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（6月）

No.1

Retina · 推荐

INCIDENCE AND RISK FACTORS OF POSTOPERATIVE ENDOPHTHALMITIS AFTER PRIMARY SURGICAL REPAIR COMBINED WITH INTRAOCULAR FOREIGN BODY REMOVAL(Retina: June 2022 – Volume 42 – Issue 6 – p 1144-1150）

眼内异物清除术后眼内炎发生率及危险因素分析

Purpose

To analyze the incidence and risk factors of postoperative endophthalmitis  after primary surgical repair and intraocular foreign body (IOFB) removal within 24 hours of injury.分析损伤后24小时内一次手术修复和眼内异物（IOFB）切除术后眼内炎的发生率和危险因素。

Methods

The records of all patients treated surgically for open globe injury and IOFBremoval at the Eye Hospital of Shandong First Medical University between January 1, 2015, and June 30, 2020, were retrospectively reviewed. Variables included time from injury to operation, cause of injury, details of surgical repair, and follow-up. The incidence and risk factors of endophthalmitis after IOFB removal were studied.回顾性审查了2015年1月1日至2020年6月30日在山东第一医科大学眼科医院接受开放性眼球损伤和IOFB切除手术治疗的所有患者的记录。变量包括从受伤到手术的时间，受伤原因，手术修复的细节和随访。研究了IOFB切除术后眼内炎的发生率和危险因素。

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

 The incidence of infectious endophthalmitis after primary surgical repaircombined with IOFB removal (#24 hours) was 3.70% in patients who received a series of standard treatments, and B. cereus infection might be a risk factor.在接受一系列标准治疗的患者中，一次手术修复联合IOFB切除（#24小时）后感染性眼内炎的发病率为3.70%，而蜡样芽孢杆菌感染可能是一个危险因素。

推荐理由

本研究探索了眼内异物清除术后眼内炎发生率及危险因素，原发性眼内修复术后感染性眼内炎的发生率联合IOFB摘除(#24小时)在接受一系列标准治疗的患者中占3.70%，蜡样芽胞杆菌感染可能是一个危险因素。文章创新点是对患者进行一个回顾性的研究，观察患者术后发生眼内炎的可能性及感染的菌株，有对患者的追溯观察。

文章的不足之处为在随访的过程中患者的信息收集可能会有误差，患者的每个人都有差异，对结果可能有一定的影响。有少量的患者在切除IOFB后发生感染性眼内炎。并且没有进行数据的统计分析，需要进一步的研究来阐明风险因素。

No.2

Investigative Ophthalmology & Visual Science · 推荐

High-Density Optical Coherence Tomography Analysis Provides Insights Into Early/Intermediate Age-Related Macular Degeneration Retinal Layer Changes(May 2022, Vol.63, 36. doi:https://doi.org/10.1167/iovs.63.5.36 ）

高密度光学相干断层扫描分析提供对早期/中期年龄相关性黄斑变性视网膜层变化的见解

Purpose

To topographically map all of the thickness differences in individual retinal layers between early/intermediate age-related macular degeneration (AMDearly/AMDint) and normal eyes and to determine interlayer relationships.1从地形上映射早期/中期年龄相关性黄斑变性（AMDearly/AMDint）和正常眼睛之间单个视网膜层的所有厚度差异，并确定层间关系。

Methods

Ninety-six AMDtotal (48 AMDearly and 48 AMDint) and 96 normal eyes from 192 participants were propensity-score matched by age, sex, and refraction. Retrospecive optical coherence tomography (OCT) macular cube scans were acquired, and highdensity (60 × 60 0.01-mm2) grid thicknesses were custom extracted for comparison between AMDtotal and normal eyes corrected for confounding. Resultant “normal differences” underwent cluster, interlayer correlation, and dose–response analyses for the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer + Henle’s fiber layer (ONL+HFL), inner and outer segment (IS/OS) thickness, and retinal pigment epithelium (RPE) to Bruch’s membrane (BM) thickness.来自192名参与者的96只AMDtotal（48 AMDearly和48 AMDint）和96只正常眼睛的倾向评分与年龄，性别和屈光相匹配。获取逆向光学相干断层扫描（OCT）黄斑立方体扫描，并定制提取高密度（60×60 0.01-mm2）网格厚度，以比较AMDtotal和正常眼睛之间的混淆。对视网膜神经纤维层（RNFL）、神经节细胞层（GCL）、内丛状层（IPL）、内核层（INL）、外丛状层（OPL）、外核层+Henle纤维层（ONL+HFL）、内和外段（IS/OS）厚度以及视网膜色素上皮（RPE）至布鲁氏膜（BM）厚度进行了簇状、层间相关性和剂量-反应分析。

