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E hoʻopaʻa inoa i kāu kikoʻī kikoʻī a me ka lāʻau lapaʻau kikoʻī o ka hoihoi a e hoʻohālikelike mākou i ka ʻike āu e hāʻawi ai me nā ʻatikala mai kā mākou waihona nui a leka uila iā ʻoe i kahi kope PDF koke.
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, 3 makahiki*Claudia Barbosa, 3 makahiki*2 Bio Faculty of Medicine – Faculty of Medicine o ke Kulanui o Porto, Porto, Pokukala 3 Faculty of Medicine o ke Kulanui o Porto, Porto, Pokukala;4 Ke Keʻena ʻO ka ʻokiʻoki a me ka Physiology, Kumu o ka Lapaʻau, Ke Kulanui o Porto, Porto, Pokukala4 Ke Keʻena ʻO ka ʻoki ʻoki a me ka Physiology, Faculty of Medicine, University of Porto, Porto, Pokukala *Ua hāʻawi like kēia mau mea kākau i kēia hana.Hernâni Monteiro Porto, 4200-319, Pokukala, leka uila [email protected] Ke kumu: Ua loiloi mākou i ka ʻili o ka corneal posterior i hoʻoponopono ʻia no ka Best Fit Sphere Back (BFSB) ma waena o nā ana ana manawa (AdjEleBmax) a me BFSB radius (BFSBR) ʻO ke kiʻekiʻe kiʻekiʻe. Ua hoʻohana ʻia ʻo ia ma ke ʻano he ʻano tomographic hou e hoʻopaʻa ai i ka holomua o ka dilatation a hoʻohālikelike ʻia me nā ʻāpana hilinaʻi hou loa o ka holomua keratoconus (KK).Nā hualoaʻa.Ua loiloi mākou iā Kmax, D index, postterior curvature radius, a me kahi ʻoki ʻoki maikaʻi loa mai 3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, a me AdjEleBmax ma ke ʻano he mau ʻāpana kūʻokoʻa e hoʻopaʻa i ka holomua KC (i wehewehe ʻia he ʻelua a ʻoi aku paha nā ʻano ʻokoʻa), ua ʻike mākou i nā sensitivities. o 70%, 82%, 79%, 65%, 51%, a me 63%, a me 91%, 98%, 80%, 73%, 80%, a me 84% kiko'ī no ka ʻike ʻana i ka holomua o KC..ʻO ka ʻāpana ma lalo o ka pihi (AUC) no kēlā me kēia hoʻololi ʻo 0.822, 0.927, 0.844, 0.690, 0.695, 0.754.Ka hopena: Hoʻohālikelike ʻia me EleBmax me ka ʻole o ka hoʻololi ʻana, ʻoi aku ka kiʻekiʻe o AdjEleBmax, kiʻekiʻe AUC a ʻoi aku ka maikaʻi o ka hana me ka ʻike like.AUC.No ka mea ʻoi aku ka aspherical a me ka curved o ke ʻano o ka ʻili ma mua o ka ʻili o mua, hiki ke kōkua i ka ʻike ʻana i nā loli, manaʻo mākou e hoʻokomo iā AdjEleBmax i ka loiloi o ka holomua KC me nā ʻano ʻē aʻe e hoʻomaikaʻi i ka hilinaʻi o kā mākou loiloi lapaʻau a me ka ʻike mua.holomua. Hua'ōlelo koʻikoʻi: keratoconus, cornea, progression, spherical dorsal shape maikaʻi loa, kiʻekiʻe kiʻekiʻe o ka ʻili hope o ka cornea.
