Офтальмохирургия. 2020; : 30-35
Исследование клинико-статистических, анатомо-оптических и функциональных характеристик первичных кератэктазий у пациентов, проживающих в Дальневосточном федеральном округе России
https://doi.org/10.25276/0235-4160-2020-4-30-35Аннотация
Цель. Исследовать клинико-статистические, анатомо-оптические и функциональные характеристики первичных кератэктазий (ПКЭ) у пациентов, проживающих в Дальневосточном федеральном округе России.
Материал и методы. Проведен ретроспективный анализ амбулаторных карт 481 пациента, наблюдавшегося в Хабаровском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России по поводу ПКЭ. Изучали выявляемость ПКЭ по годам, их количественную структуру и стадийность. Исследовали остроту зрения, рефракцию, максимальную кератометрию, минимальную толщину роговицы.
Результаты. Кератоконус (КК) имел место у 445 (92,5%) пациентов, пеллюцидная маргинальная дистрофия роговицы (ПМДР) – у 36 (7,5%). Среди пациентов с КК были 309 (69,4%) мужчин, женщин – 136 (30,6%). ПМДР была диагностирована у 19 (53%) мужчин и у 17 (47%) женщин. У 386 (86,7%) пациентов с КК поражение было двусторонним. Среди остальных 59 пациентов с КК 6 (1,3%) больных имели односторонний процесс, а у 53 (12%) пациентов были признаки субклинического КК на парном глазу. Двусторонняя ПМДР обнаружена у 35 (97%) пациентов, у одного (3%) пациента заболевание выявлена на одном глазу. При сопоставимых средних значениях рефракции и толщины роговицы в глазах с ПМДР и КК 1-й стадии показатели астигматизма при ПМДР оказались в 2–2,5 раза больше.
Заключение. Среди пациентов с КК 2-ю стадию заболевания имеют 34,9%, при которой показатели остроты зрения уже достаточно снижены, а 28,5% пациентов с 3-й и 4-й стадиями КК можно отнести к категории слабовидящих. Выявленные отличия в соотношении функциональных и рефракционных показателей глаз с КК и ПМДР обусловливают необходимость более широкого изучения диагностических особенностей и результатов лечения последней.
Список литературы
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3. Пучковская Н.А. Кератоконус. Кишинев: Тимлул; 1990. [Puchkovskaya NA. Keratokonus. Kishinev: Timlul; 1990. (In Russ.)]
4. Титаренко З.Д. О классификации кератоконуса. Офтальмологический журнал. 1982;3: 169–171. [Titarenko ZD. O klassifikatsii keratokonusa. Oftal’mologicheskiy zhurnal. 1982;3: 169–171. (In Russ.)]
5. Kennedy RH, Bourne WM, Dyer JA. A 48-year clinical and epidemiologic study of keratoconus. Am J Ophthalmol. 1986;101(3): 267–273. doi: 10.1016/0002-9394(86)90817-2
6. Khor WB, Wei RH, Lim L, Chan CM, Tan DT. Keratoconus in Asians: demographics, clinical characteristics and visual function in a hospital-based population. Clin Exp Ophthalmol. 2011;39(4): 299–307. doi: 10.1111/j.1442-9071.2010.02458.x
7. Maguire LJ, Klyce SD, McDonald MB, Kaufman HE. Corneal topography of pellucid marginal degeneration. Ophthalmology. 1987;94(5): 519–524. doi: 10.1016/s0161-6420(87)33416-5
8. Sridhar MS, Mahesh S, Bansal AK, Nutheti R, Rao GN. Pellucid marginal corneal degeneration. Ophthalmology. 2004;111(6): 1102–1107. doi: 10.1016/j.ophtha.2003.09.035
9. Tang M, Shekhar R, Miranda D, Huang D. Characteristics of keratoconus and pellucid marginal degeneration in mean curvature maps. Am J Ophthalmol. 2005;140(6): 993–1001. doi: 10.1016/j.ajo.2005.06.026
10. Belin M, Ambrosio R. Scheimpflug imaging for keratoconus and ectatic disease. Indian J Ophthalmol. 2013;61(8): 401–406. doi: 10.4103/0301-4738.116059
11. Rabinowitz YS, McDonnell PJ. Computerassisted corneal topography in keratoconus. Refrac Corneal Surg. 1989;5(6): 400–408.
