8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（8月）

No.1     Retina · 推荐

RETINAL SURFACE WRINKLING AS AN INDICATOR FOR INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR RETINAL DETACHMENT(Retina: August 2021 – Volume 41 – Issue 8 – p 1618-1626）

视网膜表面起皱作为指示剂的内界膜剥离时玻璃体切除视网膜脱离

Purpose：To assess the validity of retinal surface wrinkling (RSW) as an indicator to select patients relevant for internal limiting membrane peeling during vitrectomy for rhegmatogenous retinal detachment, to prevent postoperative visual decline due to epiretinal membrane growth.

评估视网膜表面皱褶（RSW）作为一项指标的有效性，以选择与孔源性视网膜脱离玻璃体切除术中内界膜剥离相关的患者，防止因视网膜前膜生长导致术后视力下降。

Methods：This was a prospective, interventional case series of 78 consecutive eyes that underwent initial vitrectomy to repair rhegmatogenous retinal detachments and were followed for 6 months. The presence/absence of RSW was evaluated presurgically on en face optical coherence tomographic images. The internal limiting membrane was peeled if RSW was identified. The main outcome measure was the prevalence of postsurgical epiretinal membrane growth that caused a visual decline of 0.2 or more in logarithm of the minimum angle of resolution unit.

这是一项前瞻性的干预性病例系列，连续 78 只眼睛接受了首次玻璃体切除术以修复孔源性视网膜脱离，并随访了6个月。术前在正面光学相干断层扫描图像上评估RSW的存在/不存在。如果识别出 RSW，则剥离内界膜。主要观察指标是术后视网膜前膜生长的患病率，其导致最小分辨角单位对数视力下降0.2或以上。

Results：The internal limiting membrane was peeled for RSW appearance in 22 eyes (28.2%). Mild epiretinal membranes developed in 8 of the 56 internal limiting membrane–unpeeled eyes (10.3% of total, 6 eyes at stage 1 in the classification of Govetto); however, visual decline occurred in none of them with the mean visual acuity of these 8 eyes maintained at −0.08 ± 0.11 in logarithm of the minimum angle of resolution (≈20/16).

22眼（28.2%）内界膜剥离后出现RSW。56只内界膜未剥的眼睛中有8只出现轻度视网膜前膜（占总数的10.3%，Govetto分类第1阶段有6只眼睛）；然而，这8只眼睛的平均视力保持在-0.08±0.11的最小分辨率角对数（≈20/16），均未出现视力下降。

Conclusion：Visual decline due to epiretinal membrane growth after rhegmatogenous retinal detachment repair was entirely prevented by peeling the internal limiting membrane in about 30% of cases selected for the presence of RSW.

Visual decline due to epiretinal membrane growth after retinal detachment repair was entirely prevented by peeling the internal limiting membrane during the initial vitrectomy in about 30% of eyes selected based on the presence of retinal surface wrinkling.在选择存在 RSW 的约 30% 的病例中，通过剥离内界膜完全防止了由于孔源性视网膜脱离修复后视网膜前膜生长引起的视力下降。

通过在初始玻璃体切除术期间剥离内界膜，完全防止了由于视网膜脱离修复后视网膜前膜生长引起的视力下降，大约 30% 的眼睛根据视网膜表面皱褶的存在而选择。

推荐理由：

ERM 的术后发展是RRD玻璃体切除术后的问题之一，可能会导致术后视力受损和变形。该研究通过在初始玻璃体切除术期间剥离内界膜，完全防止了由于视网膜脱离修复后视网膜前膜生长引起的视力下降。该研究的创新之处在于开展了此次前瞻性研究，以评估视网膜表面皱纹作为RRD修复玻璃体切除术期间ILM剥离的指征有效性，结果表明大约30%的眼睛根据视网膜表面皱褶的存在而选择，均未出现由于视网膜脱离修复后视网膜前膜生长引起的视力下降。

不足之处在于目前只有六个月的随访数据，还需继续进一步监测，以观察其长期有效性。

No.2

Investigative Ophthalmology & Visual Science · 推荐

Choroidal and Retinal Thickness and Axial Eye Elongation in Chinese Junior Students(Invest Ophthalmol Vis Sci. 2021;62(9):26.）

中国低年级学生脉络膜和视网膜厚度及眼轴伸长

Purpose：To explore the associations between macular choroidal and retinal thickness and axial elongation in non-myopic and myopic junior students.

