基于 OCT 的新型圆锥角膜分期系统。
New keratoconus staging system based on OCT.
机构信息
From the Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium (Lu, Koppen, Ní Dhubhghaill, Rozema); National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China (Lu, Hafezi, Aslanides, Chen, Cui); State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China (Lu, Chen, Cui); Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Lu, Wang); ELZA Institute, Dietikon, Switzerland (Lu, Hafezi, Torres-Netto); Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Switzerland (Hafezi, Torres-Netto); Faculty of Medicine, University of Geneva, Geneva, Switzerland (Hafezi, Torres-Netto); Department of Ophthalmology, University of Southern California, Los Angeles, California (Hafezi); Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium (Koppen, Rozema); Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain (Alió del Barrio); Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain (Alió del Barrio); Emmetropia Mediterranean Eye Institute, Heraklion, Crete, Greece (Aslanides); The American University of Beirut Medical Center, Beirut, Lebanon (Awwad); The Department of Ophthalmology, Brussels University Hospital, Brussels, Belgium (Ní Dhubhghaill); The faculty of Health Sciences and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Ní Dhubhghaill); Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts (Pineda).
出版信息
J Cataract Refract Surg. 2023 Nov 1;49(11):1098-1105. doi: 10.1097/j.jcrs.0000000000001276.
PURPOSE
To establish a numerical spectral-domain optical coherence tomography (SD-OCT)-based keratoconus (KC) staging system and compare it with existing KC staging systems.
SETTING
Eye Hospital of Wenzhou Medical University, Wenzhou, China.
DESIGNS
Retrospective case-control study.
METHODS
Scheimpflug tomography, air-puff tonometry, and SD-OCT were performed on 236 normal and 331 KC eyes. All SD-OCT-derived parameters of the corneal epithelium and stroma were evaluated based on their receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity to discriminate between normal and KC eyes. The best performing parameters were subsequently used to create an OCT-based staging system, which was compared with existing tomographic and biomechanical staging systems.
RESULTS
236 eyes from 236 normal patients and 331 eyes from 331 KC patients of different stages were included. The highest ranked AUC ROC SD-OCT parameters, derived from stroma and epithelium, were stroma overall minimum thickness (ST: AUC 0.836, sensitivity 90%, specificity 67%) and epithelium overall SD (EP: AUC 0.835, sensitivity 75%, specificity 78%). A numerical SD-OCT staging system called STEP including 2 parameters-"ST" and "EP"-with 5 stages was proposed.
CONCLUSIONS
The new SD-OCT-based KC staging system is the first to take the epithelium with its sublayer stroma information into account, showing a strong agreement to the existing staging systems. This system could be incorporated into daily practice, potentially leading to an overall improvement in KC treatment and follow-up management.
目的
建立基于数字谱域光学相干断层扫描（SD-OCT）的圆锥角膜（KC）分期系统，并与现有的 KC 分期系统进行比较。
设置
温州医科大学附属眼视光医院，中国温州。
设计
回顾性病例对照研究。
方法
对 236 例正常眼和 331 例 KC 眼进行 Scheimpflug 断层扫描、空气脉冲眼压测量和 SD-OCT 检查。根据受试者工作特征（ROC）曲线、曲线下面积（AUC）、敏感性和特异性，评估所有源自角膜上皮和基质的 SD-OCT 衍生参数，以区分正常眼和 KC 眼。随后，使用表现最佳的参数创建基于 OCT 的分期系统，并与现有的断层成像和生物力学分期系统进行比较。
结果
纳入了 236 例正常患者的 236 只眼和 331 例不同分期 KC 患者的 331 只眼。源自基质和上皮的最高排名 AUC ROC SD-OCT 参数是基质总最小厚度（ST：AUC 0.836，敏感性 90%，特异性 67%）和上皮总标准差（EP：AUC 0.835，敏感性 75%，特异性 78%）。提出了一种名为 STEP 的数值 SD-OCT 分期系统，包括 2 个参数——“ST”和“EP”，共 5 个阶段。
结论
新的基于 SD-OCT 的 KC 分期系统首次考虑了上皮及其亚层基质信息，与现有的分期系统具有很强的一致性。该系统可纳入日常实践，可能会全面改善 KC 的治疗和随访管理。
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