Dong Ruilan, Liu Yan, Zhang Yu, Chen Yueguo
Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
Front Bioeng Biotechnol. 2023 Oct 6;11:1266940. doi: 10.3389/fbioe.2023.1266940. eCollection 2023.
To evaluate the interocular consistency of biomechanical properties in normal, keratoconus (KC) and subclinical keratoconus (SKC) populations and explore the application of interocular asymmetry values in KC and SKC diagnoses. This was a retrospective chart-review study of 331 ametropic subjects (control group) and 207 KC patients (KC group, including 94 SKC patients). Interocular consistency was evaluated using the intraclass correlation coefficient (ICC). Interocular asymmetry was compared between the control and KC groups and its correlation with disease severity was analyzed. Three logistic models were constructed using biomechanical monocular parameters and interocular asymmetry values. The diagnostic ability of interocular asymmetry values and the newly established models were evaluated using receiver operating characteristic curves and calibration curves. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were also estimated. The interocular consistency significantly decreased and the interocular asymmetry values increased in KC patients compared with those in control individuals. In addition, the interocular asymmetry values increased with respect to the severity of KC. The binocular assisted biomechanical index (BaBI) had an area under the curve (AUC) of 0.998 (97.8% sensitivity, 99.2% specificity; cutoff 0.401), which was statistically higher than that of the Corvis biomechanical index [CBI; AUC = 0.935, < 0.001 (DeLong's test), 85.6% sensitivity]. The optimized cutoff of 0.163 provided an AUC of 0.996 for SKC with 97.8% sensitivity, which was higher than that of CBI [AUC = 0.925, < 0.001 (DeLong's test), 82.8% sensitivity]. Biomechanical interocular asymmetry values can reduce the false-negative rate and improve the performance in KC and SKC diagnoses.
评估正常人群、圆锥角膜（KC）患者和亚临床圆锥角膜（SKC）患者生物力学特性的眼间一致性，并探讨眼间不对称值在KC和SKC诊断中的应用。这是一项对331例屈光不正受试者（对照组）和207例KC患者（KC组，包括94例SKC患者）的回顾性图表审查研究。使用组内相关系数（ICC）评估眼间一致性。比较对照组和KC组之间的眼间不对称性，并分析其与疾病严重程度的相关性。使用生物力学单眼参数和眼间不对称值构建三个逻辑模型。使用受试者工作特征曲线和校准曲线评估眼间不对称值和新建立模型的诊断能力。还估计了净重新分类改善（NRI）和综合辨别改善（IDI）。与对照组相比，KC患者的眼间一致性显著降低，眼间不对称值增加。此外，眼间不对称值随着KC严重程度的增加而增加。双眼辅助生物力学指数（BaBI）的曲线下面积（AUC）为0.998（敏感性97.8%，特异性99.2%；临界值0.401），在统计学上高于Corvis生物力学指数[CBI；AUC = 0.935，<0.001（德龙检验），敏感性85.6%]。对于SKC，优化后的临界值0.163的AUC为0.996，敏感性为97.8%，高于CBI[AUC = 0.925，<0.001（德龙检验），敏感性82.8%]。生物力学眼间不对称值可以降低假阴性率，并提高KC和SKC诊断的性能。
