5月 | Vesber 最佳RIO论文推荐

R —— Retina · 推荐

《HIGHER-ORDER ABERRATIONS IN EYES WITH SILICONE OIL TAMPONADE》(Retina.2020. 40(4):735-742.)
《硅油填充眼的高阶像差
Purpose:To investigate the changes in higher-order aberrations (HOAs) after silicone oil removal and to evaluate their associations with visual acuity.
目的:探讨硅油取出术后高阶像差(HOAs)的变化及评估其与视力的关系。
Methods:Fifty-nine eyes of 58 patients who underwent SO removal were included. Total, corneal, and internal optic HOAs, and best-corrected visual acuity were measured before and 1 month after SO removal, and changes were compared between phakic and pseudophakic eyes.
方法:入组58个接受硅油取出术患者的59只眼。术前及硅油取出术后1个月分别测量总HOA、角膜HOA、内HOA和最佳矫正视力,比较有晶状体眼和假性晶状体眼的变化。
Results:Total ocular and internal optic HOAs decreased significantly after SO removal both in pseudophakic (n = 40, all P < 0.001) and phakic eyes (n = 19, P = 0.017, P = 0.004). Preoperative HOAs ( P < 0.001) and changes in HOAs ( P = 0.006) were greater in pseudophakic eyes than in phakic eyes. Best-corrected visual acuity was significantly improved after SO removal, from 20/105 to 20/78 ( P < 0.001) in pseudophakic eyes, whereas there was no difference in phakic eyes ( P = 0.714). Preoperative HOAs and the reduction in HOAs after SO removal were greater in best-corrected visual acuity–improved eyes than best-corrected visual acuity–unchanged eyes ( P < 0.001).
结果:硅油取出术后,假性晶状体眼(n=40,均P<0.001)和晶状体眼(n=19,P=0.017,P=0.004)的总眼和内眼HOAs均显著降低。假性晶状体眼的术前HOAs(P<0.001)和术后HOAs变化(P=0.006)明显大于晶状体眼。硅油取出术后假性晶状体眼最佳矫正视力由20/105提高到20/78(P<0.001),而晶状体眼的术后视力改变无差异(P=0.714)。最佳矫正视力(改善眼)比最佳矫正视力(未改变眼)术前和术后的HOAs降低幅度更大(P<0.001)。
Conclusion:Silicone oil tamponade induced an increase in HOAs, and these increases were greater in pseudophakic eyes than in phakic eyes. Silicone oil may cause additional visual impairments because of HOAs, beyond those caused by retinal diseases, particularly in pseudophakic eyes.
结论:硅油填塞可引起HOAs的升高,假性晶状体眼的HOAs升高幅度大于晶状体眼。HOAs的改变预示,特别是在假性晶状体眼中,硅油可能会导致除了那些由视网膜疾病引起的额外的视觉损伤。
推荐理由:
文章讨论了晶状体眼和假性晶状体眼在硅油取出前与取出后一个月的患者高阶像差(HOAs)的变化,以及这种变化与患者视力的关系。结果显示,在假性晶状体眼中,HOAs的前后变化显著,视力改善也显著。提示,硅油在假性晶状体患者的眼内长期存留可能会造成视神经损伤。文章特别之处在于,作者创新性的从高阶像差(HOAs)的层面分析了硅油长期填充对视神经的损伤。硅油短期填充是一个很好的替代物,但是长期填充会并发硅油乳化和移位,医生需谨慎考虑长期填充硅油的患者的治疗及预后。

但该文章依旧存在局限性。一方面其样本量不足,需要更多病例样本来支撑。另一方面,该文章变量还包括有无晶体,硅油的长期填充是变量一,代替了晶状体的屈光是变量二,所以硅油对视神经的损伤也可能是由于硅油的屈光与晶体的差异造成视神经的代偿性损伤。未来需要针对这一点做进一步的研究。另外,硅油对玻璃体氧梯度的影响没有纳入研究。

