6月 | Vesber 最佳RIO论文推荐

Retina、Investigative Ophthalmology & Visual Science、Ophthalmology中各推荐一篇眼科相关论文，合称“最佳RIO论文推荐”。

R —— Retina · 推荐

《SUTURELESS CLOSURE OF 23 — AND 25 — GAUGE LEAKING SCLEROTOMIES WITH THE SCLERAL NEEDLING TECHNIQUE 》Retina. 40(5):838-844, May 2020.

巩膜针技术对23G和25G渗漏巩膜切口的无缝线闭合影响

Purpose：To describe and evaluate the efficacy of a novel technique, scleral needling (SN), for securing 23- and 25-gauge leaking sclerotomies in microincision vitrectomy surgery.

目的：描述和评估巩膜针刺（SN）这项新技术对于微创玻切手术中23G和25G渗漏巩膜切口无缝线的有效性。

Methods：A retrospective comparative review of consecutive cases of 23- and 25-gauge pars plana vitrectomy performed by a single vitreoretinal surgeon before the introduction of the SN technique (pre-SN; November 2016 to January 2017) and after the introduction of the SN technique (post-SN; November 2017 to January 2018) was conducted. The SN technique was implemented as an alternative to suturing, using a 30-gauge needle inserted perpendicularly through the full thickness of the sclera adjacent to the scleral opening, with the needle then immediately removed and sclerotomy closure confirmed.

方法：回顾性的比较研究：在巩膜穿刺（SN）技术引入之前（pre-SN; 2016年11月至2017年1月）和在巩膜穿刺（SN）技术引入之后（post-SN; 2017年11月至2018年1月）。由同一名玻璃体视网膜外科医生连续进行的23G和25G经平坦部玻璃体切割。SN技术是一种替代缝合的方法，使用30G的针垂直插入突破巩膜，并与巩膜切口相邻，然后立即将其拔出并确认巩膜切口闭合。

Results：A total of 203 eyes, 105 from pre-SN and 98 from post-SN, were included in the study. The number of eyes requiring suture closure was significantly reduced from 39% in the pre-SN group to 2% in the post-SN group (P , 0.001). The mean postoperative intraocular pressure and incidence of hypotony on Days 1 to 2, Days 3 to 20, and Days 21 to 50 was not significantly different between the pre-SN and post-SN groups. No major complications associated with the SN technique were noted during the study period.

结果：总共选用203只眼，pre-SN为105眼，post-SN为98眼。需要缝合的眼球数量从pre-SN的39％明显减少到post-SN的2％（P，0.001）。术后第1至2天、第3至20天和第21至50天的平均眼压和眼球萎缩发病率在pre-SN和post-SN组无显着差异。在研究期间未发现与SN技术相关的主要并发症。

Conclusion：The SN technique is a safe and simple method for effectively securing leaking sclerotomies in microincision vitrectomy surgery.

结论：SN技术是一种安全、简单的方法，可有效地保护微创玻璃体手术中巩膜渗漏切口的安全性。

推荐理由：

本文是一个评价巩膜穿刺（SN）技术对23G和25G玻璃体切割巩膜渗漏切口无缝合闭合有效性的回顾性比较研究。研究结果显示SN技术既简单又安全，可以有效且保护微创玻切手术中的巩膜渗漏切口。文章独特之处在于，作者从2017年起入组了203例眼球，分为数量相近的两个组105:98，并根据术后统计数据来对比，反映出SN技术使术后巩膜渗漏切口需要缝合的数据明显下降（39%和2%）。该文章的局限性在于：回顾性研究的设计；样本量相对较小；没有记录所有可能的术后并发症，例如白内障发展和其他变量，包括手术时间。此外，样本量不能比较研究组之间的眼内炎发生率，因为鉴于这种术后并发症的发生率相对较低，导致很难测量。 

I——Investigative Ophthalmology & Visual Science · 推荐

《Comparison of Lamina Cribrosa Morphology in Normal Tension Glaucoma and Autosomal-Dominant Optic Atrophy》 Invest Ophthalmol Vis Sci 2020;61:9.

正常眼压性青光眼和常染色体显性视神经萎缩筛板形态的比较

Purpose：To compare lamina cribrosa (LC) morphology in patients with normal tension glaucoma (NTG) and autosomal-dominant optic atrophy (ADOA).

