Predicting the Prognosis of Fuchs Endothelial Corneal Dystrophy by Using Scheimpflug Tomography
Predicting the Prognosis of Fuchs Endothelial Corneal Dystrophy by Using Scheimpflug Tomography
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DOI：
10.1016/j.ophtha.2019.09.033
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发表时间：
2020-03-01
期刊：
影响因子：
13.7
通讯作者：
Baratz, Keith H.
中科院分区：
文献类型：
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作者：
Patel, Sanjay V.;Hodge, David O.;Baratz, Keith H.
目的：探讨Scheimpflug断层厚测图和后仰图模式、角膜中央厚度（CCT）和角膜后向散射是否能预测Fuchs内皮性角膜营养不良（FECD）的预后。设计：横断面研究，随访结果。受试者：96只眼睛（56名受试者），FECD的严重程度不等。方法：由角膜专科医生根据眼液面积、眼液汇合处及临床明确的水肿情况对角膜进行分级。由1名观察人员对蒙面和随机化的Scheimpflug成像测厚图和后仰角图模式进行评估，以确定规则等厚线的缺失、角膜最薄点的移位以及后表面凹陷的存在。在5年（中位）随访期间，眼睛的预后是根据FECD进展（临床明确的新发水肿或>= CCT增加5%）或内皮角膜移植术干预来确定的。通过生存分析估计进展和干预的累积概率，并使用Cox比例风险模型确定危险因素。主要观察指标：角膜厚测图和后仰图模式，角膜后向散射和CCT（超声厚测）。结果：在单因素分析中，常规等径的丧失（风险比[HR]， 18.00）、最薄点移位（风险比，11.53）、局灶性后表面凹陷（风险比，10.21）和角膜前背散射（风险比，1.22，每1个灰度单位增量）是进展或干预的危险因素（P < 0.001），而CCT（风险比，1.30，每25个灰度单位增量）不是（P = 0.15）。在多变量分析中，常规等压条缺失（HR, 11.57, P < 0.001）和最薄点移位（HR, 5.61, P = 0.02）是影响病情进展和干预的独立且重要的临床危险因素。疾病进展和干预的5年累积风险分别为7%，48%和89%，当无，1或2，以及所有3个厚测图和后抬高图参数均存在时(P
Purpose: To determine if Scheimpflug tomography pachymetry map and posterior elevation map patterns, central corneal thickness (CCT), and corneal backscatter can predict the prognosis of Fuchs endothelial corneal dystrophy (FECD).Design: Cross-sectional study with follow-up of outcomes.Participants: Ninety-six eyes (56 subjects) with a range of severity of FECD.Methods: Corneas were graded by cornea specialists according to the area and confluence of guttae and the presence of clinically definite edema. Masked and randomized Scheimpflug imaging pachymetry map and posterior elevation map patterns were assessed by 1 observer for loss of regular isopachs, displacement of the thinnest point of the cornea, and the presence of posterior surface depression. The prognosis of eyes over a 5-year (median) follow-up period was determined based on FECD progression (new onset of clinically definite edema or >= 5% increase in CCT) or intervention by endothelial keratoplasty. Cumulative probabilities of progression and intervention were estimated from survival analyses, with risk factors determined by using Cox proportional hazards models.Main Outcome Measures: Pachymetry map and posterior elevation map patterns, corneal backscatter, and CCT (ultrasonic pachymetry).Results: In univariate analyses, loss of regular isopachs (hazard ratio [HR], 18.00) displacement of the thinnest point (HR, 11.53), focal posterior surface depression (HR, 10.21), and anterior corneal backscatter (HR, 1.22, per 1-grayscale unit increment), were risk factors for progression or intervention (P < 0.001), whereas CCT (HR, 1.30, per 25-iim increment) was not (P = 0.15). In multivariate analyses, loss of regular isopachs (HR, 11.57; P < 0.001) and displacement of the thinnest point (HR, 5.61; P = 0.02) were independent and clinically important risk factors for progression and intervention. The 5-year cumulative risk of disease progression and intervention was 7%, 48%, and 89% when none, 1 or 2, and all 3 pachymetry map and posterior elevation map parameters were present, respectively (P