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Sau npe rau koj cov ntsiab lus tshwj xeeb thiab cov tshuaj tshwj xeeb ntawm kev txaus siab thiab peb yuav phim cov ntaub ntawv koj muab nrog cov ntawv los ntawm peb cov ntaub ntawv dav dav thiab xa email rau koj daim ntawv PDF tam sim ntawd.
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 xyoos *Claudia Barbosa, 3 xyoos *2 Bio Kws Qhia Ntawv ntawm Tshuaj - Kws qhia ntawv ntawm cov tshuaj ntawm University of Porto, Porto, Portugal 3 Kws qhia ntawv ntawm cov tshuaj ntawm University of Porto, Porto, Portugal;4 Department of Surgery thiab Physiology, Kws Qhia Ntawv ntawm Tshuaj, University of Porto, Porto, Portugal4 Department of Surgery and Physiology, Kws Qhia Ntawv ntawm Tshuaj, University of Porto, Porto, Portugal * Cov kws sau ntawv no tau pab sib npaug rau txoj haujlwm no.Hernâni Monteiro Porto, 4200-319, Portugal, email [email tiv thaiv] Lub Hom Phiaj: Peb tau soj ntsuam lub pob muag tom qab qhov chaw kho kom haum rau qhov zoo tshaj plaws Fit Sphere Back (BFSB) ntawm lub sij hawm ntsuas ntsuas (AdjEleBmax) thiab BFSB vojvoog (BFSBR) Qhov siab tshaj plaws nws tus kheej tau siv los ua ib qho kev ntsuas tomographic tshiab los sau cov kev loj hlob ntawm dilatation thiab piv nrog qhov tseeb txhim khu kev qha tsis zoo ntawm keratoconus progression (KK).Cov txiaj ntsig.Peb tau soj ntsuam Kmax, D Performance index, posterior curvature radius, thiab qhov zoo tshaj plaws cutoff point los ntawm 3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, thiab AdjEleBmax raws li kev ywj pheej tsis los sau KC kev vam meej (txhais tias yog ob los yog ntau qhov sib txawv), peb pom rhiab heev. ntawm 70%, 82%, 79%, 65%, 51%, thiab 63%, thiab 91%, 98%, 80%, 73%, 80%, thiab 84% tshwj xeeb rau kev kuaj xyuas KC..Qhov chaw hauv qab qhov nkhaus (AUC) rau txhua qhov sib txawv yog 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, raws li.Xaus: Muab piv rau EleBmax yam tsis muaj kev hloov kho, AdjEleBmax muaj qhov tshwj xeeb dua, siab dua AUC thiab kev ua tau zoo dua nrog qhov zoo sib xws.AUC.Txij li cov duab ntawm lub ntsej muag tom qab yog ntau aspherical thiab nkhaus tshaj qhov chaw sab nrauv, uas tuaj yeem pab txheeb xyuas cov kev hloov pauv, peb xav kom suav nrog AdjEleBmax hauv kev ntsuam xyuas ntawm KC kev vam meej nrog rau lwm yam kev hloov pauv los txhim kho kev ntseeg tau ntawm peb qhov kev soj ntsuam kev soj ntsuam thiab kev tshawb pom ntxov.Cov lus tseem ceeb: keratoconus, cornea, progression, zoo tshaj plaws spherical dorsal zoo, siab tshaj plaws ntawm lub posterior nto ntawm lub cornea.
