7月 | “ 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
OUTCOMES OF RETROPUPILLARY IRIS CLAW INTRAOCULAR LENS IMPLANTATION COMBINED WITH PARS PLANA VITRECTOMY(RETINA 42:1284–1291, 2022 ）

瞳孔后虹膜爪状人工晶状体植入联合玻璃体切除术的效果
Purpose
To report 12-month visual outcomes, incidence of intraocular pressure (IOP) changes and postoperative complications after pars plana vitrectomy with retropupillary implantation of an iris claw intraocular lens (IOL) in aphakic eyes after complicated cataract surgery and eyes with a dislocation of the IOL.报告复杂白内障手术后无晶状体眼和人工晶状体脱位眼行平坦部玻璃体切除联合瞳孔后虹膜爪状人工晶状体植入术后12个月的视力结果、眼压变化和术后并发症的发生率。

Methods
This is a retrospective analysis of eyes undergoing implantation of an iris claw IOL combined with pars plana vitrectomy from 1st of January 2009 until 30th of June 2018 after complicated cataract extraction with capsular loss (Group A) or dislocation of an IOL (Group B). Corrected distance visual acuity was analyzed in logarithm of the minimum angle of resolution (logMAR) units, IOP was recorded in mmHg.本文回顾性分析了2009年1月1日至2018年6月30日在复杂白内障摘出伴囊膜缺损术后（A组）或人工晶状体脱位（B组）行虹膜爪形人工晶状体植入联合平坦部玻璃体切除术的患者。校正距离视力以logMAR进行分析，眼压以mmHg记录。

Results
During 5 years, 99 patients with IOFB were reviewed. Of these, 19 patients were diagnosed with endophthalmitis on admission, and 5 were suspected of having endophthalmitis during operation. Fifty-four cases had no clinical signs of endophthalmitis on admission and during operation and were treated with operation within 24 hours after the injury. Two patients (2 of 54; 3.70%) developed endophthalmitis after IOFB removal, and the causative agent in both cases was Bacillus cereus.在5年中，对99例IOFB患者进行了评价。其中，19例患者入院时被诊断为眼内炎，5例患者在手术时被怀疑患有眼内炎。54例入院和手术时无眼内炎临床体征，伤后24小时内接受手术治疗。2 例患者（54 例中的 2 例;3.70%）在 IOFB 切除后出现眼内炎，两例的致病因子均为蜡样芽孢杆菌。

Conclusion
Observational analysis revealed a linear relationship between BP traits and IOPcc, with a +0.28 mm Hg increase in IOPcc per 10-mm Hg increase in systolic BP (95% confidence interval [CI], 0.26–0.29); for diastolic blood pressure (DBP) and pulse pressure (PP), these estimates were +0.41 mm Hg and +0.36 mm Hg, respectively. An inverse-variance weighted MR analysis did not support a causal relationship, as the estimated causal effect was +0.01 mm Hg IOPcc per 10-mm Hg increase in systolic blood pressure (SBP); +0.13 mm Hg IOPcc per 10-mm Hg increase in DBP; and +0.02 mm Hg IOPcc per 10-mm Hg increase in PP (all P > 0.05). With regard to the risk of POAG, MR analyse yielded causal effect estimate of odds ratio = 0.98 (95% CI, 0.92–1.04) per 10-mm Hg increase in SBP. Neither DBP nor PP demonstrated evidence of a causal effect on POAG.观察分析显示血压特征与角膜代偿性眼压呈线性关系，收缩压每增加10毫米汞柱，角膜代偿性眼压增加+0.28毫米汞柱(95% 置信区间 [CI], 0.26–0.29)；对于舒张压(DBP)和脉压(PP)，这些估计值分别为+0.41毫米汞柱和+0.36毫米汞柱。反向方差加权孟德尔随机分析不支持因果关系，因为估计的因果关系是收缩压(SBP)每增加10毫米汞柱，角膜代偿性眼压为+0.01毫米汞柱；舒张压每增加10毫米汞柱，角膜代偿性眼压为+0.13毫米汞柱；脉压每增加10毫米汞柱，角膜代偿性眼压为+0.02毫米汞柱(all P > 0.05)。关于原发性开角型青光眼的风险，孟德尔随机分析得出了收缩压每增加10毫米汞柱比值比为0.98(95% CI, 0.92–1.04)的因果关系估计。舒张压和脉压均未证明对原发性开角型青光眼有因果关系。

推荐理由：
本文研究了虹膜爪状人工晶状体植入对患者的视力和眼压改变，得出可提升患者视力，术后发生的眼压异常可慢慢恢复，在可控范围内，是安全有效的。本文创新之处在于创新性的研究了新型人工晶体，对虹膜爪状人工晶状体的有效性和安全性进行了初步评估，得出其安全且有效。

文章不足之处在于尚未对手术其他并发症做进一步的随访观察，且对虹膜爪状人工晶状体是否术后脱位情况进行观察，未来需进一步研究 。

No.2
Investigative Ophthalmology & Visual Science · 推荐

High Blood Pressure and Intraocular Pressure: A Mendelian Randomization Study (Invest Ophthalmol Vis Sci. 2022;63(6):29.)

