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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, iminyaka emi-3 *UClaudia Barbosa, iminyaka emi-3 *I-2 Bio Faculty of Medicine - iFaculty of Medicine yeYunivesithi yasePorto, ePorto, ePortugal 3 iFaculty of Medicine yeYunivesithi yasePorto, ePorto, ePortugal;4ISebe lezoTyando kunye nePhysiology, iFaculty of Medicine, iYunivesithi yasePorto, ePorto, ePortugal4 iSebe lezoTyando kunye nePhysiology, iFaculty of Medicine, iDyunivesithi yasePorto, ePorto, ePortugal *Aba babhali banikele ngokulinganayo kulo msebenzi.Hernâni Monteiro Porto, 4200-319, Portugal, i-imeyile [i-imeyile ekhuselweyo] Injongo: Sivavanye umphezulu wekhoneal ongasemva olungelelaniselwe uBuyelo obufanelekileyo obuBuyelwe nguBuyelo (BFSB) phakathi kwemilinganiselo yesikali sexesha (AdjEleBmax) kunye nerediyasi yeBFSB (BFSBR) Obona bude buphezulu ngokwayo isetyenziswe njengeparameter entsha ye-tomographic ukurekhoda ukuqhubela phambili kokwandiswa kunye nokuthelekiswa nemilinganiselo yamva nje ethembekileyo ye-keratoconus progression (KK).Iziphumo.Sivavanye i-Kmax, isalathisi se-D, i-radius ye-curvature yangasemva, kunye neyona ndawo ifanelekileyo yokusika ukusuka kwi-3.0 mm ye-thinnest point ephakathi (PRC), i-EleBmax, i-BFSBR, kunye ne-AdjEleBmax njengeeparamitha ezizimeleyo zokurekhoda ukuqhubela phambili kwe-KC (echazwe njengeziguquguquko ezimbini okanye ngaphezulu), sifumene uvakalelo. of 70%, 82%, 79%, 65%, 51%, kunye 63%, kunye 91%, 98%, 80%, 73%, 80%, kunye 84% iinkcukacha zokubona inkqubela KC..Ummandla ophantsi kwejika (AUC) kwinguqu nganye yi-0.822, 0.927, 0.844, 0.690, 0.695, 0.754, ngokulandelanayo.Isiphelo: Xa kuthelekiswa ne-EleBmax ngaphandle kohlengahlengiso, i-AdjEleBmax inobuchwephesha obuphezulu, i-AUC ephezulu kunye nokusebenza okungcono kunovakalelo olufanayo.AUC.Ekubeni ubume bomphezulu obungasemva bungaphezulu kwe-aspherical kwaye bugobile kunomphezulu wangaphambili, onokunceda ukufumanisa utshintsho, sicebisa ukubandakanya i-AdjEleBmax kuvavanyo lwenkqubela phambili ye-KC kunye nezinye izinto eziguquguqukayo ukuphucula ukuthembeka kovavanyo lwethu lwekliniki kunye nokufunyanwa kwangoko.progressions.Amagama angundoqo: ikeratoconus, i-cornea, i-progression, i-progression ye-spherical dorsal shape, ukuphakama komphezulu ongasemva we-cornea.
