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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, 3 sano jirClaudia Barbosa, 3 sano jir2 Kulliyadda Caafimaadka Bio- Kulliyadda Caafimaadka ee Jaamacadda Porto, Porto, Portugal 3 Kulliyadda Caafimaadka ee Jaamacadda Porto, Porto, Portugal;4Qaybta Qalliinka iyo Fiisigiska, Kulliyadda Caafimaadka, Jaamacadda Porto, Porto, Portugal4 Waaxda Qalliinka iyo Fiisigiska, Kulliyadda Caafimaadka, Jaamacadda Porto, Porto, Portugal * Qorayaashani waxay si isku mid ah uga qaybqaateen shaqadan.Hernâni Monteiro Porto, 4200-319, Portugal, iimaylka [email protected] Ujeeddo: Waxaan qiimeynay dusha dambe ee corneal ee lagu hagaajiyay isla Best Fit Sphere Back (BFSB) inta u dhaxaysa cabirrada waqtiga (AdjEleBmax) iyo radius BFSB (BFSBR) Dhererka ugu sarreeya lafteeda ayaa loo isticmaalay sidii halbeeg cusub oo tomografi ah si loo diiwaan geliyo horumarka ballaadhinta iyo marka la barbar dhigo qiyaasihii ugu dambeeyay ee la isku halayn karo ee horumarka keratoconus (KK).NatiijooyinkaWaxaan qiimeynay Kmax, index D, radius curvature dambe, iyo barta goynta ku habboon ee 3.0 mm barta ugu khafiifsan ee xuddunta u ah (PRC), EleBmax, BFSBR, iyo AdjEleBmax inay yihiin cabbirro madaxbannaan si loo diiwaangeliyo horumarka KC (oo lagu qeexay laba ama ka badan doorsoomayaal), waxaan helnay dareen oo ah 70%, 82%, 79%, 65%, 51%, iyo 63%, iyo 91%, 98%, 80%, 73%, 80%, iyo 84% tilmaamo lagu ogaanayo horumarka KC..Aagga ka hooseeya qalooca (AUC) doorsoome kasta wuxuu ahaa 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, siday u kala horreeyaan.Gabagabo: Marka la barbar dhigo EleBmax iyada oo aan wax hagaajin ah lahayn, AdjEleBmax wuxuu leeyahay gaar gaar ah, sare AUC iyo waxqabad ka wanaagsan oo leh dareen la mid ah.AUC.Maaddaama qaabka dusha sare uu ka badan yahay aspherical iyo qalloocan marka loo eego dusha hore, taas oo laga yaabo inay ka caawiso in la ogaado isbeddelada, waxaan soo jeedinaynaa in lagu daro AdjEleBmax ee qiimeynta horumarka KC oo ay weheliso doorsoomayaal kale si loo hagaajiyo kalsoonida qiimeynteena kiliinikada iyo ogaanshaha hore.horumarka
Keratoconus (KK) waa ectasia-ka hoose ee ugu caansan ee mindhicirka.Hadda waxa loo tixgaliyaa inuu yahay laba-geesoodka (inkasta oo asymmetric) uu yahay cudur si daba-dheeraada u socda oo keenaya isbeddelo qaab dhismeedyo badan oo ay ku xigto dhuuban xinjirowga iyo nabarrada.1,2 Kiliinik ahaan, bukaanadu waxay soo bandhigaan astigmatism aan joogto ahayn iyo myopia, photophobia, iyo/ama monocular diplopia oo leh aragga daciifka ah, aragtida ugu badan ee la saxay (BCVA) iyo hoos u dhaca tayada nolosha.3,4 Calaamadaha RP waxay badanaa bilaabaan tobanka sano ee labaad ee nolosha waxayna u gudbaan tobanka sano ee afraad, oo ay ku xigto xasilinta bukaan-socodka.Halista iyo heerka horumarka ayaa ku badan dadka da'doodu ka yar tahay 19 sano.5.6
