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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, zaka 3 *Claudia Barbosa, zaka 3 *2 Bio Faculty of Medicine - Faculty of Medicine ya University of Porto, Porto, Portugal 3 Faculty of Medicine ya University of Porto, Porto, Portugal;4Dipatimenti ya Opaleshoni ndi Physiology, Gulu la Zamankhwala, University of Porto, Porto, Portugal4 Dipatimenti ya Opaleshoni ndi Physiology, Faculty of Medicine, University of Porto, Porto, Portugal *Olemba awa adathandizira mofanana pa ntchitoyi.Hernâni Monteiro Porto, 4200-319, Portugal, imelo [imelo yotetezedwa] Cholinga: Tidawunika malo am'mbuyo omwe adasinthidwa kuti akhale a Best Fit Sphere Back (BFSB) pakati pa miyeso ya nthawi (AdjEleBmax) ndi BFSB radius (BFSBR) Kutalika kwakukulu palokha idagwiritsidwa ntchito ngati chizindikiro chatsopano cha tomographic kujambula kupitilira kwa dilatation ndikuyerekeza ndi magawo odalirika aposachedwa a keratoconus progression (KK).Zotsatira.Tidawunika Kmax, D index, posterior curvature radius, ndi cutoff point from 3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, ndi AdjEleBmax ngati magawo odziyimira pawokha kuti alembe momwe KC ikuyendera (yomwe imatanthauzidwa ngati mitundu iwiri kapena kupitilira apo), tapeza zomveka. 70%, 82%, 79%, 65%, 51%, ndi 63%, ndi 91%, 98%, 80%, 73%, 80%, ndi 84% zodziwika bwino zozindikira kupita kwa KC..Dera lomwe lili pansi pa curve (AUC) pamtundu uliwonse linali 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, motsatana.Kutsiliza: Poyerekeza ndi EleBmax popanda kusintha kulikonse, AdjEleBmax ili ndi mawonekedwe apamwamba, AUC yapamwamba komanso magwiridwe antchito abwino okhala ndi chidwi chofanana.AUC.Popeza mawonekedwe a kumbuyo kwake ndi ozungulira komanso opindika kusiyana ndi kutsogolo, zomwe zingathandize kuzindikira kusintha, tikupempha kuphatikizapo AdjEleBmax pakuwunika momwe KC ikuyendera limodzi ndi zosiyana zina kuti tipititse patsogolo kudalirika kwa kafukufuku wathu wachipatala ndi kuzindikira msanga.kupitirira.Mawu ofunikira: keratoconus, cornea, kupita patsogolo, mawonekedwe abwino kwambiri ozungulira, kutalika kwapambuyo kwa cornea.
Keratoconus (KK) ndiye ectasia yofala kwambiri ya cornea.Panopa amaonedwa kuti ndi matenda a mayiko awiri (ngakhale asymmetric) omwe amapita patsogolo kwambiri omwe amachititsa kusintha kwapangidwe kambiri ndikutsatiridwa ndi kupatulira kwa stromal ndi zipsera.1,2 Kachipatala, odwala amapezeka ndi astigmatism osakhazikika ndi myopia, photophobia, ndi / kapena monocular diplopia ndi masomphenya osokonezeka, maximally corrected visual acuity (BCVA) ndi kuchepetsa moyo.3,4 Mawonetseredwe a RP nthawi zambiri amayamba m'zaka khumi zachiwiri za moyo ndikupita patsogolo mpaka zaka khumi zachinayi, ndikutsatiridwa ndi kukhazikika kwachipatala.Chiwopsezo ndi chiwopsezo cha kutukuka ndichokwera mwa anthu ochepera zaka 19.5.6