I-Keratoconus (KK) yeyona corneal ectasia ixhaphakileyo.Ngoku ithathwa njengesifo samacala amabini (nangona i-asymmetric) engapheliyo isifo esiqhubela phambili esikhokelela kwiinguqu ezininzi zesakhiwo esilandelwa yi-stromal thinning kunye ne-scarring.I-1,2 Ngonyango, izigulane zibonelela nge-astigmatism engaqhelekanga kunye ne-myopia, i-photophobia, kunye / okanye i-diplopia ye-monocular enombono ophazamisekileyo, i-maximally corrected acuity visual (BCVA) kunye nokunciphisa umgangatho wobomi.I-3,4 Ukubonakaliswa kwe-RP ngokuqhelekileyo kuqala kwishumi lesibini leminyaka yobomi kunye nenkqubela phambili kwishumi lesine leminyaka, kulandelwa ukuzinza kwekliniki.Umngcipheko kunye nezinga lokuqhubela phambili liphezulu kubantu abangaphantsi kweminyaka eyi-19 ubudala.5.6
Nangona kungekabikho unyango olucacileyo, unyango lwangoku lwe-ocular keratoconus luneenjongo ezimbini ezibalulekileyo: ukuphucula umsebenzi wokubonwayo kunye nokuyeka ukuqhubela phambili kwe-dilation.I-7,8 yangaphambili inokubonwa kwiiglasi, iilensi eziqinileyo okanye eziqinileyo, iiringi ze-intracorneal, okanye kwi-cornea transplants xa isifo sinzima kakhulu.9 Injongo yokugqibela yintlupheko engcwele yolu nyango lwezigulana, okwangoku lufumaneka kuphela ngokudibanisa.Lo msebenzi ukhokelela ekwandeni kokuchasana kwe-biomechanical kunye nokuqina kwe-cornea kunye nokuthintela ukuqhubela phambili.I-10-13 Nangona oku kunokwenziwa nakweliphi na inqanaba lesi sifo, inzuzo enkulu ifunyenwe kwizigaba zangaphambili.I-14 kufuneka kwenziwe iinzame zokufumanisa ukuqhubela phambili kwangaphambili kwaye kuthintele ukuwohloka okuqhubekayo, kunye nokuphepha unyango olungeyomfuneko kwezinye izigulane, ngaloo ndlela kuncitshiswe umngcipheko weengxaki ezinqamlezayo ezifana nokusuleleka, ukulahlekelwa kweseli endothelial, kunye neentlungu ezinzima emva kokuhlinzwa.15.16
Ngaphandle kwezifundo ezininzi ezijolise ekuchazeni nasekuboneni ukuqhubela phambili, i-17-19 akukabikho ngcaciso ihambelanayo yokuqhubela phambili kwe-dilatation okanye indlela esemgangathweni yokuyibhala.I-9,20,21 Kwi-Global Consensus kwi-Keratoconus kunye neZifo eziHlangeneyo (2015), ukuqhubela phambili kwe-keratoconus kuchazwa njengotshintsho olulandelelanayo ubuncinane kwiiparamitha ezimbini ze-topographic: i-anterior corneal steepening, i-posterior corneal steepening, ukunciphisa kunye / okanye ubukhulu. ye-cornea Ireyithi yokutshintsha inyuka ukusuka kwi-perimeter ukuya kwi-thinnest point.9 Noko ke, ingcaciso ecace ngakumbi yenkqubela isafuneka.Iinzame zenziwe zokufumana ezona ziguquguqukayo zinamandla zokubona nokucacisa inkqubela.19:22–24
Ngenxa yokuba imilo ye-corneal surface, engaphezulu kwe-aspherical kunye ne-curved kune-surface yangaphambili, ingaba luncedo ekuboneni utshintsho, i-25 injongo ephambili yolu phononongo yayikukuvavanya iimpawu ze-angle ephezulu ye-corneal elevation angle.ilungiselelwe eyona ndawo ifanelekileyo.Umlinganiselo wexesha lomlinganiselo (BFSB) (AdjEleBmax) kunye nerediyasi ye-BFSB (BFSBR) iyodwa isebenze njengeeparamitha ezintsha zokurekhoda ukuqhubela phambili kolwandiso kwaye zithelekiswe kwezona parameters zisetyenziswa ngokuxhaphakileyo kukuqhubela phambili kwe-KC.
Amehlo angama-113 ezigulane ezilandelelanayo ze-76 eziye zafunyaniswa ukuba zine-keratoconus zaxilongwa kolu phando lwe-retrospective cohort kwiSebe le-Ophthalmology kwiSibhedlele esiPhakathi seYunivesithi yaseSão João, ePortugal.Uphononongo luvunyiwe yikomiti yokuziphatha yendawo yeCentro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto kwaye yenziwa ngokuhambelana neSibhengezo saseHelsinki.Imvume ebhaliweyo enolwazi ifunyenwe kubo bonke abathathi-nxaxheba kwaye, ukuba umthathi-nxaxheba ungaphantsi kweminyaka eyi-16, kumzali kunye / okanye umgcini osemthethweni.
Izigulana ezine-KC ezineminyaka eli-14 ukuya kuma-30 ubudala ziye zachongwa zaza zaqukwa ngokulandelelanayo kulandelelo lwethu lwe-ophthalmic kunye ne-corneal ngo-Okthobha-Disemba ka-2021.