ʻO Keratoconus (KK) ka mea maʻamau maʻamau o ka corneal ectasia.Ua manaʻo ʻia ʻo ia he maʻi bilateral (ʻoiai asymmetric) ka maʻi holomua maʻamau e alakaʻi ana i nā loli hoʻololi he nui a ukali ʻia e ka stromal thinning a me ka scarring.1,2 Clinically, nā poʻe maʻi e hōʻike ana me ka astigmatism irregular a me ka myopia, photophobia, a me / a monocular diplopia me ka ʻike kīnā ʻole, maximally hoʻoponopono ʻia ka ʻike acuity (BCVA) a hoʻemi i ka maikaʻi o ke ola.3,4 Hoʻomaka maʻamau nā hōʻike o RP i ka makahiki ʻelua o ke ola a holomua i ka makahiki ʻehā, a ukali ʻia e ka hoʻopaʻa ʻana i ke kino.ʻOi aku ka nui o ka pilikia a me ka piʻi ʻana o ka piʻi ʻana i nā poʻe ma lalo o 19 mau makahiki.5.6
ʻOiai ʻaʻohe lāʻau lapaʻau paʻa, ʻelua mau pahuhopu koʻikoʻi ka mālama ʻana i kēia manawa no ka ocular keratoconus: hoʻomaikaʻi i ka hana ʻike a hoʻōki i ka holomua o ka dilation.7,8 Hiki ke ʻike ʻia ka mea mua ma nā aniani, nā lens contact rigid or semi-rigid contact lenses, intracorneal apo, a i ʻole i ka hoʻololi ʻana i ka ʻili i ka wā i koʻikoʻi loa ka maʻi.9 ʻO ka pahuhopu hope ka grail hemolele o kēia mau lāʻau lapaʻau maʻi, hiki ke loaʻa i kēia manawa ma o ka hoʻopili ʻana.Ke alakaʻi nei kēia hana i ka piʻi ʻana o ke kūpaʻa biomechanical a me ka ʻoʻoleʻa o ka cornea a pale i ka holomua hou.10-13 ʻOiai hiki ke hana i kēia i kēlā me kēia pae o ka maʻi, loaʻa ka pōmaikaʻi nui loa i nā pae mua.14 Pono e hoʻoikaika ʻia e ʻike koke i ka piʻi ʻana a pale i ka pōʻino hou aʻe, a e pale i ka mālama pono ʻole ʻana i nā maʻi ʻē aʻe, a laila e hōʻemi ai i ka pilikia o nā hoʻopiʻi keʻa e like me ka maʻi, ka nalowale o ka cell endothelial, a me ka ʻeha nui postoperative.15.16
ʻOiai he nui nā haʻawina e pili ana i ka wehewehe ʻana a me ka ʻike ʻana i ka holomua ʻana, 17-19 ʻaʻole naʻe he wehewehe kūlike o ka holomua dilatation a i ʻole kahi ala maʻamau o ka palapala ʻana.9,20,21 I loko o ka Global Consensus on Keratoconus and Dilated Diseases (2015), ua wehewehe ʻia ka holomua o ke keratoconus ma ke ʻano he hoʻololi i ka liʻiliʻi o ʻelua o kēia mau ʻāpana topographic: anterior corneal steepening, posterior corneal steepening, thinning and/a mānoanoa. o ke kornea Pi'i ka pi'i 'ana o ka ho'ololi 'ana mai ke anapuni a i ka lae lahilahi.9 Eia naʻe, pono nō ka wehewehe kikoʻī o ka holomua.Ua hoʻoikaika ʻia e ʻimi i nā mea hoʻololi ikaika loa e ʻike a wehewehe i ka holomua.19:22–24
Ma muli o ke ʻano o ka ʻili koʻo hope, ʻoi aku ka aspherical a me ka curved ma mua o ka ʻili o mua, hiki ke kūpono no ka ʻike ʻana i nā loli, 25 ʻo ka pahuhopu nui o kēia haʻawina ʻo ia ka loiloi i nā ʻano o ke kihi kiʻekiʻe kiʻekiʻe o hope.hoʻopili ʻia i kahi ʻāpana kūpono loa.ʻO ke ana ʻana o ka manawa (BFSB) (AdjEleBmax) a me BFSB radius (BFSBR) wale nō i lawelawe ʻia ma ke ʻano he mau ʻāpana hou no ka hoʻopaʻa ʻana i ka piʻi ʻana o ka dilation a hoʻohālikelike iā lākou i nā ʻāpana maʻamau i hoʻohana ʻia no ka holomua KC.
ʻO ka huina o 113 mau maka o 76 mau maʻi maʻi i loaʻa i ka keratoconus i nānā ʻia i kēia haʻawina retrospective cohort ma ke Keʻena Ophthalmology ma ka Halemai Central o ke Kulanui o São João, Pokukala.Ua ʻae ʻia ke aʻo ʻana e ke komite etika kūloko o ka Centro Hospitalar Universitário de São João / Faculdade de Medicina da Universidade do Porto a ua mālama ʻia e like me ka Hōʻike o Helsinki.Ua loaʻa mai ka ʻae i kākau ʻia mai ka poʻe i komo a, inā ma lalo o 16 makahiki o ka mea komo, mai ka makua a/a i ʻole kahu mālama kānāwai.
Ua ʻike ʻia nā poʻe maʻi me KC mai 14 a 30 mau makahiki a ua hoʻokomo pū ʻia i kā mākou ophthalmic a me ka corneal follow-up i ʻOkakopa-Dekemapa 2021.
