目的：探讨可视化角膜生物力学分析联合Pentacam相关指数在诊断亚临床期圆锥角膜及顿挫期圆锥角膜中的诊断价值，为早期圆锥角膜筛查及诊断提供依据。

方法：采用诊断试验研究设计，纳入2018-11/2019-11期间在宁夏眼科医院的圆锥角膜患者65例128眼，根据病程程度分别将这些眼分为临床期、亚临床及顿挫期组。选取同时期接受屈光术前检查者89例89眼为正常对照组。应用Pentacam联合Corvis ST进行检测，记录角膜扩张的指标(BAD-D、TP、Kmax、Df、Db、Dp、Dt、Da、ARTh)、角膜生物力学指标(CBI、DA Ratio、SP-A1、Integrated radius)、bIOP及TBI。对不同圆锥角膜分期进行统计分析，依据受试者工作曲线探讨TBI、CBI及BAD-D的诊断阈值，评估各参数的诊断价值。

结果：临床期圆锥角膜组TBI、BAD-D、TP、Kmax、Df、Db、Dp、Dt、Da、ARTh、CBI、SP-A1具有较强诊断能力。亚临床期圆锥角膜组BAD-D、Da、Dp、TP、TBI、CBI、ARTh、Integrated radius具有较强诊断能力。顿挫期圆锥角膜组BAD-D、Dp、TBI具有一定的诊断预测能力。

结论：TBI、BAD-D、Dp等指数对早期圆锥角膜诊断具有一定的敏感性和特异性，诊断能力较强，可以用于圆锥角膜的筛查和早期诊断。

METHODS: A total of 65 patients(128 eyes)with keratoconus in Ningxia Eye Hospital from November 2018 to November 2019 were enrolled in a diagnostic trial design. According to the course of disease, these eyes were divided into clinical, subclinical and forme fruste groups. A total of 89 subjects(89 eyes)who received preoperative refractive examination at the same period were selected as the normal control group. Pentacam combined with Corvis ST was used for detection. Corneal dilatation indexes, including belin/ambrosio enhanced ectasia display(BAD-D), the thinnest point thickness(TP), max keratometry(Kmax), deviation of normality of the front elevation(Df), deviation of normality of the back elevation(Db), deviation of normality of pachymetric progression(Dp), deviation of normality of corneal thinnest point(Dt), deviation of normality of relational thickness(Da), and Ambrósio relational thickness horizontal(ARTh), corneal biomechanical indexes, including Corvis biomechanical index(CBI), deformation amplitude ratio(DA Ratio), stiffness parameters at applanation 1(SP-A1)and Integrated radius, biomechanical intraocular pressure(bIOP)and tomographic and biomechanical index(TBI)were recorded. The keratoconus at different stages was statistically analyzed, the diagnostic valve of TBI, CBI and BAD-D was explored by receiver operating curve, and the diagnostic value of each parameters was evaluated.

RESULTS:The TBI, BAD-D, TP, Kmax, Df, Db, Dp, Dt, Da, ARTh, CBI and SP-A1 of the clinical keratoconus group had strong diagnostic ability, the BAD-D, Da, Dp, TP, TBI, CBI, ARTh and Integrated radius of the subclinical keratoconus group had strong diagnostic ability, and the BAD-D, Dp and TBI of the forme fruste keratoconus group had certain diagnostic and predictive ability.

CONCLUSION:TBI, BAD-D, Dp and other index have a certain sensitivity and specificity for early keratoconus diagnosis, and can be used for screening and early diagnosis of keratoconus.