Abstract:AIM:To observe the effect of the plus power ring zone(PPRZ)area and distribution on myopia progression.

METHODS:This retrospective study enrolled 137 pre-teens aged 8-12 at Taiyuan Aier Eye Hospital between 2019 and 2021. They were fitted with Ortho-K lenses for the first time due to refractive error, with a one-year follow-up period. To indicate the peripheral plus ring zone overlapping with the pupil zone(PPROPZ)accompanying PPRZ, participants were divided based on the PPROPZ to PPRZ ratio. The experimental group had 103 eyes with a PPROPZ to PPRZ ratio of ≥0.2, and the control group had 103 eyes with a ratio of <0.2. Participants had a spherical diopter in the range of -6.00 D to -0.75 D, against-the-rule astigmatism less than 1.00 D, with-the-rule astigmatism less than 1.50 D, and corneal curvatures of 39.00 D to 46.00 D. They had a stable best corrected visual acuity of 0.10 LogMAR(20/25)or better when wearing orthokeratology(Ortho-K)lenses. PPRZ and PPROPZ were measured using ImageJ; corneal topography assessed corneal-related parameters, and an optical biometer measured the axial length of the eyes pre and post-one years of lens wear.

RESULTS: Changes in axial length elongation were found to decrease when either the PPRZ(P<0.01)or PPROPZ(P<0.001)was increased significantly. The axial length growth was faster in the control group(0.37±0.2 mm)than in the experimental group(0.21±0.11 mm). Furthermore, we found that a larger horizontal visible iris diameter(HVID)corresponded to slower axial growth of the eye. In contrast, axial length growth showed no correlation with surface regularity index(SRI), surface asymmetry index(SAI), flat keratometry value(K_f), steep keratometry value(K_s).

CONCLUSION:For orthokeratology, wearers with larger PPROPZ to PPRZ ratio usually experiences a reduction in axial length growth. The PPRZ and PPROPZ are negatively correlated with the axial length. Our findings provide a recommendation and methods for studying the myopia control mechanism through Ortho-K lenses.

Abstract:AIM:To investigate the regulatory effects of proanthocyanidins on autophagy and apoptosis in the retinas of guinea pigs with form-deprivation myopia via the AMPK/Wnt/β-catenin pathway.

METHODS:Fifty guinea pigs were randomly divided into a normal control group, a myopia model group, and low-dose, medium-dose, and high-dose proanthocyanidins groups(25, 50 and 100 mg/kg). Refractive power and axial length of right eye were measured using a retinoscope and A-scan ultrasound. Retinal pathological changes were observed via HE staining. Immunohistochemistry assessed p-AMPK and p-mTOR expression in the retina. Immunofluorescence detected p62 and LC3 expression. TUNEL staining evaluated retinal cell apoptosis. Western blot examined expression of proteins related to the AMPK/Wnt/β-catenin pathway and autophagy(p62, Beclin1, LC3-II/LC3-I), and apoptosis-related proteins(Bax, Bcl-2, Cleaved-Caspase3, Caspase3)in the retina.

RESULTS:Compared with the control group, the myopia model group showed significantly reduced refractive power and significantly increased axial length(both P<0.05); retinal cell arrangement became sparse and retinal thickness thinned. The p-AMPK levels in the retina were significantly reduced, while p-mTOR levels were significantly increased(both P<0.05), indicating suppression of the AMPK-Wnt/β-catenin pathway. The p62 levels were significantly elevated and LC3 levels were significantly reduced(both P<0.05), suggesting inhibition of autophagy. Bax and Cleaved-Caspase3 were significantly increased, while Bcl-2 was significantly decreased, indicating significantly increased apoptosis(both P<0.05). Compared with the myopia model group, all proanthocyanidins dose groups significantly inhibited refractive error reduction and axial length growth(both P<0.05), restored retinal cell alignment and thickness, activated the AMPK/Wnt/β-catenin pathway, significantly increased p-AMPK expression, and suppressed p-mTOR expression(all P<0.05); significantly suppressed p62 expression, increased Beclin1 and LC3-II/LC3-I expression(both P<0.05), and activated retinal autophagy; significantly suppressed Bax and Cleaved-Caspase3 expression, increased Bcl-2 expression(both P<0.05), and inhibited retinal cell apoptosis.

CONCLUSION:Proanthocyanidins enhance retinal autophagy by activating the AMPK/Wnt/β-catenin pathway, thereby inhibiting retinal apoptosis and preventing or alleviating the onset of myopia.

Abstract:AIM: To investigate the effect of accommodation on peripheral refraction in patients with myopia.

METHODS: Cross-sectional study. A total of 105 patients(105 eyes)with myopia were consecutively recruited in this study. According to the degree of myopia, patients were divided into high myopia(SE≤-6.00 D), moderate myopia(-6.00 DRESULTS: There were 48 males and 57 females, with a mean age of 13.6±1.6 years old. The general data of the three groups were comparable. RDV-15° remained stable, whereas other parameters shifted significantly toward hyperopia. After cycloplegia, the RDV-15°, RDV-30° and RDV-45° showed larger differences when deviated from macular fovea. There were differences among the three groups in ΔTRDV, ΔRDV-45°, ΔRDV-I and ΔRDV-N, and the change of the low and moderate myopia groups was larger than that of the high myopia group(all P<0.017), whereas low and moderate myopic eyes did not differ significantly from each other(all P>0.017).

CONCLUSION: The accommodation can affect the peripheral defocus in myopic patients, and the effect on moderate and low myopia is greater than that of high myopia.

Abstract:AIM:To evaluate the characteristics of ocular biometric parameters and the distribution of corneal astigmatism(CA)in patients with high myopia before cataract surgery.

METHODS:A prospective cross-sectional study was conducted, and 695 cataract patients(695 eyes)with high myopia \〖defined as an axial length(AL)≥26.00 mm\〗 scheduled to undergo cataract surgery at our hospital from January 2022 to December 2024 were consecutively enrolled, another 695 cataract patients(695 eyes)with normal ALs(22.00 mm ≤AL≤25.00 mm)who underwent cataract surgery at our hospital during the same period were included in the control group. For patients with both eyes eligible, the right eye was used for analysis. Before cataract surgery, IOL Master 700 was used to measure the ocular biometric parameters of both eyes for each patient in the two groups. The medical records and ocular biometric data in the two groups were recorded and collected.