高血压和眼压：孟德尔随机研究
Purpose
To test for causality with regard to the association between blood pressure (BP) and intraocular pressure (IOP) and glaucoma.测试血压（BP）和眼压（IOP）与青光眼之间的因果关系。

Methods
Single nucleotide polymorphisms (SNPs) associated with BP were identified in a genome-wide association study (GWAS) meta-analysis of 526,001 participants of European ancestry. These SNPs were used to assess the BP versus IOP relationship in a distinct sample (n = 70,832) whose corneal-compensated IOP (IOPcc) was measured. To evaluate the BP versus primary open-angle glaucoma (POAG) relationship, additional Mendelian randomization (MR) analyses were conducted using published GWAS summary statistics.在对526001名欧洲血统参与者进行的全基因组关联研究(GWAS)荟萃分析中，确定了与血压相关的单核苷酸多态性(SNPs)。在测量角膜代偿性眼压(IOPcc)的不同样本(n = 70,832)中，这些单核苷酸多态性用于评估血压与眼压的关系。为了评估血压与原发性开角型青光眼(POAG)的关系，使用已发表的全基因组关联研究摘要统计数据进行了额外的孟德尔随机(MR)分析。

Results
Observational analysis revealed a linear relationship between BP traits and IOPcc, with a +0.28 mm Hg increase in IOPcc per 10-mm Hg increase in systolic BP (95% confidence interval [CI], 0.26–0.29); for diastolic blood pressure (DBP) and pulse pressure (PP), these estimates were +0.41 mm Hg and +0.36 mm Hg, respectively. An inverse-variance weighted MR analysis did not support a causal relationship, as the estimated causal effect was +0.01 mm Hg IOPcc per 10-mm Hg increase in systolic blood pressure (SBP); +0.13 mm Hg IOPcc per 10-mm Hg increase in DBP; and +0.02 mm Hg IOPcc per 10-mm Hg increase in PP (all P > 0.05). With regard to the risk of POAG, MR analyse yielded causal effect estimate of odds ratio = 0.98 (95% CI, 0.92–1.04) per 10-mm Hg increase in SBP. Neither DBP nor PP demonstrated evidence of a causal effect on POAG.观察分析显示血压特征与角膜代偿性眼压呈线性关系，收缩压每增加10毫米汞柱，角膜代偿性眼压增加+0.28毫米汞柱(95% 置信区间 [CI], 0.26–0.29)；对于舒张压(DBP)和脉压(PP)，这些估计值分别为+0.41毫米汞柱和+0.36毫米汞柱。反向方差加权孟德尔随机分析不支持因果关系，因为估计的因果关系是收缩压(SBP)每增加10毫米汞柱，角膜代偿性眼压为+0.01毫米汞柱；舒张压每增加10毫米汞柱，角膜代偿性眼压为+0.13毫米汞柱；脉压每增加10毫米汞柱，角膜代偿性眼压为+0.02毫米汞柱(all P > 0.05)。关于原发性开角型青光眼的风险，孟德尔随机分析得出了收缩压每增加10毫米汞柱比值比为0.98(95% CI, 0.92–1.04)的因果关系估计。舒张压和脉压均未证明对原发性开角型青光眼有因果关系。

Conclusion
A range of different MR analysis methods provided evidence, in general, that the causal effect of BP on IOP (and POAG) was modest, or even zero. However, interpretation was complicated by SNPs associated with BP potentially having pleiotropic effects on IOP.一系列不同的孟德尔随机分析方法提供了证据，一般来说，血压对眼压（和原发性开角型青光眼）的因果影响是适度的，甚至是零。然而，与血压相关的单核苷酸多态性可能对眼压产生多效性影响，使得解释变得复杂。

推荐理由：
本文研究了高血压与眼压或者青光眼之间的关系，结果证明，血压对眼压的影响甚微。文章创新之处在于通过数学的假设模拟分析，得出血压和眼压之间的关联性，再结合实际数据的比对，得出该关联性的不成立。

本文的不足之处在于对于与血压相关的单核苷酸多态性对眼压的影响效果无法准确评估，尚需进一步设计更加科学的研究方案进行研究。

No.3
Ophthalmology · 推荐
Long-term Outcomes from the HORIZON Randomized Trial for a Schlemm’s Canal Microstent in Combination Cataract and Glaucoma Surgery( Ophthalmology 2022;129:742-751）