Results

AMDtotal inner retinal clusters demonstrated extensively thinned RNFL, GCL, IPL,and paracentral INL and thickened INL elsewhere, with normal difference means ranging from −8.13 μm (95% confidence interval [CI], −11.12 to −5.13) to 1.58 μm (95% CI, 1.07–2.09) (P < 0.0001 to P < 0.05). Outer retinal clusters displayed thinned paracentral OPL/ONL+HFL, central IS/OS, and peripheral RPE–BM and thickened central RPE–BM, with means ranging from −1.31 μm (95% CI, −2.06 to −0.55) to 2.99 μm (95% CI, 0.97– 5.01] (P < 0.0001 to P <0.05). Effect sizes (−2.56 to 9.93 SD), cluster sizes, and eccentricity effects varied. All interlayer correlations were negligible to moderate regardless of AMD severity. Only the RPE–BM was partly thicker with greater AMD severity (up to 5.44 μm; 95% CI, 4.88–6.00; P < 0.01).AMDtotal内部视网膜簇显示RNFL，GCL，IPL，广泛变薄，其他部位 INL 增厚，正差均值范围从−8.13 μm（95%置信区间[CI]，−11.12到−5.13）到1.58μm（95%CI，1.07-2.09）（P<0.0001到P<0.05）。视网膜外簇显示中心旁OPL/ONL+HFL、中心IS/OS和外周RPE-BM以及中心RPE-BM增厚，均值范围为−1.31 μm（95% CI，−2.06至−0.55）至2.99 μm（95% CI，0.97–5.01]（P <0.0001至P <0.05）。效应大小（−2.56 至 9.93 SD）、簇大小和偏心率效应各不相同。无论AMD严重程度如何，所有层间相关性均可忽略不计至中等。只有RPE-BM部分较厚，AMD严重程度更高（高达5.44μm; 95%CI，4.88-6.00;P < 0.01）。

Conclusion

From the early stage, AMD eyes demonstrate thickness differences compared to normal with unique topographies across all retinal layers. Poor interlayer correlations highlight that the outer retina inadequately reflects complete retinal health. The clinical importance of OCT assessment across all individual retinal layers in early/intermediate AMD requires further investigation.从早期阶段开始，AMD的眼睛就表现出与正常人相比的厚度差异，在所有视网膜层上都有独特的地形。层间相关性差凸显了外视网膜不能充分反映完整的视网膜健康。在早期/中期AMD中，OCT评估在所有个体视网膜层中的临床重要性需要进一步研究。

推荐理由

本文为高密度光学相干断层扫描分析为早期/中期年龄相关性黄斑变性视网膜层改变提供了见解，96只早期/中期年龄相关性黄斑变性视网膜层眼和96只正常眼，一共192个参与者获得了逆向光学相关断层扫描(OCT)黄斑立方体扫描对视网膜神经纤维层(RNFL)、神经节细胞层(GCL)、内丛状层(IPL)、内核层(INL)、外丛状层(OPL)、外核层+ Henle s纤维层(ONL+HFL)、内外节段(IS/OS)厚度以及视网膜色素上皮(RPE)和Bruch s膜(BM)厚度进行了聚类分析、层间相关性和剂量反应分析。

文章创新之处在采用对比论证，设计详细，减少误差，得出较差的层间相关性强调外层视网膜不能充分反映完全的视网膜健康状况。

不足之处在于在早期/中期AMD中，OCT评估所有个体视网膜层的临床重要性需要进一步研究。目前还没有既定的准则界定每个单独的视网膜层的临床重要厚度差异，特别是在人工分割的情况下的重要厚度差异。

No.3

Ophthalmology · 推荐

Genotypic and Phenotypic Spectrum of  Foveal Hypoplasia:A Multicenter Study(Volume 129, Issue 6, June 2022, Pages 708-718）

中央凹发育不全的基因型和表型谱:一项多中心研究

Purpose

To characterize the genotypic and phenotypic spectrum of foveal hypoplasia (FH).表征中央凹发育不全（FH）的基因型和表型谱。

Design

Multicenter, observational study.多中心观察研究

Participants

Individuals with a confifirmed molecular diagnosis and availability of foveal OCT scans were identifified from 12 centers or from the literature between January 2011 and March 2021. A genetic diagnosis was confifirmed by sequence analysis. Grading of FH was derived from OCT scans.在2011年1月至2021年3月期间，从12个中心或文献中识别出具有确认分子诊断和中央凹OCT扫描可用性的个体。通过序列分析证实了遗传诊断。FH的分级来自OCT扫描。

Methods

Individuals with a confifirmed molecular diagnosis and availability of foveal OCT scans were identifified from 12 centers or from the literature between January 2011 and March 2021. A genetic diagnosis was confifirmed by sequence analysis. Grading of FH was derived from OCT scans.在2011年1月至2021年3月期间，从12个中心或文献中识别出具有确认分子诊断和中央凹OCT扫描可用性的个体。通过序列分析证实了遗传诊断。FH的分级来自OCT扫描。

Main outcome measures

Grade of FH, presence or absence of photoreceptor specialization (PRS+vs PRS -), molecular diagnosis, and visual acuity (VA).晚期AMD被定义为在年度体检中在眼底照片或医疗记录中发现的区域萎缩或新生血管性年性黄斑变性，包括玻璃体内注射抗血管内皮生长因子药物。