RESULTS:There were no statistically significant differences between the two groups in genger, age, corneal diameter, and central corneal thickness(all P>0.05). In the high myopia group, the mean AL was 29.20±2.61 mm, and 252 eyes(34.1%)had AL ≥30.00 mm(extremely high myopia). The mean anterior chamber depth(ACD), lens thickness, vitreous chamber depth(VCD), CA, AL/corneal radius of curvature and VCD/AL in the high myopia group were 3.45±0.40, 4.41±0.47, 21.34±2.60 mm, 1.18±0.78 D, 3.79±0.38, and 0.73±0.03, respectively, which were all greater than those in the control group(all P<0.01). In the high myopia group, 350 eyes(50.4%)had CA ≥1.00 D, 192 eyes(27.6%)had CA ≥1.50 D, and 94 eyes(13.5%)had CA ≥2.00 D, which were all higher than those in the control group(32.8%, 15.1%, and 6.6%, respectively; all P<0.001). In the high myopia group, 87 eyes(12.5%)had flat corneas, 424 eyes(61.0%)had moderate CA, and 40 eyes(5.8%)had high CA. These proportions were all higher than those in the control group(6.0%, 46.9%, and 2.9%, respectively; all P<0.001). In the high myopia group, ACD and ACD/AL were negatively correlated with AL(r=-0.162 and -0.661, respectively; all P<0.001), while both ACD and ACD/AL in the control group were positively correlated with AL(r=0.338 and 0.105, respectively; both P<0.01). In the high myopia group, CA increased with age when the patient's age was ≥50 years(r=0.197, P<0.001), which was consistent with the control group.

CONCLUSION: The standardized ocular biometric data of cataract patients with high myopia before cataract surgery are helpful for ophthalmologists to accurately calculate the intraocular lens(IOLs)power and select the appropriate IOL type. The majority of high myopia patients need simultaneous correction of CA during cataract surgery.

Abstract:AIM: To observe the characteristics of best corrected visual acuity(BCVA), microperimetry(MP), multifocal electroretinogram(mfERG), and optical coherence tomography angiography(OCTA)parameters in patients with idiopathic epiretinal membrane(IERM), and conduct a comparative study and correlation analysis on these parameters.

METHODS:This was a cross-sectional study. A total of 56 patients(56 eyes)diagnosed with IERM who visited our hospital between February 2021 and November 2024 were collected as IERM group, and 33 healthy individuals(33 eyes)undergoing physical examinations were included as control group. Parameters were compared between the IERM group and the control group, as well as among IERM subgroups at different stages. Additionally, correlations among visual function parameters and between these visual function parameters and vascular structural OCTA parameters were analyzed.

RESULTS: The general data of patients in the control group and IERM group were comparable. In the IERM group, BCVA, retinal sensitivity(RS), P1 wave amplitude in ring 1, superficial capillary plexus parafoveal vessel density(SCPpfvd), deep capillary plexus parafoveal vessel density(DCPpfvd), and the foveal avascular zone(FAZ)area were significantly lower than the control group(all P<0.01). In contrast, central retinal thickness(CRT), superficial capillary plexus foveal vessel density(SCPfvd), and deep capillary plexus foveal vessel density(DCPfvd)were significantly increased(all P<0.001). When comparing different stages of IERM, significant differences were observed in BCVA, CRT, RS, SCPfvd, and FAZ(all P<0.01). In eyes affected by IERM, BCVA(LogMAR)was negatively correlated with RS; P1 wave amplitude in ring 1 positively correlated with P1 wave implicit time in ring 1; SCPfvd positively correlated with BCVA(LogMAR)and negatively correlated with RS; DCPfvd negatively correlated with P1 wave implicit time in ring 1; and DCPpfvd positively correlated with RS(all P<0.05).

CONCLUSION: Eyes with IERM exhibit abnormalities in visual function parameters and vascular structure, with varying degrees of alteration in BCVA, CRT, RS, SCPfvd, and FAZ across different stages. Comprehensive evaluation of BCVA, MP, mfERG, and OCTA contributes to a deeper understanding of the nature of IERM and aids in formulating appropriate diagnosis and treatment plans.

Abstract:Diabetic cataract, a prevalent ocular complication of diabetes mellitus, arises from a complex interplay of pathological mechanisms, with oxidative stress and glycation stress playing central roles. Autophagy, a critical cellular self-protection mechanism, sustains intracellular homeostasis by selectively degrading damaged organelles and misfolded proteins, thereby counteracting the detrimental effects of oxidative and glycation stress under hyperglycemic conditions. Emerging evidence indicates a synergistic interaction between glycation stress and oxidative stress, which may exacerbate autophagic dysfunction and accelerate the onset and progression of diabetic cataract. However, the precise molecular mechanisms underlying this relationship remain incompletely understood. This review systematically examines the regulatory role of autophagy inthe pathogenesis of diabetic cataract, with a particular focus on how autophagic impairment influences disease progression under the combined effects of glycation and oxidative stress. By elucidating these mechanisms, the paper aims to provide novel insights into molecular diagnostic approaches and targeted therapeutic strategies for diabetic cataract.

Abstract:Retinal vein occlusion(RVO)is the second most common blinding retinal vascular disease, and its secondary macular edema(ME)is an important cause of visual function impairment in patients. Intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs serves as the first-line treatment, yet it is confronted with such issues as the need for repeated injections and non-response in some patients. Imaging and laboratory biomarkers play a crucial role in the early accurate diagnosis, prediction of disease progression, and evaluation of visual prognosis of RVO-ME. This study systematically reviews the research progress of imaging and laboratory biomarkers related to the prognosis of RVO-ME after anti-VEGF treatment in recent years, covering imaging biomarkers like central retinal thickness and ellipsoid zone integrity, as well as laboratory biomarkers such as serum APLN and aqueous humor IL-6. It summarizes the associations between different biomarkers and the prognosis of anti-VEGF therapy, aiming to provide a basis for the early accurate assessment and optimization of individualized treatment for RVO-ME patients, which holds significant clinical reference value.

