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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,*U-Margarita Ribeiro, 1.2*UClaudia Barbosa, iminyaka emi-3*UClaudia Barbosa, iminyaka emi-3*2 Bio Faculty of Medicine – Faculty of Medicine of the University of Porto, Porto, Portugal 3 Faculty of Medicine of the University of Porto, Porto, Portugal;4 Umnyango Wokuhlinza NePhysiology, I-Faculty of Medicine, University of Porto, Porto, Portugal4 Umnyango Wokuhlinza NePhysiology, I-Faculty of Medicine, University of Porto, Porto, Portugal *Laba babhali banikele ngokulinganayo kulo msebenzi.I-Hernâni Monteiro Porto, 4200-319, Portugal, i-imeyili [i-imeyili ivikelwe] Injongo: Sihlole indawo engemuva yekhone elungiselwe i-Best Fit Sphere Back (BFSB) efanayo phakathi kwezilinganiso zesikali sesikhathi (AdjEleBmax) kanye nerediyasi ye-BFSB (BFSBR) Ubude obukhulu yona ngokwayo isetshenziswe njengepharamitha entsha ye-tomographic ukurekhoda ukuqhubeka kokunwetshwa futhi iqhathaniswa nemingcele yakamuva ethembekile ye-keratoconus progression (KK).Imiphumela.Sihlole i-Kmax, inkomba ye-D, irediyasi yokujika engemuva, nendawo ekahle yokusika ukusuka ku-3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, ne-AdjEleBmax njengamapharamitha azimele okurekhoda ukuqhubeka kwe-KC (okuchazwa njengokuguquguqukayo okubili noma ngaphezulu), sithole ukuzwela of 70%, 82%, 79%, 65%, 51%, and 63%, and 91%, 98%, 80%, 73%, 80%, kanye 84% imininingwane eqondile yokuthola ukuqhubeka kwe-KC..Indawo engaphansi kwejika (AUC) kokuguquguquka ngakunye yayingu-0.822, 0.927, 0.844, 0.690, 0.695, 0.754, ngokulandelanayo.Isiphetho: Uma iqhathaniswa ne-EleBmax ngaphandle kokulungiswa, i-AdjEleBmax inokucaciswa okuphezulu, i-AUC ephezulu nokusebenza okungcono okuzwela okufanayo.I-AUC.Njengoba ukwakheka kwendawo engemuva kune-aspherical futhi kugobile kunendawo yangaphambili, engasiza ekutholeni izinguquko, siphakamisa ukuthi kufakwe i-AdjEleBmax ekuhloleni ukuqhubeka kwe-KC kanye nokunye okuguquguqukayo ukuze kuthuthukiswe ukwethembeka kokuhlolwa kwethu komtholampilo nokutholwa kusenesikhathi.ukuqhubekela phambili.Amagama angukhiye: i-keratoconus, i-cornea, ukuqhubekela phambili, umumo ongcono kakhulu we-spherical dorsal, ukuphakama okuphezulu kwendawo engemuva ye-cornea.