Results

The most common genetic etiology for typical FH in our cohort was albinism (67.5%), followed by PAX6 (21.8%), SLC38A8 (6.8%), and FRMD7 (3.5%) variants. AHR variants were rare (0.4%). Atypical FH was seen in 67.4% of achromatopsia cases. Atypical FH in achromatopsia had signifificantly worse VA than typical FH (P < 0.0001). There was a signifificant difference in the spectrum of FH grades based on the molecular diagnosis (chi-square =60.4, P < 0.0001). All SLC38A8 cases were PRSe (P= 0.003), whereas all FRMD7 cases were PRS +(P < 0.0001). Analysis of albinism subtypes revealed a signifificant difference in the grade of FH (chisquare =31.4, P < 0.0001) and VA (P= 0.0003) between oculocutaneous albinism (OCA) compared with ocular albinism (OA) and HermanskyePudlak syndrome (HPS). Ocular albinism and HPS demonstrated higher grades of FH and worse VA than OCA. There was a signifificant difference (P < 0.0001) in VA between FRMD7 variants compared with other diagnoses associated with FH.在我们的队列中，典型FH最常见的遗传病因是白化病（67.5%），其次是PAX6（21.8%），SLC38A8（6.8%）和FRMD7（3.5%）变异。AHR变异体很少见（0.4%）。非典型FH见于67.4%的色盲病例。消色盲症中的非典型FH比典型FH明显更差（P <0.0001）。基于分子诊断，FH等级谱存在显著差异（卡方=60.4，P<0.0001）。所有SLC38A8病例均为PRSe（P= 0.003），而所有FRMD7病例均为PRS +（P <0.0001）。对白化病亚型的分析显示，与眼部白化病（OA）和HermanskyePudlak综合征（HPS）相比，眼部皮肤白化病（OCA）在FH（chisquare = 31.4，P <0.0001）和VA（P = 0.0003）的等级差异很大。眼白化病和HPS表现出比OCA更高的FH等级和更差的VA。与其他与FH相关的诊断相比，FRMD7变体之间的VA差异显着（P <0.0001）。

Main outcome measures

We characterized the phenotypic and genotypic spectrum of FH. Atypical FH is associated with a worse prognosis than all other forms of FH. In typical FH, our data suggest that arrested retinal development occurs earlier in SLC38A8, OA, HPS, and AHR variants and later in FRMD7 variants. The defined time period of foveal developmental arrest for OCA and PAX6 variants seems to demonstrate more variability. Our findings provide mechanistic insight into disorders associated with FH and have significant prognostic and diagnostic value.我们表征了FH的表型和基因型谱。与所有其他形式的 FH 相比，非典型 FH 的预后更差。在典型的FH中，我们的数据表明，在SLC38A8，OA，HPS和AHR变体中更早发生视网膜发育停滞，后来在FRMD7变体中发生。OCA和PAX6变体的中央凹发育停滞的确定时间段似乎显示出更多的变异性。我们的研究结果为与FH相关的疾病提供了机械洞察力，并具有显着的预后和诊断价值。

推荐理由

本研究探索了中央凹发育不全的基因型和表型谱,OCA和PAX6变异对中央凹发育停止的定义时间似乎显示出更多的可变性文章创新点是多中心观察研究，观察范围广，收集资料全，观察变量多，发现在典型的FH中，数据表明，视网膜发育受阻在SLC38A8、OA、HPS和AHR变异中发生得更早，在FRMD7变异中发生得更晚

文章的不足之处为数据相对可能要注意纳入标准要更详细一点，在PAX6中可能存在泛视的情况，眼球震颤在不同的病例中也是可变的，这也可能导致VA的降低，可能有一些选择偏差，包括了由OCT确定的患有FH的患者，有可能排除了有介质不透明的患者。

SILICONE OIL–FILLED FOLDABLE CAPSULAR VITREOUS BODY VERSUS SILICONE OIL ENDOTAMPONADE FOR TREATMENT OF NO LIGHT PERCEPTION AFTER SEVERE OCULAR TRAUMA

(Retina: March 2022 – Volume 42 – Issue 3 – p 553-560）

硅油填充的折叠式人工玻璃体球囊和硅油填充治疗严重眼外伤后的无光感眼

Purpose

To compare the anatomical and functional outcomes of silicone oil (SO)–fifilled foldable capsular vitreous body (FCVB) and SO endotamponade in vitrectomy for patients with no light perception after ocular trauma.

比较硅油填充的折叠式人工玻璃体球囊（FCVB）和硅油（SO）填充在严重眼外伤无光感眼患者玻璃体切割术术后的解剖和功能结果。

Methods

A total of 64 patients (64 eyes) with no light perception caused by severe ocular trauma were divided into FCVB and SO groups based on the surgical treatment. The main outcome measurements were retinal reattachment rate, intraocular pressure, bestcorrected visual acuity, and number of operations.