Abstract:Autoimmune uveitis is a blinding intraocular inflammation primarily caused by immune dysregulation mediated by CD4⁺ T cells. CD4⁺ T cells differentiate into various functional subsets, including Th1, Th2, Th17, and Treg cells. These subsets participate in immune responses and mediate the initiation and resolution of inflammation by secreting different cytokines. This article primarily focuses on the functional characteristics and interplay network of Th1/Th2 and Th17/Treg cells, along with the specific effects of their key secreted cytokines(e.g., IFN-γ, TNF-α, IL-17, IL-10, TGF-β)in driving or suppressing ocular inflammation. The goal is to clarify the fundamental pathogenesis of this disease from the perspective of immune balance. Furthermore, this work explores potential therapeutic targets based on restoring the balance between Th1/Th2 and Th17/Treg, such as modulating the differentiation of specific subsets, blocking key pro-inflammatory cytokines, or enhancing anti-inflammatory functions. This investigation aims to provide a scientific rationale and guidance for optimizing existing diagnostic and therapeutic strategies, as well as developing new immunotherapies(e.g., biological agents, cell therapies).

Abstract:As a corneal ectatic disease, keratoconus is characterized by increased corneal curvature, progressive thinning, and anterior protrusion of the cornea. Initially, patients often experience progressive myopia and irregular astigmatism. As the disease progresses, severe visual impairment may occur. Corneal collagen cross-linking(CXL)is currently recognized internationally as the only effective treatment to halt the progression of keratoconus. After the surgery, changes in stromal curvature subsequently lead to the regeneration and redistribution of corneal epithelial cells. It has been observed that the process of epithelial remodeling plays a crucial role in maintaining the smoothness and symmetry of the corneal surface, as well as in improving the visual recovery. However, the specific mechanism of epithelial remodeling in the visual recovery and efficacy maintenance after CXL surgery is still unclear. This review comprehensively summarizes the morphological characteristics, temporal patterns and clinical significance of corneal epithelial remodeling after CXL surgery, compares the effects of different CXL protocols on epithelial thickness, and explores the potential value of epithelial remodeling in the assessment of postoperative efficacy and the design of personalized surgical strategies, aiming to provide directions for further clinical practice and research.

Abstract:Retinitis pigmentosa(RP)is an inherited retinal degenerative disease characterized by progressive photoreceptor cell degeneration, in which cataract—a common complication—significantly affects visual prognosis. Currently, phacoemulsification with intraocular lens implantation has become the main treatment for RP complicated with cataract. However, postoperative complications such as posterior capsular opacification, capsular contraction syndrome, intraocular lens dislocation, and macular edema occur at considerably higher rates in these patients, severely compromising the long-term outcomes of cataract surgery. Based on the latest clinical evidence, this review systematically elaborates on the clinical characteristics of RP with cataract, key perioperative surgical considerations, and recent advances in the prevention and management of complications, aiming to optimize the surgical approach, improve postoperative visual quality, and enhance long-term efficacy for RP patients, thereby providing an evidence-based medical reference.

Abstract:Primary open angle glaucoma(POAG)is a chronic, progressive optic neuropathy characterized by pathologically elevated intraocular pressure(IOP), which is the main high-risk factor, although the etiology is still unclear. Due to the insidious onset, many patients are already in the intermediate or advanced stages at the first presentation. At these stages, optic nerve damage is often severe, the target IOP requirement is stringent(below 12 mmHg), with poor tolerance to treatment, which necessitates comprehensive treatment approaches to control disease progression. This review systematically summarizes recent advances in the clinical management of advanced POAG, including medications, laser therapy, trabeculectomy, glaucoma drainage device implantation, minimally invasive glaucoma surgery and other emerging therapies. It elaborates on the mechanisms of action, efficacy, safety, suitable populations, and indications for switching treatments. Incorporating the latest clinical research data up to 2025, the analysis evaluates the impact of different treatment approaches on clinical practice and explores the future development trends, aiming to provide comprehensive references for individualized treatment strategies to maximize preservation of visual function in patients with advanced POAG.

Abstract:Retinal vein occlusion(RVO)is often accompanied by macular edema(ME), which is the main cause of visual impairment in patients. From the perspective of traditional Chinese medicine theory, the key pathogenesis lies in Qi stagnation and blood stasis, as well as internal retention of water and dampness, which is closely related to the dysfunction of internal organs such as liver depression and qi stagnation, spleen failure to function properly, and kidney deficiency with water retention. Although anti-vascular endothelial growth factor(VEGF)therapy has become the first-line treatment option for RVO-ME, some patients show a low response or no response to this therapy, resulting in recurrent ME. According to traditional Chinese medicine, such difficult-to-treat cases are often caused by long-term illness entering the meridians and the interplay of phlegm and blood stasis, or by deficiency of the body's vital energy and the lingering of pathogenic factors. Intervention should be carried out through therapeutic methods such as promoting blood circulation and diuresis, resolving phlegm and unblocking meridians, and strengthening the body's vital energy and eliminating pathogenic factors. At present, the pathogenesis of RVO-ME is not yet fully understood. Modern medicine believes that it may involve multiple factors such as retinal microstructure damage, abnormal blood flow and systemic diseases throughout the body, while traditional Chinese medicine emphasizes the overall connection between local lesions and the imbalance of Qi, blood, Yin and Yang throughout the body. This article systematically reviews the existing research achievements of traditional Chinese and Western medicine on RVO-ME, analyzes its possible high-risk factors, and provides a theoretical basis for formulating individualized treatment plans integrating the advantages of traditional Chinese and Western medicine for such patients.

Abstract:Focal choroidal excavation(FCE)is an elusive clinical sign characterized by a localized structural depression in the choroid. It has been increasingly recognized with the widespread use of optical coherence tomography(OCT), though its pathogenesis remains incompletely understood and may involve congenital developmental anomalies or acquired factors(such as inflammation or tumor compression). Studies indicate that FCE can occur independently or secondary to various chorioretinal diseases(e.g., central serous chorioretinopathy, choroidal osteoma, age-related macular degeneration, etc.). Clinically, it has also been observed that FCE may be associated with the development of choroidal neovascularization(CNV). Potential mechanisms linking FCE and CNV include: 1)mechanical traction-hypoxia-signaling pathway activation; 2)disruption of the retinal pigment epithelium(RPE)-Bruch's membrane-choroid complex barrier; 3)structural collapse induced by inflammatory scar contraction. Anti-vascular endothelial growth factor(VEGF)therapy is currently the mainstay of treatment for CNV secondary to FCE. By reviewing relevant domestic and international literature, this paper seeks to elucidate the possible pathological relationship between FCE and CNV, with the goal of facilitating early identification of high-risk patients and optimizing anti-VEGF treatment strategies. It also highlights the limitations of current research(such as sample heterogeneity and lack of histological validation of typing criteria), and suggests future directions, such as multicenter studies and molecular mechanism investigations, to support the development of personalized diagnostic and therapeutic approaches.

