Abstract:AIM: To investigate the effect of acetyl-L-carnitine(ALCAR)on cell viability, morphological integrity, and vascular endothelial growth factor(VEGF)expression in human retinal pigment epithelium(ARPE-19)cells using a hypoxic model.

METHODS: In the first set of experiments, the optimal CoCl₂ dose was determined by exposing ARPE-19 cell cultures to different concentrations. To evaluate the effect of ALCAR on cell viability, five groups of ARPE-19 cell culture were established that included a control group, a sham group(200 μM CoCl₂), and groups that received 1, 10 and 100 mM doses of ALCAR combined with 200 μM CoCl₂, respectively. The cell viability was measured by MTT assay. The morphological characteristics of cells were observed by an inverted phase contrast microscope. The levels of VEGF and HIF-1α secretion by ARPE-19 cells were detected by enzyme linked immunosorbent assay(ELISA)assay.

RESULTS: ARPE-19 cells were exposed to different doses of CoCl₂ in order to create a hypoxia model. Nevertheless, when exposed to a concentration of 200 μM CoCl₂, a notable decrease in viability to 83% was noted. ALCAR was found to increase the cell viability at 1 mM and 10 mM concentrations, while the highest concentration(100 mM)did not have an added effect. The cell viability was found to be significantly higher in the groups treated with a concentration of 1 mM and 10 mM ALCAR compared to the Sham group(P=0.041, P=0.019, respectively). The cell viability and morphology remained unaffected by the greatest dose of ALCAR(100 mM). The administration of 10 mM ALCAR demonstrated a statistically significant reduction in the levels of VEGF and HIF-1α compared with the Sham group(P=0.013, P=0.033, respectively).

CONCLUSION: The findings from the current study indicate that ALCAR could represent a viable therapeutic option with the potential to open up novel treatment pathways for retinal diseases, particular relevance for age-related macular degeneration(AMD). However, to fully elucidate ALCAR's application potential in retinal diseases, additional investigation is necessary to clearly define the exact mechanisms involved.

Abstract:AIM:To establish pupil diameter measurement algorithms based on infrared images that can be used in real-world clinical settings.

METHODS:A total of 188 patients from outpatient clinic at He Eye Specialist Shenyang Hospital from Spetember to December 2022 were included, and 13 470 infrared pupil images were collected for the study. All infrared images for pupil segmentation were labeled using the Labelme software. The computation of pupil diameter is divided into four steps: image pre-processing, pupil identification and localization, pupil segmentation, and diameter calculation. Two major models are used in the computation process: the modified YoloV3 and Deeplabv3+ models, which must be trained beforehand.

RESULTS:The test dataset included 1 348 infrared pupil images. On the test dataset, the modified YoloV3 model had a detection rate of 99.98% and an average precision(AP)of 0.80 for pupils. The DeeplabV3+ model achieved a background intersection over union(IOU)of 99.23%, a pupil IOU of 93.81%, and a mean IOU of 96.52%. The pupil diameters in the test dataset ranged from 20 to 56 pixels, with a mean of 36.06±6.85 pixels. The absolute error in pupil diameters between predicted and actual values ranged from 0 to 7 pixels, with a mean absolute error(MAE)of 1.06±0.96 pixels.

CONCLUSION:This study successfully demonstrates a robust infrared image-based pupil diameter measurement algorithm, proven to be highly accurate and reliable for clinical application.

Abstract:AIM: To investigate the mechanism of action of Qingxuan Runmu Yin(QRY)in the treatment of dry eye(DE)based on transcriptomics and network pharmacology, and to validate the efficacy and key targets of QRY through a animal model of DE.

METHODS:RNA-sequencing(RNA-seq)technology was used to detect differentially expressed genes(DEGs)between mice in the DE group and mice in the normal control group, the active ingredients and potential targets of QRY were screened through database, and gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis were carried out after overlapping the results and obtaining key targets. Additionally, “drug-component-target signaling pathways” network was built and the protein-protein interaction(PPI)was analyzed. Mice were examined for Schirmer I test(SⅠt), tear film breakup time(BUT), and corneal fluorescein staining(FL)every 7 d from the beginning of the animal experiments. Hematoxylin-eosin staining(HE)was performed to observe pathologic changes in mouse corneal tissues. Enzyme linked immunosorbent assay(ELISA), Western blot and quantitative real-time polymerase chain reaction(qRT-PCR)were performed to verify the mRNA and protein expression levels of the core targets in mouse corneal tissues.

RESULTS:Totally 2 234 DEGs, 233 active ingredients and 457 related targets of QRY were collected, with a total of 64 key targets obtained. GO function and KEGG pathway results showed that QRY was closely related to inflammatory mediators, and 19 core targets such as interleukin-1β(IL-1β)were screened by PPI network construction; SⅠt, BUT and FL results in the QRY group were statistically significantly different compared with the model group(all P<0.05); HE staining showed that corneal epithelial cell stratification was disordered and the corneal morphology was changed in the model group. However, QRY treatment significantly improved corneal morphology and disordered stratification, with a close morphology to the blank group; ELISA, Western blot and qRT-PCR results showed that the protein expression and RNA levels of IL-1β, IL-6, and tumor necrosis factor(TNF-α)in the QRY group showed a decreasing trend compared with the model group.