将64例(64只眼)严重眼外伤致无光感患者根据手术治疗情况分为FCVB组和SO组。主要观察指标为视网膜再附着率、眼压、最佳矫正视力和手术次数。

Results

Both the FCVB group (29 eyes) and the SO group (35 eyes) showed signifificant improvement in postoperative best-corrected visual acuity and intraocular pressure. The two groups showed no signifificant differences in fifinal intraocular pressure and the retinal reattachment rate. The postoperative vision ($LP) in the FCVB group was signifificantly worse than in the SO group (FCVB [4/29] vs. SO [18/35], P = 0.003). However, the number of surgeries in the FCVB group was signifificantly lower than in the SO group (FCVB [1.10] vs. SO [2.23], P , 0.001).

FCVB组(29眼)和SO组(35眼)术后最佳矫正视力和眼压均有明显改善。两组末次随访眼压及视网膜再附着率无显著差异。FCVB组术后视力($LP)明显低于SO组(FCVB [4/29] vs. SO [18/35]， P = 0.003)。但FCVB组的手术次数明显低于SO组(FCVB [1.10] vs. SO [2.23]， P, 0.001)。

Conclusion

 Vitrectomy combined with SO endotamponade shows better short-term improvement in the treatment of no light perception caused by severe ocular trauma. However, SO-fifilled FCVB can effectively prevent many complications caused by direct SO endotamponade, such as secondary surgeries or SO dependence.

玻璃体切割术联合SO内填充治疗重度眼外伤无光感短期疗效较好。然而，硅油填充的FCVB能有效预防SO直接填充引起的许多并发症，如二次手术或硅油依赖眼等。

推荐理由

本文研究了硅油填充的FCVB与硅油填充治疗严重眼外伤后无光感对比分析了两种手术的优点和缺点，FCVB有助于减少术后并发症的发生，但玻璃体切除术联合SO内填充治疗重度眼外伤无光感短期疗效较好。

本文创新之处在于通过科学的对比，分析了无光感眼接受两种手术方式后患者的术后并发症和视力比较，得出FCVB手术可以有效预防患者术后并发症，预后好；在视力方面，SO直接填充只能起到短期的一个维持效果，从长远角度来看，预后并发症多，二次手术可能性大。

文章不足之处在于未对SO二次手术效果与第一次做FCVB手术效果进行进一步分析，SO直接填充的二次手术是否优于第一次，效果是否优于首次FCVB手术。

No.2

Investigative Ophthalmology & Visual Science · 推荐

Study of the Correlation Between Severity of Endophthalmitis and Posterior Vitreous Detachment Using a Rabbit Endophthalmitis Model

( Investigative Ophthalmology & Visual Science February 2022, Vol.63, 6. ）

用兔眼内炎模型研究眼内炎严重程度与玻璃体后脱离的相关性

Purpose

We have reported that the absence of posterior vitreous detachment (PVD) is related to the onset and severity of infectious endophthalmitis, based on clinical experience. To demonstrate clinical findings in animal models, we created endophthalmitis models for the presence or absence of PVD and examined differences in severity.

我们根据临床经验报道，后玻璃体脱离(PVD)的缺失与感染性眼内炎的发病和严重程度有关。为了证明动物模型的临床结果，我们创建了有或没有眼内病变的眼内炎模型，并检查了严重程度的差异。

Methods

We estimated a rabbit infectious eye model with and without PVD using Pseudomonas aeruginosa (PVD(+) and PVD(−) groups). After injection of bacteria inoculation for 3, 6, 12, and 24 hours, we evaluated the clinical score of the anterior chamber (n = 14). Removing the vitreous and retina from the enucleated eyeballs, the number of bacteria was counted using each specimen (n = 12). In addition, the number of inflammatory cells approximately 3 mm2 around the optic disc and histopathologic grading of intraocular inflammation was compared from histopathologic images (n = 7). Elec-troretinogram (ERG) was performed in experimentally infected rabbit eyes in both groups at three times after injection of the bacterial suspension.

我们用铜绿假单胞菌(PVD(+)组和PVD(-)组)对兔传染性眼模型进行评估。在接种细菌3、6、12和24小时后，我们对14例患者的前房进行临床评分。摘除眼球的玻璃体和视网膜后，每个标本计数细菌数(n = 12)。此外,炎症细胞的数量约3平方毫米在视神经盘和组织病理分级的眼内炎症比较病理图像(n = 7)。Elec-troretinogram (ERG)进行实验感染兔的眼睛在两组细菌悬液注射后的三倍。

Results

There was no difference between the two groups in the clinical score of the anterior chamber of each time phase, but the bacterial cultures showed significantly fewer bacteria in the PVD(−) group 24 hours after bacterial inoculation (P < 0.05). Furthermore, the number of inflammatory cells was significantly less in the PVD group (P < 0.05). As a result of ERG, the decreases of a- and b-waves in amplitude were significantly greater in the PVD(−) group than in the PVD(+) group.

两组前房各时间阶段的临床评分差异无统计学意义，但PVD(-)组在细菌接种24小时后细菌培养量明显减少(P <0.05)。此外，PVD组炎症细胞数量显著减少(P <0.05)。ERG结果显示，PVD(-)组a波和b波振幅的下降明显大于PVD(+)组。

Conclusion

The present study confirms using animal models that the absence of PVD contributed to the severity of bacterial endophthalmitis.