Abstract:The retina is an important component in the formation of vision. Retinal diseases affect normal vision. The mitogen-activated protein kinase(MAPK)signaling pathway is widely expressed in biologically active cells. The MAPK signaling pathway plays a pivotal role in regulating key physiological processes, including cell growth, proliferation, differentiation and apoptosis. Recent studies have shown that the MAPK signaling pathway is involved in the pathogenesis of retinal diseases, including pathological processes such as inflammatory responses, oxidative stress, and abnormal vascular formation. This article aims to summarize the regulatory mechanism of the MAPK signaling pathway in the occurrence and development of retinal diseases, such as diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, and other diseases. Exploring the MAPK pathway's potential as a therapeutic target may provide new insights and strategies for clinical treatment.

Abstract:Diabetic retinopathy(DR)represents one of the microvascular complications that severely imperil the visual health of patients, the pathogenesis involves inflammation, oxidative stress, and vascular endothelial dysfunction, and other aspects. Adipocytokines are closely linked to the onset and progression of diabetes mellitus. This article elaborates on the pathophysiological mechanisms underlying the role of adipocytokines in DR, with a specific focus on the functions of key adipocytokines such as Leptin, Chemerin, Omentin-1, and Apelin. Simultaneously, it analyzes the potential clinical application value of adipocytokines in the diagnosis, mechanism of action, prognostic assessment, and prediction of DR. A deeper comprehension of the mechanisms by which adipokines act on DR provides new insights for exploring the synergistic regulatory mechanisms of multiple adipokines, as well as for the early diagnosis, targeted therapy, and disease monitoring of DR.

Abstract:Diabetic retinopathy(DR)is a prevalent microvascular complication of diabetes and a leading cause of vision loss globally.Although anti-vascular endothelial growth factor(anti-VEGF)therapies remain the clinical mainstay, a significant proportion of patients exhibit suboptimal responses, highlighting the urgent need for novel therapeutic targets. Calcitonin gene-related peptide(CGRP), a multifunctional neuropeptide, is gaining attention due to its roles in vascular regulation, neuroprotection, and immunomodulation. This review summarizes the biological characteristics of CGRP and its receptor-mediated signaling, and explores emerging evidence of CGRP's involvement in DR through its vasodilatory effects and regulatory effect on neurodegenerative disorders and release of inflammatory cytokines. Furthermore, the therapeutic potential of targeting the CGRP pathway in DR is evaluated, especially in cases unresponsive to VEGF inhibition. Despite currently the lack of CGRP-targeted drugs applied for DR, the peptide demonstrates efficacy and safety in other diseases, such as migraine, suggests promising translational opportunities. However, CGRP may play a dual role in different pathological stages of DR, thus its treatment strategy needs to be considered precisely. Future research elucidating the precise mechanisms of CGRP in DR may pave the way for innovative intervention strategies.

Abstract:Basal cell carcinoma(BCC)is the most common type of skin cancer, with an increasing incidence in the eyelid each year, posing a significant health burden on patients. The Hedgehog(Hh)signaling pathway plays a crucial role in the occurrence and development of BCC, with its abnormal activation closely related to tumor formation. Therefore, Hh signaling pathway inhibitors have garnered increasing attention as an emerging therapeutic strategy. This article reviews the application of Hh signaling pathway inhibitors in the treatment of eyelid BCC, exploring their mechanisms of action, clinical effects, and future research directions. Through an analysis of existing literature, the potential of Hh signaling pathway inhibitors in treating BCC was summarized, the challenges faced in current clinical applications were highlighted, and pressing issues that need to be addressed were identified, aiming to provide references for future research and clinical practice.

Abstract:The defocus curve, which quantifies visual performance under various defocus states to accurately evaluate the eye's ability to achieve clear vision across a continuous range of distances, is a vital tool for assessing visual quality. With the aging population and improved quality of life driving a significant increase in the demand for presbyopia correction, the application of the defocus curve has continually expanded in ophthalmic clinical practice, particularly in the perioperative period of presbyopia-correcting corneal refractive surgery and refractive cataract surgery, where it aids in personalized surgical planning and proves valuable for patient education and postoperative visual quality assessment. This article systematically reviews the examination methodology, influencing factors, analytical approaches, and recent clinical advancements of defocus curves, focusing on the potential impact of variables such as pupil diameter, contrast sensitivity, and chart selection on results; it further discusses current limitations including lack of standardization and insufficient assessment of dynamic visual performance, and proposes future research directions based on the latest literature. The aim is to provide valuable insights for researchers and clinicians, promote the standardized and normative application of defocus curves, and ultimately enhance the overall efficacy of presbyopia correction and patients' quality of visual life.

Abstract:AIM: To study the effect of recombinant bovine basic fibroblast growth factor(re-bFGF)on cataract patients with low endothelial cell density(ECD)after phacoemulsification and intraocular lens implantation.

METHODS: Prospective study. A total of 82 patients(82 eyes)with cataract and low ECD who received phacoemulsification and intraocular lens implantation in the hospital from January 2021 to December 2023 were selected and divided into observation group(41 eyes)and control group(41 eyes)by random coin tossing method. Both groups were treated with phacoemulsification and intraocular lens implantation, and received postoperative routine treatment. The control group was administrated with recombinant human epidermal growth factor(rhEGF)eye drops(1-2 drops each time, 4 times/day)on the basis of routine treatment, while the observation group was given re-bFGF eye drops(1-2 drops each time, 4 times/day)on the basis of routine treatment, and both groups were treated continuously for 3 mo. The postoperative uncorrected visual acuity recovery, cornea-related indicators \〖ECD, central corneal thickness(CCT), coefficient of variation in cell area(CV), percentage of corneal endothelial hexagonal cells(HEX)\〗, serum inflammatory factors \〖tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β)and interleukin-6(IL-6)before and after surgery\〗 and complications were compared between the two groups of patients.

