6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（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。

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