INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLE COEXISTENT WITH RHEGMATOGENOUS RETINAL DETACHMENT
(Retina: 42：1491-1497，2022 ）
Purpose
To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana vitrectomy and inverted internal limiting membrane flap technique.
报告采用玻璃体平坦部切除术联合倒置内界膜瓣技术治疗黄斑裂孔合并孔源性视网膜脱离患者的临床特征和治疗结果。
Methods
Eleven consecutive patients with rhegmatogenous retinal detachment and macular hole who underwent vitrectomy and internal limiting membrane peeling with the inverted flap technique between December 2017 and February 2021 were retrospectively evaluated. The main outcome measures were retinal reattachment rate, macular hole closure rate, and postoperative best-corrected visual acuity. A nonsystematic literature review was performed to compare the study outcomes with those previously reported.
对2017年12月至2021年2月期间连续11例采用倒置皮瓣技术行玻璃体切除和内界膜剥离术的孔源性视网膜脱离和黄斑裂孔患者进行回顾性评估。主要观察指标为视网膜复位率、黄斑裂孔闭合率和术后最佳矫正视力。进行非系统文献回顾，将研究结果与先前报道的结果进行比较。
Results
The primary retinal reattachment rate was 90% (10/11) with one surgery and 100% with 2 surgical procedures. Macular hole closure was achieved in all patients (11/11). All patients showed an improvement in visual acuity at the final postoperative visit, and the mean postoperative best-corrected visual acuity was 0.60 ± 0.32 logarithm of the minimum angle of resolution (20/80 Snellen equivalent).
一次手术的原发性视网膜复位率为90%（10/11），两次手术为100%。所有患者均实现黄斑裂孔闭合（11/11）。所有患者在术后最后一次就诊时视力均有改善，平均术后最佳矫正视力为最小分辨角的0.60±0.32对数（20/80 Snellen 等效值）。
Conclusion
Vitrectomy with the inverted internal limiting membrane flap technique achieved not only favorable anatomical retinal reattachment rates but also an encouraging recovery of central macular anatomy and visual function in patients with macular hole coexistent with rhegmatogenous retinal detachment.
玻璃体切除术联合倒置内界膜瓣技术不仅获得了良好的视网膜解剖复位率，而且在黄斑裂孔合并孔源性视网膜脱离的患者中，黄斑中央解剖结构和视觉功能的恢复也令人鼓舞。
该研究表明玻璃体切除术联合倒置内界膜瓣技术不仅是孔源性视网膜脱离的有效方式，而且对于原发性黄斑裂孔闭合也是一种有效的方式。此外，它可以在术后恢复黄斑结构和视力。
该研究的亮点在于是第一个调查这种技术在非高度近视眼黄斑裂孔合并孔源性视网膜脱离中的结果的研究，实现黄斑裂孔闭合对于改善术后视力恢复至关重要。
不足之处在于其回顾性、没有对照组以及样本量相对较小。
Effects of Monocular Light Deprivation on the Diurnal Rhythms in Retinal and Choroidal Thickness
(Invest. Ophthalmol. Vis. Sci. 2022;63(8):6)
Purpose
To determine the effects of monocular light deprivation on diurnal rhythms in retinal and choroidal thickness.
确定单眼光剥夺对视网膜和脉络膜厚度昼夜节律的影响。
Methods
Twenty participants, ages 22 to 45 years, underwent spectral domain optical coherence tomography imaging every three hours, from 8 AM to 8 PM, on two consecutive days. Participants wore an eye patch over the left eye starting at bedtime of day 1 until the end of the last measurement on day 2. Choroidal, total retinal, photoreceptor outer segment + retinal pigment epithelium (RPE), and photoreceptor inner segment thicknesses were determined.