RESULTS: There were no differences in preoperative general data between the two groups. At 1 wk, 1 and 3 mo after surgery, the visual acuity in the two groups was improved compared with that before surgery(all P<0.05). The levels of corneal ECD and HEX in the observation group at 1 wk, 1 and 3 mo after surgery were higher than those in the control group, while the levels of CCT and CV were lower than those in the control group(all P<0.05). At 3 mo after surgery, levels of TNF-α, IL-1β and IL-6 in tears were lower in the observation group compared to the control group(all P<0.05). The total incidence rate of complications in the observation group was lower than that in the control group, with no statistical significance(P>0.05).

CONCLUSION: The application of re-bFGF in cataract patients with low ECD after phacoemulsification and intraocular lens implantation has good clinical value. Additionally, it can relieve the corneal injury, and reduce the burden of inflammation.

Abstract:AIM: To investigate the correlation of serum C-reactive protein(CRP)-to-albumin(ALB)ratio(CAR)and neutrophil-to-lymphocyte count ratio(NLR)with pathological staging and prognosis of retinopathy of prematurity(ROP), and the predictive value of its combined testing for the prognosis of infants.

METHODS:Prospective study. A total of 147 children with ROP who were born in our hospital from March 2022 to September 2024 were served as the ROP group, and 100 premature infants without ROP were served as the control group in the same period. Fully automatic biochemical analyzer was used to detect serum CRP and ALB; the flow cytometry nucleic acid fluorescence staining was used to count neutrophils and lymphocytes, and the CAR and NLR were calculated. Spearman correlation was used to analyze the relationship of serum CAR and NLR with ROP staging. Logistic regression was used to analyze the factors affecting the prognosis of children with ROP. ROC curve was drew to analyze the predictive value of serum CAR and NLR for the prognosis of ROP.

RESULTS: There was comparability between the ROP group and the control group. The ROP group had significantly higher serum CRP, CAR, neutrophil count, and NLR than the control group, and clearly lower ALB and lymphocyte count than the control group(all P<0.05). Children with stage IV ROP had clearly higher serum CAR and NLR than stages I, II, and III, and the differences among stages I, II, and III were significant(all P<0.05). Serum CAR and NLR were positively correlated with ROP staging(r=0.529, 0.587, all P<0.05), and there was a positive correlation between serum CAR and NLR(r=0.546, P<0.05). The poor prognosis group had clearly higher serum CAR and NLR than good prognosis group(all P<0.001). Elevated serum CAR and NLR were risk factors affecting the prognosis of children with ROP(all P<0.05). The AUC of serum CAR, NLR, and joint detection in predicting the prognosis of ROP children was 0.803, 0.825, and 0.938, respectively. The joint detection showed better predictive performance(Z_{combinatoion-CAR}=2.637, Z_{combinatoion-NLR}=2.528, all P<0.05).

CONCLUSION:Serum CAR and NLR are elevated in children with ROP, and they are closely related to pathological staging and prognosis. The joint detection has a higher predictive value in evaluating the prognosis of ROP.

Abstract:AIM: To explore the clinical efficacy of 25G minimally invasive vitrectomy combined with 41G ultra-micro subretinal injection of tissue plasminogen activator(t-PA)in the treatment of subretinal hemorrhage(SMH).

METHODS: Retrospective study. A totally 60 patients(60 eyes)who visited the Ophthalmology Department of Yuebei People's Hospital from June 2022 to September 2024 and were diagnosed with submacular hemorrhage were selected. According to different treatment methods, they were divided into a control group of 30 eyes(25G vitrectomy combined with intravitreal injection of t-PA)and an observation group of 30 eyes(25G vitrectomy combined with 41G subretinal injection of t-PA). The complete clearance rate of macular hemorrhage, best corrected visual acuity(BCVA), changes in intraocular pressure, central retinal thickness(CRT), the occurrence of postoperative complications were observed in the two groups of patients.

RESULTS:The two groups of general data are comparable. After treatment for 7 d, the rate of complete clearance of macular hemorrhage was higher in the observation group than in the control group(100% vs 80%, P<0.05). There was no significant difference between the two groups in the comparison of BCVA at 1 d and 6 mo postoperatively(all P>0.05), and in the comparison of BCVA between the two groups at 7 d, 1, and 3 mo postoperatively, BCVA of the observation group was better than that of the control group(all P<0.05); and the intraocular pressure of the observation group was lower than that of the control group at 1 d, 7 d, and 1 mo postoperatively(all P<0.05), and there was no significant difference between the two groups in the comparison of intraocular pressure at 3 and 6 mo postoperatively(all P>0.05). There was no significant difference between the two groups in the comparison of CRT at 1 d and 6 mo postoperatively(all P>0.05), and CRT was lower than that of the control group at 7 d, 1 and 3 mo postoperatively(all P<0.05). The total incidence of complications in the observation group was not statistically different from that in the control group(0 vs 10%, P>0.05).

CONCLUSION: The 25G minimally invasive vitrectomy combined with 41G ultra-microsubretinal injection of t-PA is more efficient in removing subretinal hemorrhage, promotes early anatomical restoration, and has a comparable long-term visual prognosis to the conventional method, with a favorable safety profile.

Abstract:AIM: To explore the efficacy of internal limiting membrane(ILM)flap technique and simple ILM peeling in the treatment of idiopathic macular hole(IMH)and related influencing factors.

METHODS: A retrospective cohort study was conducted on totally 32 patients(35 eyes)with IMH who received surgery at our department from January 2023 to November 2024. All the patients simultaneously received phacoemulsification combined with intraocular lens implantation, and they were divided into study group(19 eyes)and control group(16 eyes), with ILM flap technique and simple ILM peeling received in the two groups, respectively. The closure situation of macular hole, best corrected vision acuity(BCVA), and macular structure were observed in the two groups of patients. Furthermore, the correlation of BCVA and healing type of macular hole at the last time of follow-up with each parameter was analyzed.