Zonke izigulane ezikhethiweyo zalandelwa unyaka omnye yingcali ye-corneal kwaye yenze ubuncinane imilinganiselo emithathu ye-Scheimpflug tomographic (Pentacam®; Oculus, Wetzlar, Germany).Izigulane ziyekile ukunxiba iilensi zoqhagamshelwano ubuncinane kwiiyure ezingama-48 phambi kwemilinganiselo.Yonke imilinganiselo yenziwa yi-orthopedist eqeqeshiwe kwaye izikena kuphela ngesheke lomgangatho othi "Kulungile" zibandakanyiwe.Ukuba uvavanyo lwekhwalithi yomfanekiso oluzenzekelayo aluphawulwanga ngokuthi "Kulungile", uvavanyo luya kuphindwa.Zimbini kuphela izikena zeliso ngalinye eziye zahlalutywa ukuze kubonwe ukuqhubela phambili, isibini ngasinye sahlulwe ngeenyanga ezili-12 ± 3.Amehlo ane-KC encinci afakiwe (kwezi meko, elinye iliso kufuneka libonise iimpawu ezicacileyo ze-KC yeklinikhi).
Asibandakanyi kuhlalutyo lwamehlo e-KC awayekade enziwe utyando lwamehlo ngaphambili (i-corneal crosslinking, i-corneal rings, okanye i-corneal transplant) kunye namehlo anesifo esiphezulu kakhulu (ubukhulu be-corneal kwi-thinnest <350 µm, i-hydrokeratosis, okanye i-deep corneal scarring) njengoko iqela lisilela rhoqo. "Kulungile" emva kokujonga umgangatho wokuskena kwangaphakathi.
Idatha ye-demographic, ikliniki kunye ne-tomographic yaqokelelwa ukuze kuhlalutywe.Ukubona ukuqhubela phambili kwe-KC, siqokelele iinguqu ezininzi ze-tomographic ezibandakanya ubuninzi be-cornea curvature (Kmax), i-cornea curvature (Km), i-flat meridional corneal curvature (K1), i-curvature ye-meridional corneal curvature (K2), i-corneal astigmatism2 - K1 = ).), umlinganiselo omncinci wobunzima (i-PachyMin), ubude obuphezulu be-corneal (i-EleBmax), i-radius yangasemva ye-curvature (PRC) i-3.0 mm igxininise kwi-thinnest point, i-Belin / Ambrosio D-index (i-D-index), i-BFSBR kunye ne-EleBmax yahlengahlengiswa kwi-BFSB (AdjEleBmax).Njengoko kubonisiwe kwifig.I-1, i-AdjEleBmax ifunyenwe emva kokuba sigqibe ngesandla i-radius ye-BFSB efanayo kuzo zombini iimvavanyo zomatshini usebenzisa ixabiso le-BFSR ukusuka kuqikelelo lwesibini.
Irayisi.1. Ukuthelekiswa kwemifanekiso yePentacam® kwindawo ethe tye yangasemva kunye nenkqubela phambili yeklinikhi yangempela kunye nesithuba seenyanga ze-13 phakathi kweemviwo.Kwiphaneli yoku-1, i-EleBmax yayiyi-68 µm kuviwo lokuqala kunye ne-66 µm kolwesibini, ngoko ke kwakungekho nkqubela phambili kule parameter.Eyona sphere radii inikezelwa ngokuzenzekelayo ngumatshini kuvavanyo ngalunye yi-5.99 mm kunye ne-5.90 mm, ngokulandelelanayo.Ukuba sicofa kwiqhosha le-BFS, iwindow iya kuvela apho irediyasi entsha ye-BFS inokuchazwa ngesandla.Sigqibe iradiyasi efanayo kuzo zombini iimvavanyo sisebenzisa ixabiso lerediyasi yesibini elinganisiweyo ye-BFS (5.90mm).Kwiphaneli yesi-2, ixabiso elitsha le-EleBmax (EleBmaxAdj) elilungiswe kwi-BFS efanayo kuvavanyo lokuqala yi-59 µm, ebonisa ukunyuka kwe-7 µm kuvavanyo lwesibini, ebonisa ukuqhubela phambili ngokwe-7 µm threshold yethu.