Ua ukali ʻia nā mea maʻi a pau i koho ʻia no hoʻokahi makahiki e kahi loea corneal a ua loaʻa i ʻekolu mau ana tomographic Scheimpflug (Pentacam®; Oculus, Wetzlar, Kelemānia).Ua ho'ōki ka poʻe maʻi i ka hoʻohana ʻana i nā leka pili ma kahi o 48 mau hola ma mua o ke ana ʻana.Ua hana ʻia nā ana a pau e kahi orthopedis i hoʻomaʻamaʻa ʻia a hoʻopaʻa ʻia me ka nānā maikaʻi ʻana o "OK".Inā ʻaʻole hōʻailona ʻia ka loiloi kiʻi maʻalahi ma ke ʻano he "OK", e hana hou ʻia ka hoʻāʻo.ʻElua wale nō scan no kēlā me kēia maka i nānā ʻia e ʻike i ka holomua, me kēlā me kēia pālua i hoʻokaʻawale ʻia e 12 ± 3 mahina.Hoʻokomo pū ʻia nā maka me KC subclinical (i kēia mau hihia, ua hōʻike ʻia ka maka ʻē aʻe i nā hōʻailona maopopo o ka KC clinical).
Hoʻokuʻu ʻia mākou mai ka nānā ʻana i nā maka KC i hana mua ʻia i ke ʻoki ophthalmic (ka hoʻopili ʻana i ka corneal, nā apo corneal, a i ʻole transplant corneal) a me nā maka me ka maʻi ʻoi loa (ka mānoanoa o ke kino ma ka thinnest <350 µm, hydrokeratosis, a i ʻole ka ʻili ʻili hohonu) i ka pau ʻana o ka hui. "OK" ma hope o ka nānā ʻana i ka maikaʻi scan kūloko.
Ua hōʻiliʻili ʻia ka ʻikepili demographic, clinical a me tomographic no ka nānā ʻana.No ka ʻike ʻana i ka holomua ʻana o KC, ua hōʻiliʻili mākou i kekahi mau ʻano tomographic e pili ana i ka curvature corneal kiʻekiʻe (Kmax), mean corneal curvature (Km), flat meridional corneal curvature (K1), steepest meridional corneal curvature (K2), corneal astigmatism (Astig = K2 - K1 ).), ke ana mānoanoa liʻiliʻi (PachyMin), ke kiʻekiʻe o ke kiʻekiʻe hope o ka corneal kiʻekiʻe (EleBmax), ka radius hope o ka curvature (PRC) 3.0 mm i kau ʻia ma kahi kikoʻī loa, Belin/Ambrosio D-index (D-index), BFSBR a me EleBmax i hoʻoponopono ʻia i BFSB (AdjEleBmax).E like me ka hoike ana ma ka fig.1, loaʻa ʻo AdjEleBmax ma hope o ka hoʻoholo lima ʻana i ka radius BFSB like ma nā hoʻokolohua mīkini ʻelua me ka hoʻohana ʻana i ka waiwai BFSR mai ka helu lua.
Laiki.1. Ka hoʻohālikelike ʻana o nā kiʻi Pentacam® ma kahi kūlana hope kū pololei me ka holomua o ka maʻi maʻi maoli me kahi manawa 13 mau mahina ma waena o nā hoʻokolohua.Ma ka papa 1, ʻo EleBmax he 68 µm i ka hoʻokolokolo mua a me 66 µm ma ka lua, no laila ʻaʻohe holomua o kēia ʻāpana.ʻO ka radii sphere maikaʻi loa i hāʻawi ʻia e ka mīkini no kēlā me kēia loiloi ʻo 5.99 mm a me 5.90 mm.Inā mākou e kaomi i ke pihi BFS, e ʻike ʻia kahi puka aniani kahi e hiki ke wehewehe lima ʻia kahi radius BFS hou.Ua hoʻoholo mākou i ka radius like i nā hoʻokolohua ʻelua me ka hoʻohana ʻana i ka waiwai radius BFS lua (5.90mm).Ma ka papa 2, ua hoʻoponopono ʻia ka waiwai hou o EleBmax (EleBmaxAdj) no ka BFS hoʻokahi i ka loiloi mua ʻo 59 µm, e hōʻike ana i ka piʻi ʻana o 7 µm i ka loiloi lua, e hōʻike ana i ka holomua e like me kā mākou paepae 7 µm.
