Epithelial Mapping Efficacy for Subclinical Keratoconus Identification

IF 4.1 1区 医学 Q1 OPHTHALMOLOGY
BARBARA A. L. DUTRA , BASSEL HAMMOUD , BIANCA N. SUSANNA , LARA ASROUI , GIULIANO SCARCELLI , WILLIAM J. DUPPS JR , J. BRADLEY RANDLEMAN
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Abstract

PURPOSE

To evaluate the utility of automated epithelial thickness metrics to identify subclinical keratoconus (SKC) through epithelial thickness pattern comparisons between normal controls, (SKC), and manifest keratoconus (KC).

DESIGN

Retrospective cross-sectional study.

METHODS

There were 200 eyes from 200 patients evaluated, including: (1) 100 control eyes from 100 patients with bilaterally normal corneal topography/tomography and slit-lamp examination (controls); (2) 50 eyes from 50 patients with SKC; (3) 50 eyes from 50 patients with KC. Epithelial mapping was performed using anterior segment optical coherence tomography (AS-OCT) imaging (Avanti RTVue XR, Optovue). Area under the receiver operating characteristic (AUROC) curves were used to determine the overall discriminative accuracy of the significant test parameters as described by the area under the curve (AUC) and to calculate the sensitivity and specificity of each parameter.

RESULTS

There were no differences between control and SKC groups in any regional OCT epithelial thickness parameter. Among relational epithelial thickness metrics, only superonasal - inferotemporal (SN-IT) value differences reached statistical significance between control and SKC groups (–0.81 μm versus 0.41 μm), but this metric still showed limited performance in differentiating groups (AUROC = 0.68). Most stromal thickness values were significantly different between SKC and controls.

CONCLUSION

Epithelial thickness patterns were not effective as a primary metric to identify subclinical keratoconus. Scheimpflug metrics and regional stromal thickness values significantly outperformed epithelial metrics in differentiating both SKC and KC eyes from controls. Epithelial mapping metrics thus appear significantly less sensitive than predicted for subclinical keratoconus detection in early disease manifestations.
目的:通过比较正常对照组(SKC)和显性角膜病(KC)的上皮厚度模式,评估自动上皮厚度指标在识别亚临床角膜病(SKC)方面的实用性:方法:对 200 名患者的 200 只眼睛进行评估,其中包括:(1) 100 名双侧角膜地形图/断层扫描和裂隙灯检查正常的患者的 100 只对照眼(对照组);(2) 50 名 SKC 患者的 50 只眼睛;(3) 50 名 KC 患者的 50 只眼睛。使用前段光学相干断层扫描(AS-OCT)成像(Avanti RTVue XR,Optovue)进行上皮映射。使用接收者操作特征曲线下面积(AUROC)来确定曲线下面积(AUC)所描述的重要测试参数的总体判别准确性,并计算每个参数的敏感性和特异性:结果:对照组和 SKC 组在任何区域 OCT 上皮厚度参数上都没有差异(所有参数的 p>0.05)。在关系性上皮厚度指标中,对照组和 SKC 组之间只有上基底-下基底(SN-IT)值差异达到统计学意义(-0.81 μm vs. 0.41 μm,p = 0.003),但这一指标在区分组别方面仍表现有限(AUROC = 0.68)。大多数基质厚度值在 SKC 和对照组之间存在显著差异(p 结论:上皮厚度模式不能作为识别亚临床角膜病的主要指标。Scheimpflug 指标和区域基质厚度值在区分 SKC 和 KC 眼睛与对照组方面明显优于上皮指标。因此,在疾病早期表现的亚临床角膜病检测中,上皮映射指标的灵敏度明显低于预测值。
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来源期刊
CiteScore
9.20
自引率
7.10%
发文量
406
审稿时长
36 days
期刊介绍: The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.
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