June | Vesber Best RIO Paper Recommendation

Retina, Investigative Ophthalmology & Visual Science, and Ophthalmology each recommend an ophthalmology-related paper, collectively referred to as “the best RIO paper recommendation.”

R-Retina · Recommended
“SUTURELESS CLOSURE OF 23 — AND 25 — GAUGE LEAKING SCLEROTOMIES WITH THE SCLERAL NEEDLING TECHNIQUE “Retina. 40(5): 838-844, May 2020.
The effect of scleral needle technique on the seamless closure of 23G and 25G leaky scleral incisions
Purpose: To describe and evaluate the efficacy of a novel technique, scleral needling (SN), for securing 23- and 25-gauge leaking sclerotomies in microincision vitrectomy surgery.
Objective: To describe and evaluate the effectiveness of the new technique of scleral acupuncture (SN) for minimally invasive vitrectomy for 23G and 25G leaky scleral incision seamless lines.
Methods: A retrospective comparative review of consecutive cases of 23- and 25-gauge pars plana vitrectomy performed by a single vitreoretinal surgeon before the introduction of the SN technique (pre-SN; November 2016 to January 2017) and after the introduction of the SN technique (post-SN; November 2017 to January 2018) was conducted. The SN technique was implemented as an alternative to suturing, using a 30-gauge needle inserted perpendicularly through the full thickness of the sclera adjacent to the scleral opening, with the needle then immediately removed and sclerotomy closure confirmed.
Methods: Retrospective comparative study: before the introduction of scleral puncture (SN) technology (pre-SN; November 2016 to January 2017) and after the introduction of scleral puncture (SN) technology (post-SN; 2017-11 Month to January 2018). 23G and 25G were continuously cut by the vitreous retinal surgeon through the flat part. SN technology is an alternative suture method, using a 30G needle to vertically penetrate the sclera and adjacent to the scleral incision, then immediately pull it out and confirm that the scleral incision is closed.
Results: A total of 203 eyes, 105 from pre-SN and 98 from post-SN, were included in the study. The number of eyes requiring suture closure was significantly reduced from 39% in the pre-SN group to 2% in the post-SN group (P, 0.001). The mean postoperative intraocular pressure and incidence of hypotony on Days 1 to 2, Days 3 to 20, and Days 21 to 50 was not significantly different between the pre-SN and post-SN groups. No major complications associated with the SN technique were noted during the study period.
Results: A total of 203 eyes were selected, with 105 eyes in pre-SN and 98 eyes in post-SN. The number of eyeballs that needed to be sutured was significantly reduced from 39% of pre-SN to 2% of post-SN (P, 0.001). The average intraocular pressure and the incidence of atrophy of eyes on days 1 to 2, 3 to 20, and 21 to 50 after operation were not significantly different between pre-SN and post-SN groups. No major complications related to SN technology were found during the study.
Conclusion: The SN technique is a safe and simple method for effectively securing leaking sclerotomies in microincision vitrectomy surgery.
Conclusion: SN technique is a safe and simple method, which can effectively protect the safety of scleral leakage incision in minimally invasive vitreous surgery.
Recommended reason:
This article is a retrospective comparative study evaluating the effectiveness of scleral puncture (SN) technique for the seamless closure of 23G and 25G vitrectomy scleral leakage incisions. The results of the study show that the SN technique is simple and safe, and can effectively and protect the scleral leakage incision in minimally invasive vitrectomy. The article is unique in that the author has enrolled 203 eyeballs since 2017, divided into two groups of similar numbers 105:98, and according to the postoperative statistical data to compare, reflecting the SN technology for postoperative scleral leakage incision The data required for stitching decreased significantly (39% and 2%). The limitations of this article are: the design of the retrospective study; the sample size is relatively small; all possible postoperative complications such as cataract development and other variables, including the time of surgery, are not recorded. In addition, the sample size cannot compare the incidence of endophthalmitis between the study groups, because the relatively low incidence of postoperative complications makes it difficult to measure.
I——Investigative Ophthalmology & Visual Science · Recommended
“Comparison of Lamina Cribrosa Morphology in Normal Tension Glaucoma and Autosomal-Dominant Optic Atrophy” Invest Ophthalmol Vis Sci 2020; 61:9. 

Comparison of morphology of sieve plate between normal tension glaucoma and autosomal dominant optic atrophy
Purpose: To compare lamina cribrosa (LC) morphology in patients with normal tension glaucoma (NTG) and autosomal-dominant optic atrophy (ADOA).
