Henriquez Maria A, Larco Carolina, Izquierdo Luis
Research Department, Oftalmosalud Eye Institute, Lima 27, Perú.
Cornea. 2024 Dec 12. doi: 10.1097/ICO.0000000000003777.
To identify the definitions used for progressive keratoconus in the literature.
A systematic literature review aimed to identify the definitions used for "progressive keratoconus" in the published articles. A comprehensive search from January 2018 to May 2023 was conducted across Cochrane Library, PubMed, Taylor & Francis, Web of Science, and other bibliographic databases at Oftalmosalud, Lima, Peru. The inclusion criteria were articles including patients with keratoconus without any previous surgical procedure and containing the definition of "progressive keratoconus" or "keratoconus progression" and a sample size greater than 10 eyes.
A total of 221 articles were included for analysis. The 3 most frequent parameters to define progression included data from anterior curvature, pachymetry, and refraction used in 97.8% (216/221), 37.6% (83/221), and 32.1% (71/221) of the articles, respectively. Specifically, the most frequent criterion used was maximum keratometry (Kmax), used in 85.5% (189/221) of the articles. Progression was assessed between 6- and 12-month follow-up in 64.7% (143/221) of the articles. Data from posterior cornea were used in only 8.1% (18/221) of the studies. None of the studies included data from the corneal epithelium.
The present study demonstrates the lack of unified criteria to define progression of keratoconus and an underutilization of the technology described. It also shows that the single point Kmax measurement is the most commonly used criterion, followed by a change in refractive astigmatism and thinning at the thinnest pachymetric point.
确定文献中用于描述圆锥角膜进展的定义。
进行一项系统性文献综述，旨在找出已发表文章中用于“进展性圆锥角膜”的定义。于2018年1月至2023年5月在Cochrane图书馆、PubMed、泰勒与弗朗西斯数据库、科学网以及秘鲁利马Oftalmosalud的其他书目数据库中进行全面检索。纳入标准为文章纳入了未曾接受过任何手术的圆锥角膜患者，包含“进展性圆锥角膜”或“圆锥角膜进展”的定义，且样本量大于10只眼。
共纳入221篇文章进行分析。定义进展的3个最常见参数分别为来自前表面曲率、角膜厚度测量和验光的数据，分别在97.8%（216/221）、37.6%（83/221）和32.1%（71/221）的文章中使用。具体而言，最常用的标准是最大角膜曲率（Kmax），在85.5%（189/221）的文章中使用。64.7%（143/221）的文章在6至12个月的随访期间评估进展情况。仅8.1%（18/221）的研究使用了后表面角膜的数据。没有一项研究纳入角膜上皮的数据。
本研究表明缺乏统一的标准来定义圆锥角膜的进展，且所描述的技术未得到充分利用。研究还表明，单点Kmax测量是最常用的标准，其次是屈光性散光的变化和最薄角膜厚度点处的变薄。