Ukuhlalutya ukuqhubela phambili kunye nokuvavanya ukusebenza kwezifundo ezitsha eziguquguqukayo, sasebenzisa iiparitha ezisetyenziswa ngokuqhelekileyo njengabamakishi benkqubela (Kmax, Km, K2, Astig, PachyMin, PRC, kunye ne-D-Index) kunye nemigangatho echazwe kwiincwadi.nangona ingekho empirically).Itheyibhile 1 idwelisa amaxabiso amele inkqubela phambili yeparamitha yohlalutyo.Ukuqhubela phambili kwe-KC kwachazwa xa ubuncinci bezinto ezimbini eziguquguqukayo ezifundwe ziqinisekisa ukuqhubela phambili.
Itheyibhile 1 Iiparamitha zeTomographic ngokubanzi zamkelwe njengabamakishi benkqubela phambili yeRP kunye nemigangatho ehambelanayo echazwe kuncwadi (nangona ingaqinisekiswanga)
Kolu phononongo, ukusebenza kwezinto eziguquguqukayo ezintathu kwavavanywa ukuqhubela phambili (i-EleBmax, i-BFSB, kunye ne-AdjEleBmax) ngokusekelwe kubukho bokuqhubela phambili ubuncinci bezinye izinto ezimbini.Amanqaku afanelekileyo okusikwa kwezi ziguquguqukayo aye abalwa aze athelekiswe nezinye iinguqu.
Uhlalutyo lwamanani lwenziwa kusetyenziswa isoftwe yezibalo ze-SPSS (inguqulo 27.0 ye-Mac OS; SPSS Inc., Chicago, IL, USA).Iimpawu zesampulu zishwankathelwa kwaye idatha inikezelwe njengamanani kunye nokulingana kwezinto eziguquguqukayo zecandelo.Iinguqu eziqhubekayo zichazwa njengentsingiselo kunye nokutenxa okusemgangathweni (okanye uluhlu oluphakathi kunye ne-interquartile xa ukuhanjiswa kugqwethiwe).Utshintsho kwisalathiso se-keratometric lufunyenwe ngokukhupha ixabiso lokuqala ukusuka kumlinganiselo wesibini (oko kukuthi, ixabiso elilungileyo le-delta libonisa ukunyuka kwexabiso lepharamitha ethile).Iimvavanyo zeParametric kunye ne-non-parametric zenziwa ukuvavanya ukuhanjiswa kwezinto eziguquguqukayo ze-corneal curvature ezichazwe njengenkqubela phambili okanye engekho phambili, kubandakanywa novavanyo oluzimeleyo lwesampula, i-Mann-Whitney U-test, uvavanyo lwe-chi-square, kunye novavanyo oluchanekileyo lukaFisher (ukuba kufuneka).Inqanaba lokubaluleka kwamanani libekwe kwi-0.05.Ukuvavanya ukusebenza kwe-Kmax, i-D-index, i-PRC, i-BFSBR, i-EleBmax, kunye ne-AdjEleBmax njengeziqikelelo zokuqhubela phambili komntu ngamnye, sakhe ii-curves performance curves (ROC) kwaye sibale iindawo ezifanelekileyo zokuvala, ubuntununtunu, ukuchaneka, okulungileyo (PPV), kunye ne-Negative Predictive. Ixabiso (NPV).) kunye nommandla ophantsi kwegophe (AUC) xa ubuncinci iinguqu ezimbini zidlula imida ethile (njengoko kuchaziwe ngaphambili) ukuhlelela ukuqhubela phambili njengolawulo.
Amehlo e-113 ezigulane ze-76 ezine-RP zifakwe kwisifundo.Uninzi lwezigulane yayingamadoda (n=87, 77%) kwaye iminyaka yobudala kuvavanyo lokuqala yayiyi-24.09 ± 3.93 iminyaka.Ngokumalunga ne-KC stratification esekelwe kwi-Belin epheleleyo / i-Ambrosio dilatation deviation (i-BAD-D index), uninzi (n = 68, 60.2%) lwamehlo aphakathi.Abaphandi bakhetha ngazwi linye ixabiso lokunqunyulwa kwe-7.0 kwaye bahlula phakathi kwe-keratoconus emnene kunye nemodareyitha ngokweencwadi26.Nangona kunjalo, lonke uhlalutyo lubandakanya isampuli yonke.Iimpawu zokuhlala, iklinikhi kunye neempawu ze-tomographic zesampuli, kubandakanywa intsingiselo, ubuncinci, ubuninzi, ukuphambuka okusemgangathweni (SD) kunye nemilinganiselo kunye ne-95% yexesha lokuzithemba (IC95%), kunye nemilinganiselo yokuqala neyesibini.Umahluko phakathi kwamaxabiso emva kwe-12 ± 3 iinyanga unokufumaneka kwitheyibhile yesi-2.
