R——Retina推荐《Ten-Year Follow-Up Of Patients With Exudative Age-Related Macular Degeneration Treated With Intravitreal Anti–Vascular Endothelial Growth Factor Injections》Retina. 2020;40(9)1665-1672.玻璃体腔注射抗血管内皮生长因子治疗渗出性老年性黄斑变性患者10年随访 Purpose:To identify the visual acuity outcomes of patients with age-related macular degeneration treated with intravitreal anti–vascular endothelial growth factor injections over a 10-year period.目的：随访接受玻璃体内抗血管内皮生长因子注射治疗10年的老年性黄斑变性患者的视力结果。Methods:This was a retrospective, cohort study of eyes with exudative age-related macular degeneration that received $2 intravitreal anti–vascular endothelial growth factor injections and had at least 10 years of follow-up after the initiation of treatment. Snellen visual acuity was recorded at baseline and then annually until the last year of follow-up. Optical coherence tomography data were collected at the time of treatment initiation and at the last examination visit. A subanalysis was performed on patients who continued to receive anti–vascular endothelial growth factor therapy using a modifified treat and extend protocol versus those who discontinued treatment for longer than 1 year.方法：这是一项渗出性老年性黄斑变性回顾性队列研究，受试者接受2美元的玻璃体内抗血管内皮生长因子注射，并且在治疗开始后至少有10年的随访。开始初次记录Snellen视力做为视力基线，然后每年记录一次视力，直到最后一年随访。在治疗开始时和最后一次随访检查时收集光学相干断层扫描图数据。对继续接受抗血管内皮生长因子治疗的患者进行亚分析，采用改良的治疗和延长方案，与停止治疗超过1年的患者进行对比。Results: One hundred thirty eyes of 115 patients met the inclusion criteria. The mean follow-up after treatment initiation was 11.1 ± 0.7 years. Eyes received an average of 45.1 ± 32.3 intravitreal injections in total and a mean of 5 to 7 injections per year. The baseline mean logMAR visual acuity was 0.61 ± 0.5 (Snellen acuity 20/81), and the fifinal mean logMAR visual acuity was 0.88 ± 0.7 (20/152, P value = ,0.0001). There were 40 eyes that received at least one injection every year. These eyes did not have a signifificant change in visual acuity between the baseline and fifinal examinations 0.47 ± 0.4 (20/59 vs. 0.58 ± 0.5 [20/76, P = 0.28]), whereas the eyes that did not receive at least one injection every year saw a signifificant decline in visual acuity 0.67 ± 0.5 (20/94 vs. 1.01 ± 0.7 [20/205, P , 0.0001]).结果：115例患者130只眼符合纳入标准。治疗开始后平均随访11.1±0.7年。每个眼睛玻璃体腔平均注射45.1±32.3次，平均每年注射5～7次。基线平均logMAR视力为0.61±0.5（Snellen视力为20/81），第五次平均logMAR视力为0.88±0.7（20/152，P值=，0.0001）。有40只眼睛每年至少接受一次注射。在初次检查和最后一次检查之间，这些眼睛的视力没有明显的变化0.47±0.4（20/59 vs.0.58±0.5[20/76，P=0.28]），而没有每年至少接受一次注射的眼睛的视力显著下降0.67±0.5（20/94 vs.1.01±0.7[20/205，P，0.0001]）。Conclusions:Eyes with exudative age-related macular degeneration that received intravitreal injections every year had stable visual acuity over a 10-year period. Continuous intravitreal anti–vascular endothelial growth factor therapy may stabilize visual acuity for 10 years and potentially longer.结论：每年接受玻璃体腔注射的渗出性老年性黄斑变性患者的视力表现稳定超过10年。持续玻璃体内抗血管内皮生长因子治疗可稳定视力10年甚至更长时间。推荐理由：本文研究每年至少接受一次玻璃体腔内注射抗血管内皮生长因子和持续注射抗血管内皮生长因子对视力的影响。结果显示每年至少接受一次玻璃体腔注射的这些眼睛从初次检查到最后就诊都基本保持视力；持续注射抗血管内皮生长因子的渗出性老年性黄斑变性患者能更好的维持视力。此研究对一大批患者进行了至少10年的随访。迄今为止，还没有一项研究能做到这么长时间的随访。但此研究有局限性，参与者太少没有达到统计的显著性。没有区别对待根据患者使用的抗血管内皮生长因子的类型或患者在治疗过程中是否更换了药物和其他眼部的并发症，还有难以掌控患者注射药物的频率。I——Investigative Ophthalmology& Visual Science推荐《Aqueous Humor Outflow Requires Active Cellular Metabolism in Mice》Invest Ophthalmol Vis Sci. 2020;61(10)45.