20名年龄在22至45岁之间的参与者，连续两天从上午8点到晚上8点，每3小时进行一次光谱域光学相干断层成像。参与者从第1天就寝时间开始在左眼佩戴眼罩，到第2天最后一次测量结束。测定脉络膜、视网膜总面积、光感受器外段+视网膜色素上皮（RPE）和光感受器内段厚度。
Results
For both eyes, significant diurnal variations were observed in choroidal, total retinal, outer segment + RPE, and inner segment thickness (P < 0.001). For light-deprived eyes, choroid diurnal variation persisted, although the choroid was significantly thinner at 8 AM and 11 AM (P < 0.01) on day 2 compared to day 1. On the other hand, diurnal variations in retinal thickness were eliminated in the light-deprived eye on day 2 when the eye was patched (P > 0.05). Total retinal and inner segment thicknesses significantly decreased (P < 0.001) and outer segment + RPE thickness significantly increased (P < 0.05) on day 2 compared to day 1.
双眼的脉络膜、视网膜总面积、外段+RPE和内段厚度均存在显著的昼夜变化（P<0.001）。对于光线剥夺的眼睛，脉络膜的昼夜变化持续存在，尽管与第1天相比，第2天上午8点和上午11点的脉络膜明显变薄（P<0.01）。另一方面，在第2天，当眼睛被修补时，视网膜厚度的昼夜变化在光线剥夺的眼中被消除（P>0.05）。与第1天相比，第2天总视网膜和内段厚度显著降低（P<0.001），外段+RPE厚度显著增加（P<1.05）。
Conclusion
Blocking light exposure in one eye abolished the rhythms in retinal thickness, but not in choroidal thickness, of the deprived eye. Findings suggest that the rhythms in retinal thickness are, at least in part, driven by light exposure, whereas the rhythm in choroidal thickness is not impacted by short-term light deprivation.
结论：在一只眼睛中阻断光线照射，会消除被剥夺眼的视网膜厚度节律，但不会消除脉络膜厚度节律。研究结果表明，视网膜厚度的节律至少部分由光照驱动，而脉络膜厚度的节律不受短期光剥夺的影响。
在这项研究中，发现单眼光照剥夺导致仅在早晨光照剥夺的眼睛脉络膜厚度减少，而对暴露在正常光线下的对侧对照眼的脉络膜没有影响。且研究结果表明，外层视网膜厚度的节律受光/暗循环的影响，而不是仅由内源性时钟驱动，而脉络膜厚度的昼夜节律对光照模式的变化具有很强的影响。
这些发现有助于更好地理解光照在调节眼部昼夜节律中的作用。鉴于越来越多的证据表明光照和昼夜节律与眼睛的生长有关，这些发现可能会进一步深入了解他们参与屈光不正的发展。
本研究未来可通过测量视网膜内层更完整地量化光线剥夺后视网膜的变化。
Corneal Endothelial Cell Density Loss after Glaucoma Surgery Alone or in Combination with Cataract Surgery: A Systematic Review and Meta-analysis
(Ophthalmology 2022, 129：841-855）
Topic
Corneal endothelial cell density (ECD) loss after glaucoma surgery with or without cataract surgery.
青光眼手术联合或不联合白内障手术后角膜内皮细胞密度（ECD）的损失。
Clinical Relevance
Corneal ECD loss may occur as the result of intraoperative surgical trauma in glaucoma surgery or postoperatively with chronic endothelial cell trauma or irritation.
青光眼手术中的手术创伤或术后慢性内皮细胞损伤或刺激可能导致角膜ECD丢失。
Methods
Glaucoma filtration surgery or microinvasive glaucoma surgery (MIGS) in participants with ocular hypertension, primary and secondary open-angle glaucoma, normal-tension glaucoma, and angle-closure glaucoma were included. Electronic databases searched in December 2021 included MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the International Prospective Register of Systematic Reviews, Food and Drug Administration (FDA) Premarket Approval, and FDA 510(k).