12. Savini G, Barboni P, Carbonelli M, Hoffer KJ. Repeatability of automatic measurements by a new Scheimpflug camera combined with Placido topography. J Cataract Refract Surg. 2011;37(10): 1809–1816. doi: 10.1016/j.jcrs.2011.04.033
13. de Sanctis U, Loiacono C, Richiardi L, Turco D, Mutani B, Grignolo FM. Sensitivity and specificity of posterior corneal elevation measured by Pentacam in discriminating keratoconus/subclinical keratoconus. Ophthalmology. 2008;115(9): 1534–1539. doi: 10.1016/j.ophtha.2008.02.020
14. Wilson SE, Lin DTC, Klyce SD. Corneal topography of keratoconus. Cornea. 1991;10(1): 2–8.
15. Gordon-Shaag A, Millodot M, Shneor E, Liu Y. The genetic and environmental factors for keratoconus. Biomed Res Int. 2015;2015: 795738. doi: 10.1155/2015/795738
16. Bawazeer M, Hodge WG, Lorimer B. Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol. 2000;84(8): 834–836. doi: 10.1136/bjo.84.8.834
17. Georgiou T, Funnell CL, Cassels-Brown A, O’Conor R. Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asians and white patients. Eye (Lond). 2004;18(4): 379–383. doi: 10.1038/sj.eye.6700652
18. Lee LR, Hirst LW, Readshaw G. Clinical detection of unilateral keratoconus. Aust N Z J Ophthalmol. 1995;23(2): 129–133. doi: 10.1111/j.1442-9071.1995.tb00141.x
19. Lim N, Vogt U. Characteristics and functional outcomes of 130 patients with keratoconus attending a specialist contact lens clinic. Eye. 2002;16(1): 54–59. doi: 10.1038/sj.eye.6700061
20. Ota R, Fujiki K, Nakayasu K. Estimation of patient visit rate and incidence of keratoconus in the 23 wards of Tokyo. Nippon Ganka Gakkai Zasshi. 2002;106(6): 365–372.
21. Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology. 1993;100(2): 181–186. doi: 10.1016/s0161-6420(93)31673-8
22. Rafati S, Hashemi H, Nabovati P, Doostdar AB, Yekta AC, Aghamirsalim M, Khabazkhoobe M. Demographic profile, clinical, and topographic characteristics of keratoconus patients attending at a tertiary eye center. J Curr Ophthalmol. 2019;31(3): 268–274. doi: 10.1016/j.joco.2019.01.013
23. Подтынных Е.В., Измайлова С.Б., Комаровских Е.Н. Клинико-социальный портрет пациентов с кератоконусом, проживающих в южных регионах России. Офтальмохирургия. 2019;1: 62–66. [Podtynnyh EV, Izmailova SB, Komarovskikh EN. Clinical and social portrait of patients with Keratoconus, living in the southern regions of Russia. Fyodorov Journal of Ophthalmic Surgery. 2019;1: 62–66. (In Russ.)] doi: 10.25276/0235-4160-2019-1-62-66
24. Millodot M, Shneor E, Albou S, Atlani E, Gordon-Shaag A. Prevalence and associated factors of keratoconus in jerusalem: a cross-sectional study. Ophthalmic Epidemiol. 2011;18(2): 91–97. doi: 10.3109/09286586.2011.560747
25. Слонимский А.Ю., Ситник Г.В., Слонимский Ю.Б., Мягков А.В., Милаш С.В. Пеллюцидная маргинальная дегенерация роговицы и кератоконус: дифференциальный диагноз и тактика ведения больных. Офтальмология. 2019;4: 433–441. [Slonimskiy AYu, Slonimskiy YuB, Sitnik HV, Myagkov AV, Milash SV. Pellucid marginal corneal degeneration and keratoconus: differential diagnosis and management of patients. Ophthalmology in Russia. 2019;16(4): 433–442. (In Russ.)] doi: 10.18008/1816-5095-2019-4-433-441
26. Горскова Е.Н., Севостьянов Е.Н. Эпидемиология кератоконуса на Урале. Вестник офтальмологии. 1998;114(4): 38–40. [Gorskova EN, Sevostyanov EN. Epidemiology of keratoconus in the Urals. Vestnik oftal’mologii. 1998;114 (4): 38–40. (In Russ.)]
