9月 | Vesber 最佳RIO论文推荐

R——Retina推荐
《Alterations Of Macular Blood Flow In Superficial And Deep Capillary Plexuses In The Fellow And Affected Eyes Of Patients With Unilateral Idiopathic Epiretinal Membrane》Coppe AM, Lapucci G, Gilardi M,Petruzzella F,Ripandelli G.Retina. 2020;40(8):1540-1548.单侧特发性视网膜前膜患者眼内浅、深部毛细血管丛中黄斑血流的变化
Purpose:Previous research suggests that proliferation of the idiopathic epiretinal membrane (IERM) is related to microbreaks in the inner limiting membrane, which are caused by posterior vitreous detachment. In this study, we used optical coherence tomography angiography to determine whether a vascular defect in the inner retina is present before the mechanical damage caused by posterior vitreous detachment.
目的:已有研究表明特发性视网膜前膜(IERM)的增殖与玻璃体后脱离引起的内界膜微破裂有关。在这项研究中,我们使用光学相干断层扫描血管造影来确定在后玻璃体脱离造成机械性损伤之前,视网膜内是否存在血管缺损。
Methods:For patients with unilateral IERM (N = 23), optical coherence tomography angiography with blood flow measurement was performed in both eyes at the superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) with 6 mm × 6-mm scans and ETDRS grids centered on the fixation point. These values were then compared with 45 healthy control eyes (CEs).
方法:对于单侧IERM(N = 23)的患者,在TDRS网格固定点中心进行6毫米×6毫米的光学相干断层扫描血管造影,测量患者两只眼睛中在浅毛细血管丛(SCP)和深毛细血管丛(DCP)的血流量。然后将这些值与45只健康对照眼睛(CEs)进行比较。
Results:The optical coherence tomography angiography data showed that blood flow was lower in the fellow eyes of IERM patients than in CEs when the whole enface macula (SCP: P = 0.031, DCP: P = 0.004) and extramacular area (SCP: P = 0.048, DCP: P = 0.026) were compared between groups. The blood flow was also lower in the affected eyes compared with CEs in both whole en face macula (SCP: P < 0.001, DCP: P < 0.001) and extramacular areas (SCP: P = 0.011, DCP: P < 0.001).
结果:单侧IERM患者对测眼的全层黄斑(SCP:P=0.031,DCP:P=0.004)和黄斑周边(SCP:P=0.048,DCP:P=0.026)光学相干断层扫描血管造影数据,及患眼全层黄斑(SCP:P<0.001,DCP:P<0.001)和黄斑周边(SCP:P=0.011,DCP:P<0.001)光学相干断层扫描血管造影数据表明,单侧IERM患者对侧眼的血流量对比对照组要低于对照组,同样,患眼的血流量对比对照组也要低于对照组。
Conclusions:Data from this study revealed that blood flow is significantly reduced in the fellow eyes of patients with unilateral IERM when compared with CEs. Overall, the data suggest that a vascular retinal defect could produce changes in the inner retina, preceding and influencing the formation of microbreaks occurring at the time of posterior vitreous detachment in the inner limiting membrane. Understanding the upstream mechanism of inner limiting membrane microbreaks may provide a therapeutic target aimed to ultimately prevent Mu[Combining Diaeresis]ller cells, astrocyte, and fibroblast migration, which cause IERM proliferation.
结论:与对照组相比,单侧IERM患者的对侧眼血流明显减少。总的来说,数据表明,视网膜血管性缺损可能在视网膜内部产生变化,在视网膜内界膜后玻璃体脱离时先于并影响微破裂的形成。了解内界膜微破裂的上游调控机制,可能能阻止穆勒细胞(联合分裂细胞)、星形胶质细胞和成纤维细胞迁移,这些细胞迁移会导致IERM增殖,从而为治疗IERM增殖提供一个新的治疗思路。
推荐理由 :
研究通过使用光学相干断层扫描血管造影,对单侧特发性视网膜前膜(IERM)患者的对侧眼进行血流量统计,确定在玻璃体后脱离引起的机械损伤之前,是否存在视网膜内血管缺损。结果显示视网膜血管性缺损可能在视网膜内部产生变化,在视网膜内界膜后玻璃体脱离时先于并影响微破裂的形成。研究创新性的提供了特发性视网膜前膜(IERM)患者的内界膜微破裂是在玻璃体后脱离造成机械性损伤诱导的,还是先存在血管缺损诱导了内界膜微破裂问题的证据。但是,血流减少也可能与IERME患者的固有视网膜特征有关,因此在该研究中,未来需要使用更多仪器对更多眼部区域血流数据进行进一步研究,以得出更加全面客观的结论。

I——Investigative Ophthalmology & Visual Science 推荐
《Crosstalk between EP2 and PPARα Modulates Hypoxic Signaling and Myopia Development in Guinea Pigs》Srinivasalu N, Zhang S, Xu R, et al. Invest Ophthalmol Vis Sci. 2020;61(8):44.EP2和PPARα的串扰对豚鼠缺氧信号转导和近视发展的影响
Purpose:Cyclic adenosine monophosphate (cAMP) and peroxisome proliferator-activated receptor alpha (PPARα) levels mediate extracellular matrix (ECM) changes by altering the levels of hypoxia-inducible factor 1-alpha (HIF-1α) in various tissues. We aimed to determine, in the sclera of guinea pigs, whether a prostanoid receptor (EP2)-linked cAMP modulation affects PPARα and HIF-1α signaling during myopia.