Ngakhale kuti palibe chithandizo chotsimikizirika, chithandizo chamakono cha keratoconus chamakono chili ndi zolinga ziwiri zofunika: kupititsa patsogolo ntchito ya maso ndi kuletsa kufalikira.7,8 Yoyamba ikhoza kuwonedwa mu magalasi, olimba kapena osakanikirana ndi ma lens, mphete za intracorneal, kapena cornea transplants pamene matendawa ali ovuta kwambiri.9 Cholinga chomaliza ndi njira yopatulika ya machiritso oleza mtimawa, omwe akupezeka pano pokhapokha polumikizana.Opaleshoniyi imabweretsa kuwonjezeka kwa kukana kwa biomechanical ndi kuuma kwa cornea ndikuletsa kupitirirabe.10-13 Ngakhale izi zitha kuchitika pamlingo uliwonse wa matendawa, phindu lalikulu limapezeka m'magawo oyamba.14 Khama liyenera kuchitidwa kuti azindikire kukula msanga ndikupewa kuwonongeka kwina, komanso kupewa chithandizo chosayenera cha odwala ena, potero kuchepetsa chiopsezo cha zovuta zodutsana monga matenda, kuwonongeka kwa maselo a endothelial, ndi ululu wopweteka kwambiri pambuyo pa opaleshoni.15.16
Ngakhale kuti maphunziro angapo omwe cholinga chake ndi kufotokozera ndi kuzindikira momwe akuyendera, 17-19 palibe tanthauzo lofanana la kupititsa patsogolo kwa dilatation kapena njira yovomerezeka yolembera.9,20,21 Mu Global Consensus on Keratoconus and Dilated Diseases (2015), kupita patsogolo kwa keratoconus kumatanthauzidwa ngati kusintha kotsatizana pazigawo ziwiri zotsatirazi: kutsika kwa cornea, kutsika kwa cornea, kupatulira ndi / kapena makulidwe. wa cornea Mlingo wa kusintha kumawonjezeka kuchokera kuzungulira mpaka ku thinnest point.9 Komabe, tanthauzo lachindunji la kupita patsogolo likufunikabe.Khama lapangidwa kuti apeze mitundu yolimba kwambiri kuti azindikire ndi kufotokoza momwe zikuyendera.19:22-24
Poganizira kuti mawonekedwe a cornea yapambuyo, yomwe imakhala yozungulira komanso yopindika kusiyana ndi yapambuyo, ingakhale yothandiza pozindikira kusintha,25 cholinga chachikulu cha phunziroli chinali kuyesa mikhalidwe ya kutalika kwa cornea yokwera kwambiri.kutengera malo oyenera kwambiri.Muyezo wa nthawi (BFSB) (AdjEleBmax) ndi BFSB radius (BFSBR) okha adakhala ngati magawo atsopano ojambulira kakulidwe ka dilation ndikufanizira ndi magawo omwe amagwiritsidwa ntchito kwambiri pakukula kwa KC.
Maso a 113 a odwala 76 otsatizana omwe adapezeka kuti ali ndi keratoconus adafufuzidwa mu kafukufuku wotsatira wa gulu lachipatala ku Dipatimenti ya Ophthalmology ku Central Hospital ya University of São João, Portugal.Phunzirolo linavomerezedwa ndi komiti ya chikhalidwe cha Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto ndipo inachitidwa mogwirizana ndi Declaration of Helsinki.Chilolezo cholembedwa chinapezedwa kwa onse omwe atenga nawo mbali ndipo, ngati wophunzirayo ali ndi zaka zosakwana 16, kuchokera kwa kholo ndi/kapena womusamalira mwalamulo.
Odwala omwe ali ndi KC azaka zapakati pa 14 mpaka 30 adadziwika ndikuphatikizidwa motsatizana ndikutsatira kwathu kwa maso ndi maso mu Okutobala-December 2021.
