3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（3月）

No.1

Retina · 推荐

《RETINAL DISPLACEMENT AFTER IDIOPATHIC MACULAR HOLE SURGERY: Layer by Layer Analysis》

黄斑裂孔手术后黄斑区胶质组织对外层视网膜修复和视力的影响

(Retina 45(3):p 410-419, March 2025.  ）

Purpose

To investigate the impact of foveal glial tissue on the anatomical and functional results after macular hole (MH) surgery.

使用光学相干断层扫描血管造影测量特发性黄斑裂孔玻璃体切除术后视网膜血管丛和脉络膜毛细血管的位移，并将其与临床数据相关联。

Methods

Retrospective series with a 6-month follow-up. Records included Best Corrected Visual Acuity, M-charts, structural optical coherence tomography, and optical coherence tomography angiography. Coronal displacement was calculated comparing consecutive images across the 6.4 mm × 6.4 mm field and concentric circular regions of 0.5, 1.5, and 3.0 mm radii. Each circular region was further divided in four quadrants indicated as follows: SuperoTemporal; SuperNasal; InferoTemporal; InferoNasal.

随访6个月的回顾性系列研究。记录包括最佳矫正视力、M图、结构光学相干断层扫描和光学相干断层血管造影。通过比较6.4 mm×6.4 mm视图和半径为0.5、1.5和3.0 mm的同心圆形区域的连续图像，计算了冠状位移。每个圆形区域进一步分为四个象限，如下所示：颞上；鼻上；颞下；鼻下。

Results

The study comprised 33 patients (11 men and 22 women) with 68.9 ± 10.2 years mean age, similar among sexes. Macular hole closed in 31/33 (93.9%) of cases and Best Corrected Visual Acuity improved from mean 20/62 (0.50 ± 0.62 logarithm of Minimum Angle of Resolution) to 20/47 (0.23 ± 0.63 logarithm of Minimum Angle of Resolution; P = 0.0064). Vertical and horizontal metamorphopsia decreased from 0.98 ± 0.68 to 0.51 ± 0.59° (P = 0.0028) and 0.84 ± 0.63 to 0.29 ± 0.45° (P < 0.001), respectively. The average retinal displacement was 81.2 ± 44.1 µm for the superficial plexus and 79.4 ± 45.7 µm for the deep one, both greater than the choriocapillaris displacement (60.9 ± 20.2 µm; P < 0.05). The temporal and superior quadrants displaced more than the others (P < 0.05). Macular hole size correlated to retinal displacement within the central 0.5-mm radius area at all layers (P < 0.05 in all cases).

该研究包括33名患者（11名男性和22名女性），平均年龄为68.9±10.2岁，性别相似。33例中有31例（93.9%）黄斑孔闭合，最佳矫正视力从平均20/62（最小分辨角对数0.50±0.62）提高到20/47（最小分辨角度对数0.23±0.63；P=0.0064）。垂直和水平变形分别从0.98±0.68°降低到0.51±0.59°（P=0.0028）和0.84±0.63°降低到0.29±0.45°（P<0.001）。浅丛和深丛的平均视网膜位移分别为81.2±44.1µm和79.4±45.7µm，均大于脉络膜毛细血管位移（60.9±20.2µm；P<0.05）。颞上象限的位移大于其他象限（P<0.05）。黄斑孔大小与所有层中心0.5mm半径区域内的视网膜位移相关（所有病例均P<0.05）。

Conclusion

Macular hole closure is associated with significant retinal displacement of all retinal layers and choriocapillaris remodeling. Surgical peeling removes the constraining effect of the internal limiting membrane and promotes a multilayered displacement that fills the retinal defect, likely due to a change in the equilibrium of forces between the contractile retinal structures: the larger superficial retinal vessels and the retinal nerve fiber layer.