RESULTS: There was no statistical difference between the two groups of patients in preoperative general characteristics(all P>0.05). At the last time of follow-up, the macular hole was heeled in both groups, with 7 eyes of U-shaped heeling, 6 eyes of V-shaped heeling, and 6 eyes of irregular heeling in the study group, and with 13 eyes of U-shaped of heeling, 1 eye of V-shaped heeling and 2 eyes of irregular heeling in the control group(χ²=7.167, P=0.028). The postoperative BCVA was better than preoperative level(all P<0.05), there were no statistical significant differences between the two groups of patients in macular choroidal thickness before and after surgery(P>0.05), but the macular retinal thickness of the study group was thinner than that of the control group(168.11±92.11 vs 235.56±92.18 μm, P=0.03). Pearson correlation analysis indicated that BCVA at the last time of follow-up was positively correlated with the preoperative minimum diameter(r=0.476, P<0.05)and the diameter hole index(r=0.361, P<0.05), and negatively correlated with traction hole index(r=-0.364, P=0.031); Keendall correlation analysis showed that the postoperative closure types positively correlated with the basal diameter(τ=0.296, P=0.029), minimum diameter(τ=0.366, P=0.007), and visual acuity at the last time of follow-up(τ=0.412, P=0.003), while negatively correlated with macular hole index(τ=-0.415, P=0.002)and traction hole index(τ=-0.511, P<0.01). During the follow-up period, neither group of patients experienced postoperative complications.

CONCLUSION: Both ILM flap technique and simple ILM peeling are safe and effective in treating IMH. As the smaller the basal diameter and minimum diameter of the macular hole, the larger the macular hole index and traction hole index, the probability of U-shaped heeling after surgery is greater and the visual acuity is better.

Abstract:AIM: To evaluate the diagnostic value of serum Th1-type cytokine levels and extraocular muscle-related parameters in thyroid-associated ophthalmopathy(TAO).

METHODS: A retrospective study was conducted on 45 patients diagnosed with TAO in our hospital from January 2023 to December 2024, and 20 normal volunteers during the same period as controls. Venous blood samples of the patients were collected to detect the concentrations of Th1-type cytokines \〖interferon-γ(IFN-γ), tumor necrosis factor-α(TNF-α), interleukin-2(IL-2), and interleukin-12(IL-12)\〗 in the serum. Additionally, the end diastolic velocity(Ved), velocity maximum(Vmax), resistance index(RI)of the central retinal artery, as well as the thickness and left-right diameter of the medial rectus muscle were measured. Logistic regression model was used to analyze the risk factors of TAO, and receiver operating characteristic curve(ROC)was adopted to evaluate the diagnostic efficacy of each index for the occurrence of TAO.

RESULTS: The general information of the two groups was comparable. Compared with the normal control group, the serum concentrations of IFN-γ and TNF-α in TAO patients were significantly increased, Ved and Vmax were lower than those in the control group, and RI and the thickness of the medial rectus muscle were higher than those in the control group(all P<0.05). Logistic regression analysis showed that serum IFN-γ concentration, Ved, Vmax, and the thickness of the medial rectus muscle were all risk factors for TAO. ROC curve analysis indicated that the AUCs of serum IFN-γ concentration, Ved, Vmax, and the thickness of the medial rectus muscle for the diagnostic efficacy of TAO were 0.756, 0.769, 0.732, and 0.642, respectively. The combined detection of IFN-γ, Ved, Vmax, and the thickness of the medial rectus muscle had an AUC of 0.840 and a Youden index of 0.59, which was superior to the detection of a single indicator.

CONCLUSION: The levels of serum Th1-type cytokines and extraocular muscle-related ultrasound indicators have certain value in the diagnosis of TAO. The combination of IFN-γ, Ved, Vmax, and the thickness of the medial rectus muscle has better diagnosis efficiency in TAO, which can provide a certain reference for the early diagnosis of TAO.

Abstract:AIM: To compare the characteristics of corneal wavefront aberrations following small incision lenticule extraction(SMILE)and Q-value-guided femtosecond laser-assisted in situ keratomileusis(Q-value-FS-LASIK), and to evaluate the impact of these two procedures on visual quality.

METHODS:A total of 60 myopic patients(120 eyes)who underwent refractive surgery between January 2024 and June 2024 were enrolled and divided into two groups: the SMILE group(60 eyes)and the Q-value-FS-LASIK group(60 eyes). Preoperatively and at 1, 3, and 6 mo postoperatively, the following parameters were measured using the Pentacam HR and iTrace systems within a 6 mm corneal zone: root mean square of higher-order aberrations(RMS HOA), spherical aberration, vertical coma, horizontal coma, trefoil, Strehl ratio(SR), and modulation transfer function(MTF). Patient-reported outcomes(PROs)were used to assess subjective visual quality, and group differences were compared.

RESULTS:The general data of the two groups were comparable. At 6 mo postoperatively, uncorrected visual acuity(UCVA)was ≥1.0 in both groups, and the spherical equivalent(SE)remained within ±0.50 D. The total RMS HOA was significantly lower in the SMILE group(0.38±0.12 μm)than in the Q-value-FS-LASIK group(0.45±0.15 μm; P=0.012). Spherical aberration was higher in the Q-value-FS-LASIK group(0.52±0.18 μm)compared to the SMILE group(0.35±0.14 μm; P<0.001), while vertical coma was significantly greater in the SMILE group(0.21±0.09 vs 0.12±0.07 μm; P=0.003). No significant intergroup differences were observed in horizontal coma or trefoil(all P>0.05). The SR was superior in the SMILE group(0.26±0.05)compared to the Q-value-FS-LASIK group(0.22±0.04; P=0.008). PROs indicated a lower incidence of nighttime driving difficulties in the SMILE group(12% vs 21%; P=0.023).

CONCLUSION:Q-value-FS-LASIK effectively controls spherical aberration by optimizing corneal asphericity but results in higher total higher-order aberrations. SMILE reduces total aberrations due to its flap-free design but induces greater vertical coma. The choice of procedure should be tailored to the patient's refractive status and visual demands.

Abstract:AIM:To evaluate the effectiveness of EYESI binocular indirect ophthalmoscope simulation system as a training platform for fundus examination skills of general practitioner.

METHODS:Prospective randomized study. A total of 40 general practitioners who received clinical ophthalmology training at Shenzhen Eye Hospital from January 2021 to December 2024 were selected and randomly divided into two groups by random number table method, with 20 cases in the study group and 20 cases in the control group. The study group was trained by EYESI binocular indirect ophthalmoscope simulation system and the control group was trained by conventional teaching. Training effects of the two groups were analyzed.