Odwala onse osankhidwa adatsatiridwa kwa chaka chimodzi ndi katswiri wa corneal ndipo adayesedwa osachepera atatu a Scheimpflug tomographic (Pentacam®; Oculus, Wetzlar, Germany).Odwala anasiya kuvala magalasi osachepera maola 48 asanayezedwe.Miyezo yonse inachitidwa ndi katswiri wa mafupa ophunzitsidwa bwino ndipo amangoyang'ana ndi cheke cha khalidwe la "OK" anaphatikizidwa.Ngati kuwunika kwazithunzi zokha sikunalembedwe kuti "Chabwino", kuyesako kubwerezedwa.Ma scans awiri okha pa diso lililonse adawunikidwa kuti azindikire momwe akupitira patsogolo, ndipo awiriwa adalekanitsidwa ndi miyezi 12 ± 3.Maso omwe ali ndi subclinical KC adaphatikizidwanso (muzochitika izi, diso lina liyenera kukhala likuwonetsa zizindikiro zachipatala za KC).
Sitinaphatikizepo kusanthula maso a KC omwe adachitidwapo opaleshoni yamaso (corneal crosslinking, corneal rings, kapena corneal transplant) ndi maso omwe ali ndi matenda apamwamba kwambiri (corneal thick at thinnest <350 µm, hydrokeratosis, kapena deep corneal scarring) pamene gulu limalephera nthawi zonse. "Chabwino" pambuyo mkati jambulani macheke khalidwe.
Demographic, chipatala ndi tomographic deta anasonkhanitsidwa kusanthula.Kuti tiwone momwe KC ikuyendera, tidasonkhanitsa mitundu ingapo ya ma tomographic kuphatikiza kupindika kwakukulu kwa cornea (Kmax), mean corneal curvature (Km), flat meridional corneal curvature (K1), chotsetsereka kwambiri cha meridional corneal curvature (K2), corneal astigmatism2 - K1 = ).), muyeso wocheperako wa makulidwe (PachyMin), kutalika kwapambuyo kwa cornea (EleBmax), utali wozungulira wa curvature (PRC) 3.0 mm wokhazikika pa thinnest point, Belin/Ambrosio D-index (D-index), BFSBR ndi EleBmax adasinthidwa kukhala BFSB (AdjEleBmax).Monga momwe tawonetsera mkuyu.1, AdjEleBmax imapezedwa titazindikira pamanja utali wofanana wa BFSB pamayesero onse a makina pogwiritsa ntchito mtengo wa BFSR kuchokera pakuyerekeza kwachiwiri.
Mpunga.1. Kuyerekeza kwa zithunzi za Pentacam® pamalo owongoka kumbuyo ndi kupita patsogolo kowona kwachipatala ndi nthawi ya miyezi 13 pakati pa mayeso.Pagulu 1, EleBmax inali 68 µm pakuyezetsa koyamba ndi 66 µm yachiwiri, kotero panalibe kupitilira mu parameter iyi.Ma radiyo abwino kwambiri operekedwa ndi makina pakuwunika kulikonse ndi 5.99 mm ndi 5.90 mm, motsatana.Ngati tidina pa batani la BFS, zenera lidzawonekera pomwe mawonekedwe atsopano a BFS angatanthauzidwe pamanja.Tidatsimikiza utali wofanana m'mayeso onse awiri pogwiritsa ntchito utali wachiwiri woyezedwa wa BFS (5.90mm).Pagulu 2, mtengo watsopano wa EleBmax (EleBmaxAdj) wokonzedwera BFS womwewo pakuwunika koyamba ndi 59 µm, kuwonetsa kuwonjezeka kwa 7 µm pakuwunika kwachiwiri, kuwonetsa kupita patsogolo molingana ndi 7 µm chigawo chathu.
