10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（10月）
No.1
Retina · 推荐
COMBINATION OF VITRECTOMY AND INTENTIONAL MACULAR DETACHMENT IS ASSOCIATED WITH A FASTER EDEMATOUS REGRESSION THAN VITRECTOMY ALONE IN THE TREATMENT OF REFRACTORY DIABETIC MACULAR EDEMA(Retina: October 2022 – Volume 42 – Issue 10 – p 1859-1866

doi: 10.1097/IAE.0000000000003536）

在治疗难治性糖尿病性黄斑水肿时，玻璃体切除术和故意性黄斑脱离术的结合与单独进行玻璃体切除术相比能更快的水肿消退
Purpose
To compare clinical outcomes in eyes with refractory diabetic macular edema managed by vitrectomy combined with and without intentional macular detachment (IMD).比较玻璃体切除术治疗难治性糖尿病黄斑水肿合并和不合并故意性黄斑脱离（IMD）的临床结果。

Methods
This is a retrospective cohort study. Forty-one eyes with diabetic macular edema that were previously poorly responsive to at least 5 monthly anti–vascular endothelial growth factor and at least twice switch therapy previously were included in this study. All eyes underwent pars plana vitrectomy with internal limiting membrane peeling, 21 of which were combined with an IMD procedure (assigned to an IMD group) and 20 of which did not have IMD performed (nMD group). Macular morphologic and visual acuity changes were analyzed from baseline through the endpoint (24 weeks) postprocedure, and were compared between groups.这是一项回顾性队列研究。本研究纳入了41只糖尿病性黄斑水肿患者，这些患者此前对至少5个月抗血管内皮生长因子和至少两次切换治疗反应不佳。所有眼睛都接受了平面部玻璃体切除术联合内界膜剥离术，其中21只眼睛与IMD手术结合（分配给IMD组），其中20只眼睛没有进行IMD手术（nMD组）。从基线到术后终点（24周）分析黄斑形态学和视力变化，并进行了组间比较。

Results
All patients completed at least six months of follow-up, with a mean of 29.7 weeks (24–56 weeks). The mean central retinal thickness reduction was greater in the IMD group than that in the nMD group at 1 week (P = 0.001), 2 weeks (P = 0.008), and 4 weeks (P = 0.004), but there was no statistically significant difference at 12 weeks (P = 0.051) or 24 weeks (P = 0.056). There were no significant differences in the mean changes of best-corrected visual acuity from baseline to the 24 weeks endpoint in either group (P = 0.83).所有患者完成了至少6个月的随访，平均随访29.7周(24-56周)。IMD组在1周（P=0.001）、2周（P=0.008）和4周（P=0.004）的平均中心视网膜厚度减少量大于nMD组，但在12周（P=0.051）或24周（P=0.056）没有统计学上的显著差异，无统计学意义。两组的最佳矫正视力从基线到24周终点的平均变化没有明显差异（P = 0.83）。

Conclusion
Vitrectomy can release macular edema in the eyes with refractory diabetic macular edema. Combined with IMD technical, patients seemed to achieve a faster central retinal thickness decrease but neither the final morphologic outcome nor the visual acuity was affected.玻璃体切除术可以缓解难治性糖尿病黄斑水肿患者的黄斑水肿。结合IMD技术，患者的中央视网膜厚度似乎减少得更快，但最终的形态学结果和视力都没有受到影响。

推荐理由

该研究证实了玻璃体切除术，特别是联合IMD，可以对传统非手术治疗反应较差的DME眼获得非常快速的水肿解决。创新之处在于在该研究推测不可逆的黄斑损伤发生前，早期玻璃体切除联合IMD可快速解决黄斑水肿，改善视觉功能。而前瞻性随机试验加上健康经济分析的优点将提供更好地确定何时以及如何在DME管理中采用这种手术干预。

该研究的不足之处在于没有将玻璃体切除术（有或没有IMD）与反复玻璃体内注射或其他非手术治疗进行比较，也没有将单独接受玻璃体切除手术（没有ILM剥离或填充空气）的患者包括在内，且样本量相对较小。

No.2
Investigative Ophthalmology & Visual Science · 推荐

Association between Vaccination with the BNT162b2 mRNA Coronavirus Disease 2019 Vaccine and Noninfectious Uveitis: A Population-Based Study(journal/ophthalmology/vol/129/issue/10

https://doi.org/10.1167/iovs.63.10.18）

BNT162b2 mRNA冠状病毒病2019疫苗疫苗接种与非感染性葡萄膜炎之间的关系：基于人群的研究
Purpose
To examine the elongation of the retina and ciliary body in relation to myopic axial elongation.检查视网膜和睫状体的伸长与近视轴伸长的关系。