I-Keratoconus (KK) iyi-ectasia eyinhloko evamile.Manje sekubhekwa njengesifo sezinhlangothi ezimbili (nakuba i-asymmetric) eqhubekayo eqhubekayo eholela ezinguqukweni eziningi zesakhiwo esilandelwa ukuncipha kwe-stromal kanye nezibazi.1,2 Ngokomtholampilo, iziguli zikhona nge-astigmatism engavamile kanye ne-myopia, i-photophobia, kanye/noma i-monocular diplopia enombono okhubazekile, i-maximally acuity visual acuity (BCVA) kanye nekhwalithi yokuphila encishisiwe.3,4 Ukubonakaliswa kwe-RP kuvame ukuqala eshumini lesibili leminyaka lokuphila futhi kuqhubekele eshumini lesine leminyaka, kulandelwa ukuzinza komtholampilo.Ingozi kanye nezinga lokuqhubekela phambili liphezulu kubantu abangaphansi kweminyaka engu-19 ubudala.5.6
Nakuba lingekho ikhambi eliqondile, ukwelashwa kwamanje kwe-keratoconus ye-ocular kunemigomo emibili ebalulekile: ukuthuthukisa umsebenzi obonakalayo kanye nokumisa ukuqhubeka kokunwetshwa.7,8 Okwakuqala kungase kubonakale ezingilazini, kumalensi okuxhumana aqinile noma aqinile, amaringi e-intracorneal, noma ekufakeni ama-cornea lapho isifo sisibi kakhulu.9 Umgomo wokugcina ubungcwele balezi zindlela zokwelapha ezinesineke, okwamanje ezitholakala kuphela ngokuxhumanisa.Lokhu kusebenza kuholela ekwandeni kokumelana ne-biomechanical nokuqina kwe-cornea futhi kuvimbela ukuqhubeka okuqhubekayo.10-13 Nakuba lokhu kungenziwa kunoma yisiphi isigaba sesifo, inzuzo enkulu kakhulu itholakala ezigabeni zangaphambili.I-14 kufanele yenziwe imizamo yokuthola ukuqhubekela phambili kusenesikhathi futhi ivimbele ukuwohloka okuqhubekayo, nokugwema ukwelashwa okungadingekile kwezinye iziguli, ngaleyo ndlela kuncishiswe ingozi yezinkinga ezinqamulayo ezifana nokutheleleka, ukulahlekelwa kwamangqamuzana e-endothelial, nobuhlungu obunzima bangemva kokuhlinzwa.15.16
Naphezu kwezifundo eziningana ezihloselwe ukuchaza nokuthola ukuqhubeka, i-17-19 ayikabi khona incazelo engaguquki yokuqhubeka kokunwetshwa noma indlela emisiwe yokuyibhala.9,20,21 Ku-Global Consensus on Keratoconus and Dilated Diseases (2015), ukuqhubeka kwe-keratoconus kuchazwa njengoshintsho olulandelanayo okungenani emikhawulweni yesimo sendawo okungenani emibili elandelayo: i-anterior corneal steepening, posterior corneal steepening, thinning kanye/noma ukujiya. ye-cornea Izinga loshintsho liyakhuphuka ukusuka ku-perimeter ukuya endaweni ye-thinnest.9 Nokho, kusadingeka incazelo ecace kakhudlwana yentuthuko.Imizamo yenziwe yokuthola okuguquguqukayo okuqine kakhulu ukuze kutholwe futhi kuchazwe inqubekelaphambili.19:22–24
Njengoba kunikezwe ukuthi ukuma kwe-corneal yangemuva, okuyi-aspherical futhi egobile kunendawo yangaphambili, kungase kube usizo ekutholeni izinguquko, i-25 inhloso eyinhloko yalolu cwaningo kwakuwukuhlola izici ze-angle ephezulu yokuphakama kwekhone yangemuva.iguqulelwe endaweni efaneleke kakhulu.Isilinganiso sesikali sesikhathi (BFSB) (AdjEleBmax) kanye nerediyasi ye-BFSB (BFSBR) iyodwa isebenze njengemingcele emisha yokurekhoda ukuqhubeka kokunwetshwa futhi yaqhathaniswa namapharamitha asetshenziswa kakhulu asetshenziselwa ukuqhubeka kwe-KC.
Isamba samehlo angu-113 eziguli ezingu-76 ezilandelanayo ezitholwe zine-keratoconus zahlolwa kulolu cwaningo lweqembu olwenziwa kabusha eMnyangweni Wezifo Zamehlo eSibhedlela Esimaphakathi saseNyuvesi yaseSão João, ePortugal.Ucwaningo lugunyazwe ikomidi lendawo lezimiso ze-Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto futhi lwenziwa ngokuvumelana Nesimemezelo sase-Helsinki.Imvume ebhaliwe enolwazi itholwe kubo bonke ababambiqhaza futhi, uma umhlanganyeli engaphansi kweminyaka engu-16 ubudala, kumzali kanye/noma umnakekeli osemthethweni.
Iziguli ezine-KC ezineminyaka engu-14 kuya kwengu-30 zihlonzwe futhi zafakwa ngokulandelana ekulandeleni kwethu kwamehlo kanye ne-cornea phakathi no-Okthoba-Disemba 2021.