In kasta oo aan wali la helin dawo qeexan, daawaynta hadda ee keratoconus indhaha waxay leedahay laba gool oo muhiim ah: hagaajinta shaqada aragga iyo joojinta horumarka fidinta.7,8 Kan hore waxaa laga yaabaa in lagu arko muraayadaha, muraayadaha indhaha ee adag ama qayb-adagga ah, giraanta intrakorneal, ama ku-tallaalidda corneal marka cudurku aad u daran yahay.9 Hadafka dambe waa cibaadada quduuska ah ee daawaynta bukaan-socodka, oo hadda lagu gaadhi karo oo keliya isku-xidhka.Hawlgalkaani wuxuu keenayaa kororka caabbinta biomechanical-ka iyo qallafsanaanta isha waxayna ka hortagtaa horumar dheeraad ah.10-13 Inkasta oo tan la samayn karo marxalad kasta oo cudurka ah, faa'iidada ugu weyn ayaa la helayaa marxaladaha hore.14 Waa in la sameeyaa dadaal lagu ogaanayo horumarka goor hore lagana hortagayo inay sii xumaato, lagana fogaado daawaynta aan loo baahnayn ee bukaanada kale, taas oo hoos u dhigaysa halista dhibaatooyinka isdhaafsiga ah sida caabuqa, luminta unugyada endothelial, iyo xanuunka daran ee qalliinka kadib.15.16
In kasta oo ay jiraan dhawr daraasadood oo loogu talagalay in lagu qeexo laguna ogaado horumarka,17-19 weli ma jiro qeexid joogto ah oo ku saabsan horumarka ballaadhinta ama hab habaysan oo loo diiwaangeliyo.9,20,21 Is-afgaradka Caalamiga ah ee Keratoconus iyo Dilated Diseases (2015), horumarka keratoconus waxaa lagu qeexay isbeddel taxane ah ugu yaraan laba ka mid ah xudduudaha dusha sare ee soo socda: kor u kaca xagasha hore, kor u kaca xaglaha dambe, khafiifinta iyo / ama dhumucda of the cornea Heerka isbeddelku wuxuu ka kordhaa wareegga ilaa barta ugu khafiifsan.Si kastaba ha ahaatee, qeexitaan gaar ah oo horumarka ah ayaa weli loo baahan yahay.Waxaa la isku dayay in la helo doorsoomayaasha ugu adag si loo ogaado loona sharaxo horumarka.19:22-24
Marka la eego in qaabka dusha sare ee laf-dhabarka, kaas oo ka badan aspherical iyo qalloocan marka loo eego dusha hore, laga yaabo inay faa'iido u leedahay in la ogaado isbeddelada,25 Ujeedada ugu weyn ee daraasaddan ayaa ahayd in la qiimeeyo sifooyinka xagasha sare ee sare ee dambe ee dambe.la qabsaday isla goobta ugu habboon.Cabbirka cabbirka wakhtiga (BFSB) (AdjEleBmax) iyo radius BFSB (BFSBR) kaligood waxay u adeegeen sidii cabbirro cusub si loo diiwaan geliyo horumarka ballaarinta oo la barbar dhigo cabbirrada inta badan la isticmaalo ee loo adeegsado horumarka KC.
Wadarta indhaha 113 ee bukaannada 76 ee isku xigta ee laga helay keratoconus ayaa lagu baaray daraasaddan kooxeed ee dib-u-eegista ee Waaxda Ophthalmology ee Isbitaalka Dhexe ee Jaamacadda São João, Portugal.Daraasada waxaa ansixiyay guddiga anshaxa deegaanka ee Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto waxaana loo sameeyay si waafaqsan Baaqa Helsinki.Ogolaansho qoraal ah oo qoraal ah ayaa laga helay dhammaan ka qaybgalayaasha iyo, haddii ka qaybqaataha uu ka yar yahay da'da 16 sano, waalidka iyo/ama mas'uulka sharciga ah.
Bukaanka qaba KC da'doodu u dhaxayso 14 ilaa 30 sano ayaa la aqoonsaday oo si isdaba joog ah loogu daray dabagalka indhaha iyo maskaxda inta lagu jiro Oktoobar-December 2021.