Keratoconus (KK) yog qhov feem ntau ntawm cov pob txha pob txha ectasia.Nws yog tam sim no suav tias yog ob sab (txawm tias asymmetric) kab mob kis mus rau ntau yam kev hloov pauv raws li stromal thinning thiab caws pliav.1,2 Clinically, cov neeg mob uas muaj qhov tsis xwm yeem astigmatism thiab myopia, photophobia, thiab / lossis monocular diplopia nrog tsis pom kev, kho qhov muag pom qhov pom (BCVA) thiab txo lub neej zoo.3,4 Cov kev tshwm sim ntawm RP feem ntau pib nyob rau hauv lub xyoo caum thib ob ntawm lub neej thiab kev vam meej mus rau xyoo kaum plaub, tom qab ntawd los ntawm kev kho mob stabilization.Qhov kev pheej hmoo thiab tus nqi ntawm kev loj hlob yog siab dua rau cov neeg hluas dua 19 xyoo.5.6
Txawm hais tias tseem tsis tau muaj qhov tseeb kho, qhov kev kho mob tam sim no rau ocular keratoconus muaj ob lub hom phiaj tseem ceeb: txhim kho qhov muag pom kev thiab nres qhov kev loj hlob ntawm dilation.7,8 Tus qub tuaj yeem pom nyob rau hauv cov tsom iav, tawv tawv lossis ib nrab-rigid contact lenses, intracorneal rings, los yog hauv cov pob txha hloov thaum tus kab mob hnyav heev.9 Lub hom phiaj tom kawg yog qhov dawb huv ntawm cov kev kho mob ntawm tus neeg mob no, tam sim no tsuas yog ua tiav los ntawm kev sib txuas.Qhov kev ua haujlwm no ua rau muaj kev nce ntxiv hauv biomechanical tsis kam thiab nruj ntawm lub cornea thiab tiv thaiv kev loj hlob ntxiv.10-13 Txawm hais tias qhov no tuaj yeem ua tiav ntawm txhua theem ntawm tus kab mob, qhov txiaj ntsig zoo tshaj plaws tau txais nyob rau theem ua ntej.14 Kev siv zog yuav tsum tau ua kom pom tseeb thaum ntxov thiab tiv thaiv kev pheej hmoo ntawm lwm tus neeg mob uas tsis tsim kev kis mob, mob sab nrauv thiab mob plab.15.16 Nws
Txawm hais tias muaj ntau qhov kev tshawb fawb tsom rau kev txheeb xyuas thiab txheeb xyuas qhov kev nce qib, 17-19 tseem tsis tau muaj kev txhais zoo ib yam ntawm kev nthuav dav zuj zus lossis ib txoj hauv kev uas tau teev tseg.9,20,21 Hauv Kev Pom Zoo Thoob Ntiaj Teb ntawm Keratoconus thiab Dilated Diseases (2015), kev nce qib ntawm keratoconus yog txhais raws li kev hloov pauv hauv yam tsawg kawg ob ntawm cov hauv qab no: anterior corneal steepening, posterior corneal steepening, thinning thiab/lossis thickness. ntawm lub cornea Tus nqi ntawm kev hloov pauv nce los ntawm lub perimeter mus rau qhov thinnest point.9 Txawm li cas los xij, tseem xav tau ib qho kev txhais tshwj xeeb ntawm kev nce qib.Cov kev siv zog tau ua los nrhiav cov kev hloov pauv uas muaj zog tshaj plaws los txheeb xyuas thiab piav qhia txog kev nce qib.19:22–24
Muab hais tias cov duab ntawm lub pob muag tom qab, uas yog ntau aspherical thiab nkhaus tshaj qhov chaw sab nrauv, tej zaum yuav muaj txiaj ntsig zoo rau kev kuaj xyuas cov kev hloov pauv, 25 lub hom phiaj tseem ceeb ntawm txoj kev tshawb no yog los soj ntsuam cov yam ntxwv ntawm qhov siab tshaj plaws ntawm lub pob txha ntawm lub kaum sab xis.yoog mus rau tib qhov chaw tsim nyog tshaj plaws.Lub sij hawm ntsuas ntsuas (BFSB) (AdjEleBmax) thiab BFSB vojvoog (BFSBR) ib leeg tau txais kev pabcuam tshiab los sau txog kev nce zuj zus thiab muab piv rau cov kev siv feem ntau siv rau kev nce qib KC.
Tag nrho ntawm 113 lub qhov muag ntawm 76 tus neeg mob sib law liag tau kuaj pom muaj keratoconus tau kuaj hauv qhov kev tshawb fawb rov qab los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob ntawm Lub Tsev Kho Mob Central ntawm University of São João, Portugal.Txoj kev tshawb no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees hauv cheeb tsam ntawm Centro Hospitalar Universitário de São João / Faculdade de Medicina da Universidade do Porto thiab tau ua raws li Kev Tshaj Tawm ntawm Helsinki.Sau ntawv tso cai tau txais los ntawm txhua tus neeg koom nrog thiab, yog tias tus neeg koom nrog hnub nyoog qis dua 16 xyoo, los ntawm niam txiv thiab / lossis tus saib xyuas raug cai.
Cov neeg mob nrog KC hnub nyoog 14 txog 30 xyoo tau txheeb xyuas thiab ua ntu zus suav nrog hauv peb qhov kev soj ntsuam ntawm qhov muag thiab pob txha thaum lub Kaum Hli-Lub Kaum Ob Hlis 2021.
Txhua tus neeg mob xaiv tau ua raws li ib xyoos los ntawm tus kws kho mob pob txha thiab tau txais tsawg kawg peb qhov kev ntsuas Scheimpflug tomographic (Pentacam®; Oculus, Wetzlar, Lub teb chaws Yelemees).Cov neeg mob tau tso tseg tsis hnav cov tsom iav qhov muag tsawg kawg 48 teev ua ntej ntsuas.Txhua qhov kev ntsuas tau ua los ntawm tus kws kho mob orthopedist thiab tsuas yog kuaj nrog kev kuaj xyuas zoo ntawm "OK" suav nrog.Yog tias tsis siv cov duab ntsuas zoo tsis raug cim tias "OK", qhov kev ntsuam xyuas yuav rov ua dua.Tsuas yog ob qho kev soj ntsuam rau txhua lub qhov muag tau txheeb xyuas kom pom qhov kev loj hlob, nrog rau txhua khub sib cais los ntawm 12 ± 3 lub hlis.Qhov muag nrog subclinical KC kuj tau suav nrog (hauv cov xwm txheej no, lwm lub qhov muag yuav tsum tau pom cov cim pom tseeb ntawm kev kho mob KC).
Peb tshem tawm los ntawm kev tshuaj xyuas KC ob lub qhov muag uas yav tas los tau ua kev phais mob ophthalmic (pob txha sib txuas, pob txha pob txha, lossis hloov pob txha) thiab ob lub qhov muag uas muaj kab mob siab heev (pob txha tuab ntawm thinnest <350 µm, hydrokeratosis, lossis sib sib zog nqus corneal scarring) raws li pab pawg neeg tsis tu ncua. "OK" tom qab kev kuaj xyuas sab hauv zoo.
Cov ntaub ntawv pej xeem, kho mob thiab tomography tau sau rau kev tshuaj xyuas.Txhawm rau txheeb xyuas qhov kev loj hlob ntawm KC, peb tau sau ntau qhov sib txawv tomographic suav nrog qhov siab tshaj plaws pob txha curvature (Kmax), txhais tau tias pob txha curvature (Km), tiaj tus meridional corneal curvature (K1), steepest meridional corneal curvature (K2), corneal astigmatism (Astig = K2 - K1). ).), qhov tsawg kawg nkaus thickness ntsuas (PachyMin), qhov siab tshaj plaws posterior corneal qhov siab (EleBmax), posterior vojvoog ntawm curvature (PRC) 3.0 hli nruab nrab ntawm qhov taw tes thinnest, Belin / Ambrosio D-index (D-index), BFSBR thiab EleBmax tau kho rau BFSB (AdjEleBmax).Raws li qhia hauv daim duab.1, AdjEleBmax tau txais tom qab peb manually txiav txim siab tib lub voj voog BFSB hauv ob qho tib si kev sim tshuab siv tus nqi BFSR los ntawm qhov kwv yees thib ob.
Rice.1. Kev sib piv ntawm Pentacam® dluab nyob rau hauv ib tug upright posterior txoj hauj lwm nrog qhov tseeb kev kho mob kev loj hlob nrog ib tug 13-hli lub sij hawm ntawm kev ntsuam xyuas.Hauv vaj huam sib luag 1, EleBmax yog 68 µm ntawm qhov kev kuaj thawj zaug thiab 66 µm ntawm qhov thib ob, yog li tsis muaj kev nce qib hauv qhov ntsuas no.Qhov zoo tshaj plaws sphere radii tau muab los ntawm lub tshuab rau txhua qhov kev ntsuam xyuas yog 5.99 hli thiab 5.90 hli, feem.Yog tias peb nyem rau ntawm BFS khawm, lub qhov rais yuav tshwm sim qhov twg BFS lub vojvoog tshiab tuaj yeem txhais tau manually.Peb txiav txim siab tib lub vojvoog hauv ob qhov kev xeem uas siv qhov ntsuas thib ob BFS lub vojvoog tus nqi (5.90mm).Hauv vaj huam sib luag 2, tus nqi tshiab ntawm EleBmax (EleBmaxAdj) kho rau tib BFS hauv thawj qhov kev ntsuam xyuas yog 59 µm, qhia txog qhov nce 7 µm hauv qhov kev ntsuam xyuas thib ob, qhia txog kev nce qib raws li peb qhov kev ntsuas 7 µm.
Txhawm rau txheeb xyuas kev nce qib thiab ntsuas qhov ua tau zoo ntawm cov kev kawm tshiab hloov pauv, peb siv cov ntsuas uas feem ntau siv los ua cov cim kev nce qib (Kmax, Km, K2, Astig, PachyMin, PRC, thiab D-Index) nrog rau cov theem pib piav qhia hauv cov ntaub ntawv.txawm hais tias tsis yog empirically).Table 1 teev cov txiaj ntsig sawv cev ntawm kev nce qib ntawm txhua qhov kev ntsuas ntsuas.Kev nce qib ntawm KC tau txhais tau tias tsawg kawg yog ob ntawm cov kev tshawb fawb sib txawv tau lees paub tias muaj kev vam meej.
Table 1 Tomographic parameters feem ntau lees txais raws li cov cim ntawm kev nce qib ntawm RP kev nce qib thiab cov kev sib raug zoo uas tau piav qhia hauv cov ntaub ntawv (txawm tias tsis tau lees paub)
Hauv txoj kev tshawb no, qhov kev ua tau zoo ntawm peb qhov sib txawv tau raug sim rau kev nce qib (EleBmax, BFSB, thiab AdjEleBmax) raws li qhov muaj kev vam meej ntawm tsawg kawg ob qhov sib txawv.Cov ntsiab lus txiav tawm zoo tshaj plaws rau cov kev hloov pauv no tau suav thiab muab piv nrog rau lwm qhov sib txawv.
Kev txheeb xyuas txheeb cais tau ua tiav siv SPSS statistical software (version 27.0 for Mac OS; SPSS Inc., Chicago, IL, USA).Cov yam ntxwv ua piv txwv tau muab sau tseg thiab cov ntaub ntawv nthuav tawm raws li tus lej thiab feem ntau ntawm categorical variables.Qhov sib txawv tsis tu ncua tau piav qhia raws li qhov txhais tau tias thiab tus qauv sib txawv (los yog qhov nruab nrab thiab qhov sib txawv ntawm qhov sib txawv thaum qhov kev faib tawm yog skewed).Qhov kev hloov pauv hauv keratometric Performance index tau txais los ntawm kev rho tawm tus nqi qub los ntawm qhov ntsuas thib ob (piv txwv li, tus nqi zoo delta qhia tias qhov nce ntawm tus nqi ntawm ib qho kev ntsuas).Kev ntsuam xyuas Parametric thiab tsis yog parametric tau ua los ntsuas qhov kev faib tawm ntawm pob txha curvature variables cais raws li kev vam meej lossis tsis muaj kev vam meej, suav nrog kev ywj pheej-cov qauv t-test, Mann-Whitney U-test, chi-square test, thiab Fisher qhov tseeb (yog tias xav tau).Qib ntawm qhov tseem ceeb ntawm kev txheeb cais tau teeb tsa ntawm 0.05.Txhawm rau ntsuas qhov ua tau zoo ntawm Kmax, D-index, PRC, BFSBR, EleBmax, thiab AdjEleBmax raws li tus neeg ua haujlwm kev kwv yees, peb tau tsim cov neeg txais kev ua tau zoo curves (ROC) thiab suav cov ntsiab lus txiav tawm zoo tshaj plaws, rhiab heev, tshwj xeeb, zoo (PPV), thiab Kev Ntsuas Tsis Zoo. Value (NPV).) thiab cheeb tsam nyob rau hauv qhov nkhaus (AUC) thaum tsawg kawg yog ob qhov sib txawv tshaj li qhov chaw pib (raws li tau piav qhia ua ntej) txhawm rau txheeb xyuas qhov kev nce qib raws li kev tswj hwm.
Tag nrho ntawm 113 qhov muag ntawm 76 tus neeg mob nrog RP tau suav nrog hauv txoj kev tshawb no.Feem ntau ntawm cov neeg mob yog txiv neej (n = 87, 77%) thiab lub hnub nyoog nruab nrab ntawm thawj qhov kev ntsuam xyuas yog 24.09 ± 3.93 xyoo.Nrog rau KC stratification raws li nce tag nrho Belin / Ambrosio dilatation deviation (BAD-D index), feem ntau (n = 68, 60.2%) ntawm lub qhov muag yog nruab nrab.Cov kws tshawb fawb tau sib koom ua ke xaiv tus nqi txiav tawm ntawm 7.0 thiab sib txawv ntawm me me thiab nruab nrab keratoconus raws li cov ntaub ntawv 26.Txawm li cas los xij, lwm qhov kev tshuaj xyuas suav nrog tag nrho cov qauv.Demographic, soj ntsuam thiab tomographic yam ntxwv ntawm tus qauv, suav nrog qhov nruab nrab, qhov tsawg kawg nkaus, siab tshaj plaws, tus qauv sib txawv (SD) thiab kev ntsuas nrog 95% kev ntseeg siab ncua sij hawm (IC95%), nrog rau kev ntsuas thawj thiab thib ob.Qhov sib txawv ntawm qhov tseem ceeb tom qab 12 ± 3 lub hlis tuaj yeem pom nyob rau hauv rooj 2.
Table 2. Cov neeg mob, kuaj mob thiab tomographic yam ntxwv ntawm cov neeg mob.Cov txiaj ntsig tau qhia raws li qhov txhais tau tias ± tus qauv sib txawv rau qhov sib txawv tsis tu ncua (* cov txiaj ntsig tau nthuav tawm raws li qhov nruab nrab ± IQR), 95% kev ntseeg siab lub sijhawm (95% CI), txiv neej poj niam txiv neej thiab qhov muag sab xis yog qhia raws li tus lej thiab feem pua.
Table 3 qhia cov naj npawb ntawm ob lub qhov muag uas tau muab faib ua cov neeg nce qib uas xav txog txhua qhov kev ntsuas tomographic (Kmax, Km, K2, Astig, PachyMin, PRC thiab D-Index) cais.Muab rau hauv tus account qhov kev loj hlob ntawm KC, txhais los ntawm kev pom cov kev hloov hauv yam tsawg kawg yog ob lub tomographic sib txawv, 57 lub qhov muag (50.4%) pom kev nce qib.
Table 3 Tus naj npawb thiab zaus ntawm qhov muag raug cais raws li cov neeg ua haujlwm, suav nrog txhua qhov tomographic parameter cais
Kmax, D-index, PRC, EleBmax, BFSB, thiab AdjEleBmax cov qhab nia raws li kev ua haujlwm ywj pheej ntawm KC kev nce qib tau pom nyob rau hauv Table 4. Piv txwv li, yog tias peb txhais tus nqi pib rau nce Kmax los ntawm 1 diopter (D) los cim kev nce qib, txawm tias Qhov kev ntsuas no nthuav tawm qhov rhiab heev ntawm 49%, nws muaj qhov tshwj xeeb ntawm 100% (txhua tus neeg mob pom tias muaj kev vam meej ntawm qhov ntsuas no yog qhov tseeb).Cov kev nce qib saum toj no) nrog tus nqi kwv yees zoo (PPV) ntawm 100%, tus nqi kwv yees tsis zoo (NPV) ntawm 66%, thiab thaj tsam hauv qab nkhaus (AUC) ntawm 0.822.Txawm li cas los xij, qhov kev suav txiav tawm zoo tshaj plaws rau kmax yog 0.4, muab qhov rhiab heev ntawm 70%, qhov tshwj xeeb ntawm 91%, PPV ntawm 89%, thiab NPV ntawm 75%.
Table 4 Kmax, D-Index, PRC, BFSB, EleBmax, thiab AdjEleBmax cov qhab nia raws li kev kwv yees ntawm KC kev nce qib (txhais tias yog qhov hloov pauv tseem ceeb hauv ob lossis ntau qhov sib txawv)
Nyob rau hauv cov nqe lus ntawm D Performance index, qhov zoo tshaj plaws txiav tawm taw tes yog 0.435, rhiab heev yog 82%, tshwj xeeb yog 98%, PPV yog 94%, NPV yog 84%, thiab AUC yog 0.927.Peb tau lees paub tias ntawm 50 lub qhov muag uas tau nce mus, tsuas yog 3 tus neeg mob tsis tau nce qib ntawm 2 lossis ntau dua lwm qhov tsis muaj.Ntawm 63 lub qhov muag uas qhov D Performance index tsis txhim kho, 10 (15.9%) pom kev nce qib hauv tsawg kawg yog ob qhov kev txwv.
Rau PRC, qhov kev txiav tawm zoo tshaj plaws los txiav txim siab qhov kev nce qib yog qhov txo qis ntawm 0.065 nrog qhov rhiab heev ntawm 79%, qhov tshwj xeeb ntawm 80%, PPV ntawm 80%, NPV ntawm 79%, thiab AUC ntawm 0.844.
Hais txog kev nce saum npoo av tom qab (EleBmax), qhov zoo tshaj plaws rau kev txiav txim siab qhov kev nce qib yog nce ntawm 2.5 µm nrog qhov rhiab heev ntawm 65% thiab qhov tshwj xeeb ntawm 73%.Thaum hloov kho rau qhov ntsuas thib ob BSFB, qhov rhiab heev ntawm qhov ntsuas tshiab AdjEleBmax yog 63% thiab qhov tshwj xeeb tau txhim kho los ntawm 84% nrog qhov zoo tshaj plaws txiav tawm ntawm 6.5 µm.BFSB nws tus kheej tau pom qhov kev txiav tawm zoo tshaj plaws ntawm 0.05 hli nrog rhiab heev ntawm 51% thiab qhov tshwj xeeb ntawm 80%.
Ntawm daim duab.2 qhia txog ROC nkhaus rau txhua qhov kev kwv yees tomographic (Kmax, D-Index, PRC, EleBmax, BFSB thiab AdjEleBmax).Peb pom tias D-index yog qhov kev xeem zoo dua nrog AUC siab dua (0.927) ua raws li PRC thiab Kmax.AUC EleBmax yog 0.690.Thaum kho rau BFSB, qhov teeb tsa no (AdjEleBmax) txhim kho nws qhov kev ua tau zoo los ntawm kev nthuav dav AUC rau 0.754.BFSB nws tus kheej muaj AUC ntawm 0.690.
Daim duab 2. Cov neeg txais kev ua tau zoo nkhaus (ROC) uas qhia tias kev siv D Performance index los txiav txim qhov kev loj hlob ntawm keratoconus tau ua tiav qib siab ntawm rhiab heev thiab tshwj xeeb, ua raws li PRC thiab Kmax.AdjEleBmax tseem suav hais tias tsim nyog thiab feem ntau zoo dua Elebmax yam tsis muaj BFSB tuning.
Cov ntawv luv: Kmax, qhov siab tshaj plaws ntawm lub pob txha curvature;D-index, Belin/Ambrosio D-index;PRC, rov qab vojvoog ntawm curvature los ntawm 3.0 mm nyob rau hauv lub thinnest point;BFSB, zoo tshaj plaws haum rau lub nraub qaum kheej kheej;Qhov siab;AdjELEBmax, lub kaum sab xis siab tshaj plaws.lub posterior nto ntawm lub cornea yog hloov mus rau lub feem ntau haum spherical dorsum.
Xav txog EleBmax, BFSB, thiab AdjEleBmax, feem, peb tau lees paub tias 53 (46.9%), 40 (35.3%), thiab 45 (39.8%) ob lub qhov muag pom kev nce qib rau txhua qhov kev sib cais, raws li.Ntawm cov qhov muag no, 16 (30.2%), 11 (27.5%), thiab 9 (45%), raws li, tsis muaj kev vam meej raws li tau hais los ntawm tsawg kawg yog ob qhov kev txwv.Ntawm 60 lub qhov muag tsis suav tias yog kev loj hlob los ntawm EleBmax, 20 (33%) lub qhov muag tau nce mus rau 2 lossis ntau dua lwm qhov tsis muaj.Nees nkaum yim (38.4%) thiab 21 (30.9%) ob lub qhov muag tau suav hais tias tsis muaj kev vam meej raws li BFSB thiab AdjEleBmax ib leeg, raws li, qhia txog kev vam meej.
Peb npaj siab los tshawb xyuas qhov ua tau zoo ntawm BFSB thiab, qhov tseem ceeb tshaj, BFSB-kho qhov siab tshaj plaws tom qab lub pob ntseg qhov siab (AdjEleBmax) ua qhov ntsuas tshiab los kwv yees thiab kuaj pom KC kev vam meej thiab sib piv nrog lwm cov tomographic tsis uas feem ntau siv los ua cov cim ntawm kev nce qib.Kev sib piv tau ua nrog cov theem pib qhia hauv cov ntaub ntawv (txawm tias tsis raug cai), xws li Kmax thiab D-Index.20
Thaum teeb tsa EleBmax rau BFSB lub vojvoog (AdjEleBmax), peb tau pom qhov nce ntxiv hauv qhov tshwj xeeb - 73% rau qhov tsis hloov pauv thiab 84% rau qhov hloov pauv - tsis cuam tshuam rau tus nqi rhiab heev (65% thiab 63%).Peb kuj tau soj ntsuam BFSB lub vojvoog nws tus kheej yog lwm qhov muaj peev xwm kwv yees ntawm kev nce qib.Txawm li cas los xij, qhov rhiab heev (51% vs 63%), qhov tshwj xeeb (80% vs 84%) thiab AUC (0.69 vs 0.75) ntawm qhov ntsuas no tau qis dua li AdjEleBmax.
Kmax yog ib qho kev paub zoo rau kev kwv yees qhov kev loj hlob ntawm KC.27 Tsis muaj kev pom zoo rau qhov kev txiav tawm uas tsim nyog dua.12,28 Hauv peb txoj kev tshawb fawb, peb suav tias qhov nce ntawm 1D lossis ntau dua li lub ntsiab lus ntawm kev nce qib.Ntawm qhov chaw pib no, peb tau pom tias txhua tus neeg mob pom tias muaj kev vam meej tau lees paub los ntawm tsawg kawg ob qhov kev txwv, qhia txog qhov tshwj xeeb ntawm 100%.Txawm li cas los xij, nws qhov rhiab heev yog qhov tsawg (49%), thiab kev nce qib tsis tuaj yeem kuaj pom hauv 29 lub qhov muag.Txawm li cas los xij, hauv peb txoj kev tshawb fawb, qhov zoo tshaj plaws Kmax qhov pib yog 0.4 D, rhiab heev yog 70%, thiab qhov tshwj xeeb yog 91%, uas txhais tau hais tias nrog cov txheeb ze txo qhov tshwj xeeb (los ntawm 100% mus rau 91%), peb txhim kho.rhiab heev li ntawm 49% mus rau 70%.Txawm li cas los xij, qhov tseem ceeb ntawm kev kho mob ntawm qhov pib tshiab no yog questionable.Raws li Kreps txoj kev tshawb fawb txog kev rov ua dua ntawm Pentacam® kev ntsuas, qhov rov ua dua ntawm Kmax yog 0.61 hauv mob qog noj ntshav catarrhal me thiab 1.66 nyob rau hauv nruab nrab caesarean colpitis, 19 uas txhais tau hais tias tus lej txiav tawm tus nqi hauv cov qauv no tsis yog qhov tseem ceeb hauv kev kho mob raws li nws tau hais tseg. qhov xwm txheej ruaj khov.thaum qhov kev nce qib siab tshaj plaws tau siv rau lwm cov qauv.Kmax, ntawm qhov tod tes, characterizes lub steepest anterior corneal curvature ntawm cheeb tsam me me 29 thiab tsis tuaj yeem tsim cov kev hloov pauv uas tshwm sim nyob rau hauv lub pob txha anterior, posterior cornea, thiab lwm qhov chaw ntawm pachymetry.30-32 Muab piv rau cov kev ntsuas tom qab tshiab, AdjEleBmax tau pom tias muaj kev nkag siab ntau dua (63% vs. 49%).20 lub qhov muag loj hlob tau raug txheeb xyuas kom raug siv qhov ntsuas no thiab tsis siv Kmax (piv rau 12 lub qhov muag pom tau tias siv Kmax es tsis yog AdjEleBmax).Qhov kev tshawb pom no txhawb nqa qhov tseeb tias lub ntsej muag tom qab ntawm lub pob kws yog steeper thiab nthuav dav nyob rau hauv nruab nrab piv rau qhov chaw sab nrauv, uas tuaj yeem pab txheeb xyuas cov kev hloov pauv.25, 32, 33 ib
Raws li lwm cov kev tshawb fawb, D-index yog ib qho kev sib cais uas muaj qhov siab tshaj plaws (82%), tshwj xeeb (95%) thiab AUC (0.927).34 Qhov tseeb, qhov no tsis yog qhov xav tsis thoob, vim qhov no yog qhov ntsuas ntau qhov ntsuas.PRC yog qhov sib txawv tshaj plaws thib ob (79%) ua raws li AdjEleBmax (63%).Raws li tau hais ua ntej, qhov siab dua qhov siab, qhov tsis muaj qhov tsis zoo tsawg dua thiab qhov kev tshuaj ntsuam xyuas qhov zoo dua.35 Yog li ntawd, peb pom zoo kom siv AdjEleBmax (nrog rau kev txiav tawm ntawm 7 µm rau kev nce qib ntau dua li 6.5 µm txij li cov nplai digital tsim rau hauv Pentacam® tsis suav nrog cov lej lej rau qhov ntsuas no) es tsis txhob kho EleBmax, uas yuav suav nrog lwm yam hloov pauv hauv kev ntsuas.Kev nce qib ntawm keratoconus los txhim kho kev ntseeg siab ntawm peb qhov kev soj ntsuam kev soj ntsuam thiab kev tshawb pom ntxov ntawm kev loj hlob.
Txawm li cas los xij, peb txoj kev tshawb fawb ntsib qee qhov kev txwv.Ua ntej, peb tsuas yog siv tomographic shapeflug imaging parameters los txhais thiab ntsuas kev nce qib, tab sis tam sim no muaj lwm txoj hauv kev rau tib lub hom phiaj, xws li kev tsom xam biomechanical, uas yuav ua ntej cov kev hloov pauv saum toj saud lossis tomographic.36 Thib ob, peb siv ib qho kev ntsuas ntawm tag nrho cov ntsuas ntsuas thiab, raws li Ivo Guber li al., qhov nruab nrab ntawm ntau cov duab ua rau ntsuas qis qis.28 Thaum kev ntsuas nrog Pentacam® tau zoo dua qub nyob rau hauv lub qhov muag ib txwm, lawv tau qis dua ntawm qhov muag nrog pob qhov muag tsis zoo thiab pob txha ectasia.37 Nyob rau hauv txoj kev tshawb no, peb tsuas suav nrog ob lub qhov muag nrog Pentacam® ua tau zoo scan validation, uas txhais tau hais tias tus kab mob siab heev raug txiav tawm.17 Qhov thib peb, peb txhais cov neeg ua tiav qhov tseeb tias muaj tsawg kawg yog ob qhov kev ntsuas raws li cov ntaub ntawv tab sis tseem tsis tau lees paub.Thaum kawg, thiab tej zaum tseem ceeb tshaj, qhov sib txawv ntawm Pentacam® kev ntsuas yog qhov tseem ceeb hauv kev soj ntsuam xyuas qhov kev loj hlob ntawm keratoconus.18,26 Hauv peb cov qauv ntawm 113 lub qhov muag, thaum stratified raws li BAD-D qhab nia, feem ntau (n = 68, 60.2%) ob lub qhov muag yog nruab nrab, nrog rau qhov seem subclinical lossis me me.Txawm li cas los xij, muab cov qauv me me, peb khaws tag nrho cov kev ntsuam xyuas tsis hais qhov hnyav ntawm KTC.Peb tau siv tus nqi pib uas yog qhov zoo tshaj plaws rau peb cov qauv tag nrho, tab sis peb lees paub tias qhov no tuaj yeem ntxiv suab nrov (variability) rau kev ntsuas thiab ua rau muaj kev txhawj xeeb txog kev ntsuas rov tsim dua.Kev rov tsim dua ntawm kev ntsuas yog nyob ntawm qhov hnyav ntawm KTC, raws li qhia los ntawm Kreps, Gustafsson li al.18,26 ib.Yog li ntawd, peb xav kom cov kev tshawb fawb yav tom ntej coj mus rau hauv tus account theem sib txawv ntawm tus kab mob thiab ntsuas qhov zoo tshaj plaws txiav cov ntsiab lus kom tsim nyog.
Hauv kev xaus, kev tshawb pom ntxov ntawm kev loj hlob yog qhov tseem ceeb tshaj plaws txhawm rau muab kev kho mob raws sij hawm kom tsis txhob muaj kev vam meej (ntawm kev sib txuas ntawm kev sib txuas) 38 thiab pab tswj kev pom thiab lub neej zoo hauv peb cov neeg mob.34 Lub hom phiaj tseem ceeb ntawm peb txoj haujlwm yog ua kom pom tias EleBmax, tau kho rau tib lub vojvoog BFS ntawm lub sijhawm ntsuas, muaj kev ua tau zoo dua li EleBmax nws tus kheej.Qhov kev ntsuas no qhia tau hais tias muaj kev tshwj xeeb thiab kev ua tau zoo dua piv rau EleBmax, nws yog ib qho ntawm qhov tsis zoo tshaj plaws (thiab yog li qhov kev ntsuam xyuas zoo tshaj plaws) thiab yog li qhov muaj peev xwm ua tau zoo thaum ntxov biomarker.Nws raug pom zoo kom tsim ntau qhov ntsuas ntsuas ntsuas.Cov kev tshawb fawb yav tom ntej uas suav nrog kev txheeb xyuas ntau yam sib txawv yuav tsum suav nrog AdjEleBmax.
Cov kws sau ntawv tsis tau txais kev txhawb nqa nyiaj txiag rau kev tshawb fawb, kev sau ntawv thiab / lossis kev tshaj tawm ntawm tsab xov xwm no.
Margarida Ribeiro thiab Claudia Barbosa yog tus kws sau ntawv kawm.Cov kws sau ntawv qhia tsis muaj teeb meem ntawm kev txaus siab hauv txoj haujlwm no.
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