Zonke iziguli ezikhethiwe zalandelwa unyaka owodwa nguchwepheshe we-corneal futhi zenza okungenani izilinganiso ezintathu ze-Scheimpflug tomographic (Pentacam®; Oculus, Wetzlar, Germany).Iziguli ziyekile ukugqoka amalensi okuxhumana okungenani amahora angama-48 ngaphambi kwezilinganiso.Zonke izilinganiso zenziwa udokotela wamathambo oqeqeshiwe futhi amaskena kuphela anesheke lekhwalithi elithi “KULUNGILE” afakiwe.Uma ukuhlolwa kwekhwalithi yesithombe okuzenzakalelayo kungamakwanga njengokuthi “KULUNGILE”, ukuhlolwa kuzophindwa.Izikena ezimbili kuphela zeso ngalinye zahlaziywa ukuze kutholwe ukuqhubeka, futhi ipheya ngalinye lihlukaniswe ngezinyanga eziyi-12 ± 3.Amehlo ane-KC engaphansi afakiwe (kulezi zimo, elinye iso kufanele libe nezimpawu ezicacile ze-KC yomtholampilo).
Asibandakanyi ekuhlaziyeni amehlo e-KC ayekade ehlinzwe i-ophthalmic (i-corneal crosslinking, i-corneal ring, noma i-cornea transplant) kanye namehlo anesifo esithuthuke kakhulu (ugqinsi lwe-corneal ku-thinnest <350 µm, i-hydrokeratosis, noma izibazi ezijulile ze-corneal) njengoba iqembu lihluleka njalo. "KULUNGILE" ngemva kokuhlolwa kwekhwalithi yokuskena kwangaphakathi.
Idatha yezibalo zabantu, yomtholampilo kanye ne-tomographic yaqoqwa ukuze ihlaziywe.Ukuze sithole ukuqhubeka kwe-KC, siqoqe okuguquguqukayo kwe-tomographic okuningana okuhlanganisa ukugoba kwe-corneal (Kmax), i-mean corneal curvature (Km), i-flat meridional corneal curvature (K1), i-meridional corneal curvature (K2), i-corneal astigmatism2 - K1 = ).), isilinganiso sobukhulu obuncane (i-PachyMin), ukuphakama kwekhone elingemuva eliphezulu (i-EleBmax), i-radius yangemuva ye-curvature (PRC) 3.0 mm egxile endaweni ye-thinnest point, i-Belin/Ambrosio D-index (i-D-index), i-BFSBR ne-EleBmax ishintshwe yaba yi-BFSB (AdjEleBmax).Njengoba kuboniswe emkhiwaneni.1, i-AdjEleBmax itholwa ngemva kokuthi sinqume mathupha irediyasi ye-BFSB efanayo kukho kokubili ukuhlolwa komshini sisebenzisa inani le-BFSR kusukela esilinganisweni sesibili.
Ilayisi.1. Ukuqhathaniswa kwezithombe ze-Pentacam® endaweni engemuva eqondile nokuqhubeka komtholampilo kwangempela kanye nesikhawu sezinyanga eziyi-13 phakathi kokuhlolwa.Kuphaneli 1, i-EleBmax yayingu-68 µm ekuhlolweni kokuqala kanye no-66 µm kwesibili, ngakho-ke akuzange kube khona ukuqhubeka kule pharamitha.I-sphere radii ehamba phambili enikezwa ngokuzenzakalelayo umshini wokuhlola ngakunye ingu-5.99 mm no-5.90 mm, ngokulandelana.Uma sichofoza inkinobho ye-BFS, kuzovela iwindi lapho irediyasi entsha ye-BFS ingachazwa ngesandla.Sinqume irediyasi efanayo kukho kokubili ukuhlola sisebenzisa inani lerediyasi elinganisiwe yesibili ye-BFS (5.90mm).Kuphaneli yesi-2, inani elisha le-EleBmax (EleBmaxAdj) elilungiselwe i-BFS efanayo ekuhloleni kokuqala lingu-59 µm, okubonisa ukukhuphuka okungu-7 µm ekuhloleni kwesibili, okubonisa ukuqhubeka ngokuya ngomkhawulo wethu ongu-7 µm.
Ukuze sihlaziye ukuqhubeka nokuhlola ukusebenza kahle kokuhlukahluka kocwaningo olusha, sisebenzise amapharamitha avame ukusetshenziswa njengezimaka zokuqhubeka (Kmax, Km, K2, Astig, PachyMin, PRC, ne-D-Index) kanye nemikhawulo echazwe ezincwadini.nakuba kungenjalo ngokusemthethweni).Ithebula 1 libala amanani amele ukuqhubeka kwepharamitha yokuhlaziya ngayinye.Ukuqhubeka kwe-KC kwachazwa lapho okungenani iziguquguquki ezimbili ezihloliwe ziqinisekisa ukuqhubeka.