No ke kālailai ʻana i ka holomua a me ka loiloi i ka pono o nā mea hoʻololi aʻo hou, ua hoʻohana mākou i nā ʻāpana i hoʻohana mau ʻia e like me nā māka holomua (Kmax, Km, K2, Astig, PachyMin, PRC, a me D-Index) a me nā paepae i wehewehe ʻia ma ka palapala.ʻoiai ʻaʻole i ka empirically).Hōʻike ka papa 1 i nā waiwai e hōʻike ana i ka holomua o kēlā me kēia hoʻohālikelike.Ua wehewehe ʻia ka holomua ʻana o KC i ka wā i hōʻoia ʻia ai ʻelua o nā ʻano hoʻololi i aʻo ʻia i ka holomua.
Papa 1 Ua ʻae ʻia nā ʻāpana Tomographic ma ke ʻano he hōʻailona o ka holomua o ka holomua RP a me nā paepae kūpono i wehewehe ʻia ma ka palapala (ʻoiai ʻaʻole i hōʻoia ʻia)
Ma kēia haʻawina, ua hoʻāʻo ʻia ka hana o ʻekolu mau mea hoʻololi no ka holomua (EleBmax, BFSB, a me AdjEleBmax) ma muli o ka hele ʻana o ka holomua o ʻelua mau mea hoʻololi ʻē aʻe.Ua helu ʻia a hoʻohālikelike ʻia me nā ʻokoʻa ʻē aʻe.
Hana ʻia ka ʻikepili helu me ka hoʻohana ʻana i ka polokalamu helu helu SPSS (version 27.0 no Mac OS; SPSS Inc., Chicago, IL, USA).Hōʻuluʻulu ʻia nā hiʻohiʻona laʻana a hōʻike ʻia nā ʻikepili ma ke ʻano he helu a me nā ʻāpana o nā ʻano hoʻololi categorical.Hōʻike ʻia nā ʻano hoʻololi hoʻomau ma ke ʻano he mean a me ka haʻalele maʻamau (a i ʻole median a me ka laulā interquartile i ka wā e skewed ka puʻunaue).Ua loaʻa ka hoʻololi ʻana i ka helu keratometric ma ka unuhi ʻana i ka waiwai kumu mai ke ana ʻelua (ʻo ia hoʻi, ʻo ka waiwai delta maikaʻi e hōʻike ana i ka piʻi ʻana o ka waiwai o kekahi ʻāpana).Ua hana ʻia nā hoʻāʻo parametric a me nā hoʻāʻo ʻole no ka loiloi ʻana i ka puʻunaue ʻana o nā ʻāpana curvature corneal i hoʻokaʻawale ʻia ma ke ʻano he holomua a ʻaʻole holomua paha, me ka ho'āʻo kūʻokoʻa hoʻāʻo t, Mann-Whitney U-test, chi-square test, a me Fisher's exact test (inā pono).Ua hoʻonoho ʻia ka pae o ke koʻikoʻi helu ma 0.05.No ka loiloi i ka maikaʻi o Kmax, D-index, PRC, BFSBR, EleBmax, a me AdjEleBmax ma ke ʻano he mau wānana holomua hoʻokahi, ua kūkulu mākou i nā pihi hoʻokō hoʻokipa (ROC) a helu i nā helu ʻoki kūpono, sensitivity, specificity, positive (PPV), and Negative Predictive Waiwai (NPV).) a me ka ʻāpana ma lalo o ka pihi (AUC) inā ʻoi aku ka liʻiliʻi o ʻelua mau mea hoʻololi ma mua o kekahi mau paepae (e like me ka mea i wehewehe mua ʻia) e hoʻokaʻawale i ka holomua ma ke ʻano he mana.
ʻO ka huina o 113 mau maka o 76 mau maʻi me RP i komo i loko o ke aʻo ʻana.ʻO ka hapa nui o nā maʻi he kāne (n = 87, 77%) a ʻo ka makahiki maʻamau i ka loiloi mua he 24.09 ± 3.93 mau makahiki.E pili ana i ka stratification KC e pili ana i ka hoʻonui ʻia ʻana o Belin/Ambrosio dilatation deviation (BAD-D index), ʻo ka hapa nui (n=68, 60.2%) o nā maka he haʻahaʻa.Ua koho like nā mea noiʻi i kahi waiwai ʻoki ʻia o 7.0 a hoʻokaʻawale i waena o ke keratoconus haʻahaʻa a maʻalahi e like me ka palapala26.Eia naʻe, ʻo ke koena o ka hōʻike ʻana e pili ana i ka hāpana holoʻokoʻa.Demographic, clinical and tomographic hiʻohiʻona o ka hāpana, me ka mean, ka liʻiliʻi, ka nui, ka maʻamau deviation (SD) a me nā ana me 95% hilinaʻi wā (IC95%), a me nā ana mua a me ka lua.Hiki ke loaʻa ka ʻokoʻa ma waena o nā waiwai ma hope o 12 ± 3 mau mahina ma ka papa 2.