目的：比较正常眼压性青光眼（NTG）和常染色体显性视神经萎缩（ADOA）患者的筛板（LC）形态。

Methods：This cross-sectional study matched 24 patients diagnosed with ADOA (24 eyes) by age and retinal nerve fiber layer thickness with 48 patients diagnosed with NTG (48 eyes) by age with 48 healthy controls (48 eyes). Optic nerve heads were scanned by enhanced-depth imaging (EDI) optical coherence tomography (OCT). The LC curvature index (LCCI) and LC depth (LCD) on B-scan images obtained using EDI-OCT were measured at seven locations spaced equidistantly across the vertical optic disc diameter and compared among the NTG, ADOA, and control groups.

方法：这项横断面研究将24例按年龄和视网膜神经纤维层厚度诊断为ADOA的患者（24眼）与48例按年龄诊断为NTG的患者（48眼）和48例健康对照（48眼）进行了匹配。通过增强深度成像（EDI）光学相干断层扫描（OCT）扫描视神经乳头。使用EDI-OCT获得的B扫描图像上的LC曲率指数(LCCI)和LC深度(LCD)在垂直视盘直径上等距分布的7个位置进行测量，并在NTG、ADOA和对照组之间进行比较。并在NTG、ADOA和对照组之间进行了比较。

Results：Mean LCCI and LCD were significantly greater in NTG than in ADOA and healthy eyes (P < 0.001 each) but did not differ significantly in ADOA and healthy eyes.

结果：NTG组LCCI和LCD的平均值显著高于ADOA组和健康组(P < 0.001)，但ADOA组和健康组的LCCI和LCD值没有显著差异。

Conclusion：NTG eyes have a more posteriorly curved and deeper LC than ADOA and healthy eyes. This finding provides insight into the role of LC morphology in NTG and provides a clinical clue to distinguish between NTG and ADOA.

结论：与ADOA和健康的眼睛相比，NTG的眼睛有更向后弯曲和更深的LC。这一发现为LC形态学在NTG中的作用提供了见解，并为区分NTG和ADOA提供了临床线索。

推荐理由：

这项横断面研究通过使用EDI-OCT比较NTG组48眼、ADOA组24眼和健康组48眼的LC曲率指数和LC深度发现，NTG组LC曲率指数和LC深度的平均值显著高于ADOA组和健康组，但ADOA组和健康组的LC曲率指数和LC深度值没有显著差异。本研究发现，在ADOA和NTG眼中，LC特征存在显着差异。这些结果为两种疾病中视神经损伤的不同发病机理提供了见解。在不明确的情况下，LC检查可作为区分ADOA和NTG的辅助手段。这项研究也存在局限性。首先，测量LC曲线时只包括Bruch膜开口点(BMO)宽度内的LC，因为在BMO宽度外的LC通常是不可见的。但是研究中发现使用整个LC测量的LCCI(包括LC插入)与使用BMO中的LC测量的LCCI相当，这表明BMO中的LC曲线是整个LC曲线的代表。其次，研究中把弯曲的LC构型称为LC曲率，但LCCI并不对应于实际的LC曲率，而只是一个近似，还需要进一步的研究来探索计算LC实际曲率的最佳方法。最后，研究中所有受试者都是朝鲜族，故研究结果可能不适用于其他民族。 

O —— Ophthalmology · 推荐

《Anti-Vascular Endothelial Growth Factor Use and Atrophy in Neovascular Age-Related Macular Degeneration》Ophthalmology 2020;127:648-59.

抗血管内皮生长因子VEGF的使用以及治疗与年龄相关的黄斑变性新生血管的萎缩症

Topic：To summarize the rates of atrophy, risk factors, and atrophy-associated visual outcomes in patients with neovascular age-related macular degeneration (nAMD) who received antievascular endothelial growth factor (VEGF) treatment for macular neovascularization (MNV).

主题：总结接受抗血管内皮生长因子（抗VEGF）治疗黄斑新生血管（MNV）的年龄相关性黄斑变性（nAMD）患者的萎缩率，危险因素和与萎缩相关的视觉结果。

Clinical  Relevance：Age-related macular degeneration is a leading cause of vision loss worldwide, and VEGF inhibitors are the primary treatment for nAMD. However, atrophy is observed frequently in eyes treated with anti-VEGF therapy, prompting 1questions regarding a causative role for these therapies in atrophy development.