Methods
Using light microscopy, we histomorphometrically measured in enucleated human globes the length of the retina from the ora serrata to the optic disc borders. The total retinal length was the mean of the retinal length measurements obtained on both sides of the optic disc. We additionally determined the length of the ciliary body between the ora serrata and the scleral spur.利用光学显微镜，我们对摘除的人眼球进行了组织形态学上的测量，测量了从ora serrata到视盘边缘的视网膜长度。总视网膜长度为视盘两侧获得的视网膜长度测量值的平均值。我们还测定了锯齿和巩膜刺之间睫状体的长度。

Results
The study included 174 eyes (mean age, 61.7 ± 14.8 years; range, 24–89 years) with a mean sagittal eye diameter of 25.9 ± 3.2 mm (range, 21.0–37.0 mm). Retinal length (beta, 0.81; nonstandardized regression coefficient B, 0.73; 95% confidence interval (CI), 0.65–0.81; P < 0.001) and ciliary body length elongated (beta, 0.49; nonstandardized regression coefficient B, 0.16; 95% CI, 0.12–0.20; P < 0.001) with a longer sagittal eye diameter. Retinal length and ciliary body length were associated with each other (beta, 0.34; nonstandardized regression coefficient B, 0.12; 95% CI, 0.07–0.17).该研究包括174只眼睛（平均年龄，61.7±14.8岁，范围，24-89岁），平均矢状眼直径为25.9±3.2毫米（范围，21.0-37.0毫米）。视网膜长度（β，0.81;非标准化回归系数B，0.73;95%置信区间（CI），0.65-0.81;P <0.001）和纤毛体长伸长（β，0.49;非标准化回归系数B，0.16; 95% CI，0.12-0.20;P <0.001），矢状眼直径较长。视网膜长度和睫状体长度相互关联（β，0.34，非标准化回归系数B，0.12;95%CI，0.07–0.17）。

Conclusion
The retina elongates by 0.73 mm (95% CI, 0.65–0.81) and the ciliary body by 0.16 mm (95% CI, 0.12–0.20) for each millimeter of axial elongation. With the inner limiting membrane and retinal nerve fibers forming the only structures connecting the deeper retinal layers with the optic disc, retinal elongation may be associated with a stretching of the retinal nerve fibers, potentially leading to optic nerve damage in highly myopic eyes, and with an increased strain within the inner limiting membrane, potentially leading to an intraretinal elevation at the posterior pole with the sequel of a myopic maculoschisis.轴向每拉长一毫米，视网膜拉长0.73毫米(95% CI, 0.65-0.81)，睫状体拉长0.16毫米(95% CI, 0.12-0.20)。由于内界膜和视网膜神经纤维是连接深层视网膜与视盘的唯一结构，视网膜伸长可能与视网膜神经纤维的拉伸有关，可能导致高度近视眼的视神经损伤，并与内界膜内的应变增加有关，可能导致极的视网膜后内抬高，继发近视性黄斑裂。

推荐理由

该研究结果可能具有临床重要性。任何到视盘距离的增加都可能导致视网膜神经纤维的拉伸和内界膜（ILM）中的应变增加，这两种机制可能分别在视神经损伤和近视黄斑裂的发病机制中发挥作用。该研究测量了人眼组织学切片上的睫状体和视网膜的长度，并将其值与矢状眼直径相关联。创新之处在于探讨了视网膜和睫状体的伸长与近视轴伸长的关系，极具临床意义，并就高度近视眼的视神经损伤与青光眼进行了探讨，非常具有创新性。未来可以探讨乳头状黄斑纤维的延伸和拉伸是否与视网膜深层没有近视黄斑改变的高度近视眼睛的中央暗斑的发展有关。

该研究的不足之处在于研究结果可能无法直接转移到没有这些疾病的眼睛上，术后缺血和术前的组织肿胀是不可避免的摘除后变化，这可能影响了研究中眼部组织的尺寸。另外对于矢状眼直径和睫状体长度之间的关联是曲线型的，而不是线性的，统一进行一个线性回归分析并不十分合适。