Papa 2. Nā hiʻohiʻona demographic, clinical a tomographic o nā maʻi.Hōʻike ʻia nā hopena ma ke ʻano he mean ± ka hoʻokaʻawale maʻamau no nā ʻano hoʻololi mau (* hōʻike ʻia nā hopena ma ke ʻano he median ± IQR), 95% ka manawa hilinaʻi (95% CI), hōʻike ʻia ke kāne kāne a me ka maka ʻākau e like me ka helu a me ka pakeneka
Hōʻike ka papa 3 i ka helu o nā maka i helu ʻia ma ke ʻano he holomua e noʻonoʻo ana i kēlā me kēia helu tomographic (Kmax, Km, K2, Astig, PachyMin, PRC a me D-Index) kaawale.Ma ka noʻonoʻo ʻana i ka holomua o KC, i wehewehe ʻia e nā loli i ʻike ʻia ma nā liʻiliʻi ʻelua tomographic, 57 mau maka (50.4%) i hōʻike i ka holomua.
Papa 3 Ka helu a me ka pinepine o nā maka i hoʻokaʻawale ʻia ma ke ʻano he holomua, me ka noʻonoʻo ʻana i kēlā me kēia ʻāpana tomographic
Hōʻike ʻia nā helu Kmax, D-index, PRC, EleBmax, BFSB, a me AdjEleBmax ma ke ʻano he mau wānana kūʻokoʻa o ka holomua o KC ma ka Papa 4. Hōʻike kēia ʻāpana i ka sensitivity o 49 %, loaʻa iā ia kahi kikoʻī o 100% (ʻo nā hihia āpau i ʻike ʻia he holomua ma kēia ʻāpana he ʻoiaʻiʻo maoli nō).nā holomua ma luna) me ka waiwai wānana maikaʻi (PPV) o 100%, ka waiwai wānana maikaʻi ʻole (NPV) o 66%, a me kahi wahi ma lalo o ka pihi (AUC) o 0.822.Eia naʻe, ʻo ka ʻoki ʻoki kūpono i helu ʻia no kmax he 0.4, e hāʻawi ana i ka sensitivity o 70%, kahi kikoʻī o 91%, kahi PPV o 89%, a me kahi NPV o 75%.
Pākuʻi 4 Kmax, D-Index, PRC, BFSB, EleBmax, a me AdjEleBmax nā helu ma ke ʻano he mau wānana kaʻawale o ka piʻi ʻana o KC (i wehewehe ʻia ma ke ʻano he hoʻololi koʻikoʻi i ʻelua mau ʻokoʻa a ʻoi aku paha)
Ma nā huaʻōlelo o ka D index, ʻo 0.435 ka ʻoki ʻoki kūpono, 82% ka naʻau, 98% ka kikoʻī, 94% ka PPV, 84% ka NPV, a ʻo AUC ka 0.927.Ua hōʻoia mākou o nā maka 50 i holomua,ʻo 3 wale nō nā maʻi i holomuaʻole ma 2 aʻoi aʻe paha nā palena'ē aʻe.ʻO nā maka 63 i hoʻomaikaʻi ʻole ka D index, 10 (15.9%) i hōʻike i ka holomua ma ka liʻiliʻi ʻelua mau ʻāpana ʻē aʻe.
No PRC, ʻo ka helu ʻoki kūpono no ka wehewehe ʻana i ka holomua ʻana he emi o 0.065 me ka sensitivity o 79%, kikoʻī o 80%, PPV o 80%, NPV o 79%, a me AUC o 0.844.
E pili ana i ka hoʻokiʻekiʻe kiʻekiʻe o hope (EleBmax), ʻo ka paepae kūpono no ka hoʻoholo ʻana i ka holomua ʻana he piʻi o 2.5 µm me kahi sensitivity o 65% a me kahi kikoʻī o 73%.Ke hoʻololi ʻia i ka BSFB ana ʻelua, ʻo 63% ka naʻau o ka pākuʻi hou AdjEleBmax a hoʻomaikaʻi ʻia ka kikoʻī e 84% me kahi ʻoki ʻoki kūpono o 6.5 µm.Ua hōʻike ka BFSB ponoʻī i kahi ʻoki kūpono o 0.05 mm me ka sensitivity o 51% a me kahi kikoʻī o 80%.