Dhammaan bukaannada la xushay waxaa la socday hal sano oo uu ku taqasusay takhasuska dhinaca maskaxda waxaana la maray ugu yaraan saddex cabbir oo Scheimpflug ah (Pentacam®; Oculus, Wetzlar, Germany).Bukaan-socodka ayaa joojiyay xirashada muraayadaha indhaha ugu yaraan 48 saacadood ka hor cabbirada.Dhammaan cabbiraadaha waxaa sameeyay dhakhtarka lafaha u tababaran waxaana lagu soo daray oo kaliya baarista tayada ee "OK".Haddii qiimaynta tayada sawirka tooska ah aan lagu calaamadin “OK”, tijaabada waa lagu soo celin doonaa.Kaliya laba baaritaan oo il kasta ah ayaa la falanqeeyay si loo ogaado horumarka, iyadoo lammaane kasta la kala saaray 12 ± 3 bilood.Indhaha leh KC-hoosaadka ayaa sidoo kale lagu daray (xaaladahan, isha kale waa inay muujisay calaamado cad oo KC ah).
Waxaan ka reebnay falanqaynta indhaha KC ee hore loogu sameeyay qalliinka indhaha (isgoysyada corneal, giraannada corneal, ama bedelka xudunta) iyo indho qaba cudur aad u horumarsan "OK" kadib hubinta tayada sawirka gudaha.
Xogta tirade-koobeedka, bukaan-socodka iyo xog-ururinta ayaa la ururiyay si loo baaro.Si loo ogaado horumarka KC, waxaanu soo uruurinay doorsoomayaal kala duwan oo ay ku jiraan curvature corneal ugu badnaan (Kmax), celceliska qalooca corneal corneal (Km), qalooca meridional corneal flat (K1), curvature meridional corneal ee ugu dheer (K2), astigmatism corneal (Astig = K2 - K1). ).), Cabbirka dhumucda ugu yar (PachyMin), dhererka dambe ee ugu sarreeya (EleBmax), radius dambe ee curvature (PRC) 3.0 mm oo ku salaysan barta ugu khafiifsan, Belin/Ambrosio D-index (D-index), BFSBR iyo EleBmax ayaa lagu hagaajiyay BFSB (AdjEleBmax).Sida ku cad fig.1, AdjEleBmax waxaa la helay ka dib markii aan gacanta ku go'aamin isla raadiyaha BFSB ee labada tijaabo mishiinka isticmaalaya qiimaha BFSR ee qiyaasta labaad.
Bariis1. Isbarbardhigga sawirada Pentacam® ee booska dambe ee toosan oo leh horumar caafimaad oo run ah oo leh 13 bilood oo u dhexeeya baaritaannada.Guddiga 1, EleBmax wuxuu ahaa 68 µm imtixaankii kowaad iyo 66 µm ee labaad, markaa ma jirin wax horumar ah oo ku saabsan cabbirkan.Radiyada ugu fiican ee si toos ah ay u bixiso mishiinku qiimeyn kasta waa 5.99 mm iyo 5.90 mm, siday u kala horreeyaan.Haddii aan gujino badhanka BFS, daaqad ayaa ka soo bixi doonta halkaas oo raadiyaha BFS cusub lagu qeexi karo gacanta.Waxaan ku go'aansanay isla raadiyaha labada imtixaan anagoo adeegsanayna qiimaha cabirka BFS ee labaad (5.90mm).Qaybta 2, qiimaha cusub ee EleBmax (EleBmaxAdj) ee lagu saxay isla BFS qiimayntii kowaad waa 59 µm, taasoo muujinaysa korodhka 7 µm ee qiimaynta labaad, taasoo muujinaysa horumarka marka loo eego xadkayaga 7 µm.
Si loo falanqeeyo horumarka oo loo qiimeeyo waxtarka doorsoomayaasha cusub ee daraasadda, waxaan isticmaalnay cabbirro sida caadiga ah loo isticmaalo calaamadaha horumarka (Kmax, km, K2, Astig, PachyMin, PRC, iyo D-Index) iyo sidoo kale marinnada lagu sharraxay suugaanta.in kasta oo aan si dhab ah loo eegin).Jadwalka 1 wuxuu taxayaa qiyamka matalaya horumarka halbeeg kasta oo falanqayn ah.Horumarka KC waxaa lagu qeexay markii ugu yaraan laba doorsoomayaasha la bartay ay xaqiijiyeen horumarka.
