10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（10月）

No.1
Retina · 推荐
FULL-THICKNESS MACULAR HOLE IN AGE-RELATED MACULAR DEGENERATION PATIENTS WITH TWO DISTINCT ENTITIES(Retina. 2021;41(10):2066-2072.）

年龄相关性黄斑变性患者的全厚度黄斑裂孔，有两种不同的表现
Purpose
To describe optical coherence tomography characteristics of full-thickness macular holes (FTMHs) in age-related macular degeneration patients.描述年龄相关性黄斑变性患者全厚度黄斑裂孔（FTMHs）的光学相干断层扫描特征。

Methods
A multicenter, retrospective, observational case series of patients diagnosed with age-related macular degeneration and FTMHs seen between January 1, 2009, and January 3, 2020. Clinical charts and spectral-domain optical coherence tomography images were reviewed. Optical coherence tomography findings included FTMH-inverted trapezoid or hourglass appearance, central macular thickness (CMT), complete retinal pigment epithelium and complete retinal outer retinal atrophy, and presence of pigment epithelium detachment and epiretinal membrane. The mean outcome was the morphologic and functional characterization of different subtypes of FTMHs.2009年1月1日至2020年1月3日期间诊断为年龄相关性黄斑变性和FTMHs患者的多中心、回顾性、观察性病例系列。回顾了临床图表和光谱域光学相干断层扫描图像。光学相干断层扫描结果包括FTMH倒梯形或沙漏状外观、中央黄斑厚度（CMT）、完整的视网膜色素上皮和完整的视网膜外萎缩、色素上皮脱离和视网膜前膜。平均结果是不同亚型FTMHs的形态和功能特征

Results
A total of 86 eyes of 85 consecutive patients, with mean age of 80.31 ± 8.06 and mean best-corrected visual acuity of 1.17 ± 0.58 logarithm of the minimal angle of resolution. Two different subtypes of FTMHs were identified: tractional and degenerative. Fifty (58%) degenerative FTMHs characterized with inverted trapezoid appearance and 36 (42%) tractional FTMHs characterized with hourglass appearance. Degenerative FTMHs presented with 66% of CMT < 240µm, 14% of CMT > 320, and 70% of complete retinal outer retinal atrophy, in comparison with 41% of CMT < 240µm, 42.9% of CMT > 320%, and 20% of complete retinal outer retinal atrophy in the tractional FTMH group (P= 0.002, 0.003, <0.001, respectively). The presence of epiretinal membrane and pigment epithelium detachment where significantly higher in tractional FTMHs (P= 0.02, 0.03, respectively).85名连续患者共86只眼，平均年龄为80.31±8.06岁，平均最佳矫正视力为最小分辨角对数的1.17±0.58。确定了两种不同的FTMHs亚型：牵引型和退行性。50例（58%）退行性FTMHs表现为倒梯形，36例（42%）牵引性FTMHs表现为沙漏状。与牵引性FTMH组中41%的CMT<240µm、42.9%的CMT>320%和20%的完全性视网膜外萎缩相比，退行性FTMH表现为66%的CMT<240µm、14%的CMT>320和70%的完全性视网膜外萎缩（分别P=0.002、0.003和<0.001）。在牵引性FTMHs中，视网膜前膜和色素上皮脱离的出现率明显较高（分别为P=0.02和0.03）。

Conclusion
Degenerative and tractional FTMHs may be two distinct clinical entities. Discerning degenerative from tractional FTMHs is possible by using optical coherence tomography features including shape of the FTMHs, CMT, internal–external ratio of FTMHs, and presence of complete retinal outer retinal atrophy, pigment epithelium detachment, and epiretinal membrane.Full-thickness macular holes in age-related macular degeneration patients can be divided into tractional and degenerative subgroups. Discerning degenerative from tractional full-thickness macular holes is possible by using optical coherence tomography features including shape of the full-thickness macular holes, central macular thickness, presence of complete retinal outer retinal atrophy, pigment epithelium detachment, and epiretinal membrane.

退行性和牵引性FTMHs可能是两种不同的临床实体。通过光学相干断层扫描特征，包括FTMHs的形状、CMT、FTMHs的内外比、完全性视网膜外萎缩、色素上皮脱离和视网膜前膜，可以区分牵引性FTMHs和退行性FTMHs。

年龄相关性黄斑变性患者的全厚度黄斑裂孔可分为牵引性和变性亚组。通过光学相干断层扫描特征，包括全厚度黄斑裂孔的形状、中央黄斑厚度、是否存在完全的视网膜外萎缩、色素上皮脱离和视网膜前膜，可以区分牵引性全厚度黄斑裂孔和退行性全厚度黄斑裂孔。

推荐理由
该研究帮助临床医生区分了牵引性FTMHs和退行性FTMHs的两种不同表现，文章的创新之处在于通过一年时间的回顾分析86只眼的FTMHs的形状、中央黄斑厚度、是否存在完全的视网膜外萎缩、色素上皮脱离和视网膜前膜的光学相干断层扫描结果，确定了两种不同的FTMH亚型，分别为牵引型和退行性。