HORIZON随机试验中Schlemm管微支架在白内障和青光眼联合手术中的长期结果
Purpose
To present the 5-year results of the HORIZON trial comparing cataract surgery (CS) combined with an intracanalicular microstent with CS alone.介绍HORIZON试验的5年随访结果，该试验比较了单纯白内障手术与联合微管支架植入白内障手术的随访结果。

Design
Prospective, multicenter, controlled randomized clinical trial.前瞻性、多中心、对照随机临床试验。

Participants
Patients with cataract and primary open-angle glaucoma treated with 1 or more glaucoma medications, washed-out diurnal intraocular pressure (DIOP) of 22 to 34 mmHg, and no prior incisional glaucoma surgery.入选患者为白内障和原发性开角型青光眼接受一种或多种青光眼药物治疗，日间眼压（DIOP）为22至34 mmHg，之前未进行切口青光眼手术。

Methods
Eyes were randomized 2:1 to receive a Hydrus Microstent (HMS; Ivantis, Inc) or no stent after successful CS.在白内障手术成功后，眼睛被随机以2:1比例接受Hydrus微支架（HMS；Ivantis，Inc）或不接受支架。

Main outcome measures
Intraocular pressure (IOP), glaucoma medication use, repeat glaucoma surgery, visual acuity, visual field, procedure-related adverse events, and corneal endothelial cell counts.眼压（IOP）、青光眼药物使用、重复青光眼手术、视力、视野、手术相关不良事件和角膜内皮细胞计数。

Results
Three hundred sixty-nine eyes were randomized to HMS treatment, and 187 eyes were randomized to CS only. Study groups were well matched for preoperative IOP, medication use, washed-out DIOP, and glaucoma severity. Five-year follow-up was completed in 80% of patients. At 5 years, the HMS group included a higher proportion of eyes with IOP of 18 mmHg or less without medications than the CS group (49.5% vs. 33.8%; P = 0.003), as well as a greater likelihood of IOP reduction of 20% or more without medications than the CS group (54.2% vs. 32.8%; P < 0.001). The number of glaucoma medications was 0.5 ± 0.9 in the HMS group and 0.9 ± 0.9 in the CS group (P < 0.001), and 66% of eyes in the HMS group were medication free compared with 46% in the CS group (P < 0.001). The cumulative risk of incisional glaucoma surgery was lower in the HMS group (2.4% vs. 6.2%; P = 0.027, log-rank test). No clinical or statistically significant differences were found in the rate of endothelial cell loss from 3 to 60 months between the HMS and CS alone groups (P = 0.261).369只眼随机接受联合微管支架白内障手术治疗，187只眼随机接受单纯白内障手术治疗。研究组在术前眼压、药物使用、日间眼压消退和青光眼严重程度方面匹配良好。80%的患者完成了五年随访。在5年时，联合微管支架白内障手术组未经药物治疗的眼压为18 mmHg或更低的眼睛比例高于单纯白内障手术组（49.5%对33.8%；P=0.003），并且未经药物治疗的眼压降低20%或以上的可能性高于单纯白内障手术组（54.2%对32.8%；P<0.001）。联合微管支架白内障手术组和单纯白内障手术组的青光眼药物数量分别为0.5±0.9和0.9±0.9（P<0.001），联合微管支架白内障手术组66%的眼睛无药物治疗，而单纯白内障手术组为46%（P<0.001）。联合微管支架白内障手术组切口青光眼手术的累积风险较低（2.4%对6.2%；P=0.027，对数秩检验）。在3到60个月期间，联合微管支架白内障手术组和单纯白内障手术组之间的内皮细胞丢失率没有发现临床或统计上的显著差异（P=0.261）。

Conclusions
The addition of a Schlemm’s canal microstent in conjunction with CS was safe, resulted in lowered IOP and medication use, and reduced the need for postoperative incisional glaucoma filtration surgery compared with CS after 5 years. Long-term presence of the implant did not affect the corneal endothelium adversely.与5年后的单纯白内障手术相比，联合微管支架植入的白内障手术是安全的，降低了眼压和药物使用，减少了术后切口青光眼滤过手术的需要。植入物的长期存在不会对角膜内皮产生不利影响。

推荐理由：
本研究探索了单纯白内障手术与联合微管支架植入的白内障手术治疗开角型青光眼白内障患者的术后效果，发现在随访5年中，联合微管支架植入的白内障手术治疗方式更加有效，降低了眼压和药物使用，减少了术后切口青光眼滤过手术的需要，且对角膜内皮是安全的。文章创新点是评估了微管支架联合植入对青光眼白内障患者的远期疗效，发现对患者更加有利且安全。

文章的不足之处为未统计两组的视力变化，且对于微管支架植入相关并发症，比如移位等未做观察，未来可进一步观察。

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