Kuti tifufuze kupititsa patsogolo ndikuwunika momwe zosinthika zatsopano zaphunziro zikuyendera, tidagwiritsa ntchito magawo omwe amagwiritsidwa ntchito ngati zolembera (Kmax, Km, K2, Astig, PachyMin, PRC, ndi D-Index) komanso malire omwe akufotokozedwa m'mabuku.ngakhale osati mwachidziwitso).Table 1 imatchula zinthu zomwe zikuyimira kupita patsogolo kwa gawo lililonse.Kukula kwa KC kunatanthauzidwa ngati mitundu iwiri yophunzirira idatsimikizira kupita patsogolo.
Table 1 Magawo a Tomographic nthawi zambiri amavomerezedwa ngati zizindikiritso za kupita patsogolo kwa RP ndi malire omwe akufotokozedwa m'mabuku (ngakhale sanatsimikizidwe)
Pakafukufukuyu, magwiridwe antchito amitundu itatu adayesedwa kuti apite patsogolo (EleBmax, BFSB, ndi AdjEleBmax) kutengera kukhalapo kwa kupitilira kwamitundu ina iwiri.Mfundo zodulira bwino za zosinthazi zidawerengedwa ndikuyerekeza ndi zina.
Kusanthula kwachiwerengero kunachitika pogwiritsa ntchito mapulogalamu a SPSS (mtundu 27.0 wa Mac OS; SPSS Inc., Chicago, IL, USA).Makhalidwe azitsanzo amafupikitsidwa ndipo deta imaperekedwa ngati manambala ndi kuchuluka kwamitundu yosiyanasiyana.Zosintha mosalekeza zimafotokozedwa ngati kupotoza kwapakati komanso kokhazikika (kapena mtundu wapakati ndi wapakati pomwe kugawa kumakhota).Kusintha kwa ndondomeko ya keratometric kunapezedwa pochotsa mtengo wapachiyambi kuchokera muyeso wachiwiri (ie, mtengo wabwino wa delta umasonyeza kuwonjezeka kwa mtengo wa parameter inayake).Mayeso a parametric ndi osakhala a parametric adachitidwa kuti ayese kugawidwa kwa ma corneal curvature variables omwe amadziwika kuti akupita patsogolo kapena osapita patsogolo, kuphatikizapo mayeso odziyimira pawokha, mayeso a Mann-Whitney U, mayeso a chi-square, ndi mayeso enieni a Fisher (ngati zofunika).Mulingo wa kufunikira kwa ziwerengero unayikidwa pa 0.05.Kuti tiwone momwe Kmax, D-index, PRC, BFSBR, EleBmax, ndi AdjEleBmax ikugwirira ntchito ngati zolosera zapayekha, tidapanga ma curve performance curves (ROC) ndikuwerengera ma cutoff oyenerera, kukhudzika, kutsimikizika, zabwino (PPV), ndi Negative Predictive. Mtengo (NPV).) ndi malo omwe ali pansi pa curve (AUC) pamene zosintha zosachepera ziwiri zimadutsa malire ena (monga tafotokozera kale) kuti zigawike kupititsa patsogolo monga kulamulira.
Maso a 113 a odwala 76 omwe ali ndi RP adaphatikizidwa mu phunziroli.Odwala ambiri anali amuna (n = 87, 77%) ndipo zaka zoyambira pakuwunika koyamba zinali 24.09 ± 3.93 zaka.Pankhani ya KC stratification kutengera kuchuluka kwathunthu kwa Belin/Ambrosio dilatation deviation (BAD-D index), ambiri (n=68, 60.2%) a maso anali ocheperako.Ofufuzawo adasankha mogwirizana mtengo wodulidwa wa 7.0 ndikusiyanitsa pakati pa keratoconus yofatsa ndi yochepetsetsa malinga ndi zolemba26.Komabe, kusanthula kotsalako kumaphatikizapo chitsanzo chonse.Makhalidwe a chiwerengero cha anthu, zachipatala ndi zamtundu wa zitsanzo, kuphatikizapo tanthauzo, zochepa, zopambana, zosiyana kwambiri (SD) ndi miyeso yokhala ndi nthawi yodalirika ya 95% (IC95%), komanso miyeso yoyamba ndi yachiwiri.Kusiyanitsa pakati pa zikhalidwe pambuyo pa miyezi 12 ± 3 zitha kupezeka patebulo 2.