Ma ka fig.Hōʻike ka 2 i nā pihi ROC no kēlā me kēia o nā ʻāpana tomographic i manaʻo ʻia (Kmax, D-Index, PRC, EleBmax, BFSB a me AdjEleBmax).ʻIke mākou he hōʻike maikaʻi loa ka D-index me kahi AUC kiʻekiʻe (0.927) i ukali ʻia e PRC a me Kmax.He 0.690 ka AUC EleBmax.Ke hoʻolohe ʻia no BFSB, ua hoʻomaikaʻi kēia hoʻonohonoho (AdjEleBmax) i kāna hana ma ka hoʻonui ʻana i ka AUC i 0.754.Loaʻa iā BFSB ponoʻī kahi AUC o 0.690.
Kiʻi 2. Loaʻa nā ʻōkuhi hana (ROC) e hōʻike ana i ka hoʻohana ʻana i ka helu D no ka hoʻoholo ʻana i ka holomua o keratoconus i loaʻa i nā kiʻekiʻe kiʻekiʻe o ka naʻau a me ka kikoʻī, ukali ʻia e PRC a me Kmax.Manaʻo ʻia ʻo AdjEleBmax he kūpono a ʻoi aku ka maikaʻi ma mua o Elebmax me ka hoʻokani ʻole ʻana o BFSB.
Nā pōkole: Kmax, ka lōʻihi o ka curvature corneal;D-index, Belin/Ambrosio D-index;PRC, radius hope o ka curvature mai 3.0 mm i kikowaena ma ka lae lahilahi;ʻO BFSB, kūpono loa no ke kua spherical;Kiʻekiʻe;AdjELEBmax, kihi kiʻekiʻe kiʻekiʻe.hoʻoponopono ʻia ka ʻili hope o ke koʻo i ka hope pōʻai kūpono loa.
Ke noʻonoʻo nei iā EleBmax, BFSB, a me AdjEleBmax, ua hōʻoia mākou he 53 (46.9%), 40 (35.3%), a me 45 (39.8%) mau maka i hōʻike i ka holomua no kēlā me kēia ʻāpana kaʻawale.ʻO kēia mau maka, 16 (30.2%), 11 (27.5%), a me 9 (45%), kēlā me kēia, ʻaʻohe holomua maoli e like me ka mea i wehewehe ʻia e ʻelua mau ʻāpana ʻē aʻe.ʻO nā maka 60 ʻaʻole i manaʻo ʻia he holomua e EleBmax, 20 (33%) mau maka i holomua ma 2 a ʻoi aku paha nā ʻāpana ʻē aʻe.He iwakāluakūmāwalu (38.4%) a me 21 (30.9%) mau maka i manaʻo ʻia ʻaʻole holomua e like me BFSB a me AdjEleBmax wale nō, e hōʻike ana i ka holomua maoli.
Manaʻo mākou e noiʻi i ka maikaʻi o BFSB a, ʻoi aku ka mea nui, BFSB-hoʻoponopono kiʻekiʻe kiʻekiʻe o ka corneal kiʻekiʻe (AdjEleBmax) ma ke ʻano he ʻano moʻolelo e wānana a ʻike i ka piʻi ʻana o KC a hoʻohālikelike iā lākou me nā ʻāpana tomographic ʻē aʻe i hoʻohana mau ʻia e like me nā māka o ka holomua.Ua hoʻohālikelike ʻia me nā paepae i hōʻike ʻia i loko o nā puke (ʻoiai ʻaʻole i hōʻoia ʻia), ʻo ia hoʻi ʻo Kmax a me D-Index.20
I ka hoʻonohonoho ʻana iā EleBmax i ka radius BFSB (AdjEleBmax), ua ʻike mākou i ka piʻi nui ʻana o ka kikoʻī - 73% no ka mea i hoʻoponopono ʻole ʻia a me 84% no ka mea i hoʻoponopono ʻia - me ka ʻole o ka hoʻopili ʻana i ka waiwai sensitivity (65% a me 63%).Ua loiloi pū mākou i ka radius BFSB iā ia iho ma ke ʻano he wānana ʻē aʻe o ka holomua dilatation.Eia naʻe, ʻoi aku ka haʻahaʻa o ka naʻau (51% vs 63%), kikoʻī (80% vs 84%) a me AUC (0.69 vs 0.75) o kēia ʻāpana ma mua o ka AdjEleBmax.