Objective: To compare the morphology of the sieve plate (LC) in patients with normal tension glaucoma (NTG) and autosomal dominant optic atrophy (ADOA).
Methods: This cross-sectional study matched 24 patients diagnosed with ADOA (24 eyes) by age and retinal nerve fiber layer thickness with 48 patients diagnosed with NTG (48 eyes) by age with 48 healthy controls (48 eyes). Optic nerve heads were scanned by enhanced-depth imaging (EDI) optical coherence tomography (OCT). The LC curvature index (LCCI) and LC depth (LCD) on B-scan images obtained using EDI-OCT were measured at seven locations spaced equidistantly across the vertical optic disc diameter and compared among the NTG, ADOA, and control groups.
Methods: This cross-sectional study combined 24 patients (24 eyes) diagnosed with ADOA by age and retinal nerve fiber layer thickness with 48 patients (48 eyes) diagnosed with NTG by age and 48 healthy controls (48 eyes) A match was made. The optic nerve head is scanned by enhanced depth imaging (EDI) optical coherence tomography (OCT). The LC curvature index (LCCI) and LC depth (LCD) on the B-scan images obtained using EDI-OCT were measured at 7 locations equidistantly distributed on the vertical disc diameter and compared between NTG, ADOA and the control group . And compared between NTG, ADOA and the control group.
Results: Mean LCCI and LCD were significantly greater in NTG than in ADOA and healthy eyes (P <0.001 each) but did not differ significantly in ADOA and healthy eyes.
Results: The average values ​​of LCCI and LCD in NTG group were significantly higher than those in ADOA group and healthy group (P <0.001), but there was no significant difference in LCCI and LCD values ​​between ADOA group and healthy group.
Conclusion: NTG eyes have a more posteriorly curved and deeper LC than ADOA and healthy eyes. This finding provides insight into the role of LC morphology in NTG and provides a clinical clue to distinguish between NTG and ADOA.
Conclusion: Compared with ADOA and healthy eyes, NTG’s eyes have a more curved back and a deeper LC. This discovery provides insights into the role of LC morphology in NTG and provides clinical clues to distinguish NTG from ADOA.
Recommended reason:
This cross-sectional study used EDI-OCT to compare the LC curvature index and LC depth of 48 eyes in NTG group, 24 eyes in ADOA group, and 48 eyes in healthy group. The average value of LC curvature index and LC depth in NTG group was significantly higher than that in ADOA group. And the healthy group, but the LC curvature index and the LC depth value of the ADOA group and the healthy group were not significantly different. This study found that in ADOA and NTG eyes, there are significant differences in LC characteristics. These results provide insights into the different pathogenesis of optic nerve damage in the two diseases. In the case of unclear, LC examination can be used as an auxiliary means to distinguish between ADOA and NTG. This study also has limitations. First, when measuring the LC curve, only include the LC within the width of the opening point (BMO) of the Bruch film, because the LC outside the width of the BMO is usually not visible. However, the study found that the LCCI measured using the entire LC (including LC insertion) is comparable to the LCCI measured using the LC in the BMO, which indicates that the LC curve in the BMO is representative of the entire LC curve. Secondly, the curved LC configuration is called LC curvature in the study, but LCCI does not correspond to the actual LC curvature, but is only an approximation. Further research is needed to explore the best method for calculating the actual LC curvature. Finally, all the subjects in the study are Korean, so the results of the study may not be applicable to other ethnic groups.

O —— Ophthalmology · Recommended
“Anti-Vascular Endothelial Growth Factor Use and Atrophy in Neovascular Age-Related Macular Degeneration” Ophthalmology 2020;127:648-59.
Use of anti-vascular endothelial growth factor VEGF and treatment of age-related macular degeneration of neovascular atrophy
Topic: To summarize the rates of atrophy, risk factors, and atrophy-associated visual outcomes in patients with neovascular age-related macular degeneration (nAMD) who received antievascular endothelial growth factor (VEGF) treatment for macular neovascularization (MNV).
Theme: To summarize the atrophy rate, risk factors and visual results related to atrophy in patients with age-related macular degeneration (nAMD) who received anti-vascular endothelial growth factor (anti-VEGF) treatment for macular neovascularization (MNV).
Clinical Relevance: Age-related macular degeneration is a leading cause of vision loss worldwide, and VEGF inhibitors are the primary treatment for nAMD. However, atrophy is observed frequently in eyes treated with anti-VEGF therapy, prompting 1questions regarding a causative role for these therapies in atrophy development.