CONCLUSION: Through the combination of multiple components, multiple targets and multiple pathways, QRY regulated the targets such as IL-6, IL-1β and TNF through quercetin and other main components, thereby inhibiting AGE-RAGE/TNF/IL-17 and other signaling pathways, thus achieving the treatment on DE.

Abstract:AIM: To observe the early retinal degeneration and activation of microglia in C57BL/6N(Crb1^rd8/rd8)mice.

METHODS:Totally 15 male SPF C57BL/6N mice and 15 male SPF C57BL/6J mice were raised normally, and fundus photography examinations were performed by Micron-Ⅲ at the time of 0, 4, 8, 12 wk of enrollment to calculate the number and area of retinopathy. At the end of experiment, all mice were sacrificed and the right eyeballs were removed to prepare retinal tissue slices. After HE staining, the retinal tissue morphology was observed under optical microscope while the location and level of CX3CR1 expression were detected in immunohistochemical staining. The left eyeballs were removed to isolate retina, then Western-Blot was used to analyze the expression of CD86 and CD206 proteins in retina, and the concentration of IL-1β, IL-6, TNF-α, IL-4 and IL-10 in retina was detected by electrochemiluminescence.

RESULTS:The result of fundus photography examinations showed that the number of retinopathy in the C57BL/6N significantly increased at 4, 8, and 12 wk, and there were differences in variations compared with the C57BL/6J at the same time point(all P<0.05). In the changes in area of retinopathy, there was a difference between two groups at 12 wk(P<0.05), but no difference in variations within groups(both P>0.05). HE staining of retinal tissue showed that the retinal structure of C57BL/6N mice was abnormal, with loose and disordered cell arrangement, and the photoreceptor layer was obviously protruding to the inner side of retina with a drusen-like protrusion. The retinal structure of C57BL/6J mice was clearer, with orderly cell arrangement and no obvious abnormality. Immunohistochemical results showed that CX3CR1 was highly expressed in ganglion cell layer, inner and outer plexiform layer, photoreceptor cell layer and lesion in the retina of C57BL/6N mice, with a mean density of 0.285±0.056 in C57BL/6N and 0.189±0.084 in C57BL/6J mice(P<0.05). The results of Western-Blot showed that the expression of CD86 and CD206 in retina of C57BL/6N increased compared with that in C57BL/6J to varying degrees, and the difference of CD86 was statistically significant(P<0.05). The results of cytokine detection showed that the level of IL-1β, TNF-α in C57BL/6N was significantly higher than that of C57BL/6J, while IL-10 was significantly lower(all P<0.05).

CONCLUSION: The retinal degeneration of C57BL/6N(Crb1^rd8/rd8)mice progressed slowly and gradually aggravated with age. The retinal structure of the lesion was disordered and accompanied by microglial infiltration dominated by M1 polarization.

Abstract:AIM:To explore the fundus vascular characteristics of healthy individuals based on deep learning techniques, with a view to discovering the range of normal values of the fundus arteries and veins, as well as the relationship between physiological factors, such as gender, age, body mass index(BMI), blood pressure, and fundus vasculature characteristics.

METHODS:Fundus images of healthy people were taken from a professional fundus camera, and the subject's blood pressure and laboratory test was collected. Additionally, the fundus arteries and veins were segmented by the improved U-Net model, and the color, morphology and Haralick texture features of the vessels were extracted from computer vision technology.

RESULTS:A total of 4 487 cases fundus images were taken and 326 cases with healthy and clear fundus images were screened, including 200 males and 126 females. There were differences in the morphology, color, and textural characteristics of the left and right eyes, as well as of the fundus arterioles and veins, with a mean vessel width(width)of 1.146 in the arteries and 1.430 in the veins, and an arteriovenous ratio about 4:5. Fundus artery and vein characteristics in healthy individuals of different ages(21-30, 31-40, 41-50): compared with the healthy population aged 21-30 and 31-40 years, arterial and venous inverse difference moment(idm), f12 and venous angular second moment(asm)values increased, and arterial and venous contrast(con), entropy(ent), difference entropy(den), and venous sum entropy(sen)values decreased in 41-50 years. Compared with the 21-30 years age group, arterial f12 values increased and venous con values decreased in 31-40 years(all P<0.05). Fundus vascular characteristics of healthy individuals of different sexes: compared with male, fundus arterial and venous sum average(sav), sum variance(sva)values, arterial curved values, and venous b mean, bsd, variance(var), sen, ent values increased in female, while venous area value of female decreased(all P<0.05). There were no statistically significant differences in fundus arteriosus and venous features in healthy subjects with different levels of BMI(all P>0.05). Fundus characteristics of healthy people with different degrees of blood pressure: there were statistically significant differences in fundus arteriosus area, width, and venous con, idm, dva, and den values between the normal blood pressure and high blood pressure groups(all P<0.05).

CONCLUSION: The characteristics of the left and right eyes as well as the fundus arteries and veins differ in healthy individuals and correlate with physiological factors such as gender, age and blood pressure, which have the value of a potential microcirculation marker.

Abstract:AIM: To explore the diagnostic value of visualized corneal biomechanical analysis combined with Pentacam related-index in the diagnosis of subclinical keratoconus and forme fruste keratoconus, and to provide evidence for early screening and diagnosis of keratoconus.