Itheyibhile 2. Iimpawu zabantu, ikliniki kunye neempawu zezigulane.Iziphumo zichazwa njengentsingiselo ± ukutenxa okusemgangathweni kwezinto eziguquguqukayo eziqhubekayo (*iziphumo zichazwa njenge-median ± IQR), i-95% yexesha lokuzithemba (95% CI), isini samadoda kunye neliso lasekunene zichazwa njengenani kunye nepesenti.
Itheyibhile 3 ibonisa inani lamehlo ahlelwe njengabaqhubeli beqwalasela ipharamitha nganye ye-tomographic (Kmax, Km, K2, Astig, PachyMin, PRC kunye ne-D-Index) ngokwahlukileyo.Ukuthathela ingqalelo ukuqhubela phambili kwe-KC, echazwe ngotshintsho oluqatshelweyo ubuncinane kwiinguqu ezimbini ze-tomographic, amehlo angama-57 (50.4%) abonise ukuqhubela phambili.
Itheyibhile 3 Inani kunye nokuphindaphinda kwamehlo ahlelwa njengeeprogressors, kuthathelwa ingqalelo ipharamitha ye-tomographic ngokwahlukeneyo
I-Kmax, i-D-index, i-PRC, i-EleBmax, i-BFSB, kunye ne-AdjEleBmax amanqaku njengeziqikelelo ezizimeleyo zokuqhubela phambili kwe-KC ziboniswa kwiThebhile 4. Ngokomzekelo, ukuba sichaza ixabiso lomqobo lokunyusa i-Kmax nge-1 diopter (D) ukuphawula ukuqhubela phambili, nangona le parameter ibonisa ubuntununtunu be-49%, ine-specity ye-100% (zonke iimeko ezichongiweyo njengenkqubela phambili kule parameter yayiyinyani ngokwenene).abaqhubela phambili apha ngasentla) ngexabiso elichanekileyo (PPV) le-100%, ixabiso elibi (NPV) le-66%, kunye nommandla ophantsi kwe-curve (AUC) ye-0.822.Nangona kunjalo, i-cutoff efanelekileyo ebaliweyo ye-kmax yayiyi-0.4, inika uvakalelo lwe-70%, i-speciality ye-91%, i-PPV ye-89%, kunye ne-NPV ye-75%.
Itheyibhile ye-4 Kmax, i-D-Index, i-PRC, i-BFSB, i-EleBmax, kunye ne-AdjEleBmax amanqaku njengeziqikelelo ezizimeleyo zokuqhubela phambili kwe-KC (echazwe njengotshintsho olubalulekileyo kwizinto ezimbini okanye ngaphezulu)
Ngokwesalathiso se-D, indawo efanelekileyo yokusika i-0.435, i-sensitivity yi-82%, i-speciality yi-98%, i-PPV yi-94%, i-NPV yi-84%, kunye ne-AUC yi-0.927.Siye saqinisekisa ukuba amehlo e-50 aqhubela phambili, kuphela izigulane ze-3 azizange ziqhubele phambili kwi-2 okanye ezinye iiparitha.Kumehlo angama-63 apho isalathisi se-D singakhange siphucule, i-10 (15.9%) ibonise ukuqhubela phambili ubuncinane kwezinye iiparitha ezimbini.
Kwi-PRC, i-cutoff point efanelekileyo yokuchaza ukuqhubela phambili yayikukuncipha kwe-0.065 nge-sensitivity ye-79%, i-specific 80%, i-PPV ye-80%, i-NPV ye-79%, kunye ne-AUC ye-0.844.
Ngokubhekiselele kumphakamo ongemva komphezulu (EleBmax), umyinge ofanelekileyo wokumisela ukuqhubela phambili ibe kukunyuka kwe-2.5 µm ngovakalelo lwe-65% kunye nokukodwa kwe-73%.Xa kuhlengahlengiswa kwi-BSFB yesibini elinganisiweyo, ubuntununtunu beparamitha entsha i-AdjEleBmax yayiyi-63% kwaye ingcaciso iphuculwe nge-84% ngeyona ndawo ifanelekileyo yokunqunyulwa kwe-6.5 µm.I-BFSB ngokwayo ibonise i-cutoff epheleleyo ye-0.05 mm ngovakalelo lwe-51% kunye ne-80 ethile.