RESULTS: The general information of the two groups was comparable. Through training with the EYESI binocular indirect ophthalmoscope simulator, the study group showed significant improvements in total examination and drawing scores compared to pre-training results(all P<0.001). Additionally, examination duration, retinal light exposure time, and drawing time were all significantly shorter than those before training(all P<0.001).The study group achieved significantly higher total examination and drawing scores than the control group during the EYESI binocular indirect ophthalmoscope simulator assessment(all P<0.001). Furthermore, examination duration, retinal light exposure time, and drawing time were all significantly shorter in the study group compared to the control group(all P<0.001). Moreover, ratings for the novelty of the training method and overall satisfaction with the training were significantly higher in the study group than in the control group(all P<0.001); while the perceived psychological stress during training was significantly lower in the study group(P<0.001).

CONCLUSION:The EYESI binocular indirect ophthalmoscope simulaton system effectively enhances both the proficiency in fundus examination skills and overall training satisfaction among general practitioners.

Abstract:AIM: To explore the spatiotemporal distribution and the association with environmental factors of age-related cataract in Yushu, Qinghai Province from January 2023 to March 2025.

METHODS:A total of 1 121 patients with age-related cataract admitted to our hospital from January 2023 to March 2025 were collected, 121 patients were excluded according to the exclusion criteria, and finally 1 000 patients living in Yushu Tibetan Autonomous Prefecture, Qinghai Province were included, with an average age of 71.45±8.25 years. ArcGIS10.2 was used to draw the spatiotemporal distribution map of age-related cataract in each county of Yushu, Qinghai Province, and OpenGeoda was used for global spatial autocorrelation analysis. Binary Logistic regression was used to analyze the correlation between environmental factors and the incidence of age-related cataract. Multivariate Logistic regression was used to analyze the influencing factors of age-related cataract. LCA(Mplus 7.4 software)was used to compare the differences in factor distribution characteristics.

RESULTS:There were 438 cases in 2023, 472 cases in 2024, and 90 cases in 2025 among the 1 000 cases of age-related cataract. The spatiotemporal distribution map of age-related cataract in each county of Yushu, Qinghai Province showed that the incidence rate was the highest in Qumalai County and Zhiduo County, followed by Chengduo County and Yushu City, and the lowest in Nangqian County and Zaduo County. The spatial distribution presented a incidence feature of high in the northwest and low in the southeast. The highest number of confirmed cases was from July to September 2023 and 2024, accounting for 31.90% of the study population, which might be related to the peak of ultraviolet radiation intensity in the summer on the plateau. The global autocorrelation Moran's I coefficient showed that the spatial distribution characteristics of age-related cataract at the county level presented a bimodal distribution, with all Moran's I coefficients being positive. The incidence of age-related cataract in each year had a spatial positive correlation(P<0.05). The peaks were in July to September 2023 and 2024, with values of 0.423 and 0.451, respectively. The annual average ultraviolet radiation, altitude, and annual average PM2.5 concentration positively correlated with age-related cataract(all P<0.05), while the annual average temperature and annual precipitation negatively correlated with age-related cataract. However, only the annual average temperature significantly correlated with age-related cataract(P<0.05). After adjusting for confounding factors, the correlations remained stable(P<0.05). Multivariate Logistic regression analysis showed that the annual average ultraviolet radiation, altitude, annual average temperature, and annual average PM2.5 concentration were independent influencing factors for age-related cataract(all P<0.05). LCA showed that the effects of annual average ultraviolet radiation, altitude, annual average temperature, and annual average PM2.5 concentration on age-related cataract were heterogeneous.

CONCLUSION:From January 2023 to March 2025, there were obvious spatiotemporal characteristics and distribution patterns of age-related cataract in Yushu, Qinghai Province. Temporally, the number of confirmed cases reached the peak in July to September each year. Spatially, the incidence rates in each county were significantly different, presenting a distribution feature of high in the northwest and low in the southeast. In addition, ultraviolet radiation, altitude, temperature, and PM2.5 concentration are important environmental factors affecting the incidence of age-related cataract in Yushu, Qinghai Province.

Abstract:AIM: To analyze the reasons and clinical outcomes of intraocular lens(IOL)exchange.

METHODS:This retrospective case series study included 47 patients(53 eyes)who underwent IOL exchange surgery at the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, between April 2020 and May 2024, aged from 5 to 87(44.8±3.6)years old. Patients' demographics, surgical indications, surgical techniques, preoperative and postoperative uncorrected visual acuity(UCVA)and best-corrected visual acuity(BCVA), as well as postoperative complications were recorded.

RESULTS:The reasons for IOL exchange included refractive error(18 cases, 23 eyes, 43%), IOL dislocation(12 cases, 13 eyes, 25%), IOL opacification(12 cases, 12 eyes, 23%), neuroadaptation failure(3 cases, 3 eyes, 6%), and patient dissatisfaction with visual quality(2 cases, 2 eyes, 4%). The surgical techniques for IOL exchange included in-the-bag IOL fixation(16 eyes, 30%), ciliary sulcus fixation(27 eyes, 51%), and scleral suture fixation(10 eyes, 19%). There was statistical significant difference between preoperative UCVA(LogMAR)and UCVA(LogMAR)at 1 d postoperatively(1.03±0.64 vs 0.50±0.46, P<0.05), and there was statistical significant difference between preoperative BCVA(LogMAR)and BCVA(LogMAR)at 1 mo postoperatively(0.41±0.37 vs 0.17±0.21, P<0.05). Postoperative complications included posterior capsule opacification in 2 eyes and IOL dislocation in 1 eye.

CONCLUSION:Refractive error, IOL dislocation, and IOL opacification were the three most common reasons for IOL exchange. Although less frequent, factors such as neuroadaptation issues associated with multifocal IOLs and patient-reported visual quality dissatisfaction reflect growing expectations for improved visual outcomes. IOL exchange surgery, though technically challenging, demonstrates favorable clinical efficacy and a low complication rate, representing an effective intervention for managing postoperative IOL-related issues following cataract surgery.

Abstract:AIM: To explore the risk factors for visual field defect in patients with normal tension glaucoma.