METHODS: A total of 65 patients(128 eyes)with keratoconus in Ningxia Eye Hospital from November 2018 to November 2019 were enrolled in a diagnostic trial design. According to the course of disease, these eyes were divided into clinical, subclinical and forme fruste groups. A total of 89 subjects(89 eyes)who received preoperative refractive examination at the same period were selected as the normal control group. Pentacam combined with Corvis ST was used for detection. Corneal dilatation indexes, including belin/ambrosio enhanced ectasia display(BAD-D), the thinnest point thickness(TP), max keratometry(Kmax), deviation of normality of the front elevation(Df), deviation of normality of the back elevation(Db), deviation of normality of pachymetric progression(Dp), deviation of normality of corneal thinnest point(Dt), deviation of normality of relational thickness(Da), and Ambrósio relational thickness horizontal(ARTh), corneal biomechanical indexes, including Corvis biomechanical index(CBI), deformation amplitude ratio(DA Ratio), stiffness parameters at applanation 1(SP-A1)and Integrated radius, biomechanical intraocular pressure(bIOP)and tomographic and biomechanical index(TBI)were recorded. The keratoconus at different stages was statistically analyzed, the diagnostic valve of TBI, CBI and BAD-D was explored by receiver operating curve, and the diagnostic value of each parameters was evaluated.

RESULTS:The TBI, BAD-D, TP, Kmax, Df, Db, Dp, Dt, Da, ARTh, CBI and SP-A1 of the clinical keratoconus group had strong diagnostic ability, the BAD-D, Da, Dp, TP, TBI, CBI, ARTh and Integrated radius of the subclinical keratoconus group had strong diagnostic ability, and the BAD-D, Dp and TBI of the forme fruste keratoconus group had certain diagnostic and predictive ability.

CONCLUSION:TBI, BAD-D, Dp and other index have a certain sensitivity and specificity for early keratoconus diagnosis, and can be used for screening and early diagnosis of keratoconus.

Abstract:Cataract is a common eye disease caused by metabolic disorders of the lens, which can lead to visual impairment or blindness. Its occurrence and development are affected by various factors, among which age is the most important factor. At present, drug therapy only has a delaying effect on early cataracts, but surgical treatment is still needed for cataracts that affect vision in the middle and late stages. Therefore, it is crucial to establish an experimental cataract model and explore appropriate drugs for preventing and treating cataracts. D-galactose has been widely used in the study of aging animal models, and is often used in the models of diabetes cataract and age-related cataract. This article elaborates on the pathogenesis, modeling methods, and evaluation criteria for successful modeling of D-galactose-induced cataract models, in order to guide experimental researches related to cataract prevention and treatment.

Abstract:Chronic obstructive pulmonary disease(COPD)is a group of lung diseases characterized by persistent airflow limitation, often accompanied by chronic hypoxia. This chronic hypoxia can lead to structural and functional changes in the walls of blood vessels throughout the body, causing vascular injury and altered vascular reactivity. The retina and choroid are key ocular structures with rich blood supply and are particularly prone to microstructural changes due to ischemia and hypoxia. Optical coherence tomography(OCT), an ideal tool for observing these microstructural changes, serves as a non-invasive method for assessing retinal microstructures and microvascular pathology. Currently, there is a lack of comprehensive reviews summarizing OCT-based morphological changes in the eyes of COPD patients. This paper provides an in-depth review of existing studies on ocular OCT in COPD patients, focusing on structural and blood flow changes in the retina and choroid. The primary goal of this review is to summarize the impact of COPD on ocular microstructures, explore the underlying mechanisms of these morphological changes, and offer new perspectives for assessing eye diseases in COPD patients.

Abstract:The complex barriers to drug delivery in the eye make it difficult for traditional ophthalmic preparations to reach pathological tissues in the posterior segment of the eye via ocular surface. Therefore, intravitreal drug injection has been widely used for treating posterior segment diseases, but this invasive approach to drug delivery has disadvantages such as short drug half-lives, repeated injections, and many complications. Ophthalmic nanodrug delivery systems, which can overcome ocular drug delivery barriers, enhance drug permeability, and improve drug bioavailability, now make it possible to efficiently deliver drugs to the posterior segment of the eye. However, the carrier materials utilized for nanomedicine delivery are inherently intricate, and substantial disparities exist among research findings, posing a hindrance to the subsequent advancement of pertinent drug formulations. Consequently, this review centers on the principal physiological obstacles encountered in ocular drug delivery, emphasizing the utilization of diverse nanomedicine delivery systems in posterior segment pathologies. It aims to delve into their research progress in posterior segment diseases and establish a safer, more effective therapeutic approach for treating these ocular conditions.

Abstract:Thyroid-associated ophthalmopathy(TAO)is the most common orbital disease in adults, characterized by inflammatory cell infiltration in the retrobulbar and periorbital soft tissues. This condition induces a series of pathological alterations including enlargement of the extraocular muscles, increased retrobulbar adipose tissue, soft tissue edema, and orbital fibrosis, resulting in elevated intraorbital pressure and impeded venous return, and in severe cases, can cause dysthyroid optic neuropathy(DON), which is one of the main causes of vision loss in patients. There are abnormalities in ocular hemodynamics in TAO patients, and the occurrence of DON is closely related to optic nerve ischemia. Therefore, it may be important to understand and monitor changes in ocular blood flow in TAO patients as early as possible. Optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)can obtain in vivo images of retinal and choroidal tissue structure and vasculature with non-contact, non-invasive, rapid, and high-resolution characteristics. They have been used to study changes in ocular blood flow in a variety of ophthalmic and systemic diseases. To date, a multitude of scholars have employed OCT and OCTA to investigate the microcirculatory structure and blood flow in the fundus of patients with TAO. However, the research results are still controversial due to differences in measurement techniques, confounding factors, and study populations, and there is no relevant domestic literature review in this field. This article reviews the research progress of OCT and OCTA in TAO, thus exploring the application value of OCT and OCTA technology in TAO.