Ithebula 1 Amapharamitha we-Tomographic ngokuvamile amukelwa njengezimaka zokuqhubeka kokuqhubeka kwe-RP kanye nemikhawulo ehambisanayo echazwe ezincwadini (yize zingaqinisekisiwe)
Kulolu cwaningo, ukusebenza kweziguquko ezintathu kwahlolelwa ukuqhubeka (i-EleBmax, i-BFSB, ne-AdjEleBmax) ngokusekelwe ebukhoneni bokuqhubekela phambili okungenani okunye okuguquguqukayo okubili.Amaphuzu okunqanyulwa afanelekile alezi ziguquguqukayo abalwe futhi aqhathaniswa nezinye eziguquguqukayo.
Ukuhlaziywa kwezibalo kwenziwe kusetshenziswa isofthiwe yezibalo ye-SPSS (inguqulo 27.0 ye-Mac OS; SPSS Inc., Chicago, IL, USA).Izici zesampula ziyafingqwa futhi idatha yethulwa njengezinombolo nezilinganiso zokuguquguquka kwezigaba.Okuguquguqukayo okuqhubekayo kuchazwa njengokuchezuka okumaphakathi nokujwayelekile (noma ububanzi be-median ne-interquartile lapho ukusatshalaliswa kuphendukisiwe).Ushintsho kunkomba ye-keratometric lutholwe ngokukhipha inani langempela esilinganisweni sesibili (okungukuthi, inani elihle le-delta libonisa ukwanda kwenani lepharamitha ethile).Ukuhlolwa kwe-Parametric nokungewona kwepharamethri kwenziwa ukuze kuhlolwe ukusatshalaliswa kokuguquguquka kwe-corneal curvature okubhekwa njengokuqhubekayo noma okungaqhubeki, okuhlanganisa ukuhlolwa kwesampula okuzimele, ukuhlolwa kwe-Mann-Whitney U, ukuhlolwa kwe-chi-square, kanye nokuhlolwa okuyimpela kukaFisher (uma okudingekayo).Izinga lokubaluleka kwezibalo lalibekwe ku-0.05.Ukuhlola ukusebenza kahle kwe-Kmax, i-D-index, i-PRC, i-BFSBR, i-EleBmax, ne-AdjEleBmax njengezibikezelo zokuqhubeka komuntu ngamunye, sakhe ama-receiver performance curves (ROC) futhi sabala amaphuzu afanele wokunqamula, ukuzwela, ukucaciswa, okuhle (PPV), kanye Negative Predictive. Inani (NPV).) kanye nendawo engaphansi kwejika (AUC) lapho okungenani okuguquguqukayo okubili kweqa imikhawulo ethile (njengoba kuchazwe ngaphambili) ukuze kuhlelwe ukuqhubeka njengokulawula.
Ingqikithi yamehlo ayi-113 ezigulini ezingama-76 ezine-RP afakiwe ocwaningweni.Iningi leziguli kwakungamadoda (n=87, 77%) kanti isilinganiso seminyaka yobudala ekuhlolweni kokuqala sasiyiminyaka engama-24.09 ± 3.93.Ngokuphathelene nokuhlelwa kwe-KC okusekelwe ekwenyusweni okuphelele kwe-Belin/Ambrosio dilatation (inkomba ye-BAD-D), iningi (n=68, 60.2%) lamehlo belimaphakathi.Abacwaningi bakhetha ngazwi linye inani elinqunyiwe le-7.0 futhi bahlukanisa phakathi kwe-keratoconus emnene futhi elinganiselayo ngokusho kwezincwadi26.Nokho, okunye ukuhlaziya kufaka phakathi isampula yonke.Izici zesibalo sabantu, umtholampilo kanye ne-tomographic yesampula, okuhlanganisa incazelo, ubuncane, ubukhulu, ukuchezuka okujwayelekile (SD) nezilinganiso ezinezikhathi zokuzethemba ezingu-95% (IC95%), kanye nezilinganiso zokuqala nezesibili.Umehluko phakathi kwamanani ngemuva kwezinyanga eziyi-12 ± 3 ungatholakala kuthebula 2.
