4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（4月）

No.1

Retina · 推荐

《A COMPREHENSIVE REVIEW ON THE PERIFOVEAL EXUDATIVE VASCULAR ANOMALOUS COMPLEX》

中心凹周围渗出性血管异常复合体的综合述评

(Retina 45(4):p 587-600, April 2025.）

Purpose

The aim of this review was to summarize the most recent investigations on perifoveal exudative vascular anomalous complex (PEVAC) lesions and guide future research of this entity.

本文旨在综述当前关于中心凹周围渗出性血管异常复合体（PEVAC）的最新研究进展，并为未来研究方向提供指导。

Methods

Retrospective analysis of Cochrane Central, PubMed, Web of Science, and ClinicalTrials.gov databases for papers regarding PEVAC, looking for the following keywords: “perifoveal exudative anomalous vascular complex,” “PEVAC,” “PVAC,” “nePVAC,” “ePVAC,” “deep retinal age-related microvascular anomalies,” and “DRAMA.”

通过检索Cochrane Central、PubMed、Web of Science和ClinicalTrials.gov数据库，收集与PEVAC相关的研究文献，关键词包括：“中心凹周围渗出性异常血管复合体”“PEVAC”“PVAC”“nePVAC”“ePVAC”“深层视网膜年龄相关性微血管异常”及“DRAMA”。

Results

PEVACs are described as a single, massive, unilateral aneurysm that frequently present with intraretinal cystic edema surrounding the fovea, active exudation and hemorrhages, usually in healthy patients. Notwithstanding this, association with age-related macular degeneration, myopia, diabetes, lamellar hole, and pachychoroid pigment epitheliopathy are frequently reported. Currently, a multimodal imaging is warranted, especially the use of OCT and OCTA can rule out several other differential diagnoses. Because of the uncertainty of the pathophysiological mechanism, the right management of these lesions are yet to be clear. Overall, laser therapy has been effective in several reports, both with thermal and micropulse type. Anti–vascular endothelial growth factor injections and steroid injections demonstrated a nonconstant response.

PEVAC表现为单侧孤立性巨大动脉瘤样扩张，常伴中心凹周围视网膜囊样水肿、渗出及出血，多见于健康人群。但研究亦发现其与年龄相关性黄斑变性、近视、糖尿病、板层裂孔及厚脉络膜色素上皮病变存在关联。目前，多模态影像学检查（尤其OCT与OCTA）对鉴别诊断至关重要。由于发病机制尚未明确，最佳治疗方案仍存争议。现有报道显示激光治疗（包括热激光与微脉冲激光）效果显著，而抗VEGF药物及激素注射疗效不一。

Conclusion

Several new findings are revolutionizing PEVAC management. Greater standardization could help understand the correct treatment of these lesions.

新近研究正推动PEVAC诊疗策略的革新。未来需进一步规范诊疗标准以优化临床决策。

推

荐

理

由

本文聚焦中心凹周围渗出性血管异常复合体（PEVAC）这一特殊眼底病变，通过系统性综述整合近五年全球研究成果，全面解析其临床特征、影像学标志及治疗争议。研究基于Cochrane、PubMed等权威数据库的文献分析，首次系统归纳PEVAC与年龄相关性黄斑变性、糖尿病等共病的关联性，并强调多模态影像技术（如OCT/OCTA）在鉴别诊断中的核心地位。针对治疗难题，文章对比了激光（热/微脉冲）、抗VEGF药物及激素疗法的循证证据，指出激光治疗的高应答率与药物干预的疗效波动性，为临床决策提供重要参考。

本文的学术价值在于： 揭示PEVAC的独立病理学意义，挑战既往将其简单归为其他眼底病变并发症的认知； 提出发病机制假说（如深层视网膜微血管退行性变），推动基础研究深化； 呼吁建立国际诊疗共识以解决分类模糊、疗效评估标准不一等问题。对于眼科医师、眼底病研究者及期刊读者，本文不仅是更新PEVAC知识体系的实用指南，更是激发跨学科探索（如分子机制、新型靶向疗法）的关键文献。推荐阅读以把握眼底血管异常疾病领域的前沿进展与未来挑战。

No.2

Investigative Ophthalmology &

Visual Science · 推荐

《Effects of a Hyperbaric Normoxic Environment on the Retina and Choroid》

常氧高压环境对视网膜及脉络膜的影响

（Invest Ophthalmol Vis Sci. 2025 Mar 3;66(3):47.）

Purpose

Divers and individuals working in submarines and other underwater environments are exposed to normoxic hyperbaric conditions frequently. The aim of this study was to evaluate the effects of hyperbaric normoxia on the retina and choroid.