Abstract:Fungal keratitis is a serious blinding eye disease. The development of fungal infections depends primarily on the interaction of fungal virulence with host immune defense factors. The cornea is considered an immune-privileged organ, and resident macrophages are the main immune cells that respond to the heterogeneity exhibited by the microenvironment with their polarization. In the early stage of infection, macrophages polarize towards M1, which promotes inflammation and facilitates fungal clearance but produces a cellular storm that exacerbates immune damage; in the late stage of infection, macrophages polarize towards M2, which suppresses the inflammatory response and facilitates tissue repair, but may be immunosuppressed or even immune escape to the detriment of pathogen clearance. The balance between pro-inflammatory and anti-inflammatory responses is key to maintaining the functional integrity of the cornea. Current antifungal drug therapy is limited, so it is particularly important to find a therapeutic target for the inflammatory response triggered by the immune response in addition to antifungal therapy. In this review, the functional and phenotypic characterization of macrophage subsets associated with fungal keratitis was reviewed, more in-depth research is needed to explore the specific mechanisms by which macrophage polarization and their impact on fungal keratitis. Targeted regulation of macrophage differentiation based on their phenotype and function could be an effective approach to treat and manage fungal keratitis in the future.

Abstract:Keratoconus(KC)is a disease characterized by limited corneal cone-like protrusions accompanied by thinning of the corneal stroma in the area of protrusion, which commonly occurs before and after puberty, manifests itself bilaterally, and is a potentially blinding ophthalmic disease. It is a potentially blinding eye disease. Studies have shown that its pathogenesis is related to environmental factors, inflammatory response, immune function, and mechanical stimulation, but the mechanism of the occurrence and progression of KC has not yet been conclusively determined. A variety of genes, represented by corneal remodeling-related genes, have been found to have some influence on the development of cone cornea. More studies are still digging into the genetic targets associated with the development of cone cornea. This article reviews the targets and influence of genes in the pathogenesis of cone cornea, to explore the application value of genes in the early diagnosis and intervention of cone cornea, and to provide new ideas for future research on the pathogenesis of cone cornea.

Abstract:Allergic conjunctivitis is the most common type of allergic eye disease, and the incidence in children and adolescents is increasing year by year. Drug therapy can only relieve some symptoms and only in a short period, while allergen immunotherapy is currently a therapy that can significantly improve the symptoms of chronic allergy and the course of the disease. This method has been used abroad for many years but has yet to be reported in China. The author reviews the effective mechanism and clinical efficiency of allergen immunotherapy and provides a reference for the further clinical application in China.

Abstract:Opacification of intraocular lens(IOL)is a rare postoperative complication of cataract surgery. Its occurrence may be associated with various factors, including manufacturing processes, IOL material, patient factors, and surgical intervention. IOL opacification has been reported in all kinds of materials, and the morphological changes and pathological features of IOL opacification from different materials have their own characteristics, with varying clinical manifestations. With the development of related researches, the understanding of IOL opacification is becoming more and more comprehensive. This article reviews the latest research progress in the morphology, etiology, diagnosis and treatment of IOL opacification, with a view to providing guidance for current clinical work and potential directions for future scientific research.

Abstract:Neovascular glaucoma is classified as a type of refractory glaucoma. Its pathological manifestation is the formation of neovascularization of iris and chamber angle, and then the formation of neovascularization membrane. The contraction and traction of neovascularization membrane make the iris and chamber angle adhesion close, which leads to the obstruction of aqueous humor outflow and the sharp increase of intraocular pressure. Excessive intraocular pressure not only causes severe headache and eye pain, but also damages the optic nerve and affects the patient's vision, which can lead to blindness. At present, there are many methods for the treatment of neovascular glaucoma, such as panretinal photocoagulation, anti-vascular endothelial growth factor, local or systemic administration of intraocular pressure lowering drugs and anti-glaucoma surgery. The aim is to reduce neovascularization, preserve visual function and improve symptoms as much as feasible. However, due to the complex pathogenesis and pathological changes of neovascular glaucoma, the treatment of neovascular glaucoma is more difficult than primary glaucoma, and the prognosis is worse. Understanding its pathogenesis and treatment methods can aid in selecting the most appropriate treatment strategy based on individual circumstances. Therefore, this review will summarize the pathogenesis and treatment of neovascular glaucoma.

Abstract:The S100 protein family is a key component of damage-associated molecular patterns(DAMP), which play a vital role in regulating inflammation in the body's innate immune response. S100A8/S100A9 proteins play a wide range of antibacterial and anti-infective functions in many diseases, and promote the occurrence and development of the body's immune and inflammatory responses. In various retinal degenerative diseases, S100A8/S100A9 proteins are significantly upregulated at the transcription and translation stages, promoting the activation of inflammatory factors in ocular tissues, the activation and recruitment of immune cells such as macrophages and neutrophils, and the occurrence and development of ocular inflammation. This review aimsat explaining the biological functions of S100A8/S100A9 proteins and their roles and possible mechanisms in retinal degenerative diseases such as diabetic retinopathy, age-related macular degeneration and ischemic retinopathy.