Ithebula 2. Izici zezibalo zabantu, umtholampilo kanye ne-tomographic yeziguli.Imiphumela ichazwa njengokuchezuka okusho ± okujwayelekile kokuhlukahluka okuqhubekayo (*imiphumela ivezwa njengemaphakathi ± IQR), isikhawu sokuzethemba esingu-95% (95% CI), ubulili besilisa neso langakwesokudla kuvezwa njengenombolo nephesenti
Ithebula 3 libonisa inani lamehlo ahlukaniswa njengabathuthukisi ngokucabangela ipharamitha ngayinye ye-tomographic (Kmax, Km, K2, Astig, PachyMin, PRC kanye ne-D-Index) ngokuhlukana.Kucatshangelwa ukuqhubekela phambili kwe-KC, okuchazwa izinguquko ezibonwa okungenani eziguquguqukayo ezimbili ze-tomographic, amehlo angama-57 (50.4%) abonise ukuqhubeka.
Ithebula 3 Inombolo kanye nemvamisa yamehlo ahlukaniswa njengabathuthukisi, kucatshangelwa ipharamitha ye-tomographic ngayinye ngokwehlukana
I-Kmax, i-D-index, i-PRC, i-EleBmax, i-BFSB, ne-AdjEleBmax izikolo njengezibikezelo ezizimele zokuqhubeka kwe-KC ziboniswa kuThebula 4. Isibonelo, uma sichaza inani le-threshold lokukhulisa i-Kmax ngo-1 diopter (D) ukumaka ukuqhubeka, nakuba le pharamitha ikhombisa ukuzwela okungama-49 %, inokucaciswa okungu-100% (zonke izimo ezihlonzwe njengeziqhubekayo kule parameter empeleni zaziyiqiniso).abaqhubekela phambili ngenhla) abanevelu yokubikezela ephozithivu (PPV) engu-100%, inani elibikezelayo elingalungile (NPV) elingu-66%, kanye nendawo engaphansi kwejika (AUC) engu-0.822.Kodwa-ke, i-cutoff ekahle ebaliwe ye-kmax yayingu-0.4, okunikeza ukuzwela okungama-70%, ukucaciswa okungu-91%, i-PPV okungu-89%, kanye ne-NPV engu-75%.
Ithebula 4 Kmax, D-Index, PRC, BFSB, EleBmax, kanye nezikolo ze-AdjEleBmax njengezibikezelo ezingazodwa zokuqhubeka kwe-KC (kuchazwa njengoshintsho olubalulekile eziguquguqukayo ezimbili noma ngaphezulu)
Ngokwenkomba ye-D, indawo ekahle yokusika ingu-0.435, ukuzwela kungu-82%, ukucaciswa okungu-98%, i-PPV ingu-94%, i-NPV ingu-84%, kanti i-AUC ingu-0.927.Siqinisekise ukuthi kumehlo we-50 athuthukile, iziguli ze-3 kuphela azizange zithuthuke ku-2 noma eminye imingcele.Kumehlo angama-63 lapho inkomba ye-D ingazange ithuthuke khona, i-10 (15.9%) ibonise ukuqhubeka okungenani kwezinye imingcele emibili.
Ku-PRC, indawo efanelekile yokusika yokuchaza ukuqhubeka kwaba ukwehla okungu-0.065 ngokuzwela okungama-79%, ukucaciswa okungu-80%, i-PPV okungu-80%, i-NPV okungu-79%, kanye ne-AUC okungu-0.844.
Mayelana nokuphakama kwendawo engemuva (i-EleBmax), umkhawulo ofanelekile wokunquma ukuqhubekela phambili kwaba ukukhuphuka ngo-2.5 ​​µm ngokuzwela kwama-65% kanye nokucaciswa okungu-73%.Lapho ilungiswa ku-BSFB elinganisiwe yesibili, ukuzwela kwepharamitha entsha ye-AdjEleBmax kwaba ngu-63% futhi ukucaciswa kwathuthukiswa ngo-84% nendawo ekahle yokusika engu-6.5 µm.I-BFSB ngokwayo ibonise ukusika okuphelele kwe-0.05 mm nokuzwela kwe-51% kanye nokucaciswa okungu-80%.