探讨非近视和近视初中生黄斑脉络膜和视网膜厚度与眼轴伸长之间的关系。

Methods：In this school-based longitudinal observational study, axial length was measured by optical low-coherence reflectometry, and choroidal thickness and retinal thickness were measured by spectral-domain optical coherence tomography. Myopia was defined as non-cycloplegic objective spherical equivalent refraction ≤ −0.50 diopters. Structural equation modeling and multiple linear regression models were used to analyze the associations between baseline choroidal and retinal thickness with axial elongation.

在这项以学校为基础的纵向观察研究中，轴长通过光学低相干反射计测量，脉络膜厚度和视网膜厚度通过光谱域光学相干断层扫描测量。近视被定义为非散瞳物镜等效球面屈光度≤ -0.50 屈光度。结构方程模型和多元线性回归模型用于分析基线脉络膜和视网膜厚度与轴向伸长之间的关联。

Results：Out of 1307 students examined at baseline in 2017, 1197 (91.58%) returned for follow-up examination in 2018, with a median age of 12.00 years (interquartile range [IQR], 1.00) and included 667 boys (55.72%). Within a 1-year period, the median axial elongation of right eyes was 230 µm (IQR, 180) in boys and 200 µm (IQR, 160) in girls (P = 0.032). The thinner temporal choroidal thickness was associated with greater 1-year axial elongation only in myopic students (β, −0.20; 95% confidence interval [CI], −0.37, −0.03), the thinner temporal retinal thickness was associated with greater 1-year axial elongation in both non-myopic (β, −2.67; 95% CI, −4.52, −0.82) and myopic (β, −0.99; 95% CI, −1.68, −0.30) students, after adjustment for sex, age, and height. Subfoveal and nasal choroidal and retinal thickness were not significantly associated with axial elongation in either non-myopic or myopic students.

在 2017 年基线检查的 1307 名学生中，1197 名 (91.58%) 于 2018 年返回进行后续检查，中位年龄为 12.00 岁（四分位距 [IQR]，1.00），其中包括 667 名男孩（55.72%） .在 1 年内，男孩右眼的中位轴向伸长为 230 µm（IQR，180），女孩为 200 µm（IQR，160）（P= 0.032）。仅在近视学生中，较薄的颞部脉络膜厚度与较大的 1 年轴向伸长相关（β，-0.20；95% 置信区间 [CI]，-0.37，-0.03），较薄的颞部视网膜厚度与较大的 1-在调整性别、年龄后，非近视（β，-2.67；95% CI，-4.52，-0.82）和近视（β，-0.99；95% CI，-1.68，-0.30）学生的年轴向伸长率, 和高度。中心凹下和鼻部脉络膜和视网膜厚度与非近视或近视学生的轴向伸长没有显着相关性。

Conclusion：A thinner temporal choroid at age 12 years may predict greater 1-year axial elongation in myopic students, and a thinner temporal retina may predict greater 1-year axial elongation in both non-myopic and myopic students. This finding may help to identify children at risk and control axial elongation with potential preventive strategies.

在 12 岁时更薄的颞叶脉络膜可以预测近视学生更大的 1 年轴向伸长，而更薄的颞叶视网膜可以预测非近视和近视学生更大的 1 年轴向伸长。这一发现可能有助于识别有风险的儿童并通过潜在的预防策略控制轴向伸长。

推荐理由

本研究探讨了非近视和近视初中生黄斑脉络膜和视网膜厚度与眼轴伸长之间的关系。结果表明在12岁时更薄的颞叶脉络膜可以预测近视学生更大的 1 年轴向伸长，而更薄的颞叶视网膜可以预测非近视和近视学生更大的 1 年轴向伸长。创新之处在于认识到更薄的颞叶脉络膜和视网膜厚度是轴向伸长的预测因素，可以更早地识别有风险的儿童，以及谁将从潜在的预防策略中受益。

不足之处在于仅观察到了脉络膜和视网膜厚度与轴向延长之间的一年的关联，未来可进行更长时间的随访。

No.3

Ophthalmology · 推荐

Retinal Detachment after Treatment of Retinopathy of Prematurity with Laser versus Intravitreal Anti–Vascular Endothelial Growth Factor(Ophthalmology. 2021;128(8):1188-1196.）

激光与玻璃体内抗血管内皮生长因子治疗早产儿视网膜病变后的视网膜脱离

Purpose：To compare rates of short-term retinal detachment (RD) of infants treated for type 1 retinopathy of prematurity (ROP) with intravitreal anti–vascular endothelial growth factor (VEGF) therapy with infants treated with laser therapy. The choice between these 2 treatments remains controversial. Comparative data are limited and describe re-treatment rates rather than retinal structural outcomes predictive of long-term vision. Anti–vascular endothelial growth factor acts faster than laser therapy, which may be beneficial for more aggressive ROP.