Shaxda 1 Qiyaasaha sawirka guud ahaan loo aqbalay inay yihiin calamadaha horumarka horumarka RP iyo xadka u dhigma ee lagu sifeeyay suugaanta (inkasta oo aan la xaqiijin)
Daraasaddan, waxqabadka saddexda doorsoome ayaa lagu tijaabiyay horumarka (EleBmax, BFSB, iyo AdjEleBmax) oo ku salaysan joogitaanka horumarka ugu yaraan laba doorsoomayaal kale.Dhibcaha goynta ku habboon doorsoomayaashan ayaa la xisaabiyay lana barbar dhigay doorsoomayaasha kale.
Falanqaynta tirakoobka ayaa la sameeyay iyadoo la adeegsanayo software-ka SPSS (nooca 27.0 ee Mac OS; SPSS Inc., Chicago, IL, USA).Tilmaamaha tusaalaha ah ayaa la soo koobay waxaana xogta loo soo bandhigay tirooyin iyo saamiyo doorsoomayaal.Doorsoomayaasha joogtada ah waxaa lagu sifeeyaa inay yihiin weecasho dhexdhexaad ah iyo heer (ama dhexda iyo dhexda marka qaybinta la qallooco).Isbeddelka index keratometric waxaa lagu helay iyadoo laga jarayo qiimihii asalka ahaa cabbirka labaad (ie, qiimaha delta togan wuxuu muujinayaa kororka qiimaha halbeeg gaar ah).Tijaabooyin Parametric ah iyo kuwa aan ahayn parametric ayaa la sameeyay si loo qiimeeyo qaybinta doorsoomayaal qalooca corneal oo lagu sifeeyay horusocod ama aan horumar lahayn, oo ay ku jiraan muunado madax-banaan t-tijaabo, Mann-Whitney U-tijaabada, chi-square test, iyo imtixaanka saxda ah ee Fisher (haddii loo baahan yahay).Heerka muhiimada tirakoobka ayaa lagu dejiyay 0.05.Si loo qiimeeyo waxtarka Kmax, D-index, PRC, BFSBR, EleBmax, iyo AdjEleBmax sida saadaalinta horumarka shaqsiyeed, waxaan dhisnay qaloocyada waxqabadka qaataha (ROC) waxaanan xisaabinay dhibcaha goynta ku habboon, dareenka, gaarnimada, togan (PPV), iyo Saadaasha xun Qiimaha (NPV).) iyo aagga ka hooseeya qalooca (AUC) marka ugu yaraan laba doorsoomayaashu ay dhaafaan xadka qaar (sida hore loogu sharraxay) si loo kala saaro horumarka sida xakamaynta.
Wadarta 113 indhood oo 76 bukaan ah oo qaba RP ayaa lagu daray daraasadda.Bukaannada badankood waxay ahaayeen rag (n=87, 77%) celceliska da'da qiimeynta koowaad waxay ahayd 24.09 ± 3.93 sano.Marka la eego qaabaynta KC ee ku salaysan korodhka isugeynta Belin/Ambrosio dilatation weecasho (BAD-D index), badi (n=68, 60.2%) ee indhuhu waxay ahaayeen dhexdhexaad.Cilmi-baadhayaashu waxay si wadajir ah u doorteen qiimaha goynta ee 7.0 waxayna ku kala duwan yihiin keratoconus khafiif ah iyo dhexdhexaad ah marka loo eego suugaanta26.Si kastaba ha ahaatee, falanqaynta inteeda kale waxaa ku jira muunada oo dhan.Tilmaamaha tirakoobka, bukaan-socodka iyo tomographic ee shaybaarka, oo ay ku jiraan celceliska, ugu yar, ugu badnaan, leexashada caadiga ah (SD) iyo cabbirada 95% u dhexeeya kalsoonida (IC95%), iyo sidoo kale cabbirada koowaad iyo labaad.Farqiga u dhexeeya qiyamka 12 ± 3 bilood ka dib waxaa laga heli karaa shaxda 2.