黄斑孔闭合与所有视网膜层的显著视网膜移位和脉络膜毛细血管重塑有关。手术剥离消除了内界膜的约束作用，并促进了填充视网膜缺陷的多层位移，这可能是由于可收缩视网膜结构（较大的视网膜浅血管和视网膜神经纤维层）之间的力平衡发生了变化。

推

荐

理

由

这篇文献研究了特发性黄斑裂孔（IMH）手术后视网膜各层及脉络膜毛细血管的位移模式，通过光学相干断层扫描血管成像（OCTA）技术，量化了手术后的视网膜结构变化及其与临床预后的相关性。

文章创新点为首次利用OCTA结合图像处理算法（Farneback运动估计法）量化视网膜各层的位移，为术后视网膜力学变化提供了客观数据。提出内界膜（ILM）剥离通过解除机械约束，改变视网膜收缩结构（如血管和神经纤维层）的力学平衡，促进裂孔闭合的新观点揭示了位移模式与手术预后的关联，为优化手术范围（如ILM剥离面积）提供了理论依据。

不足之处为样本量较小（33例），且为单中心回顾性研究，可能影响结果的普适性。 OCTA的平面成像可能低估三维位移，且未分析轴向（矢状面）位移。

No.2

Investigative Ophthalmology &

Visual Science · 推荐

《Silicone Oil Affects Fibrosis of Human Trabecular Meshwork Cells by Upregulating Ferroptosis Through a ROS/NOX4/Smad3 Axis》

硅油通过ROS/NOX4/Smad3轴上调铁细胞凋亡影响人小梁网细胞纤维化

Investigative Ophthalmology & Visual Science January 2025;66(3):25.

Purpose

Silicone oil (SiO) is commonly employed as an intravitreal tamponade to manage complex retinal detachments associated with proliferative diabetic retinopathy, trauma, or severe myopia and to facilitate retinal reattachment. Nevertheless, SiO usage is linked to several complications, notably secondary glaucoma, which constitutes a significant proportion of adverse effects. This study investigated the impact of SiO on trabecular meshwork cells, given their pivotal role in regulating aqueous humor outflow.

硅油（SiO）通常用作玻璃体内填塞物，以治疗与增殖性糖尿病视网膜病变、创伤或严重近视相关的复杂视网膜脱离，并促进视网膜复位。然而，硅油的使用与几种并发症有关，特别是继发性青光眼，这在不良反应中占很大比例。鉴于小梁细胞在调节房水外流中的关键作用，本研究调查了硅油对小梁细胞的影响。

Methods

Human trabecular meshwork cells (HTMCs) were co-cultured with SiO. The impact on proliferation, fibrosis-related markers, and ferroptosis levels on these cells was evaluated using 5-ethynyl-2′-deoxyuridine (EdU), western blot, and immunofluorescence assays. Further gene knockdown experiments with NOX4 and Smad3 were conducted to elucidate the underlying mechanisms of SiO-induced changes.

将人小梁网细胞（HTMCs）与硅油共培养。使用5-乙炔基-2′-脱氧尿苷（EdU）、蛋白质印迹和免疫荧光测定评估了对这些细胞增殖、纤维化相关标志物和铁细胞凋亡水平的影响。进一步用NOX4和Smad3进行基因敲除实验，以阐明硅油诱导变化的潜在机制。

Results

SiO intervention inhibited HTMC proliferation, upregulated fibrosis-related markers, and elevated ferroptosis levels. Gene knockdown experiments revealed that SiO-induced ferroptosis and reactive oxygen species (ROS) increase were mediated through NOX4 upregulation and Smad3 activation.

硅油干预抑制了人小梁网细胞增殖，上调了纤维化相关标志物，并提高了铁细胞凋亡水平。基因敲除实验表明，硅油诱导的铁细胞凋亡和活性氧（ROS）增加是通过NOX4上调和Smad3激活介导的。

Conclusion

These findings highlight the significance of ferroptosis and the ROS/NOX4/Smad3 axis in the mechanism of SiO-induced intraocular pressure elevation. The insights gained from this study identify potential therapeutic targets to mitigate postoperative complications associated with SiO tamponade in ophthalmic surgery.