Table 2. Chiwerengero cha anthu, zachipatala ndi tomographic makhalidwe a odwala.Zotsatira zimawonetsedwa ngati ± kupatuka kokhazikika pazosintha mosalekeza (*zotsatira zimawonetsedwa ngati median ± IQR), 95% nthawi yodalirika (95% CI), jenda lachimuna ndi diso lakumanja zimawonetsedwa ngati nambala ndi peresenti.
Table 3 ikuwonetsa kuchuluka kwa maso omwe amagawidwa ngati opita patsogolo poganizira zamtundu uliwonse wa tomographic (Kmax, Km, K2, Astig, PachyMin, PRC ndi D-Index) padera.Poganizira kupitilira kwa KC, komwe kumatanthauzidwa ndi kusintha kosachepera pamitundu iwiri yama tomographic, maso 57 (50.4%) adawonetsa kupita patsogolo.
Table 3 Nambala ndi pafupipafupi maso m'gulu monga progressors, poganizira aliyense tomographic chizindikiro padera
Zolemba za Kmax, D-index, PRC, EleBmax, BFSB, ndi AdjEleBmax monga zolosera zodziyimira pawokha za kupita patsogolo kwa KC zikuwonetsedwa mu Table 4. Mwachitsanzo, ngati titanthawuza mtengo wowonjezera Kmax ndi 1 diopter (D) kuti tizindikire kupita patsogolo, ngakhale chizindikiro ichi chikuwonetsa chidwi cha 49%, chimakhala ndi 100% yeniyeni (milandu yonse yomwe imadziwika kuti ikupita patsogolo pazigawozi inali yowona).opita patsogolo pamwambapa) okhala ndi mtengo wolosera wabwino (PPV) wa 100%, mtengo wolosera molakwika (NPV) wa 66%, ndi malo opendekera (AUC) a 0.822.Komabe, kuwerengeredwa koyenera kwa kmax kunali 0.4, kumapereka chidwi cha 70%, kutsimikizika kwa 91%, PPV ya 89%, ndi NPV ya 75%.
Table 4 Kmax, D-Index, PRC, BFSB, EleBmax, ndi AdjEleBmax zambiri monga zolosera zapayekha za kupitilira kwa KC (kutanthawuza kusintha kwakukulu mumitundu iwiri kapena kuposerapo)
Pankhani ya D index, malo oyenera odulidwa ndi 0.435, kukhudzika ndi 82%, kutsimikizika ndi 98%, PPV ndi 94%, NPV ndi 84%, ndi AUC ndi 0.927.Tinatsimikizira kuti mwa maso a 50 omwe adapita patsogolo, odwala 3 okha sanapite patsogolo pa 2 kapena zina zambiri.Mwa maso a 63 omwe chiwerengero cha D sichinasinthe, 10 (15.9%) adawonetsa kupita patsogolo mu magawo ena osachepera awiri.
Kwa PRC, malo oyenera oti afotokoze kupitilira anali kuchepa kwa 0.065 ndi kukhudzika kwa 79%, kutsimikizika kwa 80%, PPV ya 80%, NPV ya 79%, ndi AUC ya 0.844.
Pankhani ya kukwera kwapambuyo (EleBmax), njira yabwino yodziwira kupita patsogolo inali kuwonjezeka kwa 2.5 µm ndikukhudzidwa kwa 65% ndi kutsimikizika kwa 73%.Zikasinthidwa ku BSFB yachiwiri yoyezedwa, kukhudzika kwa parameter yatsopano ya AdjEleBmax inali 63% ndipo kutsimikizika kudasinthidwa ndi 84% ndi malo abwino opumira a 6.5 µm.BFSB yokha idawonetsa kudulidwa kwabwino kwa 0.05 mm ndi chidwi cha 51% komanso kutsimikizika kwa 80%.