文章的不足之处在于虽然描述并比较了牵引性和退行性FTMHs的特征，但没有对接受PPV的患者进行随访，包括视力变化和手术结果。为了更好地了解牵引性和退行性FTMHs的病理生理学和阶段，还需要进行更大规模的前瞻性研究。

No.2
Investigative Ophthalmology & Visual Science · 推荐
Impacts of Systemic Hypertension on the Macular Microvasculature in Diabetic Patients Without Clinical Diabetic Retinopathy( Invest Ophthalmol Vis Sci. 2021;62(12):21.）

全身性高血压对无临床糖尿病视网膜病变的糖尿病患者黄斑微血管的影响
Purpose
Purpose: To identify the impact of hypertension (HTN) on macular microvasculature in type 2 diabetes (T2DM) patients without clinical diabetic retinopathy.探讨高血压（HTN）对无临床糖尿病视网膜病变的2型糖尿病（T2DM）患者黄斑微血管的影响。

Methods
 In this retrospective cross-sectional study, subjects were divided into three groups: controls (control group), patients with T2DM (DM group), and patients with both T2DM and HTN (DM + HTN group). The vessel length density (VD) was compared among the groups. Linear regression analyses were performed to identify factors associated with VD.在这项回顾性横断面研究中，受试者分为三组：对照组（对照组）、2型糖尿病患者（糖尿病组）和2型糖尿病合并HTN患者（糖尿病+HTN组）。比较各组间血管长度密度（VD）。进行线性回归分析以确定与VD相关的因素。

Results
 The VD in the control, DM, and DM + HTN groups was 20.43 ± 1.16, 19.50 ± 1.45, and 18.19 ± 2.06 mm−1, respectively (P < 0.001). The best-corrected visual acuity (B = −9.30; P = 0.002), duration of T2DM (B = −0.04; P = 0.020), HTN (B = −0.51; P = 0.016), signal strength (B = 1.12; P < 0.001), and ganglion cell–inner plexiform layer thickness (B = 0.06; P < 0.001) were significant factors affecting VD in patients with T2DM. Additionally, the hemoglobin A1c (HbA1c) (B = −0.49; P = 0.016) was significantly associated with VD in patients with both T2DM and HTN.对照组、DM组和DM+HTN组的VD分别为20.43±1.16、19.50±1.45和18.19±2.06mm−分别为1例（P<0.001）。最佳矫正视力（B=−9.30；P=0.002），T2DM持续时间（B=−0.04；P=0.020），HTN（B=−0.51；P=0.016）、信号强度（B=1.12；P<0.001）和神经节细胞-内丛状层厚度（B=0.06；P<0.001）是影响T2DM患者VD的重要因素。此外，血红蛋白A1c（HbA1c）（B=−0.49；P=0.016）与T2DM和HTN患者的VD显著相关。

Conclusion
Patients with T2DM had impaired macular microvasculature, and patients with T2DM with HTN exhibited greater impairment of the microvasculature than did patients with T2DM only. Additionally, physicians should be aware that the macular microvasculature would be more vulnerable to hyperglycemic damage under ischemic conditions by HTN.T2DM患者的黄斑微血管受损，T2DM合并HTN患者的微血管受损程度高于单纯T2DM患者。此外，医生应意识到，在HTN引起的缺血条件下，黄斑微血管更容易受到高血糖损伤。

推荐理由
本研究将受试者分为三组进行对照研究，研究结果表明，与健康个体相比，T2DM患者的黄斑微血管系统受损，并且T2DM合并HTN患者表现出比单纯的T2DM患者更严重的微血管损伤。本文的创新之处在于使用了信号强度相对较高的OCTA图像，可以进行准确的分析。此外，很少有研究报告HTN对T2DM患者黄斑微血管系统的影响。

不足之处在于没有确定受损的黄斑微血管系统与视觉功能的各个方面之间的关系，并且无法排除研究患者之前曾发生过HTN视网膜病变但随后消退，这点可能会影响黄斑微血管系统数据。

No.3
Ophthalmology · 推荐
Panretinal Photocoagulation for Diabetic Retinopathy in the RIDE and RISE Trials: Not “1 and Done”(Ophthalmology. 2021;128(10):1448-1457.）

RIDE and RISE试验中糖尿病视网膜病变的全视网膜光凝治疗：不是“1且完成”
Purpose
To evaluate panretinal photocoagulation (PRP) treatment and re-treatment patterns in patients with diabetic retinopathy (DR) and diabetic macular edema (DME).评估糖尿病视网膜病变（DR）和糖尿病黄斑水肿（DME）患者的全视网膜光凝（PRP）治疗和再治疗模式。

Design
Post hoc analysis of the phase 3 RIDE (clinicaltrials.gov identifier,NCT00473382) and RISE (clinicaltrials.gov identifier,NCT00473330) clinical trials of ranibizumab for the treatment of DME.雷尼珠单抗治疗二甲醚的3期临床试验（clinicaltrials.gov标识符，NCT00473382）和RISE（clinicaltrials.gov标识符，NCT00473330）的事后分析。

