5月 | Vesber 最佳RIO论文推荐

No.1  Retina · 推荐

POSTERIOR SCLERAL CONTRACTION TO TREAT MYOPIC FOVEOSCHISIS IN HIGHLY MYOPIC EYES(Retina.2021;41(5)_1047-1056. doi_10.1097_IAE.）
后巩膜加压术治疗高度近视眼近视性黄斑劈裂
Purpose：To evaluate the efficacy of posterior scleral contraction to treat myopic foveoschisis (MF).
评价后巩膜加固术治疗近视性黄斑劈裂的疗效。
Methods：The records of MF patients treated with posterior scleral contraction were reviewed. During posterior scleral contraction, a cross-linked fusiform strip from allogeneic sclera was used and designed axial length (AL) shortening amount was around 2.0∼3.0 mm based on preoperative AL. The middle part of the strip was placed at the posterior pole of the eye. After few aqueous humors were released, the strip was tightened to contract posterior sclera and shorten AL. Clinical data were collected at pre-operation (op) and post-op follow-ups for 12 months.
回顾性分析黄斑劈裂患者行巩膜后加压术的临床资料。在后巩膜加压时，用同种异体巩膜制成的交联梭形条，基于术前眼轴长度（AL）设计眼轴缩短量为2.0∼3.0 mm左右。条带的中间部分放在眼睛的后极。少量体液释放后，绷紧条带，收缩后巩膜，缩短眼轴长度。收集术前和术后12个月的临床资料。
Results：Twenty-four eyes were collected. The AL at pre-op, post-op 1-week, 3-month, 6-month, and 12-month were 29.84 ± 1.24, 27.39 ± 1.32, 27.73 ± 1.23, 27.86 ± 1.26, and 27.91 ± 1.29 mm. There was no AL difference between post-op 6-month and 12-month ( P = 0.242). The accumulated MF reattachment rate at post-op 1-week, 3-month, 6-month, and 12-month were 8.3%, 16.7%, 50.5%, and 95.8%. The best-corrected visual acuity at post-op 6-month and 12-month were 0.71 ± 0.39 (Snellen acuity 20/80) and 0.64 ± 0.37 (Snellen acuity 20/63), improving significantly compared with pre-op ( P = 0.006 and <0.001).
收集了24只眼睛。术前、术后1周、3个月、6个月和12个月的眼轴值分别为29.84± 1.24, 27.39 ± 1.32, 27.73 ± 1.23, 27.86 ± 1.26和27.91± 1.29毫米。术后6个月与12个月之间无显著性差异（P=0.242）。术后1周、3个月、6个月和12个月黄斑劈裂再附着率分别为8.3%、16.7%、50.5%和95.8%。术后6个月和12个月最佳矫正视力为0.71± 0.39（Snellen视力20/80）和0.64± 0.37（Snellen视力20/63），与术前相比有显著改善（P=0.006和<0.001）。
Conclusion：The posterior scleral contraction was effective to treat MF. The AL stabilized after post-op 6-month and MF reattached gradually with improved visual acuity up to post-op 12-month.
巩膜后加固术是治疗黄斑劈裂的有效方法。术后6个月眼轴轴长稳定，术后12个月黄斑劈裂逐渐复位，视力提高。