Kwikhiwane.I-2 ibonisa i-ROC curves nganye yeeparameters eziqikelelweyo ze-tomographic (Kmax, D-Index, PRC, EleBmax, BFSB kunye ne-AdjEleBmax).Siyabona ukuba i-D-index luvavanyo olusebenzayo kunye ne-AUC ephezulu (0.927) elandelwa yi-PRC kunye ne-Kmax.I-AUC EleBmax yi-0.690.Xa ilungiselelwe i-BFSB, esi silungiselelo (AdjEleBmax) siphucule ukusebenza kwayo ngokwandisa i-AUC ukuya kwi-0.754.I-BFSB ngokwayo ine-AUC ye-0.690.
Umzobo 2. I-receiver performance curves (ROC) ebonisa ukuba ukusetyenziswa kwesalathisi se-D ukugqiba ukuqhubela phambili kwe-keratoconus kuphumelele amanqanaba aphezulu okuqonda kunye neenkcukacha, ezilandelwa yi-PRC kunye ne-Kmax.I-AdjEleBmax isathathwa njengefanelekileyo kwaye ingcono ngokubanzi kune-Elebmax ngaphandle kokulungiswa kwe-BFSB.
Ushunqulelo: Kmax, ubuninzi be-corneal curvature;Isalathiso seD, iBelin/Ambrosio D-index;I-PRC, i-radius yangasemva ye-curvature esuka kwi-3.0 mm egxininise kwindawo ye-thinnest point;I-BFSB, ifaneleke kakhulu umqolo ongqukuva;Ubude;I-AdjELEBmax, i-engile yokuphakama okuphezulu.indawo engasemva ye-cornea ilungelelaniswe kwi-dorsum ye-spherical eyona ifanelekileyo.
Ukuqwalasela i-EleBmax, i-BFSB, kunye ne-AdjEleBmax, ngokulandelanayo, siqinisekisile ukuba i-53 (46.9%), i-40 (35.3%), kunye ne-45 (39.8%) amehlo abonise ukuqhubela phambili kwipharamitha nganye ezimeleyo, ngokulandelanayo.Kula mehlo, i-16 (30.2%), i-11 (27.5%), kunye ne-9 (45%), ngokulandelelanayo, yayingenankqubela-phambili yokwenyani njengoko kuchaziwe ubuncinane bezinye iiparamitha ezimbini.Kwamehlo e-60 angaqwalaselwanga inkqubela phambili ye-EleBmax, i-20 (33%) amehlo ayeqhubela phambili kwi-2 okanye ngaphezulu kwezinye iiparitha.Amehlo angamashumi amabini anesibhozo (38.4%) kunye ne-21 (30.9%) amehlo athathwe njenge-non-progressive ngokwe-BFSB kunye ne-AdjEleBmax yodwa, ngokulandelanayo, ebonisa ukuqhubela phambili kwangempela.
Sijonge ukuphanda ukusebenza kwe-BFSB kwaye, okona kubaluleke kakhulu, i-BFSB-ehlengahlengisiweyo ubuninzi bobude be-corneal yangasemva (AdjEleBmax) njengeparamitha yenoveli ukuqikelela nokubona ukuqhubela phambili kwe-KC kwaye uzithelekise kunye nezinye iiparamitha ze-tomographic ezidla ngokusetyenziswa njengeziphawuli zokuqhubela phambili.Uthelekiso lwenziwe kunye nemigangatho echazwe kwiincwadi (nangona zingaqinisekiswanga), ezizezi Kmax kunye ne-D-Index.20
Xa ubeka i-EleBmax kwi-radius ye-BFSB (i-AdjEleBmax), siye sabona ukunyuka okuphawulekayo kwi-speciality - i-73% ye-parameter engalungiswanga kunye ne-84% ye-parameter ehlengahlengisiweyo - ngaphandle kokuchaphazela ixabiso le-sensitivity (65% kunye ne-63%).Sikwavavanye iradiyasi ye-BFSB ngokwayo njengenye into enokubakho yokuqikelela ukuqhubela phambili kwe-dilatation.Nangona kunjalo, uvakalelo (51% vs 63%), ukuchaneka (80% vs 84%) kunye ne-AUC (0.69 vs 0.75) yale parameter yayingaphantsi kune-AdjEleBmax.
