Abstract:Visual electrophysiology measurements have become a routine method of functional examination in ophthalmology. Small animal visual electrophysiology is an important tool for exploring the functionality of the visual system in small animals, finding widespread applications in neuroscience and drug research and development. This guide aims to offer a standardized operational guide for the operation of visual electrophysiological norms in small animals to ensure the accuracy and repeatability of the test. The study emphasizes different types of visual electrophysiological tests, such as electroretinogram(ERG)and visual evoked potential(VEP), evoked in small animals, and their application in different disease models. Detailed descriptions are provided regarding the selection and preparation of experimental animals, including the requirements of animal species, anesthesia methods and test environment. In terms of operational procedures, this guide highlights the correct electrode placement, the selection of stimulus parameters, and the key steps for signal acquisition and processing. According to different animal models, the corresponding operation suggestions were provided, and the troubleshooting methods of common problems were introduced. Beyond fundamental operations, this guide also focuses on the interpretation and reporting of test results. It explains various types of electrophysiological waveforms. In summary, this operational specification for small animal visual electrophysiology provides a comprehensive and detailed framework for researchers to ensure the standardization and reliability of tests. By following these guidelines, researchers can effectively utilize small animal visual electrophysiology techniques to gain insight into the function and abnormalities of the visual system.

Abstract:AIM: To summarize 10 surgical pearls for managing proliferative diabetic retinopathy(PDR)adapted from the ancient Chinese allusions and analyze the application of these pearls in a real-world fashion.

METHODS: Retrospective, noncomparative, interventional study. Ten surgical pearls were summarized and adapted from the ancient Chinese philosophy. Totally 346 cases(443 eyes)that underwent pars plana vitrectomy(PPV)at our hospial from January 2016 to February 2024 were selected. Flexible combinations of these pearls were applied according to the specific condition of each patient during surgeries. The efficacy and safety were analyzed, as well as the application frequencies according to the existence of tractional retinal detachment or not.

RESULTS: A total of 473 times of surgeries were performed on all the patients. According to ancient Chinese allusions, ten surgical pearls were summarized from these surgeries. All PPVs went smoothly with the application of different combinations. Finally, almost all proliferative membranes were successfully peeled except for 10 patients(11 eyes), who went through strategy No.10(minimal membranectomy)that, only necessary relaxation incisions were made with most of the proliferative membranes left on purpose. The final visual acuities were mostly improved or stable(1.92±0.83 LogMAR preoperatively vs 1.16±0.85 LogMAR postoperatively, P<0.01). Postoperative complications mainly included early inflammatory responses in the anterior chamber and nuclear sclerosis. Recurrent vitreous hemorrhage, retinal detachment, and hyphema or neovascular glaucoma occurred in 1.9%(9/473), 3.2%(15/473), 0.4%(2/473)and 0.4%(2/473)times of PPVs, respectively. After 12/473(2.5%)times of PPVs, retinal detachment at the macular area still existed, and multiple times of subsequent PPVs were conducted. Final retinal attachment at the macular area was realized in 98.9% eyes. Those 5 unattached eyes were with heavily reproliferated membranes and subsequent tractional retinal detachment recurrence under the oil, and three of them were scleral buckled additionally.

CONCLUSION:These 10 surgical strategies and technique pearls were mostly effective and safe in the management of severe PDR patients. They were relatively easy to be memorized and applicated once the meaning of each Chinese idiom was understood. One can use different combinations flexibly according to a patient's specific condition.

Abstract:AIM: To provide references for the non-clinical evaluation of therapeutic targets or drugs for retinoblastoma, fluorescently labeled Y79 cells are injected into the vitreous body of BALB/c-nu mice to establish a retinoblastoma model, and the Melphalan treatment group is used as a positive control, which is verified by fluorescence imaging technology.