Fyodorov Journal of Ophthalmic Surgery. 2020; : 30-35
Study of clinical, statistical, anatomical, optical and functional properties of primary keratoectasia in patients living in the Far Eastern Federal District of Russia
https://doi.org/10.25276/0235-4160-2020-4-30-35Abstract
Purpose. To study clinical, statistical, anatomical, optical and functional properties of primary keratoectasia (PKE) in patients living in Far Eastern Federal District of Russia.
Material and methods. A retrospective analysis of medical outpatient cards of 481 patients with PKE who observed in the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution. We studied the detectability of PKE over the years, their quantitative structure and staging, visual acuity, refraction, maximum keratometry-readings and minimum corneal thickness.
Results. Keratoconus (KC) occurred in 445 (92.5%) patients, pellucid marginal degeneration (PMD) occurred in 36 (7.5%). Among patients with KC, it was observed in 309 (69.4%) men and 136 (30.6%) in women. PMD was diagnosed in 19 (53%) men and 17 (47%) women. In 386 (86.7%) people with KC, the lesion was bilateral. Among the remaining 59 patients with KC, 6 people (1.3%) had a one-sided process, and 53 (12%) patients had signs of subclinical KC in the second eye. Bilateral PMD was detected in 35 (97%) people, in one (3%) patient the disease was detected in one eye. At comparable average values of refraction and corneal thickness in eyes with PMD and KC 1st stage, astigmatism-at PMD were 2–2.5 times greater.
Conclusion. Among patients with KC, 34.9% eyes have the 2nd stage of the disease, in which visual acuity are already sufficiently reduced, and 28.5% eyes have KC the 3rd and the 4th stage and can be classified as visually impaired. The revealed differences in ratio of functional and refractive indexes of eyes with KC and PMD necessitate wider study of their diagnostic features and results of treatment latter.
References
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3. Puchkovskaya N.A. Keratokonus. Kishinev: Timlul; 1990. [Puchkovskaya NA. Keratokonus. Kishinev: Timlul; 1990. (In Russ.)]
4. Titarenko Z.D. O klassifikatsii keratokonusa. Oftal'mologicheskii zhurnal. 1982;3: 169–171. [Titarenko ZD. O klassifikatsii keratokonusa. Oftal’mologicheskiy zhurnal. 1982;3: 169–171. (In Russ.)]
5. Kennedy RH, Bourne WM, Dyer JA. A 48-year clinical and epidemiologic study of keratoconus. Am J Ophthalmol. 1986;101(3): 267–273. doi: 10.1016/0002-9394(86)90817-2
6. Khor WB, Wei RH, Lim L, Chan CM, Tan DT. Keratoconus in Asians: demographics, clinical characteristics and visual function in a hospital-based population. Clin Exp Ophthalmol. 2011;39(4): 299–307. doi: 10.1111/j.1442-9071.2010.02458.x
7. Maguire LJ, Klyce SD, McDonald MB, Kaufman HE. Corneal topography of pellucid marginal degeneration. Ophthalmology. 1987;94(5): 519–524. doi: 10.1016/s0161-6420(87)33416-5
8. Sridhar MS, Mahesh S, Bansal AK, Nutheti R, Rao GN. Pellucid marginal corneal degeneration. Ophthalmology. 2004;111(6): 1102–1107. doi: 10.1016/j.ophtha.2003.09.035
9. Tang M, Shekhar R, Miranda D, Huang D. Characteristics of keratoconus and pellucid marginal degeneration in mean curvature maps. Am J Ophthalmol. 2005;140(6): 993–1001. doi: 10.1016/j.ajo.2005.06.026
10. Belin M, Ambrosio R. Scheimpflug imaging for keratoconus and ectatic disease. Indian J Ophthalmol. 2013;61(8): 401–406. doi: 10.4103/0301-4738.116059
11. Rabinowitz YS, McDonnell PJ. Computerassisted corneal topography in keratoconus. Refrac Corneal Surg. 1989;5(6): 400–408.