Shaxda 2. Tirakoobyada, bukaan-socodka iyo astaamaha bukaanka.Natiijooyinka waxaa lagu muujiyay celcelis ahaan ± isbeddelka caadiga ah ee doorsoomayaal joogto ah (*natiijooyinka waxaa lagu muujiyay dhexdhexaad ± IQR), 95% muddada kalsoonida (95% CI), jinsiga lab iyo isha midig ayaa lagu muujiyay tiro iyo boqolkiiba
Shaxda 3 waxa ay tuseysaa tirada indhaha ee loo kala saaray horumarka iyaga oo si gooni gooni ah u tixgalinaya halbeeg walba (Kmax, km, K2, Astig, PachyMin, PRC iyo D-Index).Iyadoo la tixgelinayo horumarka KC, oo lagu qeexay isbeddellada la arkay ee ugu yaraan laba doorsoomayaal tomografi, 57 indhood (50.4%) ayaa muujiyay horumar.
Shaxda 3 Tirada iyo inta jeer ee indhaha ee loo kala saaro horumariyayaal, iyada oo la tixgelinayo cabbir kasta oo gaar ah
Kmax, D-index, PRC, EleBmax, BFSB, iyo AdjEleBmax buundooyinka sida saadaaliyayaal madaxbannaan ee horumarka KC ayaa lagu muujiyey Shaxda 4. Tusaale ahaan, haddii aan qeexno qiimaha bilowga ah ee kordhinta Kmax by 1 diopter (D) si loo calaamadiyo horumarka, inkastoo Halbeeggani waxa uu muujinayaa dareenka 49 %, waxa uu leeyahay 100% gaar ah (dhammaan kiisaska loo aqoonsaday horusocod ee cabbirkan run ahaantii waa run).Hormarada kor ku xusan) oo leh qiime saadaasha togan (PPV) ee 100%, qiimaha saadaasha taban (NPV) ee 66%, iyo aag ka hooseeya qalooca (AUC) ee 0.822.Si kastaba ha noqotee, goynta ugu habboon ee la xisaabiyay ee kmax waxay ahayd 0.4, taasoo siinaysa dareenka 70%, gaar ahaan 91%, PPV 89%, iyo NPV 75%.
Shaxda 4 Kmax, D-Index, PRC, BFSB, EleBmax, iyo AdjEleBmax buundooyinka sida saadaasha go'doonsan ee horumarka KC (oo lagu qeexay isbeddel weyn oo laba ama ka badan doorsoomayaal)
Marka la eego index D, meesha ugu habboon ee goyntu waa 0.435, dareenka waa 82%, gaar ahaan 98%, PPV waa 94%, NPV waa 84%, AUC waa 0.927.Waxaan xaqiijinay in 50-kii indhood ee kor u kacay, kaliya 3 bukaan aysan ku hormarin 2 ama in ka badan oo kale.Indhaha 63 ee tusaha D uusan soo hagaagin, 10 (15.9%) ayaa muujiyay horumarka ugu yaraan laba cabbir oo kale.
Dhanka PRC, meesha ugu habboon ee goynta lagu qeexi karo horumarka waxay ahayd hoos u dhac 0.065 leh dareenka 79%, gaar ahaan 80%, PPV ee 80%, NPV ee 79%, iyo AUC ee 0.844.
Marka la eego kor u qaadista dusha sare (EleBmax), heerka ugu habboon ee go'aaminta horumarka wuxuu ahaa korodhka 2.5 µm oo leh dareen ah 65% iyo gaar ahaan 73%.Marka lagu hagaajiyo BSFB-ta labaad ee la cabbiray, dareenka cabbirka cusub ee AdjEleBmax wuxuu ahaa 63% gaar ahaanna waxa uu hagaajiyay 84% iyada oo leh meel goynta ku habboon oo ah 6.5 µm.BFSB lafteedu waxay muujisay gooyn qumman oo ah 0.05 mm oo leh dareen ah 51% iyo gaar ahaan 80%.