METHODS: BALB/c-nu mice were intravitreous injected with GFP transfected Y79 cells(1.0×10⁷ cell/mL, 3 μL)to establish the model. On the 27th day, the mice were randomly divided into model control group and different doses of Melphalan groups(1, 3, 10 μg/eye groups)according to the fluorescence value of in vivo imaging, with vitreous body single administrated and ocular symptoms observed daily. Slit-lamp examination was performed at 12, 20, 29, 35, 42, 48, 55, 76, and 83 d after modeling. In vivo imaging was performed on 12, 20, 27, 41, 48, 55, 62, 69, 76, and 83 d. At the last treatment, the eyeball, brain and cerebellum tissues were removed for histopathological examination.

RESULTS: From the sixth day of modeling, cloud-like substances could be seen in the eyes of the animals, and the cloud-like substances occupied the whole eyeball of the mice in the model control group at the later stage, accompanied by irregular growth of blood vessels. After 27 days of modeling, the fluorescence value was detected in all the animals, and the fluorescence value continued to increase with the extension of modeling time. The fluorescence value of the tumor reached the peak after 69-83 days of modeling. Histological examination showed severe proliferation of intraocular tumor cells in the model control group, and tumor cells were observed in the brain of 1 model animal. In the 10 μg/eye Melphalan group, the fluorescence value was significantly decreased at 17 d after administration. The fluorescence value of the 3 μg/eye Melphalan group was significantly inhibited at 59 d after administration. No tumor cells were found in the brain tissue of animals in all Melphalan groups.

CONCLUSION: After vitreous injection of Y79/pCDH-LUC-copGFP cells in BALB/c-nu mice, significant ocular lesions and proliferation of tumor cells were observed in the eyes. Meanwhile, Melphalan intervention significantly inhibited tumor cells in a dose-dependent manner, indicating that the mouse model of retinoblastoma was successfully constructed.

Abstract:AIM: To investigate the changes of retinal nerve fiber layer(RNFL)thickness, retinal thickness and blood flow density in different stages of diabetic retinopathy(DR)patients based on optical coherence tomography angiography(OCTA).

METHODS: A retrospective analysis was conducted on 382 patients(382 eyes)diagnosed with DR in our hospital from February 2023 to February 2024. According to the staging criteria, the patients were divided into mild group(n=121), moderate group(n=133), severe group(n=72), and proliferative group(n=56). The general clinical data of the four groups of patients was compared; OCTA was used to scan and collect data from all patients, and the RNFL thickness, retinal thickness, and blood flow density were compared among the four groups of patients.

RESULTS: There was no statistically significant difference in age, gender, hypertension, chronic kidney disease, and random blood glucose among patients in the mild, moderate, severe, and proliferative groups(all P>0.05). As the stage of DR worsened, the duration of the disease gradually prolonged(P<0.05). The thickness of the RNFL(superior, inferior, temporal, nasal, and average thickness)and retinal thickness significantly increased with the severity of DR(all P<0.001); however, there was no statistically significant difference in inferior RNFL thickness between the moderate and mild groups(P>0.05). The blood flow density in the superficial and deep retinal layers, as well as in the choroidal capillary layer, significantly decreased with the progression of DR(all P<0.05). Nevertheless, there was no statistically significant difference in superficial retinal blood flow density between the moderate and severe groups(P>0.05).

CONCLUSION: OCTA can accurately observe the changes in RNFL thickness, retinal thickness, and blood flow density in patients with DR at different stages, which can serve as sensitive indicators for monitoring DR progression.

Abstract:AIM: To analyze the changes of retinal structure and function before and after panretinal photocoagulation(PRP)in patients with proliferative diabetic retinopathy(PDR).