Abstract:Fundus tessellation, commonly observed in individuals with myopia and among the elderly, represents a fundus alteration easily discernible and assessable. Long-term monitoring has revealed that fundus tessellation may persist unchanged for extended periods or progress, potentially leading to more severe fundus lesions and diminished visual quality. The clinical significance of fundus tessellation is not only as an early indicator and predictor of myopic macular degeneration(MMD), but also, to some extend, as a helpful assistance in early identification and mechanism research of the other ocular and systemic disease, including glaucoma, diabetic retinopathy, age-related macular degeneration, cognitive impairment, and Down syndrome. Currently, artificial intelligence(AI)has achieved remarkable results in detecting, grading, and quantifying fundus tessellation. Therefore, this paper discusses the ocular and systemic diseases related to changes in fundus tessellation, their underlying mechanisms, and advancements in AI-based identification and quantification of fundus tessellation, aiming to contribute to future research endeavors.

Abstract:Over half a century has passed since the inception of vitrectomy, and the indications for its utilization in ophthalmology encompass the majority of vitreoretinal disorders. Technological advancements and equipment innovation have drastically reduced the surgical risk of vitrectomy, but some complications remain unavoidable. Occasionally, unexpected or unexplained visual impairments can manifest. Vitrectomy is associated with a high incidence of optic neuropathy, which can manifest weeks to months following the procedure and result in permanent visual impairment. An intraoperative optic nerve injury and a postoperative secondary injury comprise the causes. Intraocular pressure, dye toxicity, or mechanical damage can cause intraoperative optic nerve injury. Secondary injuries that occur after surgery include an increase in intraocular pressure, toxicity to silicone oil, oxidative stress, and other alterations in the microenvironment. This review will discuss the common causes, clinical manifestations, and related management of optic neuropathy connected to vitrectomy in order to attract the interest of ophthalmologists.

Abstract:AIM: To investigate the efficacy of vitrectomy combined with intravitreal injection of dexamethasone sustained-release agent for the treatment of idiopathic macular membrane(IMEM).

METHODS: A retrospective analysis was conducted on 72 patients(72 eyes)diagnosed with IMEM at Xi'an People's Hospital from January 2019 to January 2023. They were divided into Group A and Group B according to different treatment method. Group A, consisting of 36 eyes, underwent vitrectomy, epiretinal membrane(ERM)removal surgery, and dexamethasone intraocular injection treatment; group B(36 eyes)only received vitrectomy and ERM removal surgery. Follow up for 12 mo, the best corrected visual acuity(BCVA), intraocular pressure, central macular thickness(CMT), and changes in macular retinal structure before and at 1, 3, 6, and 12 mo after surgery were compared.

RESULTS: There were significant differences in BCVA between the two groups at 1, 3, and 6 mo postoperatively(all P<0.05), with group A showing a more significant improvement in visual acuity; there was no significant difference in BCVA between the two groups at 12 mo after surgery(P=0.056). There were significant differences in CMT between the two groups at 1, 3, and 6 mo postoperatively(all P<0.05), with a more significant decrease in CMT of the group A compared with the group B; there was no significant difference in CMT between the two groups at 12 mo after surgery(P=0.165). The comparison of intraocular pressure before and after surgery were all statistically significant(F_time=2.763, P_time<0.05; F_intergroup=26.800, P_intergroup<0.05; F_interaction=5.091, P_interaction<0.05). Group A showed significant structural changes in the macula and retina after surgery.

CONCLUSION: Vitreous surgery combined with single intravitreal injection of slow-release dexamethasone in patients with late stage IMEM can rapidly improve macular morphology and help restore visual function within 6 mo after surgery.

Abstract:AIM:To explore the effect of the peripheral defocus spectacle lenses and orthokeratology(OK)on the control of myopia progression and the impact on vision related quality of life in children and adolescents.

METHODS:Prospective study. A total of 237 children initially diagnosed with myopia in the ophthalmology department of Huzhou Central Hospital from January 2021 to January 2022 were selected and divided into two groups according to different correction methods: peripheral defocus spectacle lenses group(105 cases, 105 eyes)and OK lens group(132 cases, 132 eyes). The Vision Related Quality of Life Questionnaire for Primary and Secondary School Students was used to follow up the both groups of myopic children, and the best corrected visual acuity(BCVA), spherical equivalent(SE), and axial length(AL)were recorded at the first visit and 1 a of follow-up.

RESULTS:After wearing lenses for 1 a, both the peripheral defocus spectacle lenses group and OK lens group showed an increase in SE and AL, but there was no statistical difference between two groups(P>0.05). The changes in SE and AL in the peripheral defocus spectacle lenses group were greater than those in the OK lens group(all P=0.001). After 1 a of follow-up, in the emotional dimension scores, the peripheral defocus spectacle lenses group of children's vision-related quality of life scales scored higher than in the OK lens group(P<0.05). Compared with the baseline value, the change in the emotional dimension scores of the OK lens group was greater than that in the peripheral defocus spectacle lens group(P<0.05).

CONCLUSION:OK lenses are superior to peripheral defocus spectacle lenses in controlling the progression of myopia in children and adolescents. Both correction methods can significantly improve myopic children's vision-related quality of life, with OK lenses being better at improving the emotional dimension of vision-related quality of life.

Abstract:AIM: To observe the effect of orthokeratology combined with vision therapy and Clouclip(OCVTC)on myopic children with dysfunctional accommodation.