On berde.2 waxay tusinaysaa qalooca ROC mid kasta oo ka mid ah qiyaasaha qiyaasaha tomografiga (Kmax, D-Index, PRC, EleBmax, BFSB iyo AdjEleBmax).Waxaan aragnaa in D-index-ka uu yahay imtixaan waxtar badan leh oo leh AUC sare (0.927) oo ay ku xigto PRC iyo Kmax.AUC EleBmax wuxuu ahaa 0.690 $.Markii loo habeeyey BFSB, goobtan (AdjEleBmax) waxa ay hagaajisay wax qabadkeeda iyada oo balaadhisay AUC ilaa 0.754.BFSB lafteedu waxay leedahay AUC 0.690.
Jaantuska 2. Qalloocyada waxqabadka qaataha (ROC) oo muujinaya in isticmaalka tusaha D si loo go'aamiyo horumarka keratoconus uu gaadhay heerar sare oo xasaasiyad iyo gaar ah, oo ay ku xigto PRC iyo Kmax.AdjEleBmax ayaa wali loo arkaa mid macquul ah oo guud ahaan ka fiican Elebmax iyada oo aan la hagaajin BFSB.
Soo gaabinta: Kmax, curvature ugu badan ee corneal;D-index, Belin/Ambrosio D-index;PRC, radius dhabarka ah ee qalooca oo ka yimid 3.0 mm oo udub dhexaad u ah barta ugu khafiifsan;BFSB, oo ugu habboon dhabarka wareegsan;Dhererka;AdjELEBmax, xagasha sare ee ugu badan.dusha dambe ee kornea waxaa lagu hagaajiyaa dorsum wareegsan ee ugu habboon.
Iyadoo la tixgelinayo EleBmax, BFSB, iyo AdjEleBmax, siday u kala horreeyaan, waxaan xaqiijinay in 53 (46.9%), 40 (35.3%), iyo 45 (39.8%) indhuhu waxay muujiyeen horumarka halbeeg kasta oo go'doon ah, siday u kala horreeyaan.Indhahan, 16 (30.2%), 11 (27.5%), iyo 9 (45%), siday u kala horreeyaan, ma lahayn horumar run ah sida lagu qeexay ugu yaraan laba cabbir oo kale.Indhaha 60 ee aan loo tixgalinin horusocodka EleBmax, 20 (33%) indhuhu waxay horumar ku sameeyeen 2 ama in ka badan oo kale.Sideed iyo labaatan (38.4%) iyo 21 (30.9%) indhaha ayaa loo tixgaliyay kuwo aan horumarsanayn marka loo eego BFSB iyo AdjEleBmax oo kali ah, siday u kala horreeyaan, oo muujinaya horumar dhab ah.
Waxaan dooneynaa inaan baarno waxtarka BFSB iyo, ka sii muhimsan, BFSB-lagu hagaajiyay dhererka ugu sarreeya ee xagasha dambe (AdjEleBmax) sidii halbeeg cusub si loo saadaaliyo loona ogaado horumarka KC oo aan barbar dhigno cabbirrada kale ee sawir-qaadista sida caadiga ah loo isticmaalo calaamadaha horumarka.Isbarbardhigga waxaa lagu sameeyay heerar laga soo sheegay suugaanta (inkastoo aan la ansixin), kuwaas oo kala ah Kmax iyo D-Index.20
Markaad EleBmax ku dhejinayso radius BFSB (AdjEleBmax), waxaan aragnay koror weyn oo gaar ah - 73% ee cabbirka aan la hagaajin iyo 84% ee cabbirka la hagaajiyay - iyada oo aan saameyn ku yeelan qiimaha dareenka (65% iyo 63%).Waxaan sidoo kale qiimeynay raadiyaha BFSB laftiisa inuu yahay saadaaliye kale oo suurtagal ah ee horumarka ballaarinta.Si kastaba ha ahaatee, dareenka (51% vs 63%), gaar ahaan (80% vs 84%) iyo AUC (0.69 vs 0.75) ee cabbirkan ayaa ka hooseeya kuwa AdjEleBmax.
