Na farko, mun yi amfani da ma'auni na hoton hoto kawai don ƙayyadewa da kimanta ci gaba, amma wasu hanyoyin suna samuwa a halin yanzu don wannan manufa, kamar nazarin halittu, wanda zai iya rigaya ga kowane canje-canje na topographic ko tomographic.36 Na biyu, muna amfani da ma'auni guda ɗaya na duk sigogin da aka gwada kuma, bisa ga Ivo Guber et al., Matsakaicin sakamakon hotuna da yawa a ƙananan matakan amo.28 Yayin da ma'auni tare da Pentacam® suna da kyau a sake haifuwa a cikin idanu na yau da kullum, sun kasance ƙananan idanu tare da rashin daidaituwa na corneal da ectasia na corneal.37 A cikin wannan binciken, mun haɗa idanu ne kawai tare da ginanniyar ingantacciyar sinadari mai inganci na Pentacam®, wanda ke nufin an kawar da cutar da ta ci gaba.17 Na uku, mun ayyana masu ci gaba na gaskiya da cewa suna da aƙalla sigogi biyu dangane da wallafe-wallafen amma har yanzu ba a tabbatar da su ba.A ƙarshe, kuma watakila mafi mahimmanci, sauye-sauye a cikin ma'aunin Pentacam® yana da mahimmancin asibiti wajen tantance ci gaban keratoconus.18,26 A cikin samfurin mu na idanu 113, lokacin da aka keɓe bisa ga ma'aunin BAD-D, yawancin (n=68, 60.2%) idanu sun kasance matsakaici, tare da sauran ƙananan ƙananan ko kuma masu laushi.Koyaya, idan aka ba ƙaramin girman samfurin, mun riƙe cikakken bincike ba tare da la'akari da tsananin KTC ba.Mun yi amfani da ƙimar kofa wadda ta fi dacewa ga ɗaukacin samfurin mu, amma mun yarda cewa wannan na iya ƙara ƙara (sauyi) zuwa ma'aunin kuma ya ɗaga damuwa game da sake fasalin ma'auni.Maimaita ma'aunai ya dogara da tsananin KTC, kamar yadda Kreps ya nuna, Gustafsson et al.18,26.Sabili da haka, muna ba da shawarar sosai cewa nazarin nan gaba yayi la'akari da matakai daban-daban na cutar da kuma kimanta maƙasudin yanke yanke don ci gaban da ya dace.
A ƙarshe, gano farkon ci gaba yana da mahimmancin mahimmanci don samar da magani na lokaci don dakatar da ci gaba (ta hanyar haɗin kai) 38 da kuma taimakawa wajen kiyaye hangen nesa da ingancin rayuwa a cikin marasa lafiya.34 Babban burin aikinmu shine mu nuna cewa EleBmax, wanda aka kunna zuwa radius BFS iri ɗaya tsakanin ma'aunin lokaci, yana da mafi kyawun aiki fiye da EleBmax kanta.Wannan siga yana nuna ƙayyadaddun ƙayyadaddun ƙayyadaddun inganci da inganci idan aka kwatanta da EleBmax, yana ɗaya daga cikin mafi mahimmancin sigogi (sabili da haka mafi kyawun ingancin nunawa) don haka yuwuwar ci gaban biomarker na farko.Ana ba da shawarar sosai don ƙirƙirar fihirisar ma'auni.Karatun gaba wanda ya ƙunshi bincike na ci gaba da yawa yakamata ya haɗa da AdjEleBmax.
Marubutan ba su sami wani tallafin kuɗi don bincike, marubuta da/ko buga wannan labarin ba.
Margarida Ribeiro da Claudia Barbosa mawallafa ne na nazari.Mawallafa sun ba da rahoton wani rikici na sha'awa a cikin wannan aikin.
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