Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Am J Ophthalmol. 2020 Mar;211:1-3. doi: 10.1016/j.ajo.2019.10.027. Epub 2019 Nov 5.
To discuss the value and limitations of interpreting small case series for the purpose of understanding the pathophysiology of conditions affecting the visual system and how they may influence patient care decision making.
Selective review of English-language ophthalmic articles published in peer-reviewed journals since 1950.
Author-initiated PubMed Central query of small case series in glaucoma, pediatric neuro-ophthalmology, and diabetic retinopathy.
A review of well-known ophthalmic case studies by Gass, Irvine, Brockhurst, and others shows that small samples can provide suggestions to the skilled clinician for adding steps to the examination process when uncovering rare or previously unknown associated complications, as is the case for this perspective's initiating studies by Groth and Brodsky. However, as shown by the now-retracted small case series in Lancet connecting measles-mumps-rubella vaccinations with autism, small case series do not replace the value of clinical trials, with rare exception, when considering impacts to widespread, common clinical practice.
Small case series may contribute to an improved understanding of pathophysiology of rare ophthalmic conditions, but alone are insufficient to provide evidence for changing clinical practice of common eye diseases.
讨论解读小型病例系列对于理解影响视觉系统的疾病的病理生理学以及它们如何影响患者治疗决策的意义和局限性。
选择性回顾自 1950 年以来发表在同行评议期刊上的英文眼科文献。
作者发起对青光眼、小儿神经眼科学和糖尿病视网膜病变的小型病例系列的 PubMed Central 查询。
通过对 Gass、Irvine、Brockhurst 等人的知名眼科病例研究的回顾，小型样本可以为熟练的临床医生提供在发现罕见或以前未知的相关并发症时增加检查步骤的建议，正如本观点的发起研究 Groth 和 Brodsky 所展示的那样。然而，正如现已撤回的《柳叶刀》上关于麻疹-腮腺炎-风疹疫苗接种与自闭症之间联系的小型病例系列研究所示，当考虑对广泛的常见临床实践的影响时，除了罕见情况外，小型病例系列并不能替代临床试验的价值。
小型病例系列可能有助于更好地理解罕见眼科疾病的病理生理学，但仅凭它们不足以提供改变常见眼病临床实践的证据。