Participants
Seven hundred fifty-nine patients were randomized for treatment.参与者：759名患者随机接受治疗。

Methods
Panretinal photocoagulation treatment patterns and clinical experiences were assessed by baseline PRP treatment status.通过基线PRP治疗状态评估全视网膜光凝治疗模式和临床经验。

Main Outcome Measures
Number and timing of on-study PRP treatment sessions undergone through month 24. Time to new proliferative event (composite end point) was also assessed.第24个月期间进行的研究中PRP治疗的次数和时间安排。还评估了发生新的增殖事件（复合终点）的时间。

Results
At baseline, approximately 25% of patients in RIDE and RISE had undergone PRP treatment before enrollment (22.2%, 24.4%, and 25.4% of patients in the sham, ranibizumab 0.3 mg, and ranibizumab 0.5 mg arms, respectively). In patients without prior PRP at baseline (n = 577), 9.5% of sham-treated patients underwent 1 or more PRP treatments through month 24, compared with 1.1% and 1.6% of patients receiving ranibizumab 0.3 mg and ranibizumab 0.5 mg, respectively (P < 0.001 for both ranibizumab arms vs. sham). In patients with prior PRP at baseline (n = 182), 19.3% of sham-treated patients underwent 1 or more PRP treatments through month 24. No ranibizumab-treated patients with prior PRP at baseline required additional on-study PRP through month 24 (P < 0.001 for both ranibizumab arms vs. sham). Ranibizumab treatment also significantly reduced clinical DR progression among patients who underwent prior PRP. By month 24 in patients with prior PRP at baseline, the probability of experiencing a new proliferative event was 10.3% and 9.9% in patients receiving ranibizumab 0.3 mg and ranibizumab 0.5 mg treatment, respectively, compared with 39.4% in sham-treated patients (P < 0.0001). Overall, sham-treated patients, including those patients who were PRP naïve at baseline who went on to require PRP, experienced more clinical events than ranibizumab-treated patients.在基线检查时，约25%的RIDE和RISE患者在入组前接受过PRP治疗（假手术组、0.3 mg雷尼珠单抗组和0.5 mg雷尼珠单抗组分别为22.2%、24.4%和25.4%）。在基线检查时无PRP的患者中（n=577），9.5%的假手术治疗患者在24个月内接受了1次或多次PRP治疗，而接受0.3 mg雷尼珠单抗和0.5 mg雷尼珠单抗治疗的患者分别为1.1%和1.6%（雷尼珠单抗组和假手术组的P<0.001）。在基线检查时有PRP病史的患者中（n=182），19.3%的假手术患者在24个月内接受了1次或更多的PRP治疗。在基线检查时有PRP病史的患者，在研究第24个月期间，无需接受雷尼珠单抗治疗的患者需要额外的PRP研究（雷尼珠单抗组和假手术组的P<0.001）。雷尼珠单抗治疗也显著降低了既往PRP患者的临床DR进展。在基线检查时有PRP病史的患者中，到第24个月时，接受0.3 mg雷尼珠单抗和0.5 mg雷尼珠单抗治疗的患者发生新的增殖事件的概率分别为10.3%和9.9%，而接受假治疗的患者发生新的增殖事件的概率为39.4%（P<0.0001）。总的来说，假手术治疗的患者，包括那些在基线检查时PRP幼稚并继续需要PRP的患者，比雷尼单抗治疗的患者经历更多的临床事件。

Conclusion
In RIDE and RISE, PRP treatment was not a “1 and done” procedure, with on-study PRP re-treatment occurring in patients both with and without prior PRP treatment at baseline. Ranibizumab treatment reduced on-study PRP treatment and DR progression regardless of prior PRP treatment status at baseline.在RIDE and RISE中，PRP治疗不是一个“一劳永逸”的过程，在基线检查时，既往接受过PRP治疗的患者和未接受过PRP治疗的患者都会进行研究中的PRP再治疗。无论基线检查时PRP治疗前的状态如何，研究中PRP治疗和DR进展的雷尼珠单抗治疗均减少。

推荐理由
本研究分为3个治疗组（假手术组、雷珠单抗0.3毫克、雷珠单抗0.5毫克），根据基线PRP状态进行分析。在治疗组之间比较PRP治疗事件的数量和时间，为了更好地理解既往PRP治疗与DR恶化之间的关系，使用先前描述的新增殖事件的复合终点时间对既往PRP患者进行DR恶化评估。发现雷珠单抗治疗延迟了发生新增殖事件的时间。 本研究的创新之处在于本研究结果挑战了PRP是一次性手术的看法，与PRP相比，抗VEGF治疗可改善视力、解剖和DR严重程度。并建议临床中在评估PDR患者时，可考虑将雷珠单抗治疗作为独立的选择或与PRP一起使用。 本研究不足之处是在雷珠单抗组中接受研究中PRP的患者数量很少，这限制了组间比较。
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