Pa mkuyu.2 ikuwonetsa ma curve a ROC pagawo lililonse loyerekeza la tomographic (Kmax, D-Index, PRC, EleBmax, BFSB ndi AdjEleBmax).Tikuwona kuti index ya D ndi mayeso ogwira mtima kwambiri okhala ndi AUC yapamwamba (0.927) yotsatiridwa ndi PRC ndi Kmax.AUC EleBmax ndi 0.690.Ikayankhidwa ndi BFSB, kusinthaku (AdjEleBmax) kunasintha magwiridwe ake pokulitsa AUC mpaka 0.754.BFSB yokha ili ndi AUC ya 0.690.
Chithunzi 2. Receiver performance curves (ROC) kusonyeza kuti kugwiritsa ntchito ndondomeko ya D kuti mudziwe kupititsa patsogolo kwa keratoconus kupindula kwambiri ndi kukhudzidwa kwapadera, kutsatiridwa ndi PRC ndi Kmax.AdjEleBmax imawonedwabe yololera komanso yabwinoko kuposa Elebmax yopanda BFSB ikukonzekera.
Mafupikitsidwe: Kmax, pazipita cornea kupindika;D-index, Belin/Ambrosio D-index;PRC, utali wammbuyo wa kupindika kuchokera ku 3.0 mm wokhazikika pa mfundo ya thinnest;BFSB, yoyenera kwambiri kumbuyo kozungulira;Kutalika;AdjELEBmax, ngodya yokwera kwambiri.malo akumbuyo a cornea amasinthidwa kukhala dorsum yozungulira yoyenera kwambiri.
Poganizira za EleBmax, BFSB, ndi AdjEleBmax, motsatana, tidatsimikizira kuti 53 (46.9%), 40 (35.3%), ndi 45 (39.8%) maso adawonetsa kupita patsogolo kwa gawo lililonse lakutali, motsatana.Mwa maso awa, 16 (30.2%), 11 (27.5%), ndi 9 (45%), motero, analibe kupita patsogolo kowona monga momwe tafotokozera ndi magawo ena awiri.Mwa maso a 60 omwe samaganiziridwa kuti akupita patsogolo ndi EleBmax, maso a 20 (33%) anali opita patsogolo pa 2 kapena magawo ena.Maso makumi awiri mphambu asanu ndi atatu (38.4%) ndi 21 (30.9%) maso amaonedwa kuti sanali opita patsogolo malinga ndi BFSB ndi AdjEleBmax okha, motsatira, kusonyeza kupita patsogolo kwenikweni.
Tikufuna kufufuza momwe BFSB imagwirira ntchito ndipo, chofunika kwambiri, BFSB-yosinthidwa kutalika kwa cornea (AdjEleBmax) ngati gawo laling'ono lodziwiratu ndi kuzindikira momwe KC ikuyendera ndikuziyerekeza ndi magawo ena a tomographic omwe amagwiritsidwa ntchito ngati zolembera za kupita patsogolo.Kuyerekeza kunapangidwa ndi malire omwe adanenedwa m'mabuku (ngakhale sanatsimikizidwe), omwe ndi Kmax ndi D-Index.20
Pokhazikitsa EleBmax ku radius ya BFSB (AdjEleBmax), tinawona kuwonjezeka kwakukulu kwapadera - 73% pazigawo zosasinthika ndi 84% pazigawo zosinthidwa - popanda kukhudza mtengo wa sensitivity (65% ndi 63%).Tidawunikanso radius ya BFSB yokha ngati cholozera china chakukula kwa dilatation.Komabe, kukhudzika (51% vs 63%), kutsimikizika (80% vs 84%) ndi AUC (0.69 vs 0.75) ya parameter iyi inali yotsika kuposa ya AdjEleBmax.
