Assessing progression limits in different grades of keratoconus from a novel perspective: precision of measurements of the corneal epithelium.

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

Eye and Vision Pub Date : 2024-01-02 DOI:10.1186/s40662-023-00368-9

Rui Ning, Yiran Wang, Zhenyu Xu, Ingemar Gustafsson, Jiawei Li, Giacomo Savini, Domenico Schiano-Lomoriello, Yichen Xiao, Aodong Chen, Xiaoying Wang, Xingtao Zhou, Jinhai Huang

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引用次数: 0

Abstract

Background: To assess repeatability and reproducibility of corneal epithelium thickness (ET) measured by a spectral-domain optical coherence tomographer (SD-OCT)/Placido topographer (MS-39, CSO, Florence, Italy) in keratoconus (KC) population at different stages, as well as to determine the progression limits for evaluating KC progression.

Methods: A total of 149 eyes were enrolled in this study, with 29 eyes in the forme fruste keratoconus (FFKC) group, 34 eyes in the mild KC group, 40 eyes in the moderate KC group, and 46 eyes in the severe KC group. Employing the within-subject standard deviation (S_w), test-retest variability (TRT), coefficient of variation (CoV), and intraclass correlation coefficient (ICC) to evaluate intraoperator repeatability and interoperator reproducibility.

Results: The repeatability and reproducibility of MS-39 in patients with KC were acceptable, according to ICC values ranging from 0.732 to 0.954. However, patients with more severe KC and progressive peripheralization of the measurement points had higher TRTs but a thinning trend. The current study tended to set the cut-off values of mild KC, moderate KC, and severe KC to 4.9 µm, 5.2 µm, and 7.4 µm for thinnest epithelium thickness (TET). When differences between follow-ups are higher than those values, progression of the disease is possible. As for center epithelium thickness (CET), cut-off values for mild KC, moderate KC, and severe KC should be 2.8 µm, 4.4 µm, and 5.3 µm. This might be useful in the follow-up and diagnosis of keratoconus.

Conclusions: This study demonstrated that the precision of MS-39 was reduced in measuring more severe KC patients and more peripheral corneal points. In determining disease progression, values should be differentiated between disease-related real changes and measurement inaccuracies. Due to the large difference in ET measured by MS-39 between various stages of disease progression, it is necessary to accurately grade KC patients to avoid errors in KC clinical decision-making.

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从新的角度评估不同等级角膜病的进展极限：角膜上皮测量的精确性。

背景：目的：评估光谱域光学相干断层扫描仪（SD-OCT）/Placido角膜地形图仪（MS-39，CSO，意大利佛罗伦萨）在不同阶段的角膜上皮厚度（ET）测量的重复性和再现性，并确定评估角膜上皮厚度的进展极限：本研究共招募了 149 只眼睛，其中 29 只属于 FFKC 组，34 只属于轻度 KC 组，40 只属于中度 KC 组，46 只属于重度 KC 组。采用受试者内标准偏差（Sw）、重复测试变异性（TRT）、变异系数（CoV）和类内相关系数（ICC）来评估操作者内的重复性和操作者间的再现性：根据 0.732 至 0.954 的 ICC 值，MS-39 对 KC 患者的重复性和再现性均可接受。然而，KC 更严重和测量点逐渐周边化的患者的 TRT 值更高，但有变薄的趋势。目前的研究倾向于将轻度 KC、中度 KC 和重度 KC 的最薄上皮厚度 (TET) 的临界值分别设定为 4.9 µm、5.2 µm 和 7.4 µm。当两次随访之间的差异高于这些值时，疾病就有可能恶化。至于中心上皮厚度（CET），轻度 KC、中度 KC 和重度 KC 的临界值应分别为 2.8 微米、4.4 微米和 5.3 微米。这可能有助于角膜炎的随访和诊断：这项研究表明，在测量更严重的 KC 患者和更多的周边角膜点时，MS-39 的精确度会降低。在确定疾病进展时，应区分与疾病相关的实际变化和测量误差。由于 MS-39 测得的 ET 值在疾病进展的不同阶段差异很大，因此有必要对 KC 患者进行准确分级，以避免 KC 临床决策失误。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Eye and Vision OPHTHALMOLOGY-

CiteScore

8.60

自引率

2.40%

发文量

审稿时长

15 weeks

期刊介绍： Eye and Vision is an open access, peer-reviewed journal for ophthalmologists and visual science specialists. It welcomes research articles, reviews, methodologies, commentaries, case reports, perspectives and short reports encompassing all aspects of eye and vision. Topics of interest include but are not limited to: current developments of theoretical, experimental and clinical investigations in ophthalmology, optometry and vision science which focus on novel and high-impact findings on central issues pertaining to biology, pathophysiology and etiology of eye diseases as well as advances in diagnostic techniques, surgical treatment, instrument updates, the latest drug findings, results of clinical trials and research findings. It aims to provide ophthalmologists and visual science specialists with the latest developments in theoretical, experimental and clinical investigations in eye and vision.