6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（6月）

No.1 Retina · 推荐

SIX MONTHS PRIMARY SUCCESS RATE FOR RETINAL DETACHMENT BETWEEN VITRECTOMY AND SCLERAL BUCKLING

(Retina.2021;41(6):1164-1173.）

玻璃体切除术和巩膜扣带术后6个月视网膜脱离的原发成功率

Purpose
To compare clinical outcomes between pars plana vitrectomy (PPV),scleral buckling(SB), and PPV+SB for rhegmatogenous retinal detachment in the Japan-RD Registry.比较日本RD注册中玻璃体切除术(PPV)、巩膜扣带术(SB)和PPV+SB治疗孔源性视网膜脱离的临床结果。
Methods
This is a nation-wide, multicenter, observational study based on the registry data between 2016 and 2017. The failure levels were defined as Level 1 (a failure of retinal detachment repair), Level 2 (remaining silicone oil), and Level 3 (multiple surgeries to achieve reattachment). We compared cases treated by SB or PPV in the subgroup of simple rhegmatogenous retinal detachment using multivariate Cox proportional hazard models.这是一项基于 2016 年至 2017 年注册数据的全国性、多中心、观察性研究。失败级别定义为1级(视网膜脱离修复失败)，2级(剩余硅油)和3级(多次手术实现再附着)。我们采用多变量Cox比例风险模型比较了单纯性孔源性视网膜脱离亚组中应用SB或PPV治疗的病例。
Results
A total of 2,775 cases were included. Overall, 6 months any levels of failure in total, SB, PPV, and PPV+SB were 9.2% (n = 256), 6.9% (n = 48), 8.2% (n = 157), and 21.3% (n = 51), respectively. Poor visual acuity at baseline in SB and inferior rhegmatogenous retinal detachment and larger retinal tear in PPV were associated with a higher risk of failure. Pars plana vitrectomy was associated with a higher chance of achieving primary success in cases with simple RRD, especially for cases with superior RRD (adjusted hazard ratio 3.61, 95% confidence interval 2.22–5.94,P< 0.001).共纳入2775例。总体而言，在 6 个月内，SB、PPV和PPV+SB分别为9.2% (n = 256)、6.9% (n = 48)、8.2% (n = 157)和21.3% (n = 51)。SB基线视力差、PPV患者的下孔源性视网膜脱离和较大的视网膜撕裂与较高的失败风险相关。在单纯 RRD 的病例中，尤其是RRD优于单纯RRD的患者，平坦部玻璃体切除术获得主要成功的机会更高（调整后的风险比为 3.61，95% 置信区间为 2.22-5.94，P< 0.001）。
Conclusion
In this nationwide study, surgical anatomic outcomes were equally successful in either SB or PPV. There were different baseline characteristics associated with primary success between SB and PPV.在这项全国性研究中，SB和PPV的手术解剖结果同样成功。SB和PPV之间与主要成功相关的基线特征不同。
推荐理由
该研究分析了2775例病例，得出了6个月的总成功率为90.8%；用SB、PPV和PPV+SB治疗的眼睛的总成功率分别为93.1%、91.8%和68.7%的真实数据。表明了PPV和SB可以同等地治疗孔源性视网膜脱离。视力更差，近视眼与SB失败的风险增加有关，下脱离和视网膜完全脱离与PPV失败的风险增加有关。这项研究的创新之处在于，所有病例的治疗都是通过JRVS批准的标准化方法，并由训练有素的合格外科医生进行。此外，这些数据在全国各地被收集起来。注册处可以收集26家主要医院的数据，并保持6个月的随访率为86.2%。该研究的不足之处在于完成数据输入的时间和资源以及收集后续信息的困难。此外，数据收集的覆盖范围或数据录入的可信度也不一定能在登记研究中得到保证。并且注气式视网膜固定术在日本很少进行，因此无法获得注气式视网膜固定术的数据。

No.2

Investigative Ophthalmology & Visual Science · 推荐

Relationship Between Optical Coherence Tomography Parameter and Visual Function in Eyes With Epiretinal Membrane

( Invest Ophthalmol Vis Sci.2021;62(6):6. doi:10.1167）

视网膜前膜眼光学相干断层扫描参数与视功能的关系

Purpose
To investigate the associations between visual function and the optical coherence tomography (OCT) parameters in eyes with idiopathic epiretinal membrane (ERM).研究特发性视网膜前膜(ERM)眼视功能与光学相干断层扫描(OCT)参数之间的关联。
Methods
 Thirty-nine consecutive eyes with ERM were enrolled. In addition to OCT parameters, such as central retinal thickness (CRT), the area of gap between the ERM and the retinal surface (SUKIMA) was newly defined and calculated from the vertical and horizontal OCT images (SUKIMAv and SUKIMAh). The average of SUKIMAv and SUKIMAh (SUKIMAave) was used for the statistical analysis. The vertical and horizontal metamorphopsia scores (MV, MH) and the average of MV and MH (Mave) were also used for the analysis.连续招募了39只ERM眼。除了视网膜中央厚度(CRT)等OCT参数外，ERM和视网膜表面 (SUKIMA) 之间的间隙区域也是新定义的，并根据垂直和水平 OCT 图像（SUKIMAv 和 SUKIMAH）计算得出。SUKIMAv 和 SUKIMAH (SUKIMAave) 的平均值用于统计分析。也以视物纵向和横向评分（MV，MH）以及MV和MH的平均值（Mave）进行分析。
Results
The Mave was not significantly associated with logMAR visual acuity (VA) (P=0.57, linear regression analysis). Analysis using second-order bias-corrected Akaike information criterion model selection identified the age, CRT, and SUKIMAave as being associated with logMAR VA. On the other hand, among the OCT parameters, SUKIMAave and CRT were associated with the Mave. In addition, there was a significant relationship between SUKIMAh and MV (P= 0.011) and between SUKIMAv and MH (P= 0.0014).Mave与logMAR视力(VA)无显著相关性（P=0.57，线性回归分析）。使用二阶偏差校正的Akaike信息标准模型选择进行分析，确定年龄、CRT和SUKIMAave与logMAR VA相关。另一方面，在OCT参数中，SUKIMAave和CRT与Mave相关。此外，SUKIMAh与MV之间（P=0.011）以及SUKIMAv与MH之间存在显着关系（P= 0.0014）。
Conclusion
We identified SUKIMA as a novel OCT parameter that is useful to predict both VA and metamorphopsia in patients with ERM.我们将 SUKIMA 确定为一种新的 OCT 参数，可用于预测 ERM 患者的 VA 和视物变形。
推荐理由
该研究发现SUKIMA是一个新的OCT参数，可以用来预测ERM患者的视力和视变形。创新之处在于确定了一个新的OCT参数SUKIMA作为特发性ERM患者的有用参数。SUKIMA易于从垂直和水平OCT图像进行测量，并且与其他变形视相关OCT参数相比，SUKIMA与变形视更密切相关。SUKIMA 是预测ERM患者变形程度的有用参数。该研究的局限性在于，首先，该研究本质上是回顾性的，入组的眼睛数量相对较少。其次，没有对术后ERM患者进行评估。最后，在当前的研究中没有测量轴向长度。轴向长度的可变性会导致OCT或OCT血管造影图像的放大倍数不同；因此，当考虑轴向长度时，可以更准确地测量 SUKIMA。

No.3

Ophthalmology · 推荐

Long-Term Safety and Efficacy of Adalimumab in Patients with Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis

(Ophthalmology 2021;128(6):899-909.）

阿达木单抗在非感染性中度葡萄膜炎、后葡萄膜炎或全葡萄膜炎患者中的长期安全性和有效性

Purpose
To evaluate long-term efficacy and safety of extended treatment with adalimumab in patients with noninfectious intermediate, posterior, or panuveitis.评估阿达木单抗延长治疗非感染性中间葡萄膜炎、后葡萄膜炎或全葡萄膜炎患者的长期疗效和安全性。
Design
Open-label, multicenter, phase 3 extension study (VISUAL III).开放标签，多中心，第3阶段扩展研究（视觉III）。
Participants
Adults who had completed a randomized, placebo-controlled phase 3 parent trial (VISUAL I or II) without treatment failure (inactive uveitis) or who discontinued the study after meeting treatment failure criteria (active uveitis).已完成随机、安慰剂对照3期母体试验（VISUAL I或II）且无治疗失败（非活动性葡萄膜炎）或在达到治疗失败标准（活动性葡萄膜炎）后中止研究的成人。
Methods
Patients received subcutaneous adalimumab 40 mg every other week. Data were collected for ≤ 362 weeks. Adverse events (AEs) were recorded until 70 days after the last dose.患者每隔一周接受一次皮下注射阿达木单抗40mg。收集的数据≤362周。记录不良事件(AE) 直至最后一次给药后70天。
Main Outcome Measures
Long-term safety and quiescence; other efficacy variables included inflammatory lesions, anterior chamber cell and vitreous haze grade, macular edema, visual acuity, and dose of uveitis-related systemic corticosteroids.长期安全和静止；其他疗效变量包括炎性病变、前房细胞和玻璃体混浊等级、黄斑水肿、视力和葡萄膜炎相关全身皮质类固醇的剂量。
Results
At study entry, 67% of patients (283/424) showed active uveitis and 33% (141/424) showed inactive uveitis; 60 patients subsequently met exclusion criteria, and 364 were included in the intention-to-treat analysis. Efficacy variables were analyzed through week 150, when approximately 50% of patients (214/424) remained in the study. Patients showing quiescence increased from 34% (122/364) at week 0 to 85% (153/180) at week 150. Corticosteroid-free quiescence was achieved by 54% (66/123) and 89% (51/57) of patients with active or inactive uveitis at study entry. Mean daily dose of systemic corticosteroids was reduced from 9.4 ± 17.1 mg/day at week 0 (n= 359) to 1.5 ± 3.9 mg/day at week 150 (n= 181). The percentage of patients who achieved other efficacy variables increased over time for those with active uveitis at study entry and was maintained for those with inactive uveitis. The most frequently reported treatment-emergent AEs of special interest were infections (n=275; 79 events/100 patient-years [PY]); AEs and serious AEs occurred at a rate of 396 events/100 PY and 15 events/100 PY, respectively.在研究开始时，67% (283/424) 的患者表现出活动性葡萄膜炎，33% (141/424) 表现出非活动性葡萄膜炎；60 名患者随后符合排除标准，364 名患者被纳入意向治疗分析。在第 150 周期间对疗效变量进行了分析，当时大约 50% 的患者 (214/424) 仍留在研究中。显示静止的患者从第 0 周的 34% (122/364) 增加到第 150 周的 85% (153/180)。54% (66/123) 和 89% (51/57) 的无皮质类固醇静止研究开始时患有活动性或非活动性葡萄膜炎的患者。全身性皮质类固醇的平均日剂量从第 0 周（n = 359）的 9.4 ± 17.1 mg/天减少到第 150 周（n = 181）的 1.5 ± 3.9 mg/天。对于在研究开始时患有活动性葡萄膜炎的患者，达到其他疗效变量的患者百分比随时间增加，而对于非活动性葡萄膜炎患者则保持不变。最常报告的特别关注的治疗紧急 AE 是感染（n = 275；79 个事件/100 患者年 [PY]）；AE 和严重 AE 的发生率分别为 396 个事件/100 PY 和 15 个事件/100 PY。
Conclusion
Long-term treatment with adalimumab led to quiescence and reduced corticosteroid use for patients who entered VISUAL III with active uveitis and led to maintenance of quiescence for those with inactive uveitis. AEs were comparable with those reported in the parent trials and consistent with the known safety profile of adalimumab.使用阿达木单抗的长期治疗导致进入 VISUAL III 的活动性葡萄膜炎患者静止并减少皮质类固醇的使用，并导致非活动性葡萄膜炎患者保持静止。AE 与母体试验中报告的 AE 相当，并且与阿达木单抗的已知安全性特征一致。
推荐理由
VISUAL III研究是VISUAL I和II研究的开放标签延伸研究，评估阿达木单抗对非感染性中间葡萄膜炎、后葡萄膜炎或全葡萄膜炎患者的长期疗效和安全性。VISUAL III研究的中期结果报告了阿达木单抗治疗78周的疗效和安全性。本文报告了在类似于现实世界临床实践的条件下治疗150周的最终疗效结果和362周的安全性结果。这项研究的不足之处在于，尽管评估了相对大量的患者，但一个关键的限制是78周后有可用数据的患者数量减少，因为网站关闭了监管或报销批准。且缺乏对照组和允许使用其他免疫抑制剂和局部皮质类固醇治疗。
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