比较接受玻璃体内抗血管内皮生长因子 (VEGF) 治疗的1 型早产儿视网膜病变(ROP ) 的婴儿的短期视网膜脱离(RD) 的发生率与接受激光治疗的婴儿的发生率。这两种治疗方法之间的选择仍然存在争议。比较数据是有限的，描述的是再治疗率，而不是预测长期视力的视网膜结构结果。抗血管内皮生长因子的作用比激光疗法更快，这可能有利于更具侵袭性的 ROP。

Design：Nonrandomized, comparative cohort study.

非随机、比较队列研究。

Participants：The study included 1167 eyes of 640 infants treated for type 1 ROP. Among these, 164 eyes received anti-VEGF therapy and 1003 eyes received laser therapy.

该研究包括 640 名接受 1 型 ROP 治疗的婴儿的 1167 只眼睛。其中抗VEGF治疗164眼，激光治疗1003眼。

Methods：Pretreatment and posttreatment examinations and treatments were completed by ophthalmologists with expertise in ROP. The study was a secondary analysis of data from the retrospective Postnatal Growth and Retinopathy of Prematurity Study (G-ROP) 1 study (2006–2012) and the prospective G-ROP 2 study (2015–2017).

治疗前和治疗后的检查和治疗由具有 ROP 专业知识的眼科医生完成。该研究是对早产儿回顾性出生后生长和视网膜病变研究 (G-ROP) 1 研究（2006-2012 年）和前瞻性 G-ROP 2 研究（2015-2017 年）数据的二次分析。

Main Outcome Measures：Rate of RD (ROP stages 4A, 4B, or 5) within 8 weeks of initial treatment, an end point predictive of poor long-term vision. The results were stratified by postmenstrual age (PMA) at treatment as occurring before versus at or after 36 weeks and 0 days, because earlier disease may be considered more aggressive.

初始治疗 8 周内的 RD 率（ROP 4A、4B 或 5 期），这是预测长期视力不佳的终点。结果根据治疗时的经后年龄 (PMA) 进行分层，分别是发生在 36 周零 0 天之前与之后或之后，因为较早的疾病可能被认为更具侵袭性。

Results：Among 458 eyes treated before PMA 36 weeks and 0 days, the short-term RD rate was higher after laser therapy (29/368 eyes [7.9%]) than after anti-VEGF therapy (0/90 eyes [0%]; P < 0.001). Of 709 eyes treated at or after PMA 36 weeks and 0 days, short-term RD risk did not differ between groups (laser [20/635 eyes], 3.1%; anti-VEGF [1/74 eyes], 1.4%; P = 0.27).

PMA前36周0天治疗的458眼中，激光治疗后短期RD率（29/368眼[7.9%]）高于抗VEGF治疗后（0/90眼[0%]；P < 0.001)。在 PMA 36 周和 0 天时或之后治疗的 709 只眼中，组间短期 RD 风险没有差异（激光 [20/635 眼]，3.1%；抗 VEGF [1/74 眼]，1.4%；P = 0.27）。

Conclusion：Anti–vascular endothelial growth factor therapy results in better short-term structural outcomes than laser therapy when type 1 ROP is treated before 36 weeks’ PMA. After this age, both treatments have very low rates of short-term RD. The faster action of anti-VEGF agents likely is responsible for these findings.

在 PMA 前 36 周治疗 1 型 ROP 时，抗血管内皮生长因子治疗的短期结构性结果优于激光治疗。在这个年龄之后，两种治疗的短期 RD 率都非常低。抗 VEGF 药物的更快作用可能是造成这些发现的原因。

推荐理由

研究中，大量治疗的眼睛能够比较激光治疗和抗 VEGF 治疗在治疗时按 PMA 分层。许多医院和许多不同的主治医生的地理和种族多样化样本提高了研究结果的普遍性。文章的创新之处在于证实了在 PMA 前 36 周 0 天，抗 VEGF 治疗比激光治疗具有明显的短期结构性益处，并表明在 1 型诊断时更客观的 PMA 测量可能优于对疾病区域的主观判断。然而，这种益处必须与其他风险和益处一起考虑，包括长期结构性结果、长期视力结果以及接受抗 VEGF 药物治疗的患者的短期和长期安全性数据。

不足之处在于尽管该研究中接受治疗的眼睛总数很大，但某些亚组中接受抗 VEGF 药物治疗的眼睛数量，例如 36 周 PMA 时或之后的治疗，可能限制了检测组间差异的能力。

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