METHODS: Prospective study. Totally 98 cases(98 eyes)of PDR patients who underwent PRP in Eye Hospital of Wenzhou Medical University from January 2022 to May 2023 were included. Optical coherence tomography angiography(OCTA)was used to detect central retinal thickness(CRT), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), foveal avascular zone(FAZ), deep vascular complex(DVC)blood flow density, superficial vascular complex(SVC)blood flow density before and at 1 wk, 1 and 3 mo after PRP. During the follow-up, 1 eye underwent vitrectomy, 2 eyes were lost to follow-up, and finally 95 eyes completed 1 a follow-up, with a loss rate of 3%. According to the visual prognosis at 1 a after treatment, the patients were divided into two groups: 73 eyes in good prognosis group and 22 eyes in poor prognosis group(including 9 eyes of visual disability and 13 eyes of visual regression). The changes in retinal structure and function before and after PRP treatment were compared between the two groups of patients, and the receiver operating characteristic(ROC)curve and decision curve were used to analyze the predictive value of retinal structure and function for PDR treatment.

RESULTS: There were statistical significant differences in PDR staging, CRT, CMT, SFCT, DVC blood flow density, and SVC blood flow density between the two groups of patients before treatment(all P<0.05). At 1 wk, 1 and 3 mo after treatment, the FAZ area of both groups decreased compared to before treatment, while the blood flow density of DVC and SVC increased compared to before treatment(both P<0.05). However, there was no significant difference in the blood flow density of FAZ, DVC, and SVC between the two groups at 1 wk, 1 and 3 mo after treatment(all P>0.05). The CRT, CMT and SFCT of the two groups at 1 wk after treatment were higher than those before treatment(all P<0.05), but there were no significant differences between the two groups(all P>0.05). The CRT, CMT and SFCT at 1 and 3 mo after treatment were lower than those at 1 wk after treatment and before treatment in both groups. The CRT, CMT and SFCT in the poor prognosis group at 3 mo after treatment were higher than those at 1 mo after treatment, and were higher than those in the good prognosis group(all P<0.05). ROC analysis showed that, at 3 mo after laser treatment in PDR patients, the area under the curve of the CRT, CMT, and SFCT alone or in combination after treatment for 1 a was 0.788, 0.781, 0.783, and 0.902, respectively, and the combined prediction value was better(P<0.05). Decision curve analysis showed that the combined detection of CRT, CMT, and SFCT in PDR patients at 3 mo after treatment can improve the predictive value of visual prognosis.

CONCLUSION: The optimal time for retinal structure and function recovery in PDR patients after PRP treatment is between 1 wk and 1 mo. OCTA measurement of CRT, CMT, and SFCT at 3 mo after treatment can predict the visual prognosis during the 1 a treatment period.

Abstract:AIM:To investigate the relationship between the level of monocyte chemoattractant protein-1(MCP-1)in the aqueous humor and macular microcirculation in patients with macular edema secondary to retinal vein occlusion(RVO-ME).

METHODS:A total of 327 patients(327 eyes)with RVO-ME treated in our hospital from July 2022 to July 2024 were selected as the research objects. According to the recurrence or not, they were divided into non-recurrence group(291 cases, 291 eyes)and recurrence group(36 cases, 36 eyes). The clinical data, macular microcirculation index and MCP-1 level were collected. Unordered multinomial Logistic regression was used to analyze the effect of MCP-1 on RVO-ME recurrence after excluding the influence of other factors. Cubic spline was used to analyze the dose-response relationship between macular microcirculation indexes and MCP-1 expression level and RVO-ME recurrence. Multiple linear regression was used to analyze the relationship between macular microcirculation parameters and MCP-1 expression level, and the difference of MCP-1 expression level in recurrence under different macular microcirculation parameters was analyzed. Bootstrap method was used to test the mediating effect of macular microcirculation indexes on MCP-1 expression level and RVO-ME recurrence.