本研究通过动物模型证实，PVD的缺失与细菌性眼内炎的严重程度有关。

推荐理由

本文通过动物实验研究了眼内炎严重程度与玻璃体后脱离的相关性，得出PVD的缺失与细菌性眼内炎的严重程度有关。

文章创新之处在利用动物做实验，观察更加直接，结果准确，将兔眼内严重程度做了对比分析，直接清晰可靠，数据清楚明了，有利于分析。

本文的不足之处在于未将兔眼内炎和人眼内炎做一个比较分析，有利于结果的准确性未考虑到潜在变化，未来可进一步继续优化设计方案的科学性。

No.3

Ophthalmology · 推荐

Effificacy and Safety of 8 Atropine Concentrations for Myopia Control in Children

(Volume 129, Issue 3, March 2022, Pages 322- 333）

8种阿托品浓度控制儿童近视的疗效和安全性

Topic

Comparative effificacy and safety of different concentrations of atropine for myopia control.

不同浓度阿托品控制近视的疗效和安全性比较。

Clinical Relevance

Atropine is known to be an effective intervention to delay myopia progression. Nonetheless, no well-supported evidence exists yet to rank the clinical outcomes of various concentrations of atropine.

阿托品被认为是延缓近视进展的有效干预手段。尽管如此，目前还没有得到充分支持的证据对不同浓度阿托品的临床结果进行排序。

Methods

We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov on April 14, 2021. We selected studies involving atropine treatment of at least 1 year’s duration for myopia control in children. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) and compared 8 atropine concentrations (1% to 0.01%). We ranked the atropine concentrations for the corresponding outcomes by P score (estimate of probability of being best treatment). Our primary outcomes were mean annual changes in refraction (diopters/ year) and axial length (AXL; millimeters/year). We extracted data on the proportion of eyes showing myopia progression and safety outcomes (photopic and mesopic pupil diameter, accommodation amplitude, and distance and near best-corrected visual acuity [BCVA]).

我们于2021年4月14日搜索了PubMed、EMBASE、Cochrane对照试验中央注册、世界卫生组织国际临床试验注册平台和ClinicalTrials.gov。我们选择了阿托品治疗至少1年的儿童近视控制的研究。我们对随机对照试验(rct)进行了网络荟萃分析(NMA)，并比较了8个阿托品浓度(1%至0.01%)。我们根据P评分(对最佳治疗可能性的估计)对相应结果的阿托品浓度进行排序。我们的主要结果是每年的平均屈光度(屈光度/年)和轴长(AXL;毫米/年)。我们提取了显示近视进展和安全结果(光和介浅瞳孔直径、调节幅度、距离和近最佳矫正视力[BCVA])的眼睛比例的数据。

Results

Thirty pairwise comparisons from 16 RCTs (3272 participants) were obtained. Our NMA ranked the 1%, 0.5%, and 0.05% atropine concentrations as the 3 most benefificial for myopia control, as assessed for both primary outcomes: 1% atropine (mean differences compared with control: refraction, 0.81 [95% confifidence interval (CI), 0.58e1.04]; AXL, e0.35 [e0.46 to e0.25]); 0.5% atropine (mean differences compared with control: refraction, 0.70 [95% CI, 0.40e1.00]; AXL, e0.23 [e0.38 to e0.07]); 0.05% atropine (mean differences compared with control: refraction, 0.62 [95% CI, 0.17e1.07]; AXL, e0.25 [e0.44 to e0.06]). In terms of myopia control as assessed by relative risk (RR) for overall myopia progression, 0.05% was ranked as the most benefificial concentration (RR, 0.39 [95% CI, 0.27e0.57]). The risk for adverse effects tended to rise as the atropine concentration was increased, although this tendency was not evident for distance BCVA. No valid network was formed for near BCVA.

从16项随机对照试验(3272名参与者)中获得了30个两两比较。我们的NMA将1%、0.5%和0.05%的阿托品浓度列为3个最有利于近视控制的指标，评估了两种主要结果:1%的阿托品(与对照组相比的平均差异:屈光，0.81[95%置信区间(CI)， 0.58e1.04];AXL, e0.35 [e0.46到e0.25]);0.5%阿托品(与对照组相比的平均差异:屈光度，0.70 [95% CI, 0.40e1.00];AXL, e0.23 [e0.38到e0.07]);0.05%阿托品(与对照组相比，平均差异:屈光度，0.62 [95% CI, 0.17e1.07];AXL, e0.25 [e0.44 to e0.06])。在总体近视进展的相对风险(RR)评估的近视控制方面，0.05%被列为最有益的浓度(RR, 0.39 [95% CI, 0.27e0.57])。不良反应的风险随着阿托品浓度的增加而增加，尽管这种趋势在距离BCVA中不明显。BCVA附近未形成有效网络。

Discussion

The ranking probability for effificacy was not proportional to dose (i.e., 0.05% atropine was comparable with that of high-dose atropine [1% and 0.5%]), although those for pupil size and accommodation amplitude were dose related.