Emkhiwaneni.2 ikhombisa amajika e-ROC kupharamitha ngayinye elinganiselwe ye-tomographic (Kmax, D-Index, PRC, EleBmax, BFSB kanye ne-AdjEleBmax).Siyabona ukuthi inkomba ye-D iyisivivinyo esisebenza kangcono nge-AUC ephakeme (0.927) elandelwa yi-PRC ne-Kmax.I-AUC EleBmax ingu-0.690.Uma ishunwe i-BFSB, lesi silungiselelo (AdjEleBmax) sithuthukise ukusebenza kwakho ngokunweba i-AUC ibe ngu-0.754.I-BFSB ngokwayo ine-AUC ye-0.690.
Umfanekiso 2. Amajika okusebenza komamukeli (ROC) abonisa ukuthi ukusetshenziswa kwenkomba ye-D ukuze kunqunywe ukuqhubeka kwe-keratoconus kufinyelele amazinga aphezulu okuzwela nokucaciswa, okulandelwa yi-PRC ne-Kmax.I-AdjEleBmax isabhekwa njengenengqondo futhi ngokuvamile ingcono kune-Elebmax ngaphandle kokulungiswa kwe-BFSB.
Izifinyezo: I-Kmax, i-curvature ephezulu ye-corneal;D-inkomba, Belin/Ambrosio D-inkomba;I-PRC, irediyasi engemuva yokugoba esuka ku-3.0 mm egxile endaweni encane kakhulu;I-BFSB, ifaneleka kakhulu ingemuva eliyindilinga;Ubude;I-AdjELEBmax, i-engeli ephezulu yokuphakama.indawo engemuva ye-cornea ilungiswa ibe yindilinga eyindilinga efaneleke kakhulu.
Uma sicabangela i-EleBmax, i-BFSB, ne-AdjEleBmax, ngokulandelana, siqinisekisile ukuthi amehlo angu-53 (46.9%), angu-40 (35.3%), kanye namehlo angu-45 (39.8%) abonise ukuqhubeka kwepharamitha ngayinye ehlukanisiwe, ngokulandelana.Kulawa mehlo, i-16 (30.2%), i-11 (27.5%), ne-9 (45%), ngokulandelana, ayinakho ukuqhubeka kweqiniso njengoba kuchazwe okungenani amanye amapharamitha amabili.Kumehlo we-60 angabhekwa njengenqubekela phambili yi-EleBmax, amehlo angama-20 (33%) ayeqhubekela phambili ku-2 noma amanye amapharamitha amaningi.Amehlo angamashumi amabili nesishiyagalombili (38.4%) kanye nama-21 (30.9%) athathwa njengangaqhubeki ngokusho kwe-BFSB kanye ne-AdjEleBmax iyodwa, ngokulandelana, ekhombisa ukuqhubeka kweqiniso.
Sihlose ukuphenya ukusebenza kahle kwe-BFSB futhi, okubaluleke kakhulu, ukuphakama kwekhoneal elingemuva elilungisiwe kwe-BFSB (AdjEleBmax) njengepharamitha yenoveli yokubikezela nokubona ukuqhubeka kwe-KC futhi siwaqhathanise namanye amapharamitha we-tomographic avame ukusetshenziswa njengezimpawu zokuqhubeka.Ukuqhathaniswa kwenziwe nemikhawulo ebikwe ezincwadini (nakuba zingaqinisekisiwe), okuyi-Kmax kanye ne-D-Index.20
Lapho sisetha i-EleBmax ku-BFSB radius (AdjEleBmax), sibone ukwanda okuphawulekayo kokucaciswa - 73% kupharamitha engalungisiwe kanye no-84% wepharamitha elungisiwe - ngaphandle kokuthinta inani lokuzwela (65% kanye ne-63%).Siphinde sahlola irediyasi ye-BFSB ngokwayo njengesinye isibikezelo esingaba khona sokuqhubeka kokunwetshwa.Kodwa-ke, ukuzwela (51% vs 63%), ukucaciswa (80% vs 84%) kanye ne-AUC (0.69 vs 0.75) yale pharamitha bekungaphansi kunaleyo ye-AdjEleBmax.