小鼠房水流出依赖活跃的细胞代谢Purpose: Conventional wisdom posits that aqueous humor leaves the eye by passive bulk flow without involving energy-dependent processes. However, recent studies have shown that active processes, such as cell contractility, contribute to outflow regulation. Here, we examine whether inhibiting cellular metabolism affects outflow facility in mice.目的：传统观点认为，房水流出不需消耗能量即可离开眼睛。然而，最近的研究表明，活跃的细胞代谢过程，有助于调控房水的流出，如细胞收缩。在这里，我们测试抑制细胞代谢是否影响小鼠的房水流出状态。Methods:We measured outflow facility in paired enucleated eyes from C57BL/6J mice using iPerfusion. We had three Experimental Sets: ES1, perfused at 35°C versus 22°C; ES2, perfused with metabolic inhibitors versus vehicle at 35°C; and ES3, perfused at 35°C versus 22°C in the presence of metabolic inhibitors. Inhibitors targeted glycolysis and oxidative phosphorylation (2-deoxy-D-glucose, 3PO and sodium azide). We also measured adenosine triphosphate (ATP) levels in separate murine anterior segments treated like ES1 and ES2.方法：实验采用小鼠为C57BL/6J，测定方法为iPerfusion软件测定法，对离体小鼠眼睛房水流出进行测试。设置有三个实验组：ES1，灌注35°C和22°C的不同温度灌注液；ES2，在35°C灌注温度下，灌注液添加溶媒剂或代谢抑制剂；ES3，在35°C和22°C灌注温度下，灌注含代谢抑制剂的灌注液。抑制剂（2-脱氧-D-葡萄糖、3PO和叠氮化钠）靶向调控糖酵解和氧化磷酸化代谢。我们还单独测量了ES1和ES2实验组的小鼠眼前节的三磷酸腺苷（ATP）水平。Results: Reducing temperature decreased facility by 63% [38%, 78%] (mean [95% confidence interval (CI)], n = 10 pairs; P = 0.002) in ES1 after correcting for changes in viscosity. Metabolic inhibitors reduced facility by 21% [9%, 31%] (n = 9, P = 0.006) in ES2. In the presence of inhibitors, temperature reduction decreased facility by 44% [29%, 56%] (n = 8, P < 0.001) in ES3. Metabolic inhibitors reduced anterior segment adenosine triphosphate (ATP) levels by 90% [83%, 97%] (n = 5, P<<0.001), but reducing temperature did not affect ATP.结果：在校正干预变量因子后，降低温度可使ES1组的房水流量降低63%[38%，78%]（平均[95%置信区间（CI）]，n=10对；P=0.002）。代谢抑制剂降低了ES2组房水流量21%[9%，31%]（n=9，P=0.006）。在抑制剂的存在下，温度降低使ES3组的房水流量降低44%[29%，56%]（n=8，P<0.001）。代谢抑制剂使眼前节三磷酸腺苷（ATP）水平降低90%[83%，97%]（n=5，P<0.001），但降低温度对ATP无影响。Conclusions:Inhibiting cellular metabolism decreases outflow facility within minutes. This implies that outflow is not entirely passive, but depends partly on energy-dependent cellular processes, at least in mice. This study also suggests that there is a yet unidentified mechanism, which is strongly temperature-dependent but metabolism-independent, that is necessary for nearly half of normal outflow function in mice.结论：抑制细胞代谢，可在几分钟内降低房水流出功能。这表明，至少在老鼠身上，房水外流不是完全被动的，而要部分依赖细胞代谢的能量。这项研究还表明，在正常小鼠的房水流出代谢过程中，有一个尚未确定的与温度相关性高，但与代谢不相干的一种机制，同样至少参与小鼠一半房水流出的调控。推荐理由：本文是一篇关于小鼠眼前节房水代谢的文章，通过对离体小鼠眼睛进行不同对比实验，得出小鼠的房水流出不仅是被动流走，还有细胞主动参与代谢调节的作用。文章的创新点为关注房水代谢，打破了人们常规的认为房水是被动流走的思维定势，通过实验设计，证明房水的流出有细胞代谢作用，而非完全的被动。也暗示了眼内房水代谢对眼球整体微环境稳态起着非常重要的作用。任何干预房水代谢途径的损伤均会对眼球长期预后造成影响。局限性为文章表述存在一定争议性。在文章结论中，提出一种新的机制与温度相关，但是与代谢不相干，这是一个具有争议性的表述。文章中的代谢采用的部分代谢抑制剂进行调控，但是实验设计中能调控代谢的变量还包括生物体内自身酶蛋白，而恰恰温度对酶活性是具有调控作用的。故温度的改变也是对代谢的一种调控。文章结论表述尚有争议性，但至少给人们提供一个新的思考。O——Ophthalmology 推荐《Using Uniocular Visual Acuity Substantially Underestimates the Impact of Visual Impairment on Quality of Life Compared with Binocular Visual Acuity》Ophthalmology. 2020;127(9)1145-1151.与双眼视觉清晰度相比，使用单眼视觉清晰度实质上低估了视觉缺陷对生活质量的影响。Purpose:Although the impact of vision-related quality of life (VRQoL) is assessed optimally using binocular visual acuity (VA), uniocular VA remains the preferred measurement method in clinic-based and epidemiologic studies. We compared the impact of distance presenting binocular VA and uniocular VA in the better-seeing (better-eye VA) and worse-seeing (worse-eye VA) eye on VRQoL.