RESULTS: The course of ME, the incidence of vitreomacular traction(VMT), the incidence of fibrous membrane epiretinal membrane(ERM), best corrected visual acuity(BCVA), hyperreflective foci in the inner and outer retinal layers(HRF), the frequency and dose of anti-vascular endothelial growth factor(VEGF)injection in the recurrence group were significantly higher than those in the non-recurrence group(all P<0.05). The external limiting membrane(ELM)integrity and ellipsoid zone(EZ)integrity in the recurrence group were significantly worse than those in the non-recurrence group(all P<0.05). The central foveal thickness(CFT), central macular thickness(CMT), superficial capillary plexus(SCP)vascular density, deep capillary plexus(DCP)vascular density and MCP-1 in the recurrence group were higher than those in the non-recurrence group(all P<0.05), and the foveal avascular zone(FAZ)area was lower than that in the non-recurrence group(P<0.05). Logistic analysis showed that MCP-1 was a risk factor for RVO-ME recurrence before and after adjusting for confounding factors. There was a significant non-linear dose-response relationship between macular microcirculation indexes and MCP-1 expression and the risk of RVO-ME recurrence(non-linear test, all P<0.001). The vascular density of CFT, CMT, SCP and DCP was positively correlated with the expression level of MCP-1(all P<0.05), while the FAZ was negatively correlated with MCP-1 expression level(P<0.05). With the increase of vessel density in CFT, CMT, SCP and DCP, and the decrease of FAZ, the expression level of MCP-1 increased, and the risk of RVO-ME recurrence showed an upward trend. The proportion of MCP-1 in Q3(>28.47 pg/mL)group was the highest(P<0.05). Macular microcirculation parameters play a mediating effect between MCP-1 expression level and RVO-ME recurrence.

CONCLUSION: The level of MCP-1 in aqueous humor is positively correlated with RVO-ME recurrence, and it is closely related to macular microcirculation. Macular microcirculation has a mediating effect between MCP-1 level and RVO-ME recurrence.

Abstract:AIM:To evaluate the efficacy of intravitreal ranibizumab injection(IVR)combined with subthreshold micropulse(STMP)in the treatment of diabetic macular edema(DME).

METHODS: Retrospective study. A total of 98 DME patients(98 eyes)admitted to our hospital from March 2022 to March 2023 were enrolled and divided into two groups based on treatment methods: the control group(49 eyes)received STMP yellow laser therapy alone, while the study group(49 eyes)underwent combined IVR and STMP yellow laser therapy. Comparisons were made between the two groups regarding best corrected visual acuity(BCVA), retinal neovascularization(RNV)leakage area, parafoveal macular thickness(PMT), foveal macular thickness(FMT), central retinal thickness(CRT), and foveal avascular zone(FAZ)area, quality of life was assessed using the Chinese-version low vision quality of life questionnaire(CLVQOL), and complication rates were recorded. Additionally, serum levels of nitric oxide synthase(NOS)and vascular endothelial growth factor(VEGF)were measured before and after treatment in both groups.

RESULTS: At 3 mo after treatment, both groups showed improved BCVA compared to baseline, with reduced RNV leakage area, PMT, FMT, CRT, FAZ, and serum levels of VEGF, while serum NOS levels and all CLVQOL domain scores were higher than pre-treatment(all P<0.05). Furthermore, the study group demonstrated superior outcomes in all these parameters compared to the control group(all P<0.05), and no ocular or systemic complications occurred in any patient.

CONCLUSION: IVR combined with STMP yellow laser for DME improves visual acuity, reduces RNV leakage area, PMT, FMT, CRT, and FAZ, modulates serum NOS and VEGF levels, enhances quality of life, and demonstrates good safety.

Abstract:Fuchs endothelial corneal dystrophy(FECD)is a progressive dystrophic disease characterized by gradual damage to the corneal endothelium, ultimately leading to endothelial decompensation. The current standard treatment, corneal transplantation, has several limitations. Recent studies have shown that Rho-associated kinase(ROCK)inhibitors can promote cell proliferation by modulating the cyclin D and p27 signaling pathways. Additionally, ROCK inhibitors activate Rac1, which drives the actin-related protein complex(ARPC2)to enhance cell adhesion, and regulate processes such as membrane blebbing, nuclear disintegration, and apoptotic body formation, thereby inhibiting the apoptosis of corneal endothelial cells. These findings suggest that ROCK inhibitors may be a promising therapeutic approach for FECD. This review provides an overview of the pharmacological effects, basic research, clinical trials, and potential adverse reactions associated with ROCK inhibitors in the treatment of FECD, with the aim of developing compounds with stable efficacy and minimal side effects for the treatment of FECD in the near future.