I-Kmax iyipharamitha eyaziwa kakhulu yokubikezela ukuqhubeka kwe-KC.27 Akukho ukuvumelana ngokuthi umkhawulo wokunqunywa ufaneleke kakhulu.12,28 Ocwaningweni lwethu, sicabangele ukwanda kwe-1D noma ngaphezulu njengencazelo yokuqhubeka.Kulo mngcele, sibonile ukuthi zonke iziguli ezihlonzwe njengezithuthukayo zaqinisekiswa okungenani ezinye izimiso ezimbili, okuphakamisa ukucaciswa kwe-100%.Kodwa-ke, ukuzwela kwayo kwakuphansi kakhulu (49%), futhi ukuqhubeka akutholakalanga emehlweni angama-29.Kodwa-ke, ocwaningweni lwethu, umkhawulo ofanelekile we-Kmax wawungu-0.4 D, ukuzwela kwakungama-70%, futhi ukucaciswa kwakungama-91%, okusho ukuthi ngokuncipha okuhlobene kokucacisiwe (kusuka ku-100% kuya ku-91%), sithuthukile.Ukuzwela kusuka ku-49% kuya ku-70%.Nokho, ukuhlobana ngokomtholampilo kwalo mngcele omusha kuyangabazeka.Ngokocwaningo lwe-Kreps mayelana nokuphindaphinda kwezilinganiso ze-Pentacam®, ukuphindaphinda kwe-Kmax kwaba ngu-0.61 kumdlavuza we-catarrhal obuthakathaka kanye no-1.66 ku-caesarean colpitis emaphakathi,19 okusho ukuthi inani lokunqanyulwa kwezibalo kuleli sampula alibalulekile ngokomtholampilo njengoba lichaza. isimo esizinzile.lapho inqubekelaphambili enkulu engenzeka isetshenziswa kwamanye amasampuli.I-Kmax, ngakolunye uhlangothi, ibonakalisa ukugoba kwekhoneum yangaphambili ewumqansa wesifunda esincane 29 futhi ayikwazi ukukhiqiza kabusha izinguquko ezenzeka ku-cornea yangaphambili, i-cornea yangemuva, nezinye izindawo ze-pachymetry.I-30-32 Uma kuqhathaniswa nemingcele emisha yangemuva, i-AdjEleBmax ibonise ukuzwela okuphezulu (63% vs. 49%).Amehlo aqhubekayo angama-20 akhonjwe ngendlela efanele kusetshenziswa le pharamitha futhi aphuthelwe kusetshenziswa i-Kmax (uma kuqhathaniswa namehlo aqhubekayo ayi-12 atholwe kusetshenziswa i-Kmax esikhundleni se-AdjEleBmax).Lokhu okutholakele kusekela iqiniso lokuthi indawo engemuva ye-cornea iyakhuphuka futhi inwetshwe kakhulu phakathi nendawo uma iqhathaniswa nendawo yangaphambili, engasiza ekutholeni izinguquko.25,32,33
Ngokusho kolunye ucwaningo, inkomba ye-D iyipharamitha ehlukile enokuzwela okuphezulu kakhulu (82%), ukucaciswa (95%) kanye ne-AUC (0.927).34 Empeleni, lokhu akumangazi, ngoba lokhu kuyinkomba enamapharamitha amaningi.I-PRC ibe yinguquko yesibili ebucayi kakhulu (79%) ilandelwa yi-AdjEleBmax (63%).Njengoba kushiwo ngaphambili, lapho ukuzwela kuphezulu, ama-negative ambalwa amanga futhi ngcono imingcele yokuhlola ikhula.35 Ngakho-ke, sincoma ukusebenzisa i-AdjEleBmax (enokusikwa okungu-7 µm ukuze kuqhubeke kunokungu-6.5 µm njengoba isikali sedijithali esakhelwe ku-Pentacam® singafaki izindawo zamadesimali zale pharamitha) esikhundleni se-EleBmax engalungiswanga, ezofakwa kanye okunye okuguquguqukayo ekuhloleni.ukuqhubekela phambili kwe-keratoconus ukuthuthukisa ukuthembeka kokuhlolwa kwethu komtholampilo kanye nokutholwa kusenesikhathi kokuqhubeka.