METHODS: A prospective, non-randomized control study was conducted on 99 myopic children(99 eyes)with dysfunctional accommodation at the optometry center were of Langfang Aier Eye Hospital from April 2022 to January 2023. and they selected and divided into three groups: 39 children in OCVTC group, 30 in orthokeratology(Ortho-k)group, and 30 in single vision spectacle lens(SVL)group. The OCVTC group received office-based accommodative therapy for 3 mo and home reinforcement for 3 mo, and Clouclip was used in the first 3 wk to monitor and remind children of eye habits; the accommodative amplitudes and facility were measured at baseline, 3, 6, and 12 mo after treatment.

RESULTS: The OCVTC group showed significantly better improvement in accommodative amplitude compared with both the Ortho-k group and the SVL group(all P<0.05), and the Ortho-k group was better than the SVL group at 3, 6, and 12 mo after the intervention(both P<0.05). Similarly, accommodative facility was significantly enhanced in the OCVTC group compared with the other groups at 6 and 12 mo after intervention, and the Ortho-k group was better than the SVL group(all P<0.05). Both accommodative amplitude and facility in the OCVTC group were significantly improved at 3, 6, and 12 mo after the intervention compared with the baseline(all P<0.05). Additionally, 13%(5/39)of cases in the OCVTC group showed a decrease in accommodative amplitude at 12 mo after treatment, with no cases showing a decrease in accommodative facility.

CONCLUSION: For myopic patients with dysfunctional accommodation, orthokeratology combining with visual training and Clouclip will enhance accommodative amplitude and facility, and maintain a stable effect over a long time.

Abstract:AIM: To compare the effects of defocus incorporated multiple segments(DIMS)lens with highly aspherical lenslets(HAL)on delaying the progression of myopia in adolescents.

METHODS: Clinical randomized controlled study. Totally 301 students aged 7-12 who underwent optometry in our hospital from January 2021 to June 2023 were randomly divided into two groups. The first group consisted of 154 patients who were fitted with DIMS lenses(DIMS group). In the second group, 147 cases were fitted with HAL(HAL group). Both groups used 0.01% atropine eye drops to control myopia and all students wore glasses for more than 12 h every day. The spherical equivalent(SE)and axial length(AL)after rapid mydriasis were recorded. The data of the right eyes were taken, and the results after fitting for 12 mo were compared between the two groups.

RESULTS: Multiple linear regression analysis showed that baseline age was significantly correlated with the changes of SE and AL(all P<0.01). After controlling baseline variables, the adjusted changes in SE for 12 mo after wearing glasses in the DIMS group and HAL group were -0.41±0.18 and -0.34±0.13 D, respectively(P<0.001); the changes of AL in the DIMS group and HAL group were 0.31±0.08 and 0.27±0.06 mm, respectively(P<0.001). Patients were divided into younger group(7-9 years old)and older group(10-12 years old). The changes in SE(t=2.250, P=0.025)and AL(t=3.120, P=0.002)of the younger group who wearing DIMS lens were greater than those with HAL after 12 mo, and the same was true in the older group(t=5.931, 5.033, both P<0.001).

CONCLUSION: Under the condition of combined use of 0.01% atropine eye drops, HAL is more effective than DIMS lens in controlling myopia diopter and AL of adolescents.

Abstract:AIM:To investigate the application of virtual reality(VR)technology in ocular trauma teaching for medical students.

METHODS: A total of 90 medical students who participated in the Ophthalmology teaching program between November 2022 and April 2024 were recruited as subjects. Using a case-control method, 45 students in the case group attended traditional ocular trauma teaching program combined with VR virtual simulation experiments, and 45 students in the control group solely attended traditional ocular trauma teaching program. After the teaching practice, the two groups were compared in terms of their examination performance of theoretical knowledge and case analysis, learning ability(evaluated by the Self-Directed Learning Rating Scale), and the satisfaction survey on the quality of teaching; the statistical analyses were performed using t-test or Chi-square test.

RESULTS: The scores of theoretical knowledge and case analysis examinations of the case group were significantly higher than those of the control group, and the differences were statistically significant(scores of theoretical knowledge examination: 57.27±2.78 vs 53.91±3.20; scores of case analysis examination: 35.71±3.73 vs 32.67±5.52, both P<0.05). The scores of the Self-Directed Learning Rating Scale of the case group were significantly higher than those of the control group(P<0.05), and the satisfaction with teaching quality of the case group was significantly higher than that of the control group(P<0.05).

CONCLUSION: VR-enabled teaching of ocular trauma can effectively improve medical students' mastery of theoretical knowledge and practical skills, enhance students' self-directed learning ability and improve teaching satisfaction.

Abstract:AIM: To evaluate the efficacy and safety of porcine corneal acellular stromal deep lamellar keratoplasty in the treatment of infectious keratitis.

METHODS:Prospective study. A total of 17 patients(17 eyes)with infectious keratitis who failed to receive conservative treatment in our hospital from February 2017 to October 2020 were collected, and porcine corneal acellular stromal deep lamellar keratoplasty was performed using acellular porcine corneal matrix. The postoperative follow-up was 6 mo, and best corrected visual acuity(BCVA), corneal epithelial healing, corneal transparency were observed, and the recurrence of infection and graft rejection were recorded.