Kmax ndi gawo lodziwika bwino lolosera kupitilira kwa KC.27 Palibe mgwirizano kuti malire odulidwa ndi oyenera kwambiri.12,28 Mu phunziro lathu, tidawona kuwonjezeka kwa 1D kapena zambiri monga tanthauzo la kupita patsogolo.Pofika pano, tidawona kuti odwala onse omwe adadziwika kuti akupita patsogolo adatsimikiziridwa ndi magawo ena awiri, kutanthauza kuti 100%.Komabe, chidwi chake chinali chochepa (49%), ndipo kupita patsogolo sikunadziwike m'maso 29.Komabe, mu phunziro lathu, malo abwino a Kmax anali 0.4 D, kukhudzika kunali 70%, ndipo zenizeni zinali 91%, zomwe zikutanthauza kuti ndi kuchepa kwapadera (kuchokera ku 100% mpaka 91%), tinasintha.Sensitivity idachokera ku 49% mpaka 70%.Komabe, kufunika kwachipatala kwa njira yatsopanoyi ndi yokayikitsa.Malinga ndi kafukufuku wa Kreps pa kubwereza kwa miyeso ya Pentacam®, kubwereza kwa Kmax kunali 0.61 mu khansa ya catarrhal yofatsa ndi 1.66 mu caesarean colpitis, 19 zomwe zikutanthauza kuti chiwerengero chodulidwa mu chitsanzochi sichiri chofunikira kwambiri monga momwe amafotokozera. mkhalidwe wokhazikika.pamene pazipita patsogolo zotheka ntchito zitsanzo zina.Komano, Kmax imadziwika ndi kupindika kotsetsereka kwambiri kwa kachigawo kakang'ono ka 29 ndipo sikungathe kubweretsanso kusintha komwe kumachitika mu cornea anterior, posterior cornea, ndi madera ena a pachymetry.30-32 Poyerekeza ndi zigawo zatsopano zapambuyo, AdjEleBmax inasonyeza chidwi chachikulu (63% vs. 49%).Maso opitilira 20 adadziwika bwino pogwiritsa ntchito gawoli ndipo adaphonya kugwiritsa ntchito Kmax (poyerekeza ndi maso opitilira 12 omwe adapezeka pogwiritsa ntchito Kmax m'malo mwa AdjEleBmax).Kupeza uku kumathandizira mfundo yakuti kumbuyo kwa cornea kumakhala kotsetsereka komanso kumakulitsidwa kwambiri pakati poyerekezera ndi kutsogolo, zomwe zingathandize kuzindikira kusintha.25,32,33
Malinga ndi maphunziro ena, index ya D ndi gawo lapadera lomwe lili ndi chidwi kwambiri (82%), kutsimikizika (95%) ndi AUC (0.927).34 Kwenikweni, izi sizosadabwitsa, chifukwa ichi ndi index yamitundu yambiri.PRC inali yachiwiri yovuta kwambiri (79%) yotsatiridwa ndi AdjEleBmax (63%).Monga tanenera kale, kukhudzika kwakukulu, kumachepetsa zolakwika zabodza komanso momwe zowunikira zimakhalira.35 Chifukwa chake, timalimbikitsa kugwiritsa ntchito AdjEleBmax (yokhala ndi kudulidwa kwa 7 µm kuti ipitirire m'malo mwa 6.5 µm popeza sikelo ya digito yomwe idamangidwa mu Pentacam® sichiphatikiza malo amtunduwu) m'malo mwa EleBmax yosakonzedwa, yomwe idzaphatikizidwa ndi zosintha zina pakuwunika.Kupitilira kwa keratoconus kuti tithandizire kudalirika kwa kuwunika kwathu kwachipatala komanso kuzindikira koyambirira kwa kupita patsogolo.