潜水员及潜艇等水下作业人员常暴露于常氧高压环境。本研究旨在评估常氧高压状态对视网膜和脉络膜的影响。

Methods

Healthy participants with no prior diving experience were exposed to 2.4 atmospheres absolute pressure in a normoxic hyperbaric chamber (HC). Optical coherence tomography was used to measure retinal thickness, the peripapillary retinal nerve fiber layer, and choroidal thickness (CT) before and within 30 minutes after HC exposure.

研究选取无潜水史的健康受试者，在常氧高压舱（HC）内暴露于2.4个绝对大气压环境。采用光学相干断层扫描技术测量高压暴露前及暴露后30分钟内视网膜厚度、视盘周围视网膜神经纤维层（pRNFL）及脉络膜厚度（CT）变化。

Results

The right eyes of 42 participants (mean age, 23.88 ± 2.85 years) were included in the study. The retinal nerve fiber layer thickness significantly decreased in the central 1-mm Early Treatment Diabetic Retinopathy Study (ETDRS) subfield after HC exposure (P < 0.05). The outer plexiform layer showed significant thickening in the central 1-mm ETDRS subfield (P < 0.05). The retinal pigment epithelium (RPE) thickness in the 3-mm ETDRS subfield significantly decreased after HC exposure (P < 0.01). Furthermore, nasal CT (P < 0.05), temporal CT (P < 0.05), and mean CT (P < 0.01) significantly increased after HC exposure.

42名受试者右眼纳入分析（平均年龄23.88±2.85岁）。高压暴露后，视网膜神经纤维层中央1mm区域（ETDRS分区）厚度显著降低（P<0.05）；外丛状层中央1mm区域呈现显著增厚（P<0.05）；3mm区域内视网膜色素上皮（RPE）厚度显著变薄（P<0.01）。此外，鼻侧CT（P<0.05）、颞侧CT（P<0.05）及平均CT（P<0.01）均出现显著增加。

Conclusion

This study is the first in which the effects of a hyperbaric normoxic environment on the retina and choroid were examined. The observed increases in outer plexiform layer and CTs may result from elevated intracranial perfusion pressure, likely owing to increased venous pressure with unchanged cerebral arterial blood flow under hyperbaric normoxic conditions. Elevated intracranial perfusion pressure may also contribute to venous stasis in the retinochoroidal circulation, potentially explaining the structural changes observed in this study.

本研究首次揭示常氧高压环境可引发视网膜及脉络膜结构改变。外丛状层增厚与脉络膜增厚可能与颅内灌注压升高有关，此现象源于高压常氧状态下脑动脉血流量不变而静脉压升高所致。升高的颅内灌注压还可能引起视网膜脉络膜循环静脉淤滞，这可能是本研究所观测到结构改变的潜在机制。

推

荐

理

由

本研究首次系统揭示常氧高压环境对视网膜及脉络膜的结构影响，为水下作业人员眼健康监测提供了重要理论依据。通过精密设计的常氧高压舱暴露实验（2.4 ATA），结合高分辨率OCT技术，研究定量观察到：视网膜神经纤维层中央区厚度显著降低（P<0.05）、外丛状层增厚（P<0.05）及脉络膜全周增厚（鼻/颞侧P<0.05，平均P<0.01）等特征性改变。更值得关注的是，研究创新性提出"颅内灌注压-视网膜静脉淤滞"的病理生理机制模型，从血流动力学角度阐释高压环境对视网膜微循环的影响，为职业性高压暴露相关眼病的早期识别提供了生物标志物。

本文具有三重价值： 为潜水医学领域建立眼部监测标准提供量化指标； 揭示RPE层变薄（3mm区域P<0.01）提示高压环境可能加速视网膜外层代谢紊乱； 证实短期高压暴露即可引发可逆性结构改变，这对制定防护性干预时间窗具有指导意义。推荐从事职业性眼病、视网膜血管疾病研究的同仁深入阅读，共同推进特殊环境眼健康防护体系的构建。

No.3

Ophthalmology · 推荐

《Early versus Delayed Timing of Primary Repair after Open-Globe Injury: A Systematic Review and Meta-analysis》

开放性眼外伤初次修复时机选择：早期与延期手术的系统评价与Meta分析

(Ophthalmology. 2025 Apr;132(4):431-441.)

