7月 | Vesber 最佳RIO论文推荐
卫视博每月从三大权威杂志：Retina、Investigative Ophthalmology & Visual Science、Ophthalmology中各推荐一篇眼科论文。— — 最佳“RIO”论文推荐（7月）
No.1 Retina · 推荐
Prevalence of vitreous cortex remnants in eyes with primary rhegmatogenous retinal detachment undergoing vitrectomy
(Retina. 2021;41(7)_1403-1406.）
原发性孔源性视网膜脱离患者玻璃体切除术后玻璃体皮质残留的发生率
Purpose：To evaluate the prevalence and extent of vitreous cortex remnants (VCR) on the surface of the retina in eyes with primary rhegmatogenous retinal detachment (RRD) and posterior vitreous detachment.
探讨原发性孔源性视网膜脱离（RRD）和玻璃体后脱离患者视网膜表面玻璃体皮质残留（VCR）的发生率及程度。
Materials and Methods：Triamcinolone acetonide was injected in the vitreous cavity of 100 consecutive cases of acute primary RRD undergoing pars plana vitrectomy. A multivariate regression analysis was performed to determine any association between the presence and pattern of stained VCR on the surface of the retina and the following variables: age, diabetes, axial length (AL), phakic status, extent of RRD and macular status.
对100例急性原发性RRD行玻璃体平坦部切除术的患者行玻璃体腔注射曲安奈德。进行多元回归分析，以确定视网膜表面染色模式存在下的玻璃体皮质残留与年龄、糖尿病、轴长（AL）、晶状体状态、RRD程度和黄斑状态等变量之间的关系。
Results：VCR were found in 42 eyes. These were focal in 8 eyes and diffuse in 34 eyes. Age was the only strong and independent risk factor associated with the presence of VCR (p=0.0019). Age (p<0.0001), AL (p=0.0037) and phakia (p=0.01) were independent risk factors associated with the diffuse pattern. Neither diabetes, extent of RRD nor macular status were significant risk factors for the presence or extent of VCR.
42只眼发现玻璃体皮质残留。病灶8眼，弥漫34眼。年龄是唯一与玻璃体皮质残留相关的独立危险因素（p=0.0019）。年龄（p<0.0001）、AL（p=0.0037）和晶状体混浊（p=0.01）是与弥散型相关的独立危险因素。糖尿病、RRD程度和黄斑状态均不是玻璃体皮质残留存在及严重程度的重要危险因素。
Conclusion：Older patients with primary RRD and PVD appear to be at a higher risk of having diffuse VCR. Further studies are needed to investigate the relevance of VCR in the pathogenesis, progression and treatment of RD.
患有原发性RRD和玻璃体后脱离的老年患者出现弥漫性玻璃体皮质残留的风险较高。玻璃体皮质残留在视网膜脱离的发病机制、进展和治疗中的相关性尚需进一步研究。
推荐理由：本文研究了原发性孔源性视网膜脱离与玻璃体后脱离患者行玻璃体切除术后发生玻璃体皮质残留的风险因素，得出年龄是出现弥漫性玻璃体皮质残留的重要风险因素。
本文创新之处在于通过染色，有效的观察了玻璃体皮质残留的情况，并对应相关的变量因素进行了统计分析，得出了玻璃体皮质残留与年龄具有相关性，暗示高龄患者需更加关注术后的反应。
文章不足之处在于文章证明了玻璃体皮质残留与视网膜脱离具有相关性，但是具体的相关因素仍有待进一步探讨，未来需增加对照。
No.2 Investigative Ophthalmology & Visual Science · 推荐
Association of Aberrant Posterior Vitreous Detachment and Pathologic Tractional Forces With Myopic Macular Degeneration
( Invest Ophthalmol Vis Sci. 2021;62(7)_7.）
异常玻璃体后脱离和病理牵引力与近视黄斑变性的关系
Purpose：The purpose of this study was to assess whether the tractional elements of pathologic myopia (PM; e.g. myopic traction maculopathy [MTM], posterior staphyloma[PS], and aberrant posterior vitreous detachment [PVD]) are associated with myopic macular degeneration (MMD) independent of age and axial length, among highly myopic (HM) eyes.