Abstract:Ocular surface squamous neoplasia(OSSN)is a series of pathological solid tumors formed by dysplasia of keratoconjunctival epithelium, which is one of the most common ocular surface tumors in adults. In the past two decades, the treatment of OSSN has gradually changed from surgical resection to topical chemotherapy. Interferons, 5-fluorouracil and mitomycin are the most commonly used topical agents for the clinical treatment of this disease. This paper summarizes the diagnosis of OSSN and various local chemotherapy treatment options, highlights the potential role of high-resolution optical coherence tomography(HR-OCT)technology in the diagnosis and treatment of this disease.

Abstract:Cataract extraction combined with intraocular lens implantation is a standard method for treating cataracts, significantly improving patients' vision and quality of life. In this process, the personalized selection of intraocular lenses plays a crucial role in the surgical outcome. Traditional monofocal intraocular lenses provide good distance vision but often have issues with intermediate vision, requiring patients to rely on glasses for correction in daily life. In contrast, multifocal intraocular lenses can meet vision needs at different distances, but are often accompanied by adverse reactions such as halos and glare, affecting the patient's visual experience. In recent years, new types of monofocal intraocular lenses have made significant progress in improving intermediate vision, with relatively fewer side effects. This article aims to review the different types, optical characteristics, and clinical efficacy of monofocal intraocular lenses, providing a reference for ophthalmologists in selecting suitable lenses for patients.

Abstract:Polypoid choroidal vasculopathy(PCV)is associated with poor visual prognosis in its natural course and is more prevalent in Asian populations. Despite advancements in optical coherence tomography(OCT)and OCT angiography(OCTA)that have significantly improved morphological diagnostic capabilities, imaging biomarkers are limited by temporal resolution constraints and fail to elucidate molecular mechanisms underlying vascular angiogenesis, inflammation, genetic factors, and extracellular matrix(ECM)remodeling. This review synthesizes current research on molecular biomarkers associated with PCV, focusing on its core pathological mechanisms. These biomarkers provide crucial insights into disease pathogenesis to inform precision prevention, dynamic disease monitoring, and therapeutic response prediction. Furthermore, this article proposes the integration of multi-omics data(genomics, proteomics, and radiomics)to establish a multimodal hierarchical diagnostic-therapeutic model. This framework will guide risk stratification, real-time disease assessment, and personalized treatment strategies, advancing the development of a precision medicine framework for PCV management.

Abstract:Age-related macular degeneration(ARMD)is a common multifactorial disease among the elderly, which may lead to irreversible vision loss; however, the pathogenesis of ARMD is still unclear. Metabolomics is a relatively new “omics” technique that can provide qualitative and quantitative information about low molecular weight metabolites that make up biological systems, thereby revealing the physiological or pathological state of cell or tissue samples at specific time points. In recent years, increasing evidence suggests that metabolic dysfunction plays an important role in the development and progression of ARMD. Metabolic pathway dysregulation involves lipid metabolism, nucleotide metabolism, amino acid metabolism, and energy metabolism, which may play important roles in the occurrence and development of ARMD. The retina is one of the most metabolically active tissues in the human body, so using metabolomics techniques to measure molecular changes in ARMD will further enhance our understanding of the pathogenesis. This will provide important insights for the prevention and treatment of ARMD, This article reviews the application of metabolomics in ARMD.