RESULTS:All patients successfully underwent deep lamellar keratoplasty without intraoperative complications, and there were no cases of loss to follow-up. Postoperative corneal infections were effectively controlled, and BCVA was improved(P<0.05). The complete epithelial coverage of the graft was achieved in 16 eyes by 1 mo postoperatively. Only 1 eye did not achieve complete epithelialization within this period, accompanied by relapse of viral keratitis. However, by 1.5 mo postoperatively, all patients had fully healed epithelium. Corneal edema began to improve 1 month after surgery, with 1 eye with mild turbidity and 16 eyes with severe turbidity. Corneal transparency was stable 3-6 mo after surgery, and 4 eyes were completely transparent, 6 eyes were mildly turbid, 6 eyes were moderately turbid, and 1 eye was severely turbid at 6 mo. During the follow-up period, there were no recurrences of infection, while 1 eye experienced elevated intraocular pressure, which was successfully managed with treatment.

CONCLUSION: The acellular porcine corneal stroma deep lamellar keratoplasty for the treatment of infectious keratitis not only effectively controls infection and alleviates corneal irritation symptoms, but also restores corneal anatomy and function. Additionally, it maintains good transparency and improves patients' vision, making it a viable alternative to allogeneic human corneas.

Abstract:AIM: To explore the value of the corneal/refractive analyzer OPD-Scan III in assessing visual quality after Nd:YAG laser surgery in patients with posterior capsular opacification.

METHODS: A total of 98 patients(98 eyes)with posterior capsular opacification who underwent Nd:YAG laser posterior capsulotomy in our hospital from May 2021 to April 2023 were retrospectively selected as the research subjects, and higher-order aberration parameters(coma, spherical aberration and trefoil aberration)and visual quality parameters \〖Strehl ratio(SR)and 4 mm area ratio(AR)in the human eye modulation transfer function(MTF)curve\〗 were obtained using the corneal/refractive analyzer OPD-Scan III. The patient's visual acuity, higher-order aberration parameters and visual quality before surgery, and at 1 wk and 3 mo after surgery were compared.

RESULTS: There were statistically significant differences in uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA)and uncorrected near visual acuity(UNVA), coma, spherical aberration, trefoil aberration, SR and AR before and after surgery(all P<0.001), and there were statistically significant differences in UDVA, UIVA, UNVA, coma, spherical aberration, trefoil aberration, SR and AR at 1 wk and 3 mo postoperatively(all P<0.05). Additionally, there were differences in the UDVA, UIVA, UNVA, SR and AR at 3 mo postoperatively compared with those parameters at 1 wk postoperatively(all P<0.05), while there were no statistical significance in coma, spherical aberration, trefoil aberration at 3 mo postoperatively and those at 1 wk postoperatively(all P>0.05). Furthermore, the spherical aberration, trefoil aberration were negatively correlated with SR(r_s=-0.427, P=0.009; r_s=-0.436, P=0.010), and the trefoil aberration was negatively correlated with AR(r_s=-0.406, P=0.015).

CONCLUSION: The visual acuity of patients with posterior capsular opacification improved after Nd:YAG laser surgery, and the corneal/refractive analyzer OPD-Scan III system has a high clinical value in reflecting patient's visual quality.

Abstract:AIM: To explore the risk factors of retinal detachment after stage II vitrectomy in patients with open ocular trauma.

METHODS: Retrospective analysis. Totally 278 patients(278 eyes)with open ocular trauma who received stage II vitrectomy in the hospital were included from April 2020 to July 2023. According to the postoperative retinal detachment status, they were divided into detachment group(48 eyes)and non-detachment group(230 eyes). The basic clinical conditions of the two groups of patients were compared, and the factors affecting retinal detachment were analyzed.

RESULTS: Univariate analysis revealed that there were statistical differences in wound length, injured area, surgical time after injury, and history of retinal detachment/lesion between the two groups(all P<0.05). Logistics multivariate regression analysis showed that wound length greater than 10 mm, surgical time after injury more than 1 wk, and history of retinal detachment/lesion were risk factors for retinal detachment in patients with open ocular trauma after stage II vitrectomy(all P<0.05).

CONCLUSION: The occurrence of retinal detachment in patients with open ocular trauma after stage II vitrectomy is mainly related to the severity of trauma, surgical time after injury and history of ocular retinopathy. It is necessary to perform surgical treatment for patients as soon as possible.

Abstract:AIM: To investigate the relationship between objective ocular torsion and near stereopsis in patients with primary superior oblique overaction(PSOOA).

METHODS: Retrospective study. A total of 59 strabismus patients with PSOOA who underwent strabismus surgery at Renmin Hospital of Wuhan University between January 2019 and November 2023 were collected. Based on the collected fundus photographs and the position of the fovea relative to the horizontal line through the optic disc, the eyes were categorized as incyclotorsion, excyclotorsion, or no cyclotorsion. Additionally, the fovea-disc angle(FDA)and the relationship between objective ocular torsion status, FDA, and near stereopsis function in the patients were further measured and analyzed.