目的:虽然视觉相关生活质量(VR QOL)的影响是用双目视力(VA)进行最优评估的，但单眼视力仍然是临床和流行病学研究中的首选测量方法。我们比较了双目视力和单眼视力在更好的视力(更好的眼睛视力)和更差的视力(更差的眼睛视力)对视觉相关生活质量的影响。 Design:The Singapore Chinese Eye Study 2 (2015e2017), a population-based, cross-sectional study.设计：新加坡华人眼科研究2期（2015e2017），一项基于人口的横断面研究。 Participants:One thousand eight hundred twenty-two individuals (mean age, 66.2 years [standard deviation, 8.9 years]; 51.1% women) were included.参与者：入选一千八百二十二人（平均年龄，66.2岁[标准差，8.9岁]；51.1%的女性）Methods:Presenting uniocular VA and binocular VA were assessed using a logarithm of the minimum angle of resolution number chart at a distance of 4 m under standard lighting by trained and certifified study optometrists. Multiple linear regression models were constructed to determine the independent associations between binocular VA, better-eye VA, and worse-eye VA and the outcome (VRQoL), adjusted for potential confounders, including age, gender, socioeconomic status, and presence of comorbidities. In addition, a cluster sandwich estimator was used to determine if any differences in b estimates between the associations were statistically signifificant.方法：在标准照明下，由经过训练和认证的验光师，在4米的距离上，用最小分辨率数图的对数来评估单眼视力和双眼视力。建立多元线性回归模型，确定双眼视力、好眼视力和差眼视力与结果(视觉相关生活质量)之间的独立关联，并对潜在的混杂因素进行调整，包括年龄、性别、社会经济地位和共患病的存在。此外，使用聚类三明治估计器来确定关联之间b估计数的任何差异是否具有统计学意义。 Main outcome measures:Vision-related quality of life was measured using Rasch-transformed scores fromthe emotional, mobility, and reading domains of the Impact of Visual Impairment (IVI) questionnaire.主要预后指标：视觉相关的生活质量使用从情绪，行动和阅读领域的视觉障碍(IVI)问卷得出的Rasch转换分数评估。Results: Although every 2-line increase (worsening) in binocular VA and uniocular VA was associated independently with decrements in emotional, mobility, and reading IVI scores (P < 0.05 for all), the reductions in all VRQoL domains were substantially lower (P < 0.1) when using either the better-eye VA (compared with binocular VA b-estimates, e27.8%, e19.4%, and e24.2% difference in emotional, mobility, and reading IVI scores, respectively) or worse-eye VA (compared with binocular VA b estimates, e38.9%, e58.1%, and e57.5% reduction in emotional, mobility, and reading IVI scores, respectively) to quantify vision loss.结果：虽然双眼视力和单眼视力的每2行增加（恶化）与情绪、移动性和阅读视觉障碍评分的降低无关(P<0.05)，但当使用较好的眼视力(与双眼视力b-估计值相比较，情绪、移动性和阅读视觉障碍评分分别e27.8%、e19.4%和e24.2%)或较差的眼视力(与双眼视力b估计值相比较，情绪、移动性和阅读视觉障碍评分分别e38.9%、e58.1%和e57.5%)来量化视力损失时，所有视觉相关生活质量显著降低(P<0.1）。Conclusions:Uniocular VA seems to underestimate the impact of vision loss on VRQoL indices compared with binocular VA. Our data suggest that researchers, clinicians, and policy planners should consider using binocular instead of uniocular measures of VA in patient-reported outcome evaluation of vision loss because it may better reflflect its impact on VRQoL.结论：与双目视力相比，单眼视力似乎低估了视力丧失对视觉相关生活质量指数的影响。我们的数据表明，研究人员、临床医生和政策规划者应该考虑在患者报告的视力丧失结果评估中使用双目而不是单眼测量视力，因为它可能更好地反映其对视觉相关生活质量的影响。推荐理由：本文研究视力较好和视力较差的双眼视力对比单眼视力对患者生活质量的影响。研究结果表明使用单眼视力会低估视力丧失对视觉相关生活质量的影响，随着视力的恶化，这种差异会逐渐增加。尤其是在更严重的疾病中，用双眼评估视力损失，可以更准确地评估视力。此前也没有人研究比较双眼视力和生活质量与单目视力的关系。此研究也收集1822名参与者的人口统计学和社会经济特征（例如年龄、性别、收入、教育程度）的信息，生活方式因素（如吸烟）和病史（如存在糖尿病，心血管疾病[包括心肌梗死、不稳定型心绞痛、中风或短暂性脑缺血甲状腺疾病）采用标准化访谈问卷，在大数据的分析评估下此研究更有真实性和说服力。但研究也存在一些问题，研究方案中没有包括抑郁的测量，因此，我们无法确定观察到的单眼和双眼视力与视觉相关生活质量关系之间的差异是否被抑郁症状的存在和严重程度所混淆。三篇论文原文已放在百度网盘中，点击“链接”，输入提取码：ncdk，即可下载论文。