推荐理由

本文研究了后巩膜加固术治疗高度近视黄斑劈裂的疗效，证明该手术方法对于黄斑的复位有效。本文创新之处在于从病理根源上治疗近视造成的危害，而不仅仅是简单通过改变屈光纠正视力，改变屈光可以纠正的视力范围也是有阈值的，一但高度近视造成的损伤超过纠正阈值，造成眼睛结构的损伤，则需要依赖手术治疗的方式从病理上治疗和控制。
文章不足之处在于本文仅研究了该手术方式的有效性，尚未判断该方法的安全性，未来可以针对相应并发症，比如移位，暴露，压迫缺血，排异反应，远期视力情况等做进一步的分析。
No.2 Investigative Ophthalmology & Visual Science · 推荐
Longitudinal Observation of Border Tissue Configuration During Axial Elongation in Childhood( Invest Ophthalmol Vis Sci.2021;62(4)_10.）
儿童轴向伸长时边缘组织形态的纵向观察
Purpose
To investigate the change of border tissue configuration during axial elongation in childhood.探讨儿童轴向延长时边缘组织形态的变化。
Methods
Fifty-four subjects (108 eyes; age range, 29.3–132.5 months) who had undergone a series of swept-source optical coherence tomography scans at intervals of 6 months or longer were classified into stable axial length (AXL) eyes (n = 55; AXL change of ≤0.36 mm) and elongating AXL eyes (n = 53; AXL change of >0.36 mm). The angle between the Bruch’s membrane opening (BMO) reference plane and the border tissue of Elschnig was defined as the border tissue angle (BTA). The border tissue angle, BMO distance (BMOD) and minimum rim width (MRW) were measured in the temporal and nasal regions.入选54人108眼；年龄范围为29.3-132.5个月。根据每隔6个月或更长时间进行一系列OCT扫描图，分为稳定轴长（AXL）眼（n=55；眼轴改变≤0.36毫米）和延长眼轴眼（n=53；眼轴改变>0.36 mm）。将Bruch膜孔参考面与Elschnig边缘组织的夹角定义为边缘组织角。测量颞部和鼻部的边缘组织角度、Bruch膜孔参考面距离和最小边缘宽度。
Results
During 15.6 ± 7.2 months of follow-up, the AXL significantly increased from 22.8 ± 1.3 mm to 23.3 ± 1.4 mm (P < 0.001). Changes of border tissue angle and AXL showed a significant correlation only in the temporal region of elongating AXL eyes (r = –0.409; P = 0.002), but not in stable AXL eyes. Both BMOD and nasal MRW significantly increased from 1482.5 ± 153.0 to 1506.1 ± 154.6 µm and from 310.6 ± 83.2 to 324.6 ± 95.6 µm, respectively (all Ps < 0.001). The changes of BMOD and nasal MRW showed a significant positive correlation with changes of AXL in elongating AXL eyes but not in stable AXL eyes.随访15.6±7.2个月，入选者眼轴轴长明显从22.8%± 1.3毫米提高至至23.3毫米± 1.4毫米（P<0.001）。边缘组织角与眼轴轴长的变化仅在延长眼轴轴长眼的颞区有显著相关性（r=-0.409；P=0.002），但在稳定的眼轴轴长眼睛中没有。Bruch膜孔直径显著从1482.5± 153.0提高至1506.1± 154.6µm，，鼻毛细血管周围组织值从310.6± 83.2提高至324.6± 95.6µm（均p<0.001）。Bruch膜孔、鼻毛细血管周围组织与眼轴轴长的变化呈显著正相关，而与眼轴稳定眼无显著正相关。
Conclusion
During the axial elongation in childhood, temporal border tissue configuration change, BMO enlargement, and nasal peripapillary tissue elevation showed a significant correlation with changes in the AXL.儿童期轴向延长时，颞缘组织形态改变、Bruch膜孔增大、鼻毛细血管周围组织升高与眼轴轴长的改变有显著相关性。