Clinical relevance: Age-related macular degeneration nAMD is the leading cause of vision loss worldwide, and anti-vascular endothelial growth factor anti-VEGF as an inhibitor is the main treatment for nAMD. However, atrophy of the eyeball is often observed during treatment with anti-VEGF therapies, which raises a question about the cause of these therapies in the development of atrophy.
Methods: PubMed was searched for articles published in the past 5 years (January 1, 2014, through January 10, 2019). Studies including atrophy outcome(s) in patients with age-related macular degeneration who received anti-VEGF treatment were included. Review articles, retrospective studies, case reports or studies, preclinical studies, prevalence data reports, and non-English studies were excluded. Randomization was not required.
Method: Search PubMed for articles published in the past 5 years (January 1, 2014 to January 10, 2019). The study included atrophy results in nAMD patients receiving anti-VEGF therapy. Review articles, literature reviews, retrospective studies, case reports or studies, preclinical studies, epidemiological data reports, and exclude non-English research materials. No randomization is required.
Conclusion: Overall, 145 studies were identifified; 29 publications were included, with cohorts ranging from 8 to 1185 eyes. Imaging methods used to assess atrophy varied across studies. All studies confifirmed the occurrence of atrophy, and when available, longitudinal data from the included studies demonstrated an increase in atrophy incidence over time. Key risk factors or phenotypes associated with atrophy were fellow eye atrophy, reticular pseudodrusen, increased injections, and type 3 lesion. In addition, visual acuity loss was noted with foveal atrophy.
Conclusion: A total of 145 studies have been confirmed: including 29 publications, ranging from 8 eyeballs to 1185 eyeballs included in the study. The imaging methods used to assess atrophy vary from study to study. All studies have confirmed the occurrence of atrophy, and when feasible, the longitudinal data of the included studies indicate an increase in the incidence of atrophy over time. The main risk factors or phenotypes associated with atrophy are: ipsilateral eye atrophy, reticular pseudo-glass membrane, increased number of injections, and 3 types of lesions. In addition, vision loss is accompanied by foveal atrophy.
Discussion: All studies demonstrated that atrophy occurs in the context of MNV treated with anti-VEGF therapy; however, it is not clear whether anti-VEGF treatment is causative of atrophy versus being associated with atrophy development. The included studies were not designed or powered to assess atrophy as a primary outcome. In addition, it is diffificult to determine whether prognostic factors directly affect atrophy. Furthermore, patient populations in clinical trials do not necessarily represent real-world patients. Although phenotypes and risk factors may help to identify those at greater risk of atrophy developing, it is important to recognize that adequately treating exudative MNV remains the best option to optimize vision outcomes in patients with nAMD, particularly given the risk of vision loss with undertreatment observed in the real world.
Discussion: All studies have shown that anti-VEGF treatment of MNV can cause atrophy; however, whether anti-VEGF treatment causes atrophy and whether it is related to the development of atrophy is currently unclear. The included studies did not design or support the assessment of atrophy as the main result. In addition, it is difficult to determine whether prognostic factors directly affect atrophy. In addition, the patient population in clinical trials does not necessarily represent “real world” patients. Although phenotypes and risk factors may help to identify patients who are at greater risk of developing atrophy, it is important to realize that adequate treatment of exudative MNV is still the best choice to optimize the visual outcome of patients with nAMD. Especially considering the risk of vision loss due to insufficient treatment in the real world.
Recommended reason:
This study searched PubMed for the literature published in the past 5 years and screened according to certain conditions. Finally, 29 articles were included and analyzed. The cohort ranged from 8 eyes to 1185 eyes, and it was concluded that adequate treatment of exudative MNV (macular Neovascularization is still the best choice for optimizing vision outcomes in patients with nAMD (neovascular age-related macular degeneration). This study summarizes and analyzes 29 articles, lists the research methods, processes, and results used in each article in detail. It reports the atrophy results of anti-VEGF (vascular endothelial growth factor) treatment of nAMD, explaining why not all AMD Patients have the same atrophy-related results. However, in the included studies, atrophy was evaluated when anti-VEGF drugs were used to treat MNV; therefore, it is difficult to distinguish whether atrophy is part of AMD’s natural history or secondary to the MNV process. In addition, imaging methods may also affect the assessment and interpretation of atrophy.
The original texts of the three papers have been placed on Baidu’s network disk. Click on the “link” and enter the extraction code: 1npd to download the paper.