Nokho, isifundo sethu sibhekana nokulinganiselwa okuthile.Okokuqala, sisebenzise kuphela imingcele ye-tomographic shapeflug imaging ukuze sichaze futhi sihlole ukuqhubeka, kodwa ezinye izindlela okwamanje zitholakala ngenjongo efanayo, njengokuhlaziywa kwe-biomechanical, okungase kwandulele noma yiziphi izinguquko ze-topographic noma tomographic.36 Okwesibili, sisebenzisa ukulinganisa okukodwa kwawo wonke amapharamitha ahloliwe futhi, ngokusho kuka-Ivo Guber et al., ukwenza isilinganiso phezu kwezithombe eziningi kubangela amazinga aphansi omsindo wokulinganisa.28 Nakuba izilinganiso nge-Pentacam® zaziphindaphindeka kahle emehlweni avamile, zaziphansi emehlweni ngokungahambi kahle kwe-cornea kanye ne-ectasia ye-cornea.37 Kulolu cwaningo, sifake kuphela amehlo anokuqinisekiswa kwekhwalithi ephezulu ye-Pentacam® eyakhelwe ngaphakathi, okusho ukuthi isifo esithuthukisiwe sasikhishiwe.17 Okwesithathu, sichaza abathuthukisi beqiniso njengabanezimiso okungenani ezimbili ezisekelwe ezincwadini kodwa ezingakaqinisekiswa.Okokugcina, futhi mhlawumbe okubaluleke nakakhulu, ukuhlukahluka kwezilinganiso ze-Pentacam® kubaluleke kakhulu emtholampilo ekuhloleni ukuqhubeka kwe-keratoconus.18,26 Kusampula yethu yamehlo angu-113, uma ehlutshiwe ngokuya ngesikolo se-BAD-D, amehlo amaningi (n=68, 60.2%) abemaphakathi, nensalela i-subclinical noma imnene.Kodwa-ke, uma kubhekwa usayizi omncane wesampula, sigcine ukuhlaziya konke ngokunganaki ubukhali be-KTC.Sisebenzise inani le-threshold elilungele isampula yethu yonke, kodwa siyavuma ukuthi lokhu kungase kwengeze umsindo (ukuhlukahluka) esilinganisweni futhi kuphakamise ukukhathazeka mayelana nokuphindaphinda kokulinganisa.Ukukhiqizwa kabusha kwezilinganiso kuncike ebucayini be-KTC, njengoba kuboniswe ngabakwa-Kreps, Gustafsson et al.18,26.Ngakho-ke, sincoma ngokuqinile ukuthi izifundo zesikhathi esizayo zicabangele izigaba ezihlukene zesifo futhi zihlole izindawo ezifanelekile zokunquma ukuze kuthuthuke okufanele.
Sengiphetha, ukutholwa kusenesikhathi kokuqhubeka kubaluleke kakhulu ukuze kuhlinzekwe ukwelashwa okufika ngesikhathi ukuze kumiswe ukuqhubeka (ngokuxhumanisa)38 nokusiza ukulondoloza umbono kanye nezinga lempilo ezigulini zethu.34 Umgomo oyinhloko womsebenzi wethu ukukhombisa ukuthi i-EleBmax, eshuthelwe endaweni efanayo ye-BFS phakathi kwezilinganiso zesikhathi, inokusebenza okungcono kune-EleBmax ngokwayo.Le pharamitha ikhombisa ukucaciswa okuphezulu nokusebenza ngempumelelo uma kuqhathaniswa ne-EleBmax, ingenye yemingcele ebucayi kakhulu (ngakho-ke isebenza kahle kakhulu ekuhloleni) futhi ngaleyo ndlela ibe yi-biomarker yokuqhubeka kwangaphambi kwesikhathi engaba khona.Kunconywa kakhulu ukudala izinkomba zamapharamitha amaningi.Izifundo zesikhathi esizayo ezibandakanya ukuhlaziywa kokuqhubeka kwe-multivariate kufanele zifake i-AdjEleBmax.
Ababhali abalutholi ukusekelwa kwezezimali ngocwaningo, ubunikazi kanye/noma ukushicilelwa kwalesi sihloko.
UMargarida Ribeiro noClaudia Barbosa bangababhali abakanye nabo ocwaningweni.Ababhali babika ukuthi akukho ukungqubuzana kwezintshisekelo kulo msebenzi.
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