I —— Invest Ophthalmol Vis Sci · 推荐

《Association Between Clinical Biomarkers and Optical Coherence Tomography Angiography Parameters in Type 2 Diabetes Mellitus》(Ophthalmol. Vis. Sci., 2020, 61: 4.)
2型糖尿病临床生物标志物和光学相干断层扫描血管造影参数之间的关联
Purpose:To investigate the clinical significance of the changes in the macular microvasculature in patients with diabetes mellitus type 2 without diabetic retinopathy.
目的: 探讨无糖尿病性视网膜病变的2型糖尿病患者黄斑微血管变化的临床意义。
Methods:Fifty-five patients with diabetes mellitus type 2 without diabetic retinopathy and 48 healthy individuals were enrolled in a prospective cross-sectional study. We identified the changes of optical coherence tomography angiography parameters (foveal avascular zone [FAZ] area and circularity, vessel density, and perfusion index) of the 6 × 6-mm macular scan. Correlation and multiple regression analyses were performed between optical coherence tomography angiography parameters and previously known diabetes mellitus type 2-related demographic and systemic characteristics, and serum biochemical markers.
方法:55例无糖尿病性视网膜病变的2型糖尿病患者和48名健康个体入选了前瞻性横断面研究。我们确定了6×6毫米黄斑扫描的光学相干断层扫描血管造影参数(中心凹无血管区域面积和圆形度,血管密度和灌注指数)的变化。在光学相干断层扫描血管造影参数和先前已知的2型糖尿病相关人口和系统特征与血清标记物之间进行了相关性和多元回归分析。
Results:FAZ parameters and perfusion index of the superficial and deep vascular plexus showed significant correlation with serum insulin level, and homeostasis model assessment indices. In multiple linear regression analysis, low insulin levels predicted increased FAZ areas in both the superficial (β = –0.007; P = 0.030) and deep layers (β = –0.010; P = 0.018) and a decreased perfusion index in the deep layer (β = 0.003; P = 0.001).
结果:浅层和深层血管丛的中心凹无血管区域参数和灌注指数与血清胰岛素水平和稳态模型评估指标呈显着相关。在多元线性回归分析中,低胰岛素水平预测浅层(β= –0.007; P = 0.030)和深层(β= –0.010; P = 0.018)的中心凹无血管区域面积增加,和减少深层灌注指数。(β= 0.003;P = 0.001)。
Conclusion:The expansion and loss of circularity of the FAZ and the decrease in the perfusion index may be affected by insulin resistance and secretory capacity in patients with diabetes mellitus type 2 with no diabetic retinopathy.
结论: 在没有糖尿病性视网膜病变的2型糖尿病患者中,胰岛素抵抗和分泌能力可能影响中心凹无血管区域扩张和圆度缺失以及灌注指数的降低。
推荐理由:
这是一篇关于糖尿病视网膜疾病(DR)的研究论文,本研究评估了光学相干断层扫描血管造影(OCT-A)定量测量的黄斑微血管参数对人口统计学和糖代谢参数的临床相关性,并揭示了没有糖尿病视网膜病变的2型糖尿病患者的空腹胰岛素水平以及胰岛素耐受性稳态模型评估(HOMA-IR)和β细胞功能稳态模型评估(HOMA-B)评分导致DR的早期微血管变化,于2020年发表在IOVS杂志上。有研究表明,OCT-A可无创地评估视网膜脉管系统的结构和流量。在这项研究中,作者揭示了在具有2型糖尿病病史但没有DR的患者中,浅层血管丛比深层血管丛更早的出现血管密度和灌注降低以及中心凹无血管区域边界受损的情况;血清胰岛素水平和HOMA值与黄斑微血管损害水平呈中等程度的负相关。因此,胰岛素水平可能可以作为没有DR的糖尿病患者未来糖尿病视网膜疾病发展的标记物。

但本文属于前瞻性基础研究,尽管在研究中表示胰腺β细胞功能和胰岛素可能比糖尿病视网膜病变重要的生物标志物糖化血红蛋白(HbA1c)更加敏感,可通过检测早期发现糖尿病血管并发症,但是否可以作为抗糖尿病治疗的有用标志物,仍需要更多的实验来研究,同时对于胰岛素分泌能力和抵抗力,黄斑血管损伤和糖尿病其他血管并发症之间的因果关系同样需要进一步的基础研究来证明。