Kmax waa halbeeg caan ah oo saadaaliya horumarka KC.27 Ma jiro wax la isku raacsan yahay oo ku saabsan xadka goynta ee ku habboon.12,28 Daraasaddeena, waxaan u tixgelinay kororka 1D ama ka badan sida qeexitaanka horumarka.Marka la eego heerkan, waxaan aragnay in dhammaan bukaannada loo aqoonsaday inay horumarayaan lagu xaqiijiyay ugu yaraan laba cabbir oo kale, oo soo jeedinaya gaar ahaan 100%.Si kastaba ha ahaatee, dareenkeedu waxa uu ahaa mid hooseeya (49%), horumarkana laguma ogaan karo 29 indhood.Si kastaba ha ahaatee, daraasaddeena, heerka ugu habboon ee Kmax wuxuu ahaa 0.4 D, dareenka wuxuu ahaa 70%, gaar ahaanna wuxuu ahaa 91%, taas oo macnaheedu yahay in hoos u dhac ku yimid gaar ahaan (laga bilaabo 100% ilaa 91%), waan hagaajinnay.Dareenku wuxuu u dhexeeyay 49% ilaa 70%.Si kastaba ha ahaatee, khusaynta kiliinikada ee xadkan cusub waa su'aal.Marka loo eego daraasadda Kreps ee ku saabsan dib-u-celinta ee cabbirada Pentacam®, dib-u-celinta Kmax waxay ahayd 0.61 kansarka catarrhal khafiif ah iyo 1.66 ee colpitis caesarean dhexdhexaad ah,19 taas oo macnaheedu yahay in qiimaha dhimista tirakoobka ee muunaddani aanu ahayn mid caafimaad ahaan muhiim ah sida ay qeexayso. xaalad deggan.marka horumarka ugu badan ee suurtogalka ah lagu dabaqo muunado kale.Kmax, dhinaca kale, waxa uu tilmaamayaa qalooca hore ee hore ee ugu dheer ee gobolka yar 29 mana soo saari karo isbeddelada ka dhaca cornea hore, cornea dambe, iyo meelaha kale ee pachymetry.30-32 Marka loo eego xuduudaha dambe ee cusub, AdjEleBmax wuxuu muujiyay dareen sare (63% vs. 49%).20 indho horusocod ah ayaa si sax ah loo aqoonsaday iyadoo la isticmaalayo cabbirkan oo la waayay iyadoo la isticmaalayo Kmax (marka la barbar dhigo 12 indhood oo horumar leh oo la ogaaday iyadoo la isticmaalayo Kmax halkii AdjEleBmax).Natiijooyinkani waxay taageerayaan xaqiiqda ah in dusha sare ee cornea uu yahay mid qotodheer oo aad u ballaaran oo ku yaala bartamaha marka loo eego dusha hore, taas oo laga yaabo inay caawiso in la ogaado isbeddelada.25,32,33
Marka loo eego daraasado kale, D-index waa halbeeg gooni ah oo leh dareenka ugu sarreeya (82%), gaar ahaan (95%) iyo AUC (0.927).34 Dhab ahaantii, tani maahan wax la yaab leh, mar haddii kani yahay tusmaynta cabbirro badan.PRC waxay ahayd doorsoomaha labaad ee ugu xasaasisan (79%) waxaa ku xigay AdjEleBmax (63%).Sidii hore loo soo sheegay, dareenka sare u kaca, yaraanta xumaanta beenta ah iyo sida wanaagsan ee cabbirrada baadhistu u horumaraan.35 Sidaa darteed, waxaan kugula talineynaa inaad isticmaasho AdjEleBmax (oo leh gooyn 7 µm horumarka halkii 6.5 µm maadaama miisaanka dhijitaalka ah ee lagu dhisay Pentacam® aysan ku jirin jajab tobanle ee cabbirkan) halkii EleBmax aan la saxin, kaas oo lagu dari doono doorsoomayaasha kale ee qiimaynta.horumarka keratoconus si loo hagaajiyo isku halaynta qiimayntayada caafimaad iyo ogaanshaha hore ee horumarka.
Si kastaba ha ahaatee, waxbarashadeenu waxay wajaheysaa xaddidaadyo.Marka hore, waxaanu isticmaalnay oo kaliya cabbiraadaha sawir-qaadista sawirka si loo qeexo oo loo qiimeeyo horumarka, laakiin habab kale ayaa hadda loo heli karaa isla ujeeddo la mid ah, sida falanqaynta biomechanical, oo laga yaabo inay ka horreyso isbeddel kasta oo muuqaal ah ama tomographic.36 Marka labaad, waxaanu isticmaalnaa hal cabbir oo dhammaan cabbirada la tijaabiyay iyo, sida uu qabo Ivo Guber et al., celceliska sawirada badan waxay keenayaan heerarka qaylada cabbirka hoose.28 Iyadoo cabbirada Pentacam® ay si fiican u soo saari karaan indhaha caadiga ah, waxay ahaayeen kuwa hoose ee indhuhu oo leh cillad la'aanta xuubka iyo ectasia corneal.37 Daraasaddan, kaliya waxaan ku soo darnay indho leh Pentacam® ku dhex dhisan ansaxinta iskaanka tayada sare leh, taas oo macnaheedu yahay in cudurka horumaray meesha laga saaray.17 Seddexaad, waxaan ku qeexnaa horumariyeyaasha dhabta ah inay leeyihiin ugu yaraan laba cabbir oo ku salaysan suugaanta laakiin aan weli la xaqiijin.Ugu dambeyntii, iyo laga yaabee in ka sii muhiimsan, kala duwanaanshaha cabbirada Pentacam® waa muhiimad caafimaad marka la qiimeeyo horumarka keratoconus.18,26 Muunaddayada 113 indhood, marka loo qaabeeyey si waafaqsan buundada BAD-D, badi (n=68, 60.2%) indhuhu waxay ahaayeen kuwo dhexdhexaad ah, inta soo hadhayna waa mid hoose ama mid khafiif ah.Si kastaba ha ahaatee, marka la eego cabbirka muunada yar, waxaanu sii haynay falanqaynta guud iyadoon loo eegin darnaanta KTC.Waxaan isticmaalnay qiimihii bilowga ahaa ee ugu wanagsan muunadayada oo dhan, laakiin waxaan aqoonsanahay in tani ay ku dari karto buuqa (kala duwanaanshiyaha) cabirka oo ay kor u qaaddo welwelka ku saabsan dib u soo saarista cabbirka.Soo saarista cabbiradu waxay ku xidhan tahay darnaanta KTC, sida lagu muujiyey Kreps, Gustafsson et al.18,26.Sidaa darteed, waxaan si adag ugu talineynaa in daraasadaha mustaqbalka ay tixgeliyaan marxaladaha kala duwan ee cudurka oo ay qiimeeyaan dhibcaha goynta ugu habboon ee horumarka ku habboon.
Gebagebadii, ogaanshaha hore ee horumarka ayaa ah muhiimada ugu weyn si loo bixiyo daawayn waqtiyeysan si loo joojiyo horumarka (iyada oo la isku xidhidhayo)34 Hadafka ugu weyn ee shaqadeenu waa in aan muujino in EleBmax, oo ku dheggan isla raadiyaha BFS inta u dhaxaysa cabbirada wakhtiga, uu leeyahay waxqabad ka wanaagsan EleBmax laftiisa.Halbeeggani wuxuu muujinayaa gaar ahaan iyo waxtar sare marka la barbar dhigo EleBmax, waa mid ka mid ah cabbirrada ugu xasaasisan (iyo sidaas darteed waxtarka baarista ugu fiican) oo markaa suurtagal ah horusocodka biomarker hore.Waxaa si weyn loogu talinayaa in la sameeyo tusmooyinka cabbirrada badan.Daraasadaha mustaqbalka ee ku lug leh falanqaynta horumarka kala duwan waa inay ku jiraan AdjEleBmax.
Qorayaashu ma helaan wax taageero maaliyadeed ah cilmi-baarista, qorista iyo/ama daabacaadda maqaalkan.
Margarida Ribeiro iyo Claudia Barbosa waa wada-qorayaal daraasadeed.Qorayaashu ma soo sheegaan wax khilaaf ah oo ku saabsan shaqadan.
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