ʻO Kmax kahi ʻāpana kaulana no ka wānana i ka holomua o KC.27 ʻAʻohe manaʻo e pili ana i ka palena ʻoki i kūpono.12,28 Ma kā mākou noiʻi ʻana, manaʻo mākou i ka piʻi ʻana o 1D a i ʻole ma ke ʻano he wehewehe o ka holomua.Ma kēia paepae, ua ʻike mākou ua hōʻoia ʻia nā maʻi āpau i ʻike ʻia e holomua ana e ka liʻiliʻi ʻelua mau ʻāpana ʻē aʻe, e hōʻike ana i kahi kikoʻī o 100%.Eia naʻe, ua haʻahaʻa loa kona naʻau (49%), a ʻaʻole hiki ke ʻike ʻia ka holomua ma 29 mau maka.Eia naʻe, i kā mākou noiʻi ʻana, ʻo ka paepae Kmax maikaʻi ʻo 0.4 D, ʻo 70% ka naʻau, a ʻo 91% ka kikoʻī, ʻo ia hoʻi me ka emi ʻana o ka kikoʻī (mai 100% a 91%), ua hoʻomaikaʻi mākou.ʻO ka sensitivity mai 49% a 70%.Eia naʻe, he mea kānalua ka pili o ke kino o kēia paepae hou.Wahi a ka noiʻi Kreps e pili ana i ka hoʻihoʻi hou ʻana o nā ana Pentacam®, ʻo 0.61 ka hoʻihoʻi hou ʻana o Kmax i ka maʻi maʻi catarrhal haʻahaʻa a me 1.66 i ka colpitis caesarean moderate, ʻo ia hoʻi, ʻaʻole koʻikoʻi ka nui o ka helu ʻoki ʻia o kēia hāpana e like me ka wehewehe ʻana. he kūlana paʻa.ke hoʻohana ʻia ka holomua kiʻekiʻe loa i nā laʻana ʻē aʻe.ʻO Kmax, ma ka ʻaoʻao ʻē aʻe, ʻike ʻia ka curvature corneal mua o ka ʻāpana liʻiliʻi 29 a ʻaʻole hiki ke hana hou i nā hoʻololi i hana ʻia ma ka cornea mua, ka hope hope, a me nā wahi ʻē aʻe o ka pachymetry.30-32 Ke hoʻohālikelike ʻia i nā ʻāpana hope hou, ua hōʻike ʻo AdjEleBmax i ka ʻike kiʻekiʻe (63% vs. 49%).Ua ʻike pololei ʻia nā maka holomua he 20 me ka hoʻohana ʻana i kēia ʻāpana a nalo i ka hoʻohana ʻana iā Kmax (i hoʻohālikelike ʻia me 12 mau maka holomua i ʻike ʻia me ka hoʻohana ʻana iā Kmax ma kahi o AdjEleBmax).Ke kākoʻo nei kēia ʻimi i ka ʻoiaʻiʻo ʻoi aku ka ʻoi aku o ka ʻili hope o ka cornea a ʻoi aku ka hoʻonui i ke kikowaena i hoʻohālikelike ʻia me ka ʻili o mua, hiki ke kōkua i ka ʻike ʻana i nā loli.25,32,33
Wahi a nā haʻawina ʻē aʻe, ʻo ka D-index kahi ʻāpana kaʻawale me ka ʻike kiʻekiʻe (82%), kikoʻī (95%) a me AUC (0.927).34 ʻOiaʻiʻo, ʻaʻole ia he mea kupanaha, no ka mea, he helu helu helu-parameter kēia.ʻO PRC ka lua o ka hoʻololi maʻalahi loa (79%) a ukali ʻia e AdjEleBmax (63%).E like me ka mea i ʻōlelo ʻia ma mua, ʻoi aku ka kiʻekiʻe o ka sensitivity, ʻoi aku ka liʻiliʻi o nā hewa hewa a ʻoi aku ka maikaʻi o ka hoʻomohala ʻana o nā ʻāpana screening.35 No laila, paipai mākou e hoʻohana iā AdjEleBmax (me kahi ʻoki o 7 µm no ka holomua ʻana ma mua o 6.5 µm no ka mea ʻaʻole i hoʻokomo ʻia ka unahi kikohoʻe i loko o ka Pentacam® i nā wahi decimal no kēia ʻāpana) ma kahi o ka EleBmax i hoʻoponopono ʻole ʻia, e hoʻopili pū ʻia me nā mea hoʻololi ʻē aʻe i ka loiloi.ka holomua o keratoconus e hoʻomaikaʻi i ka hilinaʻi o kā mākou loiloi lapaʻau a me ka ʻike mua ʻana o ka holomua.