这些发现强调了铁细胞凋亡和ROS/NOX4/Smad3轴在硅油诱导的眼压升高机制中的意义。从这项研究中获得的见解确定了潜在的治疗靶点，以减轻眼科手术中与硅油填塞相关的术后并发症。

推

荐

理

由

这篇文献探讨了硅油（Silicone Oil, SO）在青光眼发病机制中的作用。研究发现，硅油通过激活ROS/NOX4/Smad3信号轴，上调铁细胞凋亡（ferroptosis），进而促进人小梁网细胞（HTMCs）的纤维化，最终导致小梁网功能障碍和眼压升高。这一机制为硅油填充术后继发性青光眼的治疗提供了新的分子靶点。  文章创新点为首次揭示硅油通过铁细胞凋亡途径影响HTMCs的纤维化，提出ROS/NOX4/Smad3轴是关键调控通路，为继发性青光眼的病理机制提供了新见解。  文章不足不足之处为研究仅基于细胞实验，缺乏动物模型或临床数据支持，需进一步验证其在活体中的适用性ROS/NOX4/Smad3轴与其他纤维化通路（如TGF-β）的交互作用未充分探讨，可能遗漏协同效应。实验中硅油的处理浓度和时间是否完全模拟临床情境尚不明确，需更贴近实际手术条件的设计。  本文为硅油相关青光眼的机制研究开辟了新方向，尽管存在转化医学的局限性，但其发现对理解术后并发症和开发靶向疗法具有重要价值，值得眼科医生和研究者关注。

No.3

Ophthalmology · 推荐

《Retinoblastoma Outcomes Based on the 8th Edition American Joint Committee on Cancer Pathological Classification in 1411 Patients》

基于美国癌症病理分类联合委员会第8版1411例患者的视网膜母细胞瘤结果

Ophthalmology,Volume 132, Issue 3,2025,Pages 317-326

Purpose

To evaluate the outcomes of retinoblastoma (RB) based on the 8th edition of the American Joint Committee on Cancer (AJCC) pathological classification in a global cohort of patients.

根据美国癌症联合委员会（AJCC）第8版在全球患者队列中的病理分类，评估视网膜母细胞瘤（RB）的结果。

Design

Retrospective, multicenter, intercontinental, collaborative study.

回顾性、多中心、洲际、合作研究。

Participants

A total of 1411 patients.

共1411名患者。

Intervention

Primary enucleation with or without adjuvant chemotherapy or radiotherapy.

一期眼球摘除术，有或没有辅助化疗或放疗。

Main Outcome Measures

Orbital tumor recurrence, tumor-related metastasis, and tumor-related death.

眼眶肿瘤复发、肿瘤相关转移和肿瘤相关死亡。

Results

According to the 8th edition AJCC pathological classification, 645 eyes (46%) belonged to pathological T (pT)1, 164 (11%) to pT2, 493 (35%) to pT3, and 109 (8%) to pT4 categories. At a mean follow-up of 38 months (median, 35 months; < 1–149 months), orbital tumor recurrence was seen in 8 (1%), 5 (3%), 22 (4%), and 25 (23%) of pT1, pT2, pT3, and pT4 (P < 0.001) categories, respectively; tumor-related metastasis was seen in 7 (1%), 5 (3%), 40 (8%), and 46 (43%) of pT1, pT2, pT3, and pT4 (P < 0.001) categories, respectively; tumor-related death was seen in 12 (2%), 7 (4%), 64 (13%), and 64 (59%) of pT1, pT2, pT3, and pT4 (P < 0.001) categories, respectively. Multivariate Cox proportional hazards analysis of outcomes revealed pT category and adjuvant therapy as independent predictors of outcomes. Categories pT3b (P = 0.005), pT3c (P < 0.001), pT3d (P < 0.001), and pT4 (P < 0.001) had a greater hazard for orbital recurrence; categories pT2a (P = 0.015), pT3a (P < 0.001), pT3b (P < 0.001), pT3c (P < 0.001), pT3d (P < 0.001), and pT4 (P < 0.001) had a greater hazard for tumor-related metastasis; and categories pT2a (P = 0.068), pT2b (P = 0.004), pT3a (P < 0.001), pT3b (P < 0.001), pT3c (P < 0.001), pT3d (P < 0.001), and pT4 (P < 0.001) had a greater hazard for tumor-related death when compared with the pT1 category. Patients who did not receive adjuvant therapy had greater hazards of orbital tumor recurrence in categories pT3b (P = 0.005), pT3c (P = 0.003), and pT4 (P = 0.002); greater hazards of tumor-related metastasis in categories pT3a (P = 0.001), pT3b (P = 0.01), pT3c (P = 0.001), and pT4 (P = 0.007); and tumor-related death in categories pT3a (P < 0.001), pT3b (P = 0.009), pT3c (P = 0.018), and pT4 (P < 0.001) when compared with those who received adjuvant therapy.