Abstract:One of the significant hurdles in telemedicine, particularly in ophthalmology, is the absence of direct physical examination. This specialty depends extensively on specialized instruments that typically require proficient operators. Visual function tests are crucial for both outpatient and inpatient ophthalmic services, playing a vital role in screening, diagnosing, monitoring treatment effectiveness, and managing follow-ups for various eye conditions. The progress in mobile technology has paved the way for expanding these tests beyond traditional clinic settings, promoting the creation of patient-focused, straightforward, cost-effective, and efficient measurement tools. In light of the swift advancement of digital technologies, this article reviews the characteristics, and reliability of self-administered visual function tests tools, including visual acuity, refractive error assessment, visual field, contrast sensitivity, and color vision, along with other pertinent diagnostic tools that have been developed and validated for accuracy and repeatability through research, with a view to providing ophthalmologists and patients with scientific and practical references when selecting and using these tools, further promoting efficiency and efficacy of teleophthalmology.

Abstract:Phacoemulsification with intraocular lens implantation(Phaco+lOL)has become the main treatment for cataracts due to small incision and fast recovery. Phacoemulsification can damage the conjunctiva, cornea and other ocular surface tissues, causing local inflammation, which in turn leads to eye dryness and discomfort after surgery. According to studies, patients who suffer from phacoemulsification most experience dry eye syndrome within 24 h, which gradually worsens and reaches its peak in the following 1 wk, seriously affecting their quality of life. The review aims to comprehensively investigate the effects of preoperative patient physical conditions and local ocular status, intraoperative maneuvers and postoperative treatments on postoperative dry eye, with the expectation of formulating scientific and effective preventive measures for potential dry eye patients after phacoemulsification, and providing a theoretical basis for postoperative dry eye treatment.

Abstract:Congenital cataract is a leading cause of childhood blindness worldwide. By inducing visual impairment from birth, it disrupts the normal development of the visual system and profoundly impacts patients' quality of life. Therefore, timely diagnosis and the implementation of effective, safe interventions, particularly during the critical period of visual development, are of paramount clinical importance. Cataract extraction is a cornerstone therapeutic intervention. The success of the surgery, as well as postoperative visual recovery and the incidence of complications in pediatric patients, largely depends on the selected surgical approach and instrumentation. Surgical approaches are primarily categorized into the anterior approach(via corneal or limbal incision)and the posterior approach(via pars plana). Surgical instruments are typically classified by the gauge of the vitreous cutter, such as 20 G, 23 G, and 25 G. The choice of surgical approach not only directly influences the incidence of postoperative complications but also significantly impacts visual recovery. This article reviews and analyzes these critical aspects to provide valuable guidance for clinical practice.

Abstract:Glaucoma is a neurodegenerative disorder primarily characterized by the degeneration of retinal ganglion cells(RGCs). This condition can arise from a complex interplay of multiple mechanisms, including elevated intraocular pressure(IOP), neurotrophic factor deprivation, immune-mediated responses, oxidative stress, and excitotoxicity. Due to the absence of significant clinical symptoms in its initial stages, individuals often remain unaware of the disease until they experience irreversible vision loss, highlighting the critical importance of early diagnosis. Current diagnostic methods predominantly focus on measuring elevated IOP, assessing characteristic visual field deficits, and examining fundoscopic changes in the optic disc. Unfortunately, these indicators typically manifest only after considerable optic nerve damage has already occurred. Consequently, the identification of biomarkers associated with RGCs loss is essential for enhancing the early diagnosis and management of glaucoma. This study aims to investigate the molecular mechanisms underlying RGCs degeneration and to determine the potential existence of biomarkers within these pathways. By identifying early alterations in these biomarkers, we hope to facilitate timely intervention strategies for glaucoma, ultimately reducing the risk of vision loss and improving the overall quality of life for affected individuals.

Abstract:This review summarizes the applications and advancements of artificial intelligence(AI)in the analysis of retinal vascular parameters. Retinal vascular parameters, including vessel diameter, fractal dimension, vascular tortuosity, branching angles, and vessel density, are important indicators for assessing changes in the retinal vascular network structure. These parameters are not only related to various ophthalmic diseases but also reflect the conditions of systemic diseases such as diabetes and Alzheimer's disease. This article provides a detailed discussion on the advantages of AI technology in the automated identification and quantification of retinal vascular parameters, particularly in improving measurement efficiency and accuracy, and enabling the early detection and monitoring of various diseases. