Ribeiro Margarida, Barbosa Cláudia, Correia Paulo, Torrão Luís, Neves Cardoso Pedro, Moreira Raúl, Falcão-Reis Fernando, Falcão Manuel, Pinheiro-Costa João
Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.
Department of Biomedicine - Faculty of Medicine of Porto University, Porto, Portugal.
Clin Ophthalmol. 2022 Dec 20;16:4239-4248. doi: 10.2147/OPTH.S388614. eCollection 2022.
We evaluated the Maximum Elevation of Corneal Back Surface adjusted to the same Best Fit Sphere Back (BFSB) between timeline measurements (AdjEleBmax) and the BFSB radius (BFSBR) itself as new tomographic parameters for documentation of ectasia progression and compare them with the most recent and reliable parameters used on keratoconus (KC) progression.
We evaluated the performance and the ideal cutoff point of Kmax, D-index, posterior radius of curvature from the 3.0 mm centered on the thinnest point (PRC), EleBmax, BFSBR, and AdjEleBmax as isolated parameters to document KC progression (defined as a significant change in two or more variables), we found a sensitivity of 70%, 82%, 79%, 65%, 51%, and 63% and a specificity of 91%, 98%, 80%, 73%, 80%, and 84% to detect KC progression. The area under the curve (AUC) for each variable was 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, respectively.
AdjEleBmax presented a greater specificity, larger AUC, and better performance compared to EleBmax without any adjustment, with similar sensitivity. Although AdjEleBmax and BFSB demonstrated smaller AUC and specificities comparing with Kmax and D-Index, AdjEleBmax still presented a good performance with a reasonable AUC. Since the shape of the posterior surface, more aspheric and curved than the anterior, may facilitate detection of change, we suggest the inclusion of AdjEleBmax in the evaluation of KC progression in conjunction with other variables to increase the reliability of our clinical evaluation and early detection of progression.
我们评估了在时间线测量之间调整到相同最佳拟合球面后表面（BFSB）的角膜后表面最大高度（AdjEleBmax）和BFSB半径（BFSBR）本身，作为记录扩张进展的新断层扫描参数，并将它们与用于圆锥角膜（KC）进展的最新且可靠的参数进行比较。
我们评估了Kmax、D指数、以最薄点为中心的3.0mm处的后曲率半径（PRC）、EleBmax、BFSBR和AdjEleBmax作为记录KC进展（定义为两个或更多变量的显著变化）的独立参数的性能和理想截断点，我们发现检测KC进展的敏感性分别为70%、82%、79%、65%、51%和63%，特异性分别为91%、98%、80%、73%、80%和84%。每个变量的曲线下面积（AUC）分别为0.822、0.927、0.844、0.690、0.695、0.754。
与未进行任何调整的EleBmax相比，AdjEleBmax具有更高的特异性、更大的AUC和更好的性能，敏感性相似。尽管AdjEleBmax和BFSB与Kmax和D指数相比显示出较小的AUC和特异性，但AdjEleBmax仍具有良好的性能和合理的AUC。由于后表面的形状比前表面更非球面且更弯曲，可能有助于检测变化，我们建议将AdjEleBmax与其他变量一起纳入KC进展的评估中，以提高我们临床评估的可靠性和进展的早期检测。