疗效排名的概率与剂量无关(即0.05%阿托品与高剂量阿托品具有可比性[1%和0.5%])，尽管瞳孔大小和调节幅度与剂量相关。

推荐理由

本研究探索了8种阿托品浓度控制儿童近视的疗效和安全性得出在总体近视进展的相对风险(RR)评估的近视控制方面，0.05%被列为最有益的浓度(RR, 0.39 [95% CI, 0.27e0.57]),0.05%阿托品与高剂量阿托品具有可比性[1%和0.5%]

文章创新点是关注不同阿托品浓度，从大数据中提取合适患者进行研究，数据准确度高，通过科学的方案设计分析出阿托品浓度控制对于视力的影响

文章的不足之处为没有做患儿之间的差异性比较，可能存在偏差。

昨日（10月21日）晚上，新视界跨学科名医论坛第一期直播圆满结束。4位中山大学中山眼科中心不同学科专家，眼外伤科林晓峰教授担任主持嘉宾，白内障科郑丹莹教授、屈光与低视力科杨晓教授、角膜科梁凌毅教授，就“角膜损伤后散光的产生及处理”进行深度访谈，探讨不规则散光的类型、早期干预办法、后期解决方案，以及针对散光的创新治疗等内容，为大家提供了一场精彩的学术盛宴！值得一提的是，在直播中有多人陆续进行线上提问，各位教授也一一进行解答。以下为直播视频，点击可观看▽、

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搭建跨越不同学科的学术平台，邀请各学科领域专家学者，每期以各学科热点难点话题，探讨疑难病例、创新产品与技术，进行多元化交流，展现学术风采。

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名医面对面>>各界名医无缝交流，高峰论坛碰撞思想火花跨学科产品速递>>名医深度解析不同学科创新产品和技术

1月25日晚上，新视界跨学科名医论坛第三期直播圆满结束！中山大学中山眼科中心不同学科的四位专家，眼底外科胡洁教授担任主持嘉宾联袂白内障科罗莉霞教授、小儿眼病&眼底外科丁小燕教授和眼外伤科何丽文教授，放眼眼科历史之河，回眸过往，共同对眼科重大发明发现进行多维度深度讨论与解析。

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此前在2021年，名医论坛共开展两期直播，分别为“角膜损伤后散光的产生及处理”和“硅油依赖眼的出路在哪里？”，共有五千多人观看实时直播。未来，卫视博还将以北京、上海为直播基地，邀请全国各地专家名医进行直播分享，敬请期待！

名医论坛

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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（9月）Evaluation of the efficacy of posterior scleral contraction in the treatment of macular hole with retinal detachment in high myopia Macular surgery on sclera(Ye J, Wu Y, Zhu S, et al. EVALUATION OF THE EFFICACY OF POSTERIOR SCLERAL CONTRACTION IN THE TREATMENT OF MACULAR HOLE WITH RETINAL DETACHMENT IN HIGH MYOPIA. Retina. 2021;41(9)_1874-1882.）

后巩膜收缩术治疗高度近视黄斑裂孔合并视网膜脱离的手术疗效评价

Purpose

To evaluate efficacy of posterior scleral contraction (PSC) for macular hole withretinal detachment (MHRD) in high myopia.评价后巩膜收缩术（PSC）治疗高度近视黄斑裂孔合并视网膜脱离（MHRD）的疗效。

Methods

Seventy-three MHRD eyes were treated with PSC. A strip was sent across inferiortemporal scleral surface to posterior pole, then two ends were led out from nasal-inferior and temporal-superior areas. It was tightened to contract posterior sclera with designed axial length (AL) shortening ([10% of pre-operative AL-0.5]mm) after aqueous humors drained from anterior chamber. Recovery was classified as type I (retinal reattachment with MH bridged) and II (retinal reattachment without MH bridged). Follow-up duration was 25.3±18.0 months.73只高度近视黄斑裂孔合并视网膜脱离眼接受后巩膜收缩术治疗。将条带穿过颞下巩膜面至后极，然后从鼻下区和颞上区引出两端。前房排出房水后，用设计的轴向长度（AL）缩短法（[10%术前轴向长度-0.5]mm）收紧后巩膜，以收缩后巩膜。恢复类别分为I型（黄斑裂孔桥接的视网膜复位）和II型（无黄斑裂孔桥接的视网膜复位）。随访时间为25.3±18.0个月。

Results

AL was 30.01±2.27mm at pre-operation and shortened by 2.57±0.82mm intraoperatively. At final post-operation, maintained AL shortening was 1.87±0.92mm. Forty-six eyes (63.0%) recovered as type I and 26 eyes (35.6%) as type II, 1 eye (1.4%) unrecovered. Postoperative best-corrected visual acuity (BCVA, logarithm of minimal angle of resolution [LogMAR]) was better than pre-operative one (0.85±0.50 [Snellen 20/125] vs. 1.11±0.56 [Snellen 20/250], P<0.001) with correlation (r=0.662, P<0.001) and consistency (Kappa=0.34, P<0.001) between two. BCVA improvement didn’t differ between recovery types (P=0.206).术前轴向长度为30.01±2.27mm，术中缩短2.57±0.82mm。术后最后一次手术时，维持的轴向长度缩短为1.87±0.92mm。46只眼（63.0%）恢复为I型，26只眼（35.6%）恢复为II型，1只眼（1.4%）未恢复。术后最佳矫正视力（BCVA，最小分辨角对数[LogMAR]）优于术前（0.85±0.50[Snellen 20/125]vs.1.11±0.56[Snellen 20/250]，P<0.001），两者之间具有相关性（r=0.662，P<0.001）和一致性（Kappa=0.34，P<0.001）。恢复类型之间的术后最佳矫正视力改善没有差异（P=0.206）。