No.3
Ophthalmology · 推荐
Association between Vaccination with the BNT162b2 mRNA Coronavirus Disease 2019 Vaccine and Noninfectious Uveitis: A Population-Based Study(journal/ophthalmology/vol/129/issue/10

https://doi.org/10.1016/j.ophtha.2022.05.015）

BNT162b2 mRNA冠状病毒病2019疫苗疫苗接种与非感染性葡萄膜炎之间的关系：基于人群的研究
Purpose
To assess the association between BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccine and the risk of active noninfectious uveitis (NIU).评估BNT162b2 mRNA冠状病毒病2019（COVID-19）疫苗与活动性非感染性葡萄膜炎（NIU）风险之间的关联。

Design
Retrospective, population-based study.回顾性、基于人群的研究。

Participants
Two million six hundred two thousand five hundred fifty-seven people who received the first vaccine dose between December 20, 2020, and April 30, 2021, and 2 441 719 people who received the second vaccine dose between January 10, 2021, and April 30, 2021.2020年12月20日至2021年4月30日期间接种了第一剂疫苗的266020557人，以及2021年1月10日至2021年4月30日期间接种了第二剂疫苗的2441719人。

Methods
Events of active NIU were included if they occurred within 21 days after either vaccine dose. Active NIU was defined as newly active or worsening ocular inflammation requiring initiation or increase in local or systemic corticosteroids. Observed cases were compared with the expected number, based on the experience of the population in 2019.如果活动性NIU事件发生在任一疫苗接种后21天内，则包括在内。活动性NIU被定义为新的活动性或恶化的眼部炎症，需要开始使用或增加局部或全身性皮质类固醇。根据2019年人群的经验，将观察到的病例与预期数量进行比较。

Main Outcome Measures
Age- and sex-adjusted standardized incidence ratios (SIRs) and attributable risks after BNT126b2 vaccination.接种BNT126b2疫苗后，经年龄和性别调整的标准化发病率（SIRs）和归因风险。

Results
Overall, 100 and 88 events of active NIU were recorded within 21 days after the first and second vaccine doses, respectively. Using the experience of the population in 2019 as a reference, after the first dose, the estimated age- and sex-adjusted SIR was 1.41 (95% confidence interval [CI], 1.15–1.71) along with a 21-day attributable risk of 1.12 cases per 100 000 vaccinees. After the second dose, the SIR was 1.31 (95% CI, 1.05–1.62), with an estimated attributable risk of 0.86 cases per 100 000 vaccinees. Anterior uveitis was the most common site of inflammation, occurring in 90.96% of eyes, and idiopathic uveitis was the most common cause (56.38%).总体而言，在第一剂和第二剂疫苗接种后的21天内，分别记录了100和88起活动性NIU事件。以2019年人群的经验为参考，第一剂疫苗接种后，经年龄和性别调整的SIR估计为1.41(95%置信区间[CI]为1.15-1.71)，21天归因风险为每10万名疫苗接种者1.12例。在第二次注射后，SIR为1.31 (95% CI, 1.05-1.62)，估计归因风险为每10万名疫苗接种者0.86例。前葡萄膜炎是最常见的炎症部位，发生在90.96%的眼睛中，特发性葡萄膜炎是最常见的原因(56.38%)。

Conclusions
This study suggests that the BNT162b2 mRNA COVID-19 vaccine may be associated with an increased risk of active NIU. However, considering the small effect size and study limitations, this study does not provide proof for a cause-and-effect relationship. The small estimated attributable risks suggest that the impact on public health is relatively minor.本研究表明，BNT162b2 mRNA COVID-19疫苗可能与活动性NIU风险增加有关。然而，考虑到小规模的影响和研究的局限性，本研究并没有提供因果关系的证据。估计的归因风险较小，表明对公共健康的影响相对较小。

推荐理由

该研究检查了一个大型的、基于人群的接受BNT162b2疫苗的个体数据库，并比较了需要治疗的活动性非传染性葡萄膜炎（NIU）的发病率与COVID-19大流行前后的发病率。结果表明，在有葡萄膜炎病史的患者中，活跃的NIU的发病率增加，总体AR约为每1000名接种者1例，在特定年龄组中每1000名接种者多达3例。该研究的亮点在于选择了在前2剂注射后的前21天内检测活性NIU的发生率。该窗口被认为足以治疗短期并发症，而不会太长而稀释效果，并且与几项研究用来检查COVID-19疫苗短期并发症的窗口一致。这个时间框架限制了其他可能导致与疫苗无关的活动性疾病的潜在因素的影响。

该研究的局限性与其回顾性观察的性质有关，依赖于最初为行政和临床管理目的而收集的数据，而不是专门为目前的研究设计的。因此，研究中的数据提取可能会出现错误和缺乏数据，很可能导致非差异性的错误分类。

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