目的:环磷酸腺苷(cAMP)和过氧化物酶体增殖物激活受体α(PPARα)水平通过改变不同组织中缺氧诱导因子1-α(HIF-1α)水平来介导细胞外基质(ECM)变化。我们的目的是确定在豚鼠巩膜中,前列腺素受体(EP2)连接的cAMP调节是否会影响近视过程中的PPARα和HIF-1α信号传导。
Methods:Three-week-old guinea pigs (n = 20 in each group), were monocularly injected with either an EP2 agonist (butaprost 1 μmol/L/10 μmol/L), an antagonist (AH6809 10 μmol/L/30 μmol/L) or a vehicle solution for two weeks during normal ocular growth. Separate sets of animals received these injections and underwent form deprivation (FD) simultaneously. Refraction and axial length (AL) were measured at two weeks, followed by scleral tissue isolation for quantitative PCR (qPCR) analysis (n = 10) and cAMP detection (n = 10) using a radioimmunoassay.
方法:3周龄的豚鼠(每组20只),单眼注射EP2激动剂(布他前列素1 μmol/L /10 μmol/L)、拮抗剂(AH6809 10 μmol/L/30 μmol/ L)、或溶酶溶液2周,同时观察正常眼生长。不同组的动物同时接受注射和形觉剥夺(FD)。在两周时测量屈光度和轴向长度(AL),然后使用放射免疫测定法对巩膜组织进行定量PCR(qPCR)分析(n = 10)和cAMP检测(n = 10)。
Results:Butaprost induced myopia development during normal ocular growth, with proportional increases in AL and cAMP levels. FD did not augment the magnitude of myopia or cAMP elevations in these agonist-injected eyes. AH6809 suppressed cAMP increases and myopia progression during FD, but had no effect in a normal visual environment. Of the diverse set of 27 genes related to cAMP, PPARα and HIF-1α signaling and ECM remodeling, butaprost differentially regulated 15 of them during myopia development. AH6809 injections during FD negated such differential gene expressions.
结果:在正常眼生长过程中,布他前列素引起近视,同时AL和cAMP水平呈比例增长。在注射激动剂的眼中,FD并没有增加近视程度或使cAMP升高。AH6809在FD期间抑制了cAMP的增加和进一步近视,但在正常视觉环境中没有效果。在与cAMP,PPARα和HIF-1α信号转导及ECM重构相关的27个基因中,布他前列素在近视眼发育过程中对其中15个基因进行了差异性调节。FD期间注射AH6809可消除这种基因的差异表达。
Conclusions:EP2 agonism increased cAMP and HIF-1α signaling subsequent to declines in PPARα and RXR mRNA levels, which in turn decreased scleral fibrosis and promoted myopia. EP2 antagonism instead inhibited each of these responses. Our data suggest that EP2 suppression may sustain scleral ECM structure and inhibit myopia development.
结论:在PPARα和RXR mRNA水平下降之后,EP2激动剂增加了cAMP和HIF-1α信号传导,进而减少了巩膜纤维化,促进了近视。EP2拮抗剂反而抑制了这些反应。我们的数据表明,抑制EP2可能维持巩膜ECM结构,抑制近视的发展。推荐理由 :在本研究中,使用3周龄的豚鼠,单眼注射EP2激动剂、拮抗剂、或溶酶溶液,观察2周,正常眼作对照。不同组的动物同时接受注射和形觉剥夺。在两周时测量屈光度和轴向长度,然后使用放射免疫测定法对巩膜组织进行定量PCR分析和cAMP检测。结果表明,EP2介导的巩膜cAMP调节通过豚鼠中PPARα和HIF-1α信号之间的串扰影响近视发展。

此类EP2激活是由抑制PPARα/ RXR活性并增加HIF-1α水平的cAMP水平增加所介导的,最终导致近视。但是,抑制EP2可以消除这些变化并延缓近视的加深。该研究成功地确定了巩膜中这种相互作用的存在和意义,这对于控制近视发展至关重要。这项研究的局限性可能在于,缺乏在近视恢复过程中关于屈光度,基因表达和cAMP水平的数据。观察发现,FD期间的两次AH6809注射都抑制了近视进展,而只有最高剂量抑制了近视眼轴的伸长,这也否定了FD介导的基因表达变化。后续需要对其他PGE受体亚型(例如,抑制cAMP水平的EP3)参与的进一步研究,以拓宽对前列腺素及其同源受体亚型在控制近视发展中总体作用的理解。
O——Ophthalmology 推荐
《Primary Retinal Detachment Outcomes Study Report Number 2: Phakic Retinal Detachment Outcomes》Ryan EH,Ryan CM,Forbes NJ,et al. 2020;127(8):1077-1085.原发性视网膜脱离结果研究报告2:有晶状体视网膜脱离结果
Purpose:Anatomically similar rhegmatogenous retinal detachments (RRDs) can be treated with scleral buckle (SB), pars plana vitrectomy (PPV), or SB combined with PPV (PPV/SB). This study compares moderately complex phakic primary RRD treated with SB, PPV, or PPV/SB to review anatomic and visual outcomes.