Conclusion

MHRD was successfully recovered by PSC with AL shortening. Visual improvement was achieved, correlated and consistent with pre-operative BCVA while independent of recovery types.黄斑裂孔伴视网膜脱离通过后巩膜收缩和轴向长度缩短成功恢复。视力得到改善，与术前最佳矫正视力一致，且与恢复类型无关。

推荐理由

本文研究了高度近视黄斑裂孔伴视网膜脱离患者采用巩膜加压术进行治疗，术后视网膜复位，眼轴缩短，手术治疗效果好。本文创新之处在于对比了术后不同类型的恢复与最佳矫正视力之间的关系，得出恢复类型与视力之间不具相关性。
文章不足之处在于文章病例随访时间显示，手术末次随访的眼轴数据较术中缩短的数据缩短的区间有所降低，对于更远期的随访，比如5年、10年是否依旧能够维持是个未知数，需进一步随访观察。

No.2

Investigative Ophthalmology & Visual Science · 推荐

COVID-19 Home Quarantine Accelerated the Progression of Myopia in Children Aged 7 to 12 Years in China( Ma M, Xiong S, Zhao S, Zheng Z, Sun T, Li C. COVID-19 Home Quarantine Accelerated the Progression of Myopia in Children Aged 7 to 12 Years in China. Invest Ophthalmol Vis Sci. 2021;62(10)_37.）

新冠病毒-19家庭隔离加速了中国7-12岁儿童近视的发展

Purpose

To investigate the effect of home quarantine during the COVID-19 pandemic on myopia progression in children and its associated factors.探讨在COVID-19大流行期间，家庭隔离对儿童近视进展的影响及其相关因素。

Methods

Myopic children aged 7 to 12 years with regular follow-up visits every half a year from April 2019 to May 2020 were included. Cycloplegic refraction was measured at baseline and at two follow-up visits. The first follow-up visit (visit 1) was conducted before the COVID-19 home quarantine, whereas the second (visit 2) was four months after the home quarantine. Myopia progression at visits 1 and 2 were compared. Factors associated with changes in myopia progression were tested with a multiple regression analysis.包括2019年4月至2020年5月每半年定期随访的7至12岁近视儿童。在基线检查和两次随访时测量睫状肌麻痹性屈光。第一次随访（第1次随访）是在COVID-19家庭隔离之前进行的，而第二次随访（第2次随访）是在家庭隔离四个月之后进行的。比较第1次和第2次就诊时的近视进展情况。用多元回归分析测试与近视进展变化相关的因素。

Results

In total, 201 myopic children were enrolled. There was a significantly greater change in spherical equivalent at visit 2 (−0.98 ± 0.52 D) than at visit 1 (−0.39 ± 0.58 D; P < 0.001). Students were reported to have spent more time on digital devices for online learning (P < 0.001) and less time on outdoor activities (P < 0.001) at visit 2 than at visit 1. Children using television and projectors had significantly less myopic shift than those using tablets and mobile phones (P < 0.001). More time spent on digital screens (β = 0.211, P < 0.001), but not less time on outdoor activities (β = −0.106, P = 0.110), was associated with greater myopia progression at visit 2.总共有201名近视儿童入选。在第2次就诊时(−0.98±0.52 D），比第1次随访时(−0.39±0.58天；P<0.001）球面当量的变化显著更大。据报道，与第1次随访相比，第2次随访的学生在用于在线学习的数字设备上花费的时间更多（P<0.001），而在户外活动上花费的时间更少（P<0.001）。与使用平板电脑和手机的儿童相比，使用电视和投影仪的儿童近视转移明显减少（P<0.001）。在第2次随访时发现，控制户外活动的时间不降低（β=−0.106，P=0.110），但是在数字屏幕上花费的时间增加（β=0.211，P<0.001），近视进展同样显著。

Conclusion

Changes in behavior and myopic progression were found during the COVID-19 home quarantine. Myopic progression was associated with digital screen use for online learning, but not time spent on outdoor activities. The projector and television could be better choices for online learning.在COVID-19居家隔离期间发现了行为和近视进展的变化。近视进展与在线学习使用数字屏幕有关，但与户外活动时间无关。投影仪和电视可能是在线学习的更好选择。

推荐理由

本文研究了新冠疫情期间，居家隔离的防控政策对教学方式的改变进一步影响了儿童近视的发展，得出数字屏幕的使用时间与近视的发展想关。文章创新之处在于通过借助社会环境改变的背景设置变量，收集到数字屏幕的使用时长与近视关联，得出针对该环境下更有利于控制近视防控的建议。本文的不足之处在于仅分析了儿童屈光度的进展改变，未收集其他数据改变，例如视力，未来可进一步丰富研究内容。