根据第8版AJCC病理分类，645只眼睛（46%）属于病理pT1，164只眼睛（11%）属于pT2，493只眼睛（35%）属于pT3，109只眼睛（8%）属于pT4。平均随访38个月（中位数为35个月；<1-149个月），pT1、pT2、pT3和pT4（P<0.001）类别中分别有8例（1%）、5例（3%）、22例（4%）和25例（23%）出现眼眶肿瘤复发；pT1、pT2、pT3和pT4类别中分别有7例（1%）、5例（3%）、40例（8%）和46例（43%）出现肿瘤相关转移（P<0.001）；在pT1、pT2、pT3和pT4（P<0.001）类别中，肿瘤相关死亡分别为12例（2%）、7例（4%）、64例（13%）和64例（59%）。结果的多变量Cox比例风险分析显示，pT类别和辅助治疗是结果的独立预测因素。类别pT3b（P=0.005）、pT3c（P<0.001）、pT3d（P<0.001）和pT4（P<0.001）对眼眶复发的风险更大；pT2a（P=0.015）、pT3a（P<0.001）、pT3b（P<0.001）和pT3c（P<0.001）类别对肿瘤相关转移的风险更大；与pT1类别相比，pT2a（P=0.068）、pT2b（P=0.004）、pT3a（P<0.001）、pT3b（P<0.001）和pT3c（P<0.001）类别的肿瘤相关死亡风险更大。未接受辅助治疗的患者在pT3b（P=0.005）、pT3c（P=0.003）和pT4（P=0.002）类别中复发眼眶肿瘤的风险更大；在pT3a（P=0.001）、pT3b（P=0.01）、pT3c（P=0.000）和pT4（P=0.007）类别中，肿瘤相关转移的风险更大；与接受辅助治疗的患者相比，pT3a（P<0.001）、pT3b（P=0.009）、pT3c（P=0.018）和pT4（P<0.001）类患者的肿瘤相关死亡。

Conclusions

The 8th edition AJCC pathological classification predicts outcomes in patients undergoing primary enucleation for RB, and adjuvant therapy is associated with a lower risk of orbital recurrence, tumor-related metastasis, and tumor-related death in the pT3 and pT4 categories.

第8版AJCC病理分类预测了接受视网膜母细胞瘤原发性剜除术的患者的预后，辅助治疗与pT3和pT4类别的眼眶复发、肿瘤相关转移和肿瘤相关死亡风险较低有关。

推

荐

理

由

这篇文献是一项多中心、回顾性的全球协作研究，旨在评估第8版AJCC病理分类对视网膜母细胞瘤（RB）患者预后的预测价值。研究纳入了1411例接受原发性眼球摘除术的患者，根据病理T分期（pT1-pT4）分类，并分析了辅助治疗（化疗和放疗）对肿瘤复发、转移和死亡的影响。

文章创新点为研究覆盖了多个国家和治疗中心，提供了更全面的RB预后数据，减少了单一中心的偏倚。首次大规模验证了第8版AJCC病理分类在RB预后分层中的实用性，明确了不同pT分期的风险差异。研究证实辅助治疗显著降低了pT3和pT4患者的肿瘤复发、转移和死亡风险，为临床决策提供了有力依据。

文章不足之处为研究依赖历史数据，可能存在信息偏倚，例如部分患者的辅助治疗记录不完整。各中心对高风险特征的定义和辅助治疗方案不一致，可能影响结果的普适性。中位随访时间为35个月，对长期生存率的评估可能不够充分。