临床相关性：与年龄有关的黄斑变性nAMD是全世界视力丧失的主要原因，而抗血管内皮生长因子抗VEGF作为抑制剂是主要治疗nAMD的方法。然而，在用抗VEGF疗法治疗中经常观察到眼球萎缩，这引发了一个关于这些疗法在萎缩发展中的起因作用的问题。

Methods：PubMed was searched for articles published in the past 5 years (January 1, 2014, through January 10, 2019). Studies including atrophy outcome(s) in patients with age-related macular degeneration who received anti-VEGF treatment were included. Review articles, retrospective studies, case reports or studies, preclinical studies, prevalence data reports, and non-English studies were excluded. Randomization was not required.

方法：在PubMed上搜索了过去5年(2014年1月1日至2019年1月10日)发表的文章。研究包括接受抗VEGF治疗的nAMD患者的萎缩结果。评论文章、文献综述、回顾性研究、病例报告或研究、临床前研究、流行病学数据报告，并且排除非英语研究资料。不需要随机化。

Conclusion：Overall, 145 studies were identifified; 29 publications were included, with cohorts ranging from 8 to 1185 eyes. Imaging methods used to assess atrophy varied across studies. All studies confifirmed the occurrence of atrophy, and when available, longitudinal data from the included studies demonstrated an increase in atrophy incidence over time. Key risk factors or phenotypes associated with atrophy were fellow eye atrophy, reticular pseudodrusen, increased injections, and type 3 lesion. In addition, visual acuity loss was noted with foveal atrophy.

结论：总共有145项研究得到确认: 包含29份出版物，计入研究的从8只眼球至1185只眼球不等。用于评估萎缩的影像学方法因研究而异。所有的研究都证实了萎缩的发生，在可行的情况下，纳入研究的纵向数据表明萎缩的增加随着时间的推移发病率。与萎缩相关的主要危险因素或表型有:同侧眼萎缩、网状假性玻璃膜、增加注射次数以及3种病变均有。此外，视力减退伴中央凹萎缩。

Discussion：All studies demonstrated that atrophy occurs in the context of MNV treated with anti-VEGF therapy; however, it is not clear whether anti-VEGF treatment is causative of atrophy versus being associated with atrophy development. The included studies were not designed or powered to assess atrophy as a primary outcome. In addition, it is diffificult to determine whether prognostic factors directly affect atrophy. Furthermore, patient populations in clinical trials do not necessarily represent real-world patients. Although phenotypes and risk factors may help to identify those at greater risk of atrophy developing, it is important to recognize that adequately treating exudative MNV remains the best option to optimize vision outcomes in patients with nAMD, particularly given the risk of vision loss with undertreatment observed in the real world.

讨论：所有研究均表明，抗VEGF治疗的MNV可导致萎缩;然而，抗VEGF治疗是否导致萎缩，是否与萎缩的发展相关，目前尚不清楚。纳入的研究并没有设计或支持将萎缩作为主要结果进行评估。此外，判断预后因素是否直接影响萎缩也很困难。此外，临床试验中的患者群体不一定代表“真实世界”的患者。虽然表型和危险因素可能有助于识别那些有更大萎缩发展风险的患者，但重要的是要认识到，充分治疗渗出性MNV仍然是优化nAMD患者视力结果的最佳选择。特别是考虑到在现实世界中由于治疗不足而导致视力丧失的风险。

推荐理由：

此研究通过搜索PubMed过去5年间发表的文献，按照一定的条件进行筛选，最终纳入分析了29篇文献，队列从8只眼至1185只眼不等，得出了充分治疗渗出性MNV（黄斑新生血管）仍然是nAMD（新生血管年龄相关性黄斑变性）患者优化视力结果的最佳选择。此研究通过将29篇文献汇总分析，详细列出了每篇文献所使用的研究方法、过程、结果，报道了抗VEGF（血管内皮生长因子）治疗nAMD的萎缩结果，解释了为什么不是所有的AMD患者都有相同的萎缩相关结果。但在纳入的研究中，萎缩是在使用抗VEGF药物治疗MNV的情况下评估的；因此，很难区分萎缩是AMD自然史的一部分，还是MNV过程中继发的。另外，影像学的方法也有可能影响对萎缩的评估和解释。

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