No.3

Ophthalmology · 推荐

Bidirectional Association between Visual Impairment and Dementia Among Older Adults in the United States Over Time(Chen SP, Azad AD, Pershing S. Bidirectional Association between Visual Impairment and Dementia Among Older Adults in the United States Over Time. Ophthalmology. 2021;128(9)_1276-1283.）

随着时间的推移，美国老年人视力障碍和痴呆症之间的相互影响

Purpose

Although visual impairment (VI) has been associated with worse cognitive performance among older adults, the temporal relationship between the 2 remains subject to debate. Our objective was to investigate the longitudinal impact of VI on cognitive function and vice versa.尽管视力障碍（VI）与老年人的认知能力较差（老年痴呆症）有关，但两者之间的先后影响关系仍存在争议。我们的目的是研究视力障碍与老年痴呆症的相互影响关系。

Design

Retrospective, time-to-event study.回顾性、事件时间研究。

Participants

National Health and Aging Trends Study (NHATS) participants from 2011 to 2018 cycles.参与者为入选2011年至2018年国家健康和老龄化趋势研究（NHAT）的人员。

Methods

A total of 10 676 participants aged 65 years and older were included. Cox proportional hazards regression models evaluated the impact of baseline VI on subsequent dementia and impact of baseline dementia on subsequent VI. Models were adjusted for potential confounding variables, including demographics, clinical comorbidities, and hearing and physical function limitations.共有10676名65岁及以上的参与者被纳入研究。采用考克斯比例风险回归模型，评估初始视力障碍人群继发痴呆的概率以及初始痴呆患者后续继发视力障碍的概率。模型针对潜在的混杂变量进行干扰排除，包括人口统计学、临床共病、听力和身体功能限制。

Main Outcome Measures

Hazard ratio (HR) for incident dementia among participants with baseline selfreported VI and HR for incident VI among participants with baseline dementia.初始视力损害参与者中继发痴呆的比例和初始痴呆参与者中继发视力损害的比例。

Results

Of the 10 676 participants included in the analysis, approximately 40% were aged 65-74 years, 40% were aged 75-84 years, and the remaining 20% were aged 85 years and older. The majority were female (59%), and 68% self-identifified as non-Hispanic White. Among participants with normal cognitive status at baseline, subsequent dementia was observed in 1753 (16%), and among participants with normal self-reported vision at baseline, subsequent VI was reported in 2371 (22%). In adjusted regression models, participants with baseline VI had higher likelihood of developing dementia over subsequent follow-up (HR, 2.3; 95% confifidence interval [CI], 2.0e2.6; P < 0.001). Likewise, participants with baseline dementia had a higher likelihood of developing self-reported VI over time (HR, 2.5; 95% CI, 2.2e2.8; P < 0.001).在纳入分析的10676名参与者中，约40%的人年龄在65-74岁，40%的人年龄在75-84岁，其余20%的人年龄在85岁及以上。大多数是女性（59%），68%的非西班牙裔白人。在初始检查时非老年痴呆症的参与者中，1753人（16%）出现继发性痴呆，在初始检查时视力正常的参与者中，2371人（22%）出现继发性视力障碍。在调整后的回归模型中，初始为视力障碍的参与者在随后的随访中发生痴呆的可能性更高（HR，2.3；95%可信区间[CI]，2.0-2.6；P<0.001）。同样，初始痴呆患者随着时间的推移出现视力障碍的可能性也更高（HR，2.5；95%CI，2.2-2.8；P<0.001）。

Conclusion

Self-reported VI in the US Medicare population is associated with greater dementia likelihood over time, and dementia is similarly associated with greater VI likelihood over time. Associations are likely multifactorial and bidirectional and could be explained by intervening variables in the path from VI to dementia, or vice versa, or by common risk factors for pathological processes in both eyes and brain. These fifindings suggest the need for early identifification of older adults with visual compromise and consideration of visual disability in the cognitively impaired.美国医疗保险人群中视力障碍患者继发老年痴呆有更大的可能性，而痴呆症随着时间的推移继发视力障碍也有更大的可能性。该影响可能是多因素和双向的，可以通过从视力障碍与痴呆的途径中的干预变量来解释，或者通过眼睛和大脑病理过程的共同风险因素来解释。这些发现表明，有必要早期识别患有视力损害的老年人，并重视痴呆患者的视力障碍。

推荐理由

本研究探索了美国老年人视力障碍和痴呆症之间的双向关联,得出两者之间的关系是双向的，相互影响。文章创新点是通过数万人的大样本统计数据进行概率分析，发现视力障碍的参与者继发痴呆的可能性比非视力障碍者更高。痴呆患者继发视力障碍的可能性比非痴呆参与者更高。文章的不足之处为变量因素复杂，尽管在统计学中排除了无关变量，但是对于一些多因素综合影响的结果，无关变量并不是绝对的无关因素，未来须从多个角度，多个方向继续探讨。