圆锥角膜自然进展：11529 只眼的系统评价和荟萃分析。

Keratoconus Natural Progression: A Systematic Review and Meta-analysis of 11 529 Eyes.

机构信息

The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia.

出版信息

Ophthalmology. 2019 Jul;126(7):935-945. doi: 10.1016/j.ophtha.2019.02.029. Epub 2019 Mar 8.

DOI:10.1016/j.ophtha.2019.02.029

PMID:30858022

Abstract

PURPOSE

We set out to describe the natural history of keratoconus. We included untreated patients, and our key outcome measures were vision, refraction, and corneal curvature.

CLINICAL RELEVANCE

Keratoconus affects 86 in 100 000 people, causing visual loss due to increasing irregular corneal astigmatism, and the quality of life declines in patients. Interventions are used to stabilize the disease or improve vision, including corneal cross-linking (CXL) and grafting, but these carry risks. Detailed knowledge of the natural history of keratoconus is fundamental in making informed decisions on when their benefits outweigh these risks.

METHODS

We included prospective or retrospective studies of pediatric or adult patients who reported 1 or more of visual acuity, refraction, and corneal curvature measures: steep keratometry (K), mean keratometry (K), or maximum keratometry (K), thinnest pachymetry, corneal transplantation rates, corneal scarring incidence, and patient-reported outcome measures (PROMs). Databases analyzed included Medline, Embase, CENTRAL, and CINAHL. Searches were carried out until October 2018. Bias assessment was carried out using the Joanna Briggs Institute model of evidence-based healthcare.

RESULTS

Our search yielded 3950 publication titles, of which 41 were included in our systematic review and 23 were incorporated into the meta-analysis. Younger patients and those with greater K demonstrated more steepening of K at 12 months. The meta-analysis for K demonstrated a significant increase in K of 0.7 diopters (D) at 12 months (95% confidence interval [CI], 0.31-1.14; P = 0.003). Our meta-regression model predicted that patients had 0.8 D less K steepening over 12 months for every 10-year increase in age (P = 0.01). Patients were predicted to have 1 D greater K steepening for every 5 D of greater baseline K (P = 0.003). At 12 months, there was a significant increase in the average K of 0.4 D (95% CI, 0.18-0.65; P = 0.004).

CONCLUSIONS

We report the first systematic review and meta-analysis of keratoconus natural history data including 11 529 eyes. Younger patients and those with K steeper than 55 D at presentation have a significantly greater risk of progression of keratoconus. Closer follow-up and a lower threshold for cross-linking should be adopted in patients younger than 17 years and steeper than 55 D K.

摘要

目的

我们旨在描述圆锥角膜的自然病程。我们纳入了未经治疗的患者，主要的结局指标是视力、屈光度和角膜曲率。

临床相关性

圆锥角膜的发病率为每 10 万人中有 86 人，可导致角膜不规则散光逐渐加重而导致视力丧失，患者的生活质量下降。目前采用角膜交联术（CXL）和移植术等方法来稳定病情或改善视力，但这些方法存在风险。详细了解圆锥角膜的自然病程对于在何时权衡其获益与风险做出明智决策至关重要。

方法

我们纳入了报告 1 项或多项视力、屈光度和角膜曲率指标（角膜陡峭值 K、平均角膜曲率 K 或最大角膜曲率 K、最薄角膜厚度、角膜移植率、角膜瘢痕发生率和患者报告结局指标（PROMs）的前瞻性或回顾性儿科或成人患者的研究。分析的数据库包括 Medline、Embase、CENTRAL 和 CINAHL。检索截至 2018 年 10 月。使用循证医疗的 Joanna Briggs 研究所证据评估模型进行偏倚评估。

结果

我们的检索得到了 3950 个出版物标题，其中 41 个被纳入系统评价，23 个被纳入荟萃分析。年轻患者和 K 值较大的患者在 12 个月时 K 值的陡峭程度增加更明显。K 值的荟萃分析显示，在 12 个月时 K 值显著增加 0.7 屈光度（D）（95%置信区间[CI]，0.31-1.14；P=0.003）。我们的元回归模型预测，患者的年龄每增加 10 岁，12 个月时 K 值的陡峭程度就会减少 0.8 D（P=0.01）。患者的 K 值基线每增加 5 D，K 值的陡峭程度就会增加 1 D（P=0.003）。在 12 个月时，平均 K 值显著增加 0.4 D（95%CI，0.18-0.65；P=0.004）。