目的:解剖特征上相似的孔源性视网膜脱离(RRDs)可采用巩膜扣带(SB)、平坦部玻璃体切除术(PPV)或SB联合PPV(PPV/SB)治疗。本研究比较了SB、PPV或PPV/SB治疗中度复杂的原发性有晶体眼RRD的解剖和视觉结果。
Design:Multicenter, retrospective, interventional cohort study.
设计:多中心,回顾性,介入性群体研究。
Participants:Data were gathered on all patients from multiple retina practices in the United States with RRD in 2015 and >90 days of follow-up. The cohort of phakic patients with moderately complex RRD was analyzed.
参与者:我们收集了2015年美国多个视网膜手术患者的数据,这些患者的随访时间超过90天。分析中度复杂RRD的有晶状体眼患者群体。
Methods:A large and detailed database was generated. Eyes with findings that would bias toward PPV (vitreous hemorrhage, dense cataract, proliferative vitreoretinopathy, giant retinal tear, among others) were excluded. Age <40 years (bias toward SB) was excluded. Comparable cases of moderately complex RRD were then chosen naive to surgeon, surgery, and outcome for subgroup analysis.
方法:统计范围为一个大而详细的数据库。排除利于PPV(玻璃体出血、致密性白内障、增殖性玻璃体视网膜病变、巨大视网膜裂孔等)和SB(年龄<40岁)的眼睛。选择中等复杂RRD的病例,随后被分到不同外科医生进行不同外科手术,进行结果分析。
Main Outcome Measures:Single surgery anatomic success (SSAS), defined as retinal attachment with no other RRD surgery within 90 days, is the main outcome measure. Final visual acuity is the secondary outcome measure. Pearson’s chi-square and analysis of variance were used to test treatment effect of surgery type on SSAS and vision.
主要预后指标:单次手术复位成功率(SSAS),其定义为90天内无其他RRD手术的视网膜附着。次要的结果指标为最终视力。采用Pearson卡方检验和方差分析评价不同手术方式对SSAS和视力的治疗效果。
Results:Single surgery anatomic success was noted in 155 of 169 SB cases (91.7%), 207 of 249 PPV cases (83.1%), and 271 of 297 PPV/SB cases (91.2%). Scleral buckle and PPV/SB were superior to PPV for SSAS (P = 0.0041). For macula-on or split cases, SB had significantly better visual outcomes than PPV or PPV/SB even after controlling for cataract (cases with minimal cataract at final follow-up or after cataract surgery) (P < 0.001).
结果:单次手术复位成功率分别为:169例SB中155例(91.7%)复位,249例PPV中207例(83.1%)复位和297例PPV/SB患者中271例(91.2%)复位。对于SSAS来评价,SB和PPV/SB优于PPV(P=0.0041)。对不论黄斑是否劈裂的病例,SB在控制白内障后(在最后随访或白内障手术后有轻微白内障的病例)视觉结果仍明显优于PPV或PPV/SB(P<0.001)。
Conclusions:For phakic moderately complex primary RRDs in this study of PPV versus SB versus PPV/SB, SB had the best visual outcomes, and PPV had the worst SSAS outcomes.
结论:在PPV与SB与PPV/SB的研究中,对于有晶体眼的中度复杂的原发性RRDs,SB的视觉效果最好,PPV的SSAS结果最差。
推荐理由 :本文是一篇综合大样本数据,对比分析巩膜扣带、玻璃体切除术和两者联合手术治疗轻、中度原发性孔源性视网膜脱离的研究。研究结果表明,对于轻、中度原发性孔源性视网膜脱离,选用外路巩膜扣带手术远期效果最佳。
该文章采用的样本量有700多,数据相对更加的客观且具有统计学意义。通过随访远期的效应,从手术复位成功率,患者远期视力保持率与白内障的发生率这三条重要指标进行对比分析,得出外路手术优于内路手术。但文章依旧存在局限性。首先对于远期的时间,文章定义为一年,将来可以增加随访时间,探讨3年内的一个更远期的一个数据。其次对于患者视力的改善,文章采用的是视力的均值,依赖术前视力基线值,将来的研究可以通过视力改变值进行更客观的分析。
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