Komabe, phunziro lathu limayang’anizana ndi zopereŵera zina.Choyamba, tidangogwiritsa ntchito mawonekedwe a tomographic shapeflug imaging kuti tifotokoze ndikuwunika momwe apitira patsogolo, koma njira zina zilipo pakali pano ndi cholinga chomwecho, monga kusanthula kwa biomechanical, komwe kungatsogolere kusintha kulikonse kwamtundu kapena tomographic.36 Chachiwiri, timagwiritsa ntchito muyeso umodzi wa magawo onse oyesedwa ndipo, malinga ndi Ivo Guber et al., kuyerekeza zithunzi zingapo kumapangitsa kuti phokoso likhale lochepa.28 Ngakhale miyeso yokhala ndi Pentacam® inali yopangidwa bwino m'maso abwinobwino, inali yotsika m'maso ndi zolakwika za cornea ndi cornea ectasia.37 Mu phunziro ili, tinangophatikizapo maso omwe ali ndi mawonekedwe apamwamba a Pentacam®, omwe amatanthawuza kuti matenda apamwamba adachotsedwa.17 Chachitatu, timatanthawuza kuti opita patsogolo enieni ali ndi magawo awiri ozikidwa pa mabuku koma osatsimikiziridwa.Pomaliza, ndipo mwina chofunikira kwambiri, kusiyanasiyana kwa miyeso ya Pentacam® ndikofunikira pachipatala pakuwunika momwe keratoconus ikuyendera.18,26 Muchitsanzo chathu cha maso a 113, pamene adayikidwa molingana ndi chiwerengero cha BAD-D, maso ambiri (n = 68, 60.2%) anali ochepa, ndi otsala ochepa kapena ofatsa.Komabe, kutengera kukula kwachitsanzo chaching'ono, tidasungabe kusanthula konse mosasamala kanthu za kuuma kwa KTC.Tagwiritsa ntchito mtengo wocheperako womwe ndi wabwino kwambiri kwa zitsanzo zathu zonse, koma timavomereza kuti izi zitha kuwonjezera phokoso (kusinthasintha) pakuyezera ndikuwonjezera nkhawa za kuchuluka kwa kuyeza.Kuchulukitsa kwa miyeso kumadalira kuuma kwa KTC, monga momwe Kreps, Gustafsson et al.18,26.Choncho, timalimbikitsa kwambiri kuti maphunziro amtsogolo aganizire magawo osiyanasiyana a matendawa ndikuwunika malo abwino odulidwa kuti apite patsogolo.
Pomaliza, kuzindikira koyambirira kwa kupititsa patsogolo ndikofunikira kwambiri kuti apereke chithandizo chanthawi yake kuti aletse kupita patsogolo (kudzera panjira yolumikizirana)38 ndikuthandizira kusunga masomphenya ndi moyo wabwino mwa odwala athu.34 Cholinga chachikulu cha ntchito yathu ndikuwonetsa kuti EleBmax, yolumikizidwa ku radius yomweyo ya BFS pakati pa miyeso ya nthawi, ili ndi ntchito yabwino kuposa EleBmax yokha.Izi zikuwonetsa kutsimikizika kwapamwamba komanso kuchita bwino poyerekeza ndi EleBmax, ndi imodzi mwamagawo okhudzidwa kwambiri (ndipo chifukwa chake ndiyowunikira bwino kwambiri) motero ndizotheka kupitilira patsogolo.Ndikofunikira kwambiri kupanga ma index amitundu yambiri.Maphunziro amtsogolo okhudza kusanthula kwamachulukidwe osiyanasiyana ayenera kuphatikiza AdjEleBmax.
Olembawo samalandira thandizo lililonse lazachuma pakufufuza, kulemba ndi/kapena kufalitsa nkhaniyi.
Margarida Ribeiro ndi Claudia Barbosa ndi olemba anzawo.Olembawo akunena kuti palibe kusagwirizana kwa chidwi pa ntchitoyi.
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