本研究的目的是评估病理性近视的牵引因素（如：近视牵引性黄斑病变[MTM]、后葡萄肿[PS]和异常后玻璃体脱离[PVD]）是否与高度近视（HM）眼的近视性黄斑变性（MMD）相关，而与年龄和眼轴长度无关。
Methods：One hundred twenty-nine individuals with 239 HM eyes from the Myopic and Pathologic Eyes in Singapore (MyoPES) cohort underwent ocular biometry, fundus photography, swept-source optical coherence tomography, and ocular B-scan ultrasound.Images were analyzed for PVD grade, and presence of MTM, PS, and MMD. The χ2 test was done to determine the difference in prevalence of MMD between eyes with and without PVD, PS, and MTM. Multivariate probit regression analyses were performed to ascertain the relationship between the potential predictors (PVD, PS, and MTM) and outcome variable (MMD), after accounting for possible confounders (e.g. age and axial length). Marginal effects were reported.
对来自新加坡近视眼和病理眼（MyoPES）队列的129例239只高度近视眼患者进行了眼部生物测量、眼底照相、扫描源光学相干断层扫描和眼部B超检查。分析异常后玻璃体脱离级别、近视牵引性黄斑病变、后葡萄肿和近视性黄斑变性的存在。用χ2检验分析异常后玻璃体脱离、后葡萄肿、近视牵引性黄斑病变眼近视性黄斑变性患病率是否存在差异。在排除可能存在的混杂因素（如年龄和轴向长度）后，进行多变量线性回归分析以确定潜在预测因素（异常后玻璃体脱离、后葡萄肿和近视牵引性黄斑病变）与结果变量（近视性黄斑变性）之间的关系。报道边缘效应。
Results：Controlling for potential confounders, eyes with MTM have a 29.92 percentage point higher likelihood of having MMD (P = 0.003), and eyes with PS have a 25.72 percentage point higher likelihood of having MMD (P = 0.002). The likelihood of MMD increases by 10.61 percentage points per 1 mm increase in axial length (P < 0.001). Subanalysis revealed that eyes with incomplete PVD have a 22.54 percentage point higher likelihood of having MMD than eyes with early PVD (P = 0.04).
控制潜在的混杂因素后，近视牵引性黄斑病变患者患近视性黄斑变性的可能性高29.92个百分点（P=0.003），后葡萄肿患者患近视性黄斑变性的可能性高25.72个百分点（P=0.002）。轴向长度每增加1mm，发生近视性黄斑变性的可能性增加10.61个百分点（P<0.001）。亚组分析显示，不完全性异常后玻璃体脱离眼发生近视性黄斑变性的可能性比早期异常后玻璃体脱离眼高22.54个百分点（P=0.04）。
Conclusion：Our study demonstrated an association between tractional (MTM, PS, and persistently incomplete PVD) and degenerative elements of PM independent of age andaxial length. These data provide further insights into the pathogenesis of MMD.
我们的研究证实了病理性近视的牵引（近视牵引性黄斑病变、后葡萄肿和持续不完全异常后玻璃体脱离）和退行性因素之间的关联，与年龄和轴长无关。这些数据为近视性黄斑变性的发病机制提供了进一步的见解。
推荐理由：本文研究了病理性近视的牵引与近视性黄斑变性的关联，得出黄斑变性与年龄和眼轴长度的关联不大，和病理性近视造成的牵引性关联显著。
文章创新之处在于通过大数据样本量的数据图片分析得出了近视性黄斑变性的发病机制的新的见解。同时通过科学的统计方式，控制了混杂因素，使结果更可靠。
本文的不足之处在于研究的素材均是图片素材，缺乏直接的解刨证据的收集，未来可从其他方面综合侧面分析牵引力的作用，进一步验证分析结果的真实性。
No.3 Ophthalmology · 推荐
THE BIDIRECTIONAL RELATIONSHIP BETWEEN VISION AND COGNITION: A SYSTEMATIC REVIEW AND META-ANALYSIS
(Ophthalmology. 2021;128(7)_981-992.）
视觉与认知的双向关系：系统综述与META分析
Topic：Visual impairment (VI) and cognitive impairment (CIM) are prevalent age-related conditions that impose substantial burden on the society. While the bidirectional association of VI and CIM has been hypothesized, findings have been equivocal. Hence, we conduct a systematic review and meta-analysis to examine the bidirectional relationship between VI and CIM. Clinical Relevance: 60% risk of CIM has not been well-elucidated in the literature. A bidirectional relationship between CIM and VI may provide opportunities for developing public health strategies for early detection and management of risk factors for both VI and CIM in older people.