O ——Ophthalmology · 推荐

《The Course of Visual Recovery after Optic Neuritis: Experience of the Optic Neuritis Treatment Trial》(Ophthalmology 2020;127:S174-S81.)
《视神经炎后视力恢复的过程:视神经炎治疗试验的经验》
Purpose:To define the time course of visual recovery after optic neuritis and factors predictive of this course in the patients enrolled in the Optic Neuritis Treatment Trial.
目的:确定视神经炎患者视神经炎后视力恢复的时间进程和影响因素。
Methods:The cohort for this study consisted of the 438 patients who completed the 6-month follow-up visit. Visual acuity was measured at baseline and at seven follow-up visits during the first 6 months. Factors predictive of recovery were evaluated with univariate and multivariate statistical tests.
方法:本研究的队列包括完成6个月随访的438名患者。在前6个月的基线和7次随访中测量视力。通过单变量和多变量的统计检验对预后因素进行评估。
Results:Visual recovery was rapid in all three treatment groups. In almost all patients, regardless of treatment group and initial severity of visual loss, improvement began within the first month. Among the 278 patients with baseline visual acuity of 20/ 50 or worse, all patients improved at least one line of visual acuity, and all except six improved at least three lines, during the 6-month follow-up period. Baseline visual acuity was the best predictor of the 6-month visual acuity outcome (P = 0.0001). Older age was statistically associated with a slightly worse outcome (P = 0.02), but this appeared to be of no clinical importance.
结果:三个治疗组的视力恢复都很快。几乎所有的患者,不论治疗组和初期视力损失的严重程度,在第一个月内就开始改善。278例基线视力为20/ 50或更差的患者,在6个月的随访期间,所有患者至少改善了一条视力线,除6例外,所有患者至少改善了3条视力线。基线视力是6个月视力结果的最佳预测因子(P = 0.0001)。在统计学上,年龄越大,预后越差(P = 0.02),但这似乎没有临床意义。
Conclusion:In most patients with optic neuritis, visual recovery is rapid. The only factor of value in predicting the visual outcome is initial severity of visual loss. However, even when initial loss is severe, visual recovery is still good in most patients. Patients not following the usual course of visual recovery should be considered atypical. For such patients, further investigation in regard to etiology of the visual loss may be appropriate.
结论:大部分视神经炎患者视力恢复较快。预测视力恢复结果的唯一有价值的因素是最初视力丧失的严重程度。然而,即使最初的视力损失很严重,大多数患者的视力恢复仍然很好。没有遵循正常视力恢复过程的患者应被认为是非典型的。对于这样的患者,进一步调查视力丧失的病因可能是合适的。
推荐理由:
本研究进一步描述了使用糖皮质激素对急性视神经炎后视力恢复的时间进程,并确定哪些因素可以预测6个月的视力结果。该研究为多中心随机对照试验,随机将患者分为三组:(1)强的松组:口服强的松(1 mg/kg/d,连续14天);(2)静脉注射组:患者接受甲泼尼龙静脉注射(持续3周,每6小时250毫克),然后口服强的松(持续11天,每天1毫克/公斤);(3)安慰剂组:患者接受口服安慰剂14天。第1组和第2组是在第15天口服20毫克强的松,第16天和第18天口服10毫克。

将6个月时视力为20/50或更差的患者的临床资料与6个月时视力优于20/50的患者的临床资料进行比较。该研究包含了ANA(antinuclear antibody,结核抗体)阳性的患者,结果发现,无论是否使用皮质类固醇,ANA阳性的患者都有良好的恢复。因此,对于具有典型临床特征的患者,在视神经炎时进行ANA测定是没有必要的。

但该研究只针对于具有典型特征的视神经炎,非典型的患者并不纳入分析。并且随访时间只持续6个月,未完全恢复的患者在6个月至1年期间可能会继续改善,但具体改善程度及时间并不确定。

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