I-Kmax yiparameter eyaziwayo yokuqikelela ukuqhubela phambili kwe-KC.27 Akukho mvumelwano malunga nokuba umda wokunqunyulwa ufanelekile ngakumbi.12,28 Kwisifundo sethu, siqwalasele ukwanda kwe-1D okanye ngaphezulu njengenkcazo yokuqhubela phambili.Kulo mngcelele, siye sabona ukuba zonke izigulane ezichongiweyo ziqhubela phambili ziqinisekiswa ubuncinane ezinye iiparitha ezimbini, ezibonisa ukuba yi-100%.Nangona kunjalo, uvakalelo lwayo lwalusezantsi kakhulu (49%), kwaye ukuqhubela phambili akuzange kubonwe kumehlo angama-29.Nangona kunjalo, kwisifundo sethu, i-Kmax threshold efanelekileyo yayiyi-0.4 D, i-sensitivity yayiyi-70%, kwaye i-specific i-91%, oku kuthetha ukuba ngokunciphisa okuhambelanayo kwizinto ezithile (ukusuka kwi-100% ukuya kwi-91%), siphucule.Uvakalelo lusuka kuma-49% ukuya kuma-70%.Nangona kunjalo, ukufaneleka kweklinikhi yalo mda omtsha kuyathandabuzeka.Ngokophononongo lwe-Kreps malunga nokuphindaphinda kwemilinganiselo ye-Pentacam®, ukuphindaphinda kwe-Kmax kwakuyi-0.61 kumhlaza we-catarrhal obuthathaka kunye ne-1.66 kwi-caesarean colpitis ephakathi, i-19 ethetha ukuba ixabiso lokunqunyulwa kwezibalo kule sampuli ayibalulekanga ngokwezonyango njengoko ichaza. imeko ezinzile.xa ubuninzi benkqubela phambili enokwenzeka isetyenziswa kwezinye iisampuli.I-Kmax, kwelinye icala, ibonakalisa owona mnqantsa wangaphambili we-corneal curvature yengingqi encinci ye-29 kwaye ayikwazi ukuvelisa kwakhona utshintsho olwenzeka kwi-cornea yangaphambili, i-cornea yangasemva, kunye nezinye iindawo ze-pachymetry.I-30-32 xa kuthelekiswa neeparamitha ezintsha zangasemva, i-AdjEleBmax ibonise uvakalelo oluphezulu (63% vs. 49%).Amehlo aqhubela phambili angama-20 achongiwe ngokuchanekileyo kusetyenziswa le parameter kwaye akaphoswanga usebenzisa i-Kmax (xa kuthelekiswa ne-12 yamehlo aqhubekayo afunyenwe kusetyenziswa i-Kmax endaweni ye-AdjEleBmax).Oku kufunyaniswayo kuxhasa into yokuba umphezulu we-cornea ungasemva kwaye wandiswa ngakumbi embindini xa kuthelekiswa nomphezulu wangaphambili, onokunceda ukufumanisa utshintsho.25,32,33
Ngokwamanye amaphononongo, i-D-index yiparameter eyedwa kunye novakalelo oluphezulu (82%), ukuchaneka (95%) kunye ne-AUC (0.927).34 Ngokwenyani, oku akumangalisi, kuba esi sisalathiso seeparamitha ezininzi.I-PRC yayiyeyesibini eyona nguqu ibuthathaka (79%) ilandelwa yi-AdjEleBmax (63%).Njengoko bekutshiwo ngaphambili, okukhona uvakalelo luphezulu, kokukhona kuncinci ukunganyaniseki okungeyonyani kwaye ngcono iiparamitha zokuhlola ziphuhla.35 Ke ngoko, sincoma ukusebenzisa i-AdjEleBmax (kunye ne-cutoff ye-7 µm yokuqhubela phambili kune-6.5 µm ekubeni isikali sedijithali esakhelwe kwi-Pentacam® asibandakanyi iindawo zedesimali zale parameter) endaweni ye-EleBmax engalungiswanga, eya kubandakanywa kunye nayo. ezinye iinguqu kuvavanyo.ukuqhubela phambili kwekeratoconus ukuphucula ukuthembeka kovavanyo lwethu lweklinikhi kunye nokufumanisa kwangaphambili ukuqhubela phambili.