Eia naʻe, ke kū nei kā mākou haʻawina i kekahi mau palena.ʻO ka mea mua, ua hoʻohana wale mākou i nā ʻāpana kiʻi tomographic shapeflug e wehewehe a loiloi i ka holomua, akā aia nā ʻano hana ʻē aʻe i kēia manawa no ke kumu like, e like me ka biomechanical analysis, hiki ke ma mua o nā loli topographic a tomographic paha.36 ʻO ka lua, hoʻohana mākou i hoʻokahi ana hoʻokahi o nā ʻāpana i hoʻāʻo ʻia a, e like me Ivo Guber et al., ʻo ka awelika ʻana ma luna o nā kiʻi he nui e hopena i nā pae leo haʻahaʻa.28 ʻOiai hiki ke hana hou ʻia nā ana me Pentacam® i nā maka maʻamau, ʻoi aku ka haʻahaʻa o nā maka me nā ʻano ʻino ʻole a me ka ectasia corneal.37 I loko o kēia haʻawina, ua hoʻokomo wale mākou i nā maka me ka Pentacam® i hoʻopaʻa ʻia i ka hōʻoia kiʻekiʻe kiʻekiʻe, ʻo ia hoʻi, ua kāpae ʻia ka maʻi holomua.17 ʻO ke kolu, wehewehe mākou i nā mea holomua ʻoiaʻiʻo me ka loaʻa ʻana o ʻelua mau palena ma muli o ka palapala akā ʻaʻole i hoʻopaʻa ʻia.ʻO ka hope, a ʻoi aku paha ka mea nui, ʻo ka ʻokoʻa o nā ana Pentacam® he mea koʻikoʻi koʻikoʻi i ka loiloi ʻana i ka holomua o keratoconus.18,26 I kā mākou hāpana o 113 mau maka, i ka wā i hoʻopaʻa ʻia e like me ka helu BAD-D, ʻoi aku ka nui (n = 68, 60.2%) mau maka, me ke koena subclinical a ʻoluʻolu paha.Eia nō naʻe, ma muli o ka liʻiliʻi liʻiliʻi o ka laʻana, ua mālama mākou i ka loiloi holoʻokoʻa me ka nānā ʻole i ka paʻakikī o KTC.Ua hoʻohana mākou i ka waiwai paepae i mea maikaʻi loa no kā mākou laʻana holoʻokoʻa, akā ke ʻae nei mākou hiki ke hoʻohui i ka walaʻau (ka loli) i ke ana a hāpai i nā hopohopo e pili ana i ke ana reproducibility.ʻO ka reproducibility o nā ana e pili ana i ka paʻakikī o KTC, e like me ka hōʻike ʻana e Kreps, Gustafsson et al.18,26.No laila, koi ikaika mākou e noʻonoʻo nā haʻawina e hiki mai ana i nā pae like ʻole o ka maʻi a loiloi i nā wahi ʻoki kūpono no ka holomua kūpono.
I ka hopena, he mea koʻikoʻi ka ʻike mua ʻana i ka piʻi ʻana i mea e hoʻolako ai i ka lāʻau lapaʻau i ka manawa e hoʻōki i ka holomua (ma o ka hoʻopili ʻana)38 a kōkua i ka mālama ʻana i ka ʻike a me ka maikaʻi o ke ola o kā mākou poʻe maʻi.34 ʻO ka pahuhopu nui o kā mākou hana ʻo ia ka hōʻike ʻana i ka EleBmax, i hoʻopaʻa ʻia i ka radius BFS like ma waena o nā ana manawa, ʻoi aku ka maikaʻi o ka hana ma mua o EleBmax ponoʻī.Hōʻike kēia ʻāpana i ka kikoʻī kiʻekiʻe a me ka maikaʻi i hoʻohālikelike ʻia me EleBmax, ʻo ia kekahi o nā ʻāpana koʻikoʻi (a no laila ʻo ka ʻoi aku ka maikaʻi o ka nānā ʻana) a no laila kahi biomarker holomua mua.Manaʻo nui ʻia e hana i nā indexes multi-parameter.Pono nā haʻawina e hiki mai ana e pili ana i ka loiloi holomua multivariate e komo pū me AdjEleBmax.
ʻAʻole loaʻa i nā mea kākau ke kākoʻo kālā no ka noiʻi, ka mea kākau a/a i ʻole ka hoʻolaha ʻana o kēia ʻatikala.
ʻO Margarida Ribeiro lāua ʻo Claudia Barbosa nā hoa kākau.ʻAʻole hōʻike nā mea kākau i ka hakakā o ka hoihoi ma kēia hana.
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