包括高眼压、原发性和继发性开角型青光眼、正常眼压性青光眼和闭角型青光眼参与者的青光眼滤过手术或微创青光眼手术（MIGS）。2021年12月搜索的电子数据库包括MEDLINE、Embase、Cochrane对照试验中央登记册、ClinicalTrials.gov、国际前瞻性系统评价登记册、食品和药物管理局（FDA）上市前批准和FDA 510（k）。
Results
A total of 39 studies were included in quantitative synthesis. Twelve months after suprachoroidal MIGS, mean ECD loss was 282 cells/mm2 (95% confidence interval [CI], 220–345; P < 0.00001; chi-square = 0.06; I2 = 0%; 2 studies; very low certainty). Mean ECD loss after Schlemm’s canal implantable devices was 338 cells/mm2 (95% CI, 185–491; P < 0.0001; chi-square = 0.08; I2 = 0%; 2 studies; low certainty) at 12 months. Mean ECD loss was 64 cells/mm2 (95% CI, 21–107; P = 0.004; chi-square = 4.55; I2 = 0%; 6 studies; low certainty) after Schlemm’s canal procedures (without implantable devices) at 12 months. At 12 months, the mean ECD loss after trabeculectomy was 33 cells/mm2 (95% CI, −38 to 105, P = 0.36, chi-square = 1.17; I2 = 0%; moderate certainty). At 12 months, mean ECD loss was 121 cells/mm2 (95% CI, 53–189; P = 0.0005; chi-square = 3.00; I2 = 0%; 5 studies; low certainty) after Express (Alcon) implantation. When compared with the control fellow eye, aqueous shunt surgery reduced ECD by 5.75% (95% CI, −0.93 to 12.43; P = 0.09, chi-square = 1.32; I2 = 0%; low certainty) and 8.11% ECD loss (95% CI, 0.06–16.16 P = 0.05; chi-square = 1.93; I2 = 48%) at 12 and 24 months, respectively.
共有39项研究被纳入定量综合。脉络膜上MIGS术后12个月，平均ECD损失为282个细胞/mm2（95%置信区间[CI]，220-345；P<0.00001；卡方=0.06；I2=0%；2项研究；非常低的确定性）。12个月时，施累姆氏管植入装置后的平均ECD损失为338个细胞/平方毫米（95%CI，185-491；P<0.0001；卡方=0.08；I2=0%；2项研究；低确定性）。施莱姆管手术（无植入装置）后12个月，平均ECD损失为64个细胞/mm2（95%CI，21-107；P=0.004；卡方=4.55；I2=0%；6项研究；低确定性）。12个月时，小梁切除术后的平均ECD损失为33个细胞/mm2（95%CI，−38至105，P=0.36，卡方=1.17；I2=0%；中等确定性）。在12个月时，快速（Alcon）植入后，平均ECD损失为121个细胞/mm2（95%CI，53-189；P=0.0005；卡方=3.00；I2=0%；5项研究；低确定性）。与对照对侧眼相比，房水分流手术将ECD降低了5.75%（95%CI，−0.93至12.43；P=0.09，卡方=1.32；I2=0%；低确定性）和8.11%的ECD损失（95%CI，0.06–16.16 P=0.05；卡方=1.93；I2=48%）。
Conclusions
Overall, there is low certainty evidence to suggest that glaucoma surgery involving long-term implants has a greater extent of ECD loss than glaucoma filtration surgeries without the use of implants. The results of this review support follow-up beyond 36 months to assess ECD loss and corneal decompensation after implantation of glaucoma drainage implants.
总的来说，有低确定性的证据表明，涉及长期植入物的青光眼手术比不使用植入物的青光眼滤过手术的ECD损失程度更大。本综述的结果支持随访36个月以上，以评估青光眼引流植入物植入后的ECD损失和角膜失代偿。
青光眼手术中使用的植入设备由不同的材料制成，具有不同的生物相容性，对角膜内皮有不同的影响。最后，无论是急性发作、低眼压还是术后前房变浅，眼压的剧烈变化都会影响内皮的功能。
该研究有低确定性证据表明涉及长期植入物的青光眼手术比不使用植入物的青光眼滤过手术具有更大程度的 ECD 损失。对植入设备的研究应将ECD作为安全监测的一部分进行测量。
该研究的不足之处在于平均ECD差异的值是不确定的，因为它需要针对人群进行年龄调整。还应注意的是，有各种技术可通过镜面显微镜测量ECD损失，但这在许多研究中未标准化，可能导致计算ECD的错误。
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