Noko ke, ufundisiso lwethu lunemida ethile.Okokuqala, sisebenzise kuphela iiparamitha zokucinga ze-tomographic shapeflug ukuchaza nokuvavanya ukuqhubela phambili, kodwa ezinye iindlela zikhoyo ngoku ngenjongo efanayo, njengohlalutyo lwe-biomechanical, olunokwandulela naluphi na utshintsho lwe-topographic okanye i-tomographic.36 Okwesibini, sisebenzisa umlinganiselo omnye wazo zonke iiparameters ezivavanyiweyo kwaye, ngokutsho kuka-Ivo Guber et al., i-avareji kwimifanekiso emininzi iphumela kumanqanaba asezantsi engxolo.28 Ngelixa imilinganiselo kunye ne-Pentacam® yayiveliswa kakuhle emehlweni aqhelekileyo, yayingaphantsi kwamehlo kunye nezitenxo ze-corneal kunye ne-corneal ectasia.I-37 Kolu phononongo, sibandakanya kuphela amehlo ane-Pentacam® yokuqinisekiswa komgangatho ophezulu we-scan, nto leyo ethetha ukuba isifo esiphezulu sikhutshwe.17 Okwesithathu, sichaza abo bahambela phambili ngokwenyani njengabanemilinganiselo emibini esekelwe kuncwadi kodwa engekaqinisekiswa.Ekugqibeleni, kwaye mhlawumbi kubaluleke kakhulu, ukuhluka kwimilinganiselo yePentacam® kubaluleke kakhulu kwikliniki ekuhloleni ukuqhubela phambili kwekeratoconus.18,26 Kwisampulu yethu yamehlo e-113, xa i-stratified ngokwamanqaku e-BAD-D, amaninzi (n = 68, 60.2%) amehlo ayemodareyitha, kunye nentsalela engaphantsi okanye encinci.Nangona kunjalo, xa sinikwa ubungakanani besampulu encinci, silugcinile uhlalutyo lulonke nokuba bubungqongqo be-KTC.Sisebenzise ixabiso lomqobo elilungele isampuli yethu yonke, kodwa siyavuma ukuba oku kunokongeza ingxolo (ukuguquguquka) kumlinganiselo kwaye kuphakamise iinkxalabo malunga nokuphindaphinda ukulinganisa.Ukuveliswa kwakhona kwemilinganiselo kuxhomekeke kubunzima be-KTC, njengoko kuboniswe nguKreps, uGustafsson et al.18,26.Ke ngoko, sicebisa ngamandla ukuba izifundo ezizayo zithathele ingqalelo amanqanaba ahlukeneyo esi sifo kwaye zivavanye iindawo ezifanelekileyo zokunqunyulwa kwenkqubela phambili efanelekileyo.
Ukuququmbela, ukufumanisa kwangaphambili ukuqhubela phambili kubaluleke kakhulu ukwenzela ukubonelela unyango lwangexesha lokumisa ukuqhubela phambili (ngokudibanisa ukudibanisa) 38 kunye nokunceda ukugcina umbono kunye nomgangatho wobomi kwizigulane zethu.34 Injongo ephambili yomsebenzi wethu kukubonisa ukuba i-EleBmax, idityaniswe kwirediyasi efanayo ye-BFS phakathi kwemilinganiselo yexesha, inokusebenza okungcono kune-EleBmax ngokwayo.Le parameter ibonisa ukuchaneka okuphezulu kunye nokusebenza kakuhle xa kuthelekiswa ne-EleBmax, yenye yezona parameters ezinovakalelo (kwaye ke ngoko yeyona ndlela ibalaseleyo yokuhlola) kwaye ke inokuba yi-biomarker yokuqhubela phambili kwangaphambili.Kucetyiswa kakhulu ukwenza izalathisi ezininzi zeeparamitha.Izifundo zexesha elizayo ezibandakanya uhlalutyo lwenkqubela phambili ye-multivariate kufuneka zibandakanye i-AdjEleBmax.
Ababhali abafumani nayiphi na inkxaso yemali yophando, ububhali kunye / okanye ukupapashwa kweli nqaku.
UMargarida Ribeiro kunye noClaudia Barbosa ngababhali abasebenzisanayo.Ababhali baxela ukuba akukho ngquzulwano yomdla kulo msebenzi.
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