METHODS: The general data of 164 patients(164 eyes)with normal tension glaucoma diagnosed and treated in our hospital from July 2022 to January 2025 were retrospectively analyzed. According to the visual field defect, the patients were divided into visual field defect group(93 eyes)and no visual field defect group(71 eyes). The clinical data of the two groups were compared, and the risk factors of visual field defect in patients with normal intraocular pressure glaucoma were analyzed by Logistic regression.

RESULTS: Totally 93 eyes had visual field defect among 164 eyes with normal tension glaucoma, with an incidence rate of 57%. The age, proportion of high myopia, intraocular pressure, intraocular pressure fluctuation and resistance index(RI)in the visual field defect group were higher than those in the non-visual field defect group(all P<0.01), while the retinal nerve fiber layer thickness, the optic disc vascular density, peak systolic blood flow velocity(PSV)and end diastolic blood flow velocity(EDV)in the visual field defect group were lower than those in the non-visual field defect group(all P<0.01). Multivariate Logistic regression showed that advanced age(OR=1.171), high myopia(OR=2.316), ocular hypertension(OR=1.662), high intraocular pressure fluctuation(OR=1.770), low retinal nerve fiber layer thickness(OR=0.744), low optic disc vascular density(OR=0.547), low PSV(OR=0.618), low EDV(OR=0.577)and high RI(OR=1.980)were all risk factors for visual field defect in patients with normal tension glaucoma(all P<0.01).

CONCLUSION: The age, high myopia, intraocular pressure, intraocular pressure fluctuation, retinal nerve fiber layer thickness, optic disc vascular density, PSV, EDV and RI are influence factors for visual field defect in patients with normal tension glaucoma.

Abstract:AIM: To investigate the effect of intravitreal injection of recombinant tissue plasminogen activator(r-TPA)before pars plana vitrectomy(PPV)on surgical outcomes in patients with rupture of the globe(RG).

METHODS: A retrospective study was conducted on 37 patients(37 eyes)with RG who underwent PPV 7-10 d after Stage Ⅰ suturing and stabilization at our hospital between April 2020 and November 2023. Based on whether an intravitreal r-TPA injection was administered 1 d before PPV, patients were divided into two groups, with 14 cases(14 eyes)in pre-operative r-TPA injection group, and 23 cases(23 eyes)in control group without pre-operative r-TPA injection. The intraoperative retinal reattachment rate, intraoperative silicone oil application, postoperative intraocular rebleeding, postoperative hypotony, and best-corrected visual acuity(BCVA)were compared between the two groups.

RESULTS: The baseline characteristics were comparable between the two groups(P>0.05). Significant differences were found between the two groups in the intraoperative retinal reattachment rate, the volume of silicone oil injected, and the proportion of BCVA(all P<0.05). No statistically significant differences were observed in the intraoperative silicone oil tamponade rate, postoperative intraocular rebleeding, or postoperative hypotony rates(all P>0.05).

CONCLUSION: RG patients who received an intravitreal r-TPA injection 1 d before PPV demonstrated significantly higher intraoperative retinal reattachment rates and better postoperative visual acuity outcomes.

Abstract:AIM: To evaluate the efficacy of 0.05% cyclosporine eye drops in promoting ocular surface recovery following pterygium excision combined with autologous corneal limbal stem cell transplantation.

METHODS:This study is a prospective randomized controlled trial, selecting 104 cases(104 eyes)of primary pterygium with monocular onset admitted to Baoding First Central Hospital from September 2023 to September 2024 as the initial sample. The patients were divided into an experimental group and a control group using a random number table method, with 52 eyes in each group. Both groups underwent pterygium excision and autologous corneal limbal stem cell transplantation performed by the same surgeon. The control group received tobramycin dexamethasone eye drops combined with 0.3% sodium hyaluronate eye drops, while the experimental group was additionally treated with 0.05% cyclosporine eye drops. The corneal epithelial repair status, ocular surface function \〖corneal fluorescein staining(FL)score, Schirmer I test(SIt), break-up time of tear film(BUT)\〗 at preoperative and postoperative time points(1 and 3 mo), and dry eye symptoms \〖ocular surface disease index(OSDI), standard patient evaluation of eye dryness(SPEED)scores\〗. Additionally, the recurrence rate and postoperative complications were recorded.

RESULTS: During the follow-up period, there was 1 case of loss to follow-up in both the experimental group and the control group, with lost to follow-up rate of 1.9%. Finally, 51 cases in each group completed all followed-up. No statistically significant difference was observed in preoperative general characteristics of patients between the two groups(P>0.05), and there was no statistically significant difference in corneal epithelial repair time or suture removal time(all P>0.05). At 1 mo postoperatively, the SIt and BUT decreased in both groups compared to preoperative levels, with the experimental group showing higher values than the control group(all P<0.05). FL scores increased compared to preoperative levels but were lower in the experimental group(all P<0.05). By 3 mo, the SIt, BUT and FL score of the control group were not statistically different from preoperative levels(all P>0.05), whereas the experimental group showed increased SIt and BUT, which were higher than the control group, and reduced FL scores, and decreased FL scores, which was lower than the control group(all P<0.05). At 3 mo postoperatively, both groups showed increased SIt and BUT compared to 1-month values, with the experimental group outperforming the control group(all P<0.05). FL scores decreased in both groups compared to 1-month values, with the experimental group maintaining lower scores(P<0.05). At 1 mo postoperatively, OSDI and SPEED scores were higher than preoperative levels, with the experimental group higher than the control group(all P<0.05); at 3 mo postoperatively, the scores returned to preoperative level(all P>0.05), and the OSDI and SPEED scores of the control group increased and higher than those of the experiment group(all P<0.05); at 3 mo postoperatively, the OSDI and SPEED scores decreased when compared with 1-month preoperative level, and the experiment group was lower than the control group(all P<0.05). There was no difference in the total incidence of postoperative complications between the two groups(P>0.05). According to the statistics of 6 mo follow-up after operation, there was no recurrence in the experimental group, and the recurrence rate was 11.8% in the control group(P<0.05).

CONCLUSION: Adjunctive use of 0.05% cyclosporine eye drops after pterygium excision with limbal stem cell transplantation enhances ocular surface recovery, reduces dry eye symptoms, and lowers recurrence rates without compromising corneal epithelial healing or safety.