RESULTS: Totally 59 patients(92 eyes)showed superior oblique overaction. There were no cases of excyclotorsion, 32 cases with no cyclotorsion, and 27 cases with incyclotorsion. The total binocular FDA was significantly smaller in the no-cyclotorsion group compared with the incyclotorsion group(2.83°±2.89° vs 16.12°±5.74°, P<0.001). The preservation rates of near stereopsis were 66% and 15% in the no-cyclotorsion and incyclotorsion groups, respectively, with a significant statistical difference(P<0.001), and the preservation rates of fine near stereopsis were 38% and 11% in the no-cyclotorsion and incyclotorsion groups, respectively, with a significant statistical difference(P=0.02). Among all patients, near stereopsis was correlated with total binocular FDA(r=-0.526, P<0.001), with the strongest correlation observed with the FDA of the incyclotorsion(r=-0.546, P<0.001). In the incyclotorsion group, there was no correlation between near stereopsis and total binocular FDA(r=-0.366, P=0.060), with a negative correlation between near stereopsis and the FDA of both the incyclotorsion and the overaction(r=-0.424, P=0.028; r=-0.485, P=0.010). In the no-cyclotorsion group, near stereopsis was not correlated with total binocular FDA, incyclotorsion FDA, or overaction FDA.

CONCLUSION:PSOOA patients with incyclotorsion have a lower preservation rate of near stereopsis than those without cyclotorsion. Near stereopsis function of patients with PSOOA is negatively correlated with total binocular FDA, especially the greater the FDA of the incyclotorsion and overaction, the worse the near-stereoscopic function.

Abstract:AIM:To investigate the clinical efficacy of phakic implantable collamer lens(ICL)implantation in correcting low-to-moderate myopia.

METHODS: Retrospective study. A total of 48 patients(85 eyes)with low to moderate myopia who underwent ICL implantation were included in the study. The changes in uncorrected visual acuity(LogMAR), corrected visual acuity(LogMAR), refractive outcomes, intraocular pressure, vault and endothelial cell were observed at 1 a postoperatively.

RESULTS: At 12 mo postoperatively, uncorrected and best-corrected visual acuity were -0.10(-0.20, -0.10)and -0.10(-0.20, -0.10), respectively, with an efficacy index of 1.07±0.13 and a safe index of 1.10±0.14. The difference between the actual corrected diopter and the expected corrected diopter was 91%(77/85)in the range of ±0.50 D, and 100%(85/85)in the range of ±1.00 D. The mean vault was 501.16±210.46 μm at 12 mo postoperatively. There was no significant difference in corneal endothelial cell density between preoperative and 6 and 12 mo postoperatively(F=1.050, P=0.352). All patients had no anterior subcapsular opacification, cataract, pupillary block, or other sight threatening complications during follow-up.

CONCLUSION: ICL implantation for the correction of low to moderate myopia has good efficacy, safety and predictability.

Abstract:AIM: To study the degree of astigmatism, axial distribution and axial symmetry pattern of binocular astigmatism in primary and secondary school students aged 7-18 years with myopia.

METHODS:A total of 239 cases(478 eyes)of primary and secondary school students aged 7-18 years who underwent keratoplasty for myopia correction at the Fifth Affiliated Hospital of Zhengzhou University from 2020 to 2022 were randomly selected, and optometry was performed under ciliary muscle paralysis and was statistically analyzed.

RESULTS:Astigmatism degree: 0.25 to 1.00 D accounted for 78.5%, 1.25 to 2.00 D accounted for 17.1%, and >2.00 D accounted for 4.4%. The axial distribution of astigmatism: 86.6% was astigmatism with the rule, 5.9% was astigmatism against the rule, and 7.5% was oblique astigmatism; both genders and different astigmatism degrees were dominated by astigmatism with the rule, and there were differences with the other two axes(both P<0.05). Axial symmetry pattern of astigmatism: the median axial difference in astigmatism between the direct symmetry model and the mirror symmetry model was 7° and 10°, respectively, with no statistical significance in both models(P=0.158), and there was no difference between the two in gender, degree of astigmatism, and axial distribution of astigmatism, but in the age group of 7-12 years old, the difference between the axial astigmatism of the direct symmetry model and the mirror symmetry model was statistically significant(P=0.027).

CONCLUSION:The axial distribution of binocular astigmatism in myopic primary and middle school students is mostly astigmatism with the rule; the degree of astigmatism is more common from 0.25 to 1.0 D; however, there is no tendency for axial symmetry pattern of astigmatism.

Abstract:AIM:To investigate the challenges and needs of individual ophthalmologists participated in the training and their countries in the prevention and treatment of blindness and visual impairment, sum up the training effects, and discuss how to promote the development of eye health in the Belt and Road countries in the future.

METHODS:A total of 48 ophthalmologists from 6 countries, including Kenya, Zambia, Nigeria, South Africa, Malawi, Botswana between August 1 and August 30, 2022, were trained and anonymous questionnaire survey was conducted. The questionnaire consists of 15 questions covering three aspects: challenges and strategies related to vision impairment and blindness in the country, training satisfaction, and recommendations for establishing optometric centers in Africa.

RESULTS: A total of 48 questionnaires were distributed and 47 valid questionnaires were collected. The ophthalmologists hold the view that the biggest challenge of their countries in prevention and treatment of ocular diseases was high nursing costs, accounting for 36.17%, the biggest challenge faced by ophthalmologists was low wages, accounting for 29.79%. Building more eye specialist hospitals(38.30%)and providing more training opportunities(65.96%)can effectively help the countries and the ophthalmologists. The organizational satisfaction with the training courses reached 98%, the content and the lecturers' satisfaction were 100%.

CONCLUSION:There are urgent needs to build more ophthalmic hospitals and provide more professional training opportunities to solve the difficulties in the prevention and treatment of eye diseases of the countries and the ophthalmologists. This training program has high satisfaction and good feedback.