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作者 Ribeiro M., Barbosa C., Correia P., Torrao L., Neves Cardoso P., Moreira R., Falcao-Reis F., Falcao M., Pinheiro-Costa J.
Margarida Ribeiro,1,2,*Margarita Ribeiro, 1.2*Claudia Barbosa, makore matatu*Claudia Barbosa, makore matatu*2 Bio Faculty of Medicine - Faculty of Medicine yeYunivhesiti yePorto, Porto, Portugal 3 Faculty of Medicine yeYunivhesiti yePorto, Porto, Portugal;4Dhipatimendi Rokuvhiya uye Physiology, Faculty of Medicine, University of Porto, Porto, Portugal4 Dhipatimendi Rokuvhiya nePhysiology, Faculty of Medicine, University of Porto, Porto, Portugal *Vanyori ava vakapa zvakaenzana mubasa iri.Hernâni Monteiro Porto, 4200-319, Portugal, email [email yakadzivirirwa] Chinangwa: Takaongorora corneal posterior surface yakagadziridzwa yakafanana Best Fit Sphere Back (BFSB) pakati pezviyero zvenguva (AdjEleBmax) neBFSB radius (BFSBR) Iyo yakanyanya kureba. pachayo yakashandiswa seyetomographic parameter kurekodha kufambira mberi kwedilatation uye ichienzaniswa neazvino anovimbika maparamita e keratoconus progression (KK).Results.Isu takaongorora Kmax, D index, posterior curvature radius, uye yakakodzera cutoff point kubva pa3.0 mm thinnest point centered (PRC), EleBmax, BFSBR, uye AdjEleBmax semaparamita akazvimirira ekurekodha kufambira mberi kweKC (inotsanangurwa semabhii maviri kana anopfuura), takawana manzwiro. ye70%, 82%, 79%, 65%, 51%, uye 63%, uye 91%, 98%, 80%, 73%, 80%, uye 84% chaiyo yekuona kufambira mberi kweKC..Nzvimbo iri pasi pe curve (AUC) yega yega yega yaive 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, zvichiteerana.Mhedziso: Kuenzaniswa neEleBmax pasina chero gadziriso, AdjEleBmax ine hunyanzvi hwepamusoro, yakakwira AUC uye kuita zvirinani nekunzwa kwakafanana.AUC.Sezvo chimiro chemashure chepamusoro chakanyanyisa uye chakakomberedzwa kupfuura chekare, chinogona kubatsira kuona shanduko, tinokurudzira kusanganisira AdjEleBmax mukuongorora kufambira mberi kweKC pamwe chete nezvimwe zvakasiyana-siyana kuti tivandudze kuvimbika kwekuongororwa kwedu kwekliniki uye kuona kwekutanga.kufambira mberi.Mazwi akakosha: keratoconus, cornea, progression, best spherical dorsal shape, kureba kwepamusoro kwemashure epamusoro pe cornea.
Keratoconus (KK) ndiyo inonyanya kuzivikanwa yekutanga cornea ectasia.Ikozvino yava kuonekwa sechirwere chemativi maviri (asi asymmetric) chirwere chisingaperi chinoramba chichienderera mberi chinotungamirira kukuchinja kwemaitiro akawanda kunoteverwa ne stromal thinning uye mavanga.1,2 Kliniki, varwere vanouya neastigmatism isina kujairika uye myopia, photophobia, uye/kana monocular diplopia ine kusaona zvakanaka, maximally corrected visual acuity (BCVA) uye kuderedzwa kwehupenyu.3,4 Zviratidzo zveRP zvinowanzotanga mumakore gumi echipiri ehupenyu uye kufambira mberi kusvika kumakore gumi, zvichiteverwa nekugadzikana kwekliniki.Ngozi uye chiyero chekufambira mberi chakakwirira muvanhu vaduku kudarika makore gumi nemapfumbamwe.5.6
Kunyange zvazvo kusati kwave kusati kwanyatsogadziriswa, kurapwa kwemazuva ano kweocular keratoconus kune zvinangwa zviviri zvakakosha: kuvandudza basa rekuona uye kumisa kufambira mberi kwekuwedzera.7,8 Iyo yekare inogona kuonekwa mumagirazi, yakaoma kana semi-rigid contact lenses, intracorneal rings, kana mune corneal transplants kana chirwere chakanyanya.9 Chinangwa chekupedzisira ndicho chitsvene chemishonga iyi yevarwere, parizvino inongogoneka kuburikidza nekubatanidza.Uku kuvhiya kunotungamirira kukuwedzera kweiyo biomechanical kuramba uye kuoma kwecornea uye kunodzivirira kuenderera mberi.10-13 Kunyange zvazvo izvi zvinogona kuitwa pane chero chikamu chechirwere, rubatsiro rukuru runowanikwa mumatanho ekutanga.14 Nhamburiko dzinofanira kuitwa kuti dzione kufambira mberi nokukurumidza uye kudzivirira kuwedzera kuparara, uye kudzivisa kurapwa kusingakoshi kwevamwe varwere, nokudaro kuderedza dambudziko rematambudziko akadai sehutachiona, kupera kwemasero ekupedzisira, uye kurwadziwa kwakanyanya kwepashure.15.16
Pasinei nezvidzidzo zvakawanda zvine chinangwa chekutsanangura uye kuona kufambira mberi, 17-19 hapasati paine tsanangudzo inowirirana yekuenderera mberi kwekuwedzera kana nzira yakarongeka yekuinyora.9,20,21 MuGlobal Consensus pamusoro peKeratoconus uye Dilated Diseases (2015), kufambira mberi kwekeratoconus kunotsanangurwa seshanduko inotevedzana mune zvingangoita zviviri zvezvinotevera zviteshi zve topographic parameters: anterior corneal steepening, posterior corneal kunyura, kutetepa uye/kana ukobvu. of the cornea Rate yekuchinja inowedzera kubva paperimeter kusvika kune thinnest point.9 Zvisinei, imwe rondedzero yakananga zvikuru yefambiro mberi ichiri kudikanwa.Nhamburiko dzakaitwa dzekutsvaga misiyano yakasimba kwazvo yekuona nekutsanangura mafambiro.19:22–24
Zvichipa kuti chimiro chemashure epamusoro pekona, iyo inonyanya kufanana uye yakakomberedzwa kupfuura yakare, inogona kubatsira pakuona kuchinja, 25 chinangwa chikuru chechidzidzo ichi chaiva chekuongorora maitiro ehupamhi hwepamusoro hwepamusoro hwepamusoro hwekona.yakagadziridzwa kunzvimbo imwechete yakakodzera.Chiyero chenguva (BFSB) (AdjEleBmax) neBFSB radius (BFSBR) chete yakashanda sematanho matsva ekurekodha kufambira mberi kwedilation uye akaaenzanisa neanonyanya kushandiswa paramita anoshandiswa kufambira mberi kweKC.
Maziso e113 evarwere vane 76 vakatevedzana vakaonekwa kuti vane keratoconus vakaongororwa mune iyi retrospective cohort chidzidzo paDhipatimendi reOphthalmology paCentral Hospital yeYunivhesiti yeSão João, Portugal.Chidzidzo chacho chakabvumirwa nekomiti yezvetsika yemunharaunda yeCentro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto uye yakaitwa maererano neDeclaration of Helsinki.Mvumo yakanyorwa ine ruzivo yakawanikwa kubva kune vese vatori vechikamu uye, kana mutori wechikamu ari pasi pemakore gumi nematanhatu, kubva kumubereki uye/kana muchengeti wemutemo.
Varwere vane KC vane makore gumi nemana kusvika makumi matatu emakore vakaonekwa uye vachisanganisirwa mukutevedzana kwedu kwemaziso uye corneal kutevera muna Gumiguru-Zvita 2021.
Vese varwere vakasarudzwa vakateverwa kwegore rimwe nenyanzvi yekorneal uye vakawana kanenge katatu Scheimpflug tomographic zviyero (Pentacam®; Oculus, Wetzlar, Germany).Varwere vakamira kupfeka macontact lens maawa angangoita 48 maawa asati ayera.Zviyero zvose zvakaitwa nenyanzvi yemapfupa akadzidziswa uye inongoongorora chete nekutarisa kwehutano hwe "OK" yakabatanidzwa.Kana otomatiki mufananidzo wemhando yekuongorora isina kunyorwa se "Zvakanaka", bvunzo inodzokororwa.Zviyero zviviri chete zveziso rimwe nerimwe zvakaongororwa kuti zvione kufambira mberi, uye imwe neimwe yakaparadzaniswa ne12 ± 3 mwedzi.Maziso ane subclinical KC akabatanidzwawo (muzviitiko izvi, rimwe ziso rinofanira kunge rakaratidza zviratidzo zvakajeka zvekliniki KC).
Isu takabvisa kubva pakuongorora maziso eKC akambovhiyiwa maziso (corneal crosslinking, corneal rings, kana corneal transplant) uye maziso ane chirwere chepamusoro (corneal thickness at thinnest <350 µm, hydrokeratosis, kana deep corneal scarring) sezvo boka rinoramba richikundikana. "Zvakanaka" mushure mekutariswa kwemhando yemukati.
Demographic, kliniki uye tomographic data yakaunganidzwa kuti iongororwe.Kuti tione kufambira mberi kweKC, takaunganidza akati wandei tomographic variables zvinosanganisira maximum corneal curvature (Kmax), kureva corneal curvature (Km), flat meridional corneal curvature (K1), steepest meridional corneal curvature (K2), corneal astigmatism2 - K1 = K1 = )), chiyero chekushomeka kwehudiki (PachyMin), kureba kwemashure corneal urefu (EleBmax), posterior radius of curvature (PRC) 3.0 mm yakanangana nethinnest point, Belin/Ambrosio D-index (D-index), BFSBR neEleBmax zvakagadziridzwa kuita BFSB (AdjEleBmax).Sezvinoratidzwa mufig.1, AdjEleBmax inowanikwa mushure mekuona isu pachedu iyo BFSB radius mune ese ari maviri emuchina bvunzo tichishandisa iyo BFSR kukosha kubva payechipiri fungidziro.
Mupunga.1. Kuenzanisa kwemifananidzo yePentacam® munzvimbo yakarurama shure kwekufambira mberi kwekiriniki pamwe nemwedzi we13 pakati pekuongorora.Mupanera 1, EleBmax yaive 68 µm pabvunzo yekutanga uye 66 µm yechipiri, saka pakanga pasina kufambira mberi mune iyi parameter.Iyo yakanakisa sphere radii inopihwa otomatiki nemuchina kune yega yega ongororo ndeye 5.99 mm uye 5.90 mm, zvichiteerana.Kana tikadzvanya bhatani reBFS, hwindo rinozoonekwa uko itsva BFS radius inogona kutsanangurwa nemaoko.Isu takasarudza radius yakafanana mune zvese bvunzo tichishandisa yechipiri yakayerwa BFS radius kukosha (5.90mm).Mupanera 2, kukosha kutsva kweEleBmax (EleBmaxAdj) yakagadziridzwa kune imwecheteyo BFS muongororo yekutanga ndeye 59 µm, ichiratidza kuwedzera kwe7 µm muongororo yechipiri, zvichiratidza kufambira mberi zvinoenderana ne7 µm chikumbaridzo chedu.
Kuti tiongorore kufambira mberi uye kuongorora kushanda kwezvitsva zvitsva zvekudzidza, takashandisa parameters inowanzoshandiswa sezvikwangwani zvekufambira mberi (Kmax, Km, K2, Astig, PachyMin, PRC, uye D-Index) pamwe chete nematanho anotsanangurwa mumabhuku.kunyangwe zvisiri zvesimba).Tafura 1 inonyora kukosha kunomiririra kufambira mberi kwega yega yekuongorora parameter.Kufambira mberi kweKC kwakatsanangurwa apo angangoita maviri emhando dzakadzidzwa dzakasimbisa kufambira mberi.
Tafura 1 Tomographic parameters inowanzogamuchirwa sezviratidzo zvekufambira mberi kweRP kufambira mberi uye zvikumbaridzo zvinowirirana zvinotsanangurwa mumabhuku (kunyangwe zvisina kusimbiswa)
Muchidzidzo ichi, mashandiro emhando nhatu akaedzwa kuti aenderere mberi (EleBmax, BFSB, uye AdjEleBmax) zvichibva pakuvapo kwekufambira mberi kwemamwe maviri akasiyana.Ideal cut-off points for these variables yakaverengwa uye yakaenzaniswa nemamwe mabhii.
Kuongorora kwenhamba kwakaitwa pachishandiswa SPSS statistical software (version 27.0 yeMac OS; SPSS Inc., Chicago, IL, USA).Sample maitiro anopfupikiswa uye data inoratidzwa senhamba uye chiyero chezvikamu zvakasiyana.Zvinoramba zvichichinja zvinotsanangurwa sezvinoreva uye zvakajairwa kutsauka (kana yepakati nepakati uye interquartile renji kana kugoverwa kwakatsvetwa).Shanduko yekeratometric index yakawanikwa nekubvisa kukosha kwepakutanga kubva pachiyero chechipiri (kureva kuti, yakanaka delta kukosha inoratidza kuwedzera kwekukosha kweimwe parameter).Miedzo yeParametric uye isiri-parametric yakaitwa kuti iongorore kugoverwa kwekorneal curvature variables inotsanangurwa seinofambira mberi kana isingaenderere mberi, kusanganisira yakazvimirira-sample t-test, Mann-Whitney U-test, chi-square test, uye bvunzo yaFisher chaiyo (kana zvinodiwa).Chiyero chekukosha kwenhamba chakaiswa pa0.05.Kuongorora kushanda kweKmax, D-index, PRC, BFSBR, EleBmax, uye AdjEleBmax semafambiro emunhu ega ega, isu takavaka mugamuchiri performance curves (ROC) uye akaverengera akakodzera cutoff mapoinzi, sensitivity, chaiyo, yakanaka (PPV), uye Negative Predictive. Kukosha (NPV).) uye nharaunda iri pasi pe curve (AUC) kana zvingangoita maviri akasiyana anodarika mamwe maburi (sezvatsanangurwa pakutanga) kurongedza kufambira mberi sekutonga.
Maziso e113 evarwere ve76 vane RP akabatanidzwa muchidzidzo.Ruzhinji rwevarwere vaive varume (n = 87, 77%) uye zera repakati pekutanga kuongororwa raive 24.09 ± 3.93 makore.Nezve KC stratification yakavakirwa pakuwedzera kweBelin / Ambrosio dilatation deviation (BAD-D index), ruzhinji (n = 68, 60.2%) rwemaziso aive pakati nepakati.Vatsvakurudzi vakasarudza pamwe chete kukosha kwekucheka kwe7.0 uye vakasiyanisa pakati penyoro uye pakati keratoconus maererano nemabhuku26.Zvisinei, kumwe kuongorora kunosanganisira muenzaniso wose.Demographic, kiriniki uye tomographic maitiro emuenzaniso, kusanganisira zvinoreva, zvishoma, zvakanyanya, zvakajairwa kutsauka (SD) uye zviyero zvine 95% nguva yekuvimba (IC95%), pamwe neyekutanga neyechipiri kuyerwa.Musiyano uripo pakati pezvakakosha mushure memwedzi gumi nemaviri ± 3 unogona kuwanikwa mutafura 2.
Tafura 2. Demographic, kliniki uye tomographic maitiro evarwere.Mhedzisiro inoratidzwa sezvinoreva ± kutsauka kwakajairwa kune zvinoramba zvichichinja (* mhedzisiro inoratidzwa sepakati ± IQR), 95% nguva yekuvimba (95% CI), murume murume uye ziso rekurudyi zvinoratidzwa senhamba uye muzana.
Tafura 3 inoratidza huwandu hwemaziso akaiswa sevanofambira mberi vachifunga yega yega tomographic parameter (Kmax, Km, K2, Astig, PachyMin, PRC uye D-Index) zvakasiyana.Tichifunga nezvekufambira mberi kweKC, inotsanangurwa nekucherechedzwa kuchinja mune kanenge maviri tomographic variables, 57 maziso (50.4%) akaratidza kufambira mberi.
Tafura 3 Nhamba uye kuwanda kwemaziso akaiswa sevanofambira mberi, vachifunga nezve yega tomographic parameter zvakasiyana
Kmax, D-index, PRC, EleBmax, BFSB, uye AdjEleBmax zvibodzwa sezvimiriri zvakazvimiririra zvekufambira mberi kweKC zvinoratidzwa muTebhu 4. Semuenzaniso, kana tikatsanangura kukosha kwechikumbaridzo chekuwedzera Kmax ne1 diopter (D) kuratidza kufambira mberi, kunyange zvazvo iyi parameter inoratidza kunzwisiswa kwe49%, ine chaiyo ye100% (nyaya dzese dzakaonekwa sedzinofambira mberi pane iyi parameter dzaive chokwadi).vanofambira mberi pamusoro) neine fungidziro yakanaka (PPV) ye100%, yakashata yekufungidzira kukosha (NPV) ye66%, uye nzvimbo iri pasi pe curve (AUC) ye0.822.Nekudaro, iyo yakaverengerwa yakanakira cutoff yekmax yaive 0.4, ichipa kunzwa kwe70%, chaiyo ye91%, PPV ye89%, uye NPV ye75%.
Tafura 4 Kmax, D-Index, PRC, BFSB, EleBmax, uye AdjEleBmax zvibodzwa sezviyero zvakasarudzika zvekufambira mberi kweKC (inotsanangurwa seshanduko yakakosha mumabhii maviri kana anopfuura)
Panyaya yeiyo D index, iyo yakakodzera yekucheka-nzvimbo i0.435, senitivity i82%, chaiyo i98%, PPV iri 94%, NPV 84%, uye AUC iri 0.927.Takasimbisa kuti pameso e50 akafambira mberi, varwere ve3 chete havana kufambira mberi pa 2 kana mamwe mamwe maitiro.Pamaziso e63 umo iyo D index haina kuvandudza, 10 (15.9%) yakaratidza kufambira mberi mune dzimwe mbiri mbiri.
KuPRC, iyo yakakodzera cutoff point yekutsanangura kufambira mberi yaive kudzikira kwe0.065 nekunzwa kwe79%, chaiyo ye80%, PPV ye80%, NPV ye79%, uye AUC ye0.844.
Nezvekumashure kwekumusoro kukwidziridzwa (EleBmax), chikumbaridzo chakakodzera chekutarisa kufambira mberi kwaive kuwedzera kwe2.5 µm nekunzwa kwe65% uye chaiyo ye73%.Payakagadziridzwa kune yechipiri kuyerwa BSFB, kunzwa kweiyo nyowani parameter AdjEleBmax yaive 63% uye iyo chaiyo yakagadziridzwa ne84% ine yakanaka cutoff point ye6.5 µm.Iyo BFSB pachayo yakaratidza cutoff yakakwana ye0.05 mm nekunzwa kwe51% uye chaiyo ye80%.
Pamusoro pemuonde.2 inoratidza ROC curves kune imwe neimwe inofungidzirwa tomographic paramita (Kmax, D-Index, PRC, EleBmax, BFSB uye AdjEleBmax).Isu tinoona kuti iyo D-index ndiyo bvunzo inoshanda nepamusoro AUC (0.927) inoteverwa nePRC neKmax.AUC EleBmax iri 0.690.Kana yakarongedzerwa BFSB, kuseta uku (AdjEleBmax) yakavandudza mashandiro ayo nekuwedzera iyo AUC kusvika 0.754.BFSB pachayo ine AUC ye0.690.
Mufananidzo 2. Receiver performance curves (ROC) inoratidza kuti kushandiswa kweiyo D index kuti ione kufambira mberi kwekeratoconus yakawana yakakwirira yekunzwa uye yakananga, inoteverwa nePRC neKmax.AdjEleBmax ichiri kutorwa seine musoro uye kazhinji iri nani pane Elebmax isina BFSB tuning.
Mapfupiso: Kmax, yakanyanya corneal curvature;D-index, Belin/Ambrosio D-index;PRC, back radius ye curvature kubva pa3.0 mm yakanangana neiyo thinnest point;BFSB, yakanyatsokodzera kuseri kwedenderedzwa;Urefu;AdjELEBmax, yakanyanya kukwirisa angle.iyo posterior surface ye cornea inogadziriswa kune yakanyanya kufanira spherical dorsum.
Tichifunga nezveEleBmax, BFSB, uye AdjEleBmax, zvichiteerana, takasimbisa kuti makumi mashanu nenhatu (46.9%), makumi mana (35.3%), uye 45 (39.8%) maziso airatidza kufambira mberi kune yega yega parameter, zvichiteerana.Pamaziso aya, gumi nematanhatu (30.2%), 11 (27.5%), uye 9 (45%), zvichiteerana, akange asina kufambira mberi kwechokwadi sekutsanangurwa kungangoita mamwe maviri maparameter.Pameso e60 asingatariswe kufambira mberi neEleBmax, 20 (33%) maziso aive achifambira mberi pa2 kana mamwe ma parameter.Makumi maviri nemasere (38.4%) uye 21 (30.9%) maziso akaonekwa seasina kufambira mberi maererano neBFSB neAdjEleBmax chete, zvichiteerana, zvichiratidza kufambira mberi kwechokwadi.
Isu tine chinangwa chekuongorora kushanda kweBFSB uye, zvakanyanya kukosha, BFSB-yakagadziridzwa yakakwira posterior corneal urefu (AdjEleBmax) serinoveli paramita yekufanotaura uye kuona kufambira mberi kweKC uye nekuaenzanisa nemamwe ma paramita e tomographic anowanzoshandiswa semakaki ekufambira mberi.Kuenzanisa kwakaitwa nezvikumbaridzo zvakashumwa muzvinyorwa (kunyange zvisina kusimbiswa), zvinoti Kmax uye D-Index.20
Pakuisa EleBmax kuBFSB radius (AdjEleBmax), takaona kuwedzera kukuru kwehumwe - 73% yeparameter isina kugadziriswa uye 84% yeparameter yakagadziriswa - pasina kukanganisa kukosha kwekunzwa (65% uye 63%).Isu takaongororawo iyo BFSB radius pachayo seimwe inogona kufanotaura yekuenderera mberi kwedilatation.Nekudaro, iyo sensitivity (51% vs 63%), chaiyo (80% vs 84%) uye AUC (0.69 vs 0.75) yeiyi parameter yaive yakaderera pane iyo yeAdjEleBmax.
Kmax inzvimbo inozivikanwa yekufanotaura mafambiro eKC.27 Hapana kubvumirana kuti muganhu wekucheka wakakodzera zvakanyanya.12,28 Muchidzidzo chedu, takafunga kuwedzera kwe1D kana kupfuura setsanangudzo yekufambira mberi.Pachikumbaridzo ichi, takaona kuti varwere vose vakaonekwa kuti vari kufambira mberi vakasimbiswa nemimwe miviri miviri, zvichiratidza kuti 100%.Zvisinei, kunzwisiswa kwayo kwaive kwakaderera (49%), uye kufambira mberi kwaisagona kuonekwa mumaziso e29.Nekudaro, mukudzidza kwedu, iyo yakakodzera Kmax chikumbaridzo yaive 0.4 D, senitivity yaive 70%, uye chaiyo yaive 91%, izvo zvinoreva kuti nekuderera kwehukama mune chaiyo (kubva pa100% kusvika 91%), takavandudza.Sensitivity yakabva pa49% kusvika pa70%.Nekudaro, kukosha kwekiriniki kwechikumbaridzo chitsva ichi hakuna mubvunzo.Zvinoenderana neiyo Kreps kudzidza nezve kudzokorora kwezviyero zvePentacam®, kudzokororwa kweKmax yaive 0.61 mugomarara rekenza uye 1.66 mune ine mwero caesarean colpitis,19 zvinoreva kuti iyo nhamba yekucheka-kubvisa kukosha mumuenzaniso uyu haina kukosha kuchipatara sezvainotsanangura. mamiriro akagadzikana.apo iyo yakanyanya kufambira mberi inogoneka inoshandiswa kune mamwe masampuli.Kmax, kune rumwe rutivi, inotaridza kukwirisa anterior corneal curvature yedunhu diki 29 uye haigone kuberekazve shanduko dzinoitika muanterior cornea, posterior cornea, nedzimwe nzvimbo dzepachymetry.30-32 Kuenzaniswa nemashure matsva emashure, AdjEleBmax yakaratidza kunzwisisika kwepamusoro (63% vs. 49%).20 maziso anofambira mberi akaonekwa nenzira kwayo achishandisa iyi parameter uye akapotsa kushandisa Kmax (kuenzaniswa ne12 maziso anofambira mberi akaonekwa achishandisa Kmax panzvimbo yeAdjEleBmax).Kuwanikwa uku kunotsigira chokwadi chekuti kumashure kwecornea kwakakwira uye kwakawedzera kuwedzera pakati kana ichienzaniswa neanterior, iyo inogona kubatsira kuona shanduko.25,32,33
Zvinoenderana nezvimwe zvidzidzo, iyo D-index ndiyo yakasarudzika parameter ine yakanyanya kunzwa (82%), chaiyo (95%) uye AUC (0.927).34 Chaizvoizvo, izvi hazvishamise, nekuti iyi indekisi yeparamita yakawanda.PRC yaive yechipiri yakanyanya kujeka shanduko (79%) ichiteverwa neAdjEleBmax (63%).Sezvambotaurwa, iyo yakanyanya kunzwisiswa, iyo shoma yenhema yakaipa uye zviri nani iyo yekuongorora paramita inokura.35 Naizvozvo, isu tinokurudzira kushandisa AdjEleBmax (ine cutoff ye7 µm yekufambira mberi kwete 6.5 µm sezvo chiyero chedhijitari chakavakirwa muPentacam® isingabatanidze nzvimbo dzegumi dzeparamita iyi) pachinzvimbo cheEleBmax isina kurongeka, iyo ichaverengerwa zvimwe zvakasiyana mukuongorora.kufambira mberi kwekeratoconus kuvandudza kuvimbika kwekuongorora kwedu kwekliniki uye kuona kwekutanga kwekufambira mberi.
Zvisinei, kudzidza kwedu kunotarisana nezvimwe ganhuriro.Kutanga, isu takangoshandisa tomographic shapeflug imaging parameters kutsanangura uye kuongorora kufambira mberi, asi dzimwe nzira dziripo iye zvino nechinangwa chimwe, senge biomechanical analysis, inogona kutangira chero topographic kana tomographic shanduko.36 Chechipiri, tinoshandisa chiyero chimwe chete cheese akaedzwa paramita uye, sekureva kwaIvo Guber et al., kuenzana pamusoro pemifananidzo yakawanda kunoguma nekudzika kweyero ruzha.28 Nepo kuyerwa nePentacam® kwainyatso kudhirowa mumaziso akajairwa, aive akadzikira mumaziso ane corneal irregularities uye corneal ectasia.37 Muchidzidzo ichi, isu takangobatanidza maziso ane yakavakwa muPentacam® high-quality scan kusimbiswa, izvo zvaireva kuti chirwere chepamusoro chakanga chabviswa.17 Chechitatu, tinotsanangura vafambire mberi vechokwadi sevane mativi anenge maviri akavakirwa pamabhuku asi asati asimbiswa.Pakupedzisira, uye zvichida zvakanyanya kukosha, kusiyana-siyana kwePentacam® zviyero ndeyekukosha kwekliniki pakuongorora kufambira mberi kwekeratoconus.18,26 Mumuenzaniso wedu wemaziso e113, payakarongwa maererano neBAD-D mamakisi, mazhinji (n = 68, 60.2%) maziso aive pakati nepakati, uye akasara ari madiki kana akapfava.Nekudaro, tichipihwa saizi diki yemuenzaniso, isu takachengeta kuongororwa kwese zvisinei nekuomarara kweKTC.Isu takashandisa kukosha kwechikumbaridzo kwakanakira sampuli yedu yese, asi tinobvuma kuti izvi zvinogona kuwedzera ruzha (kusiyana) kune kuyerwa uye kusimudza kunetseka nezve kuyerwa kuberekana.Kudzokororwa kwezviyero zvinoenderana nekuoma kweKTC, sezvakaratidzwa naKreps, Gustafsson et al.18,26.Nokudaro, tinokurudzira zvakasimba kuti zvidzidzo zvenguva yemberi zvitarise matanho akasiyana echirwere uye kuongorora nzvimbo dzakakodzera dzekucheka kuti dzifambire mberi kwakakodzera.
Mukupedzisa, kuonekwa kwekutanga kwekufambira mberi kunonyanya kukosha kuitira kupa kurapa panguva yakakodzera kumisa kufambira mberi (kuburikidza nekubatanidza) 38 uye kubatsira kuchengetedza maonero uye hupenyu hwehupenyu muvarwere vedu.34 Chinangwa chikuru chebasa redu ndechekuratidza kuti EleBmax, yakarongedzwa kune imwechete BFS radius pakati pezviyero zvenguva, ine kushanda kuri nani pane EleBmax pachayo.Iyi parameter inoratidza hunyanzvi hwepamusoro uye hunoshanda kana ichienzaniswa neEleBmax, ndiyo imwe yeakanyanya kutarisisa paramita (uye nekudaro yakanyanya kunaka yekuongorora) uye nekudaro inogona kutanga kufambira mberi biomarker.Inokurudzirwa zvikuru kugadzira multi-parameter indexes.Zvidzidzo zvenguva yemberi zvinosanganisira multivariate progression analysis inofanira kusanganisira AdjEleBmax.
Vanyori havagamuchire chero rutsigiro rwemari patsvagiridzo, hunyori uye / kana kuburitswa kwechinyorwa ichi.
Margarida Ribeiro naClaudia Barbosa vanyori vezvidzidzo.Vanyori vanotaura kuti hapana kupesana kwekufarira mubasa iri.
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