推荐理由

本文研究了儿童轴向眼轴延长时，对于眼部其他组织结构的改变，暗示儿童近视对于眼部其他组织结构均有不同程度的影响。文章创新之处在于通过对照研究近视儿童和未近视儿童的眼轴变化与周边组织的变化，得出近视的一系列相关因素，未来对于儿童的近视监控可提供新的检测思路。本文的不足之处在于仅得出了周边组织的一些改变与眼轴轴长改变具有相关性，并不清楚两者之间的先后关系，或者是同步改变的关系，未来需要做更多的研究和分析，进一步解释儿童近视的相关病理特征。
No.3 Ophthalmology · 推荐
Autologous Retinal Transplantation for Primary and Refractory Macular Holes and Macular Hole Retinal Detachments: The Global Consortium(Ophthalmology. 2021;128(5):672-685.）
自体视网膜移植治疗原发性和难治性黄斑裂孔和伴视网膜脱离黄斑裂孔：全球联合体
Purpose
To report the anatomic and functional outcomes of autologous retinal transplantation (ART).报告自体视网膜移植的解剖和功能结果。
Design
Multicenter,retrospective,interventional, consecutive case series.多中心，回顾性，介入性， 连续病例系列。
Participants
One hundred thirty eyes of 130 patients undergoing ART for the repair of primary and refractory macular holes (MHs), as well as combined MH-rhegmatogenous retinal detachment (MH-RRD), between January 2017 and December 2019.入选2017年1月至2019年12月 期间的130例130眼原发性和难治性黄斑裂孔 (MHs），以及伴视网膜脱离黄斑裂孔（MH-RRD）患者。
Methods
All patients underwent pars plana vitrectomy and ART, with surgeon modification of intraoperative variables. A large array of preoperative, intraoperative, and postoperative data was collected. Two masked reviewers graded OCT images. Multivariate statistical analysis and subgroup analysis were performed.所有患者均接受平坦部玻璃体切除术以及自体视网膜移植治疗手术，在医生术中对病情进行修复的基础上。收集了大量的术前、术中和术后数据。两个单盲的审稿人给OCT图像评分，进行多因素统计分析和亚组分析。
Main Outcome Measures
Macular hole closure rate, visual acuity (VA), external limiting membrane and ellipsoid zone (EZ) band integrity, and alignment of neurosensory layers (ANL) on OCT.黄斑裂孔闭合率，视力（VA），外界膜和椭球带的完整性，以及OCT上神经感觉层的排列。
Results
One hundred thirty ART surgeries were performed by 33 vitreoretinal surgeons worldwide. Patient demographics were: mean age of 63 ± 6.3 years, 58% female, 41% White, 23% Black, 19% Asian, and 17% Latino. Preoperative VA was 1.37 ± 0.12 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, approximately 20/500), which improved significantly to 1.05 ± 0.09 logMAR (Snellen equivalent, approximately 20/225; P < 0.001) after surgery (mean follow-up, 8.6 ± 0.8 months). Autologous retinal transplantation was performed for primary MH repair in 27% of patients (n = 35), for refractory MH in 58% of patients (n = 76; mean number of previous surgeries, 1.6 ± 0.2), and for MH-RRD in 15% of patients (n = 19). Mean maximum MH diameter was 1470 ± 160 μm, mean minimum diameter was 840 ± 94 μm, and mean axial length was 24.6 ± 3.2 mm. Overall, 89% of MHs closed (78.5% complete; 10% small eccentric defect), with a 95% closure rate in MH-RRD (68.4% complete; 26.3% small eccentric defect). Visual acuity improved by at least 3 lines in 43% of eyes and by at least 5 lines in 29% of eyes. Reconstitution of the EZ (P = 0.02) and ANL (P = 0.01) on OCT were associated with better final VA. Five cases of ART graft dislocation (3.8%), 5 cases of postoperative retinal detachment (3.8%), and 1 case of endophthalmitis (0.77%) occurred.全世界33位玻璃体视网膜外科医生进行了130例自体视网膜移植手术。患者人口统计数据为：平均年龄63岁± 6.3岁，58%为女性，41%为白人，23%为黑人，19%为亚裔，17%为拉丁裔。术前视力为1.37± 0.12最小分辨角对数（logMAR；Snellen视力，约为20/500），显著提高至1.05± 0.09 最小分辨角对数（logMAR；Snellen视力，约为20/225；P < 0.001）（平均随访8.6± 0.8个月）。患者行自体视网膜移植，27%进行原发性黄斑裂孔修复（n = 35)，58%的患者行难治性黄斑裂孔修复（n = 76; 平均手术次数，1.6± 0.2），15%的患者行伴视网膜脱离黄斑裂孔修复（n = 19)。平均最大黄斑裂孔直径为1470± 160μm、平均最小直径为840± 94μm、平均轴向长度为24.6± 3.2毫米。总的来说，黄斑裂孔闭合率89%（78.5%完成；10%的小偏心缺陷），伴视网膜脱离黄斑裂孔闭合率95%（68.4%完成；26.3%的小偏心缺陷）。术后患者视力提高至少3行的有43%，视力至少提高5行的有29%。椭球区的重建（P = 0.02）和神经感觉层排列（P = 0.01）与较好的最终视力相关。术后视网膜移植体脱落5例（3.8%），视网膜脱离5例（3.8%） ，眼内炎发生1例 (发生率为0.77%）。
Conclusion
In this global experience, patients undergoing ART for large primary and refractory MHs and MH-RRDs achieved good anatomic and functional outcomes, with low complication rates despite complex surgical pathologic features.在这项全球性的经验分享中，接受自体视网膜移植治疗的原发性和难治性黄斑裂孔以及伴视网膜脱离黄斑裂孔患者取得了良好的解剖和功能效果，尽管手术病理特征复杂，但并发症发生率较低。

推荐理由

本研究探索了自体视网膜移植治疗原发性和难治性的黄斑裂孔，及治疗伴视网膜脱离黄斑裂孔的解刨和功能效果，证明该方法有效。文章创新点是采用了自体的视网膜进行移植，降低了术后的排异反应，为黄斑裂孔的患者视力改善提供一种新的手术方式。文章的不足之处为手术病理复杂，远期治疗效果仍有待进一步的探索与研究，且术后效果的评价因从多个方面分析，需进行全面的术后检测分析。
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