Topic

The timing of primary repair of open-globe injury is variable in major trauma centers worldwide, and consensus on optimal timing is lacking.

全球主要创伤中心对开放性眼外伤的初次修复时机存在较大差异，目前尚未就最佳手术时机达成共识。

Clinical relevance

Surgery is the mainstay of open-globe injury management, and appropriate timing of surgical repair may minimize the risk of potentially blinding complications such as endophthalmitis, thereby optimizing visual outcomes.

手术是开放性眼外伤治疗的主要方式，选择恰当的手术时机可最大程度降低眼内炎等可能导致失明的并发症风险，从而获得最佳视力预后。

Methods

A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (International Prospective Register of Systematic Reviews identifier, CRD42023442972). The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ISRCTN registries and ClinicalTrials.gov were searched from inception through October 29, 2023. Prospective and retrospective nonrandomized studies of patients with open-globe injury with a minimum of 1 month of follow-up after primary repair were included. Primary outcomes included visual acuity at last follow-up and the proportion of patients with endophthalmitis. Certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

本研究按照系统评价和Meta分析优先报告条目(PRISMA)指南开展（国际系统评价前瞻注册号CRD42023442972）。检索了Cochrane临床对照试验中心注册库、MEDLINE、Embase、ISRCTN注册平台及ClinicalTrials.gov数据库，时间范围为建库至2023年10月29日。纳入标准为开放性眼外伤患者接受初次修复术后至少随访1个月的前瞻性或回顾性非随机对照研究。主要结局指标包括末次随访视力和眼内炎发生率。采用GRADE系统评估证据质量。

Results

Fifteen studies met inclusion criteria, reporting a total of 8497 eyes. The most common injury types were penetrating and intraocular foreign body (IOFB). Meta-analysis found that primary repair less than 24 hours after open-globe injury was associated with 0.30 odds of endophthalmitis compared with primary repair conducted more than 24 hours after trauma (odds ratio, 0.39; 95% confidence interval [CI], 0.19-0.79; I2 = 95%; P = 0.01). No significant difference was found in reported visual outcomes between patients whose open-globe injuries were repaired more than, compared with less than, 24 hours after trauma (odds ratio, 0.89; 95% CI, 0.61-1.29; I2 = 70%; P = 0.52). All included studies were retrospective and nonrandomized, demonstrating an overall low certainty of evidence on GRADE assessment.

共纳入15项研究（8497眼），最常见的损伤类型为眼球穿通伤和眼内异物伤。Meta分析显示：与伤后24小时后进行修复相比，24小时内行初次修复的眼内炎发生风险降低70%（OR=0.39，95%CI：0.19-0.79，I²=95%，P=0.01）。但两组患者的最终视力预后无显著差异（OR=0.89，95%CI：0.61-1.29，I²=70%，P=0.52）。所有纳入研究均为回顾性非随机研究，GRADE评估显示总体证据质量较低。

Discussion

Only retrospective data exist around the effect of timing of open-globe repair, resulting in low certainty of the available evidence. However, this review of current evidence, predominantly including penetrating and IOFB injuries, suggests that primary repair performed less than 24 hours after open-globe injury is associated with a reduced endophthalmitis rate compared with longer delays, consistent with delay to primary repair increasing endophthalmitis risk.

目前关于开放性眼外伤修复时机的证据均来自回顾性研究，导致现有证据质量不高。但本综述通过对现有证据的分析（主要基于眼球穿通伤和眼内异物伤数据）表明：与延迟修复相比，伤后24小时内实施初次修复可降低眼内炎发生率，这一结果与"延迟修复会增加眼内炎风险"的临床认知相符。

推

荐

理

由

这篇系统评价与Meta分析针对开放性眼外伤修复时机这一临床难题提供了重要循证依据。研究通过分析全球8497眼临床数据，首次量化比较了不同修复时机的疗效差异，发现24小时内早期修复可使眼内炎风险显著降低70%（OR=0.39），这一结论为临床实践提供了明确的时间窗参考。研究严格遵循PRISMA指南，采用GRADE系统进行证据质量评价，方法学严谨可靠。特别值得关注的是，研究在证实早期修复降低感染风险的同时，也客观指出不同时机修复的最终视力预后无统计学差异，这种辩证结论避免了临床决策的简单化倾向。尽管受限于回顾性研究的证据等级，但作为目前该领域最大规模的Meta分析，其结论对制定创伤性眼病诊疗规范具有重要参考价值。推荐眼科医师、急诊科医师及创伤救治相关人员阅读，以优化开放性眼外伤的临床决策。