12. Savini G, Barboni P, Carbonelli M, Hoffer KJ. Repeatability of automatic measurements by a new Scheimpflug camera combined with Placido topography. J Cataract Refract Surg. 2011;37(10): 1809–1816. doi: 10.1016/j.jcrs.2011.04.033
13. de Sanctis U, Loiacono C, Richiardi L, Turco D, Mutani B, Grignolo FM. Sensitivity and specificity of posterior corneal elevation measured by Pentacam in discriminating keratoconus/subclinical keratoconus. Ophthalmology. 2008;115(9): 1534–1539. doi: 10.1016/j.ophtha.2008.02.020
14. Wilson SE, Lin DTC, Klyce SD. Corneal topography of keratoconus. Cornea. 1991;10(1): 2–8.
15. Gordon-Shaag A, Millodot M, Shneor E, Liu Y. The genetic and environmental factors for keratoconus. Biomed Res Int. 2015;2015: 795738. doi: 10.1155/2015/795738
16. Bawazeer M, Hodge WG, Lorimer B. Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol. 2000;84(8): 834–836. doi: 10.1136/bjo.84.8.834
17. Georgiou T, Funnell CL, Cassels-Brown A, O’Conor R. Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asians and white patients. Eye (Lond). 2004;18(4): 379–383. doi: 10.1038/sj.eye.6700652
18. Lee LR, Hirst LW, Readshaw G. Clinical detection of unilateral keratoconus. Aust N Z J Ophthalmol. 1995;23(2): 129–133. doi: 10.1111/j.1442-9071.1995.tb00141.x
19. Lim N, Vogt U. Characteristics and functional outcomes of 130 patients with keratoconus attending a specialist contact lens clinic. Eye. 2002;16(1): 54–59. doi: 10.1038/sj.eye.6700061
20. Ota R, Fujiki K, Nakayasu K. Estimation of patient visit rate and incidence of keratoconus in the 23 wards of Tokyo. Nippon Ganka Gakkai Zasshi. 2002;106(6): 365–372.
21. Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology. 1993;100(2): 181–186. doi: 10.1016/s0161-6420(93)31673-8
22. Rafati S, Hashemi H, Nabovati P, Doostdar AB, Yekta AC, Aghamirsalim M, Khabazkhoobe M. Demographic profile, clinical, and topographic characteristics of keratoconus patients attending at a tertiary eye center. J Curr Ophthalmol. 2019;31(3): 268–274. doi: 10.1016/j.joco.2019.01.013
23. Podtynnykh E.V., Izmailova S.B., Komarovskikh E.N. Kliniko-sotsial'nyi portret patsientov s keratokonusom, prozhivayushchikh v yuzhnykh regionakh Rossii. Oftal'mokhirurgiya. 2019;1: 62–66. [Podtynnyh EV, Izmailova SB, Komarovskikh EN. Clinical and social portrait of patients with Keratoconus, living in the southern regions of Russia. Fyodorov Journal of Ophthalmic Surgery. 2019;1: 62–66. (In Russ.)] doi: 10.25276/0235-4160-2019-1-62-66
24. Millodot M, Shneor E, Albou S, Atlani E, Gordon-Shaag A. Prevalence and associated factors of keratoconus in jerusalem: a cross-sectional study. Ophthalmic Epidemiol. 2011;18(2): 91–97. doi: 10.3109/09286586.2011.560747
25. Slonimskii A.Yu., Sitnik G.V., Slonimskii Yu.B., Myagkov A.V., Milash S.V. Pellyutsidnaya marginal'naya degeneratsiya rogovitsy i keratokonus: differentsial'nyi diagnoz i taktika vedeniya bol'nykh. Oftal'mologiya. 2019;4: 433–441. [Slonimskiy AYu, Slonimskiy YuB, Sitnik HV, Myagkov AV, Milash SV. Pellucid marginal corneal degeneration and keratoconus: differential diagnosis and management of patients. Ophthalmology in Russia. 2019;16(4): 433–442. (In Russ.)] doi: 10.18008/1816-5095-2019-4-433-441
26. Gorskova E.N., Sevost'yanov E.N. Epidemiologiya keratokonusa na Urale. Vestnik oftal'mologii. 1998;114(4): 38–40. [Gorskova EN, Sevostyanov EN. Epidemiology of keratoconus in the Urals. Vestnik oftal’mologii. 1998;114 (4): 38–40. (In Russ.)]