视力障碍（VI）和认知障碍（CIM）是普遍存在的与年龄相关的疾病，给社会带来了巨大的负担。但是，已有的模棱两可的发现中，视力障碍和认知障碍的双向关联都是假设。因此，我们进行了系统的回顾和meta分析来检验视力障碍和认知障碍之间的双向关系。临床相关性也显示：60%的认知障碍风险在文献中没有很好的阐明。但搞清楚认知障碍和视力障碍之间的双向关系可能为制定公共卫生战略提供机会，以便早期发现和管理老年人中视力障碍和认知障碍的风险因素。
Methods：Pubmed, Embase and Cochrane Central registers were systematically searched for observational studies, published from inception until 6 April 2020, in adults aged ≥ 40 years reporting objectively measured VI, and CIM assessment using clinically validated cognitive screening tests or diagnostic evaluation. Meta-analyses on cross-sectional and longitudinal associations between VI and CIM outcomes (any CIM assessed using screening tests, and clinically diagnosed dementia) were examined. Random effect models were used to generate pooled odds ratios (OR), and 95% confidence interval (CI). Publication bias and heterogeneity were examined using Egger’s test, meta-regression, and trim-and-fill methods.
对Pubmed、Embase和Cochrane中央登记册进行了系统的搜索，使用经临床验证的认知筛查测试或诊断评估方法、对系统从开始到2020年4月6日发表的年龄大于40的老年人的观察性研究中的客观测量视力障碍和认知障碍数据进行评估。对视力障碍和认知障碍结果之间的横截面和纵向关联进行荟萃分析（使用筛选试验评估的任何认知障碍，以及临床诊断的痴呆）。随机效应模型用于产生合并优势比（OR）和95%置信区间（CI）。使用Egger’s测验、元回归和修剪填充法检查发表偏差和异质性。
Results：Forty studies were included (N=47,913,570). Meta-analyses confirmed that persons with VI were more likely to have CIM, with significantly higher odds [OR (95%CI)] of: (i) any CIM [cross-sectional: 2.38 (1.84-3.07); longitudinal: 1.66 (1.46-1.89)], and (ii) clinically diagnosed dementia [(cross-sectional: 2.43 (1.48-4.01); longitudinal: 2.09 (1.37-3.21)], compared to persons without VI. Significant heterogeneity was partially explained by differences in age, sex and follow-up duration. There was also some evidence that individuals with CIM, relative to cognitively intact persons, were more likely to have VI, with most papers (8/9, 89%) reporting significantly positive associations, however meta-analyses on this association could not be conducted due to insufficient data.
共纳入40项研究（N=47913570）。Meta分析证实，视力障碍患者更容易发生认知障碍，其发生认知障碍的几率（OR（95%CI））显著高于无视力障碍的人：比如（i）任何认知障碍[横截面：2.38（1.84-3.07）；纵向：1.66（1.46-1.89）]；和（ii）临床诊断痴呆[横截面：2.43（1.48-4.01）；纵向：2.09（1.37-3.21）]。年龄、性别和随访时间部分解释了统计的异质性。大多数论文（8/9，89%）报告表明，与认知完整的人相比，认知障碍患者更有可能出现视力障碍，但是由于数据不足，无法对这种关联进行荟萃分析。
Conclusion：Overall, our work suggests that VI is a risk factor of CIM while further work is needed to confirm the association of CIM as a risk factor for VI. Strategies for early detection and management of both visual and cognitive impairment in older people may minimize individual clinical and public health consequences.
总的来说，我们的工作表明，视力障碍是认知障碍的一个危险因素，同时需要进一步的工作来确认认知障碍是视力障碍的一个危险因素。早期发现和管理老年人视觉和认知障碍的策略可以最大限度地减少个人的临床和公共健康后果。
推荐理由：本研究探索了视力障碍与认知障碍之间的彼此关系，得出视力障碍是认知障碍的一个高危因素，需重视老年人的视力健康，预防老年视力受损，避免进一步造成认知障碍。
文章创新点是通过大数据的统计与回顾分析，确认了有视力障碍的人员比无视力障碍的人员有更高认知障碍风险，暗示了视力变化是认知障碍的重要关键因素。
文章的不足之处为仅解释了视力障碍是认知障碍的高危因素，但是认知障碍对视力障碍的影响不明，两者的相互关联依旧是不明确的，需做进一步的统计分析研究，比如选取有认知障碍的老年痴呆患者，对比同龄未换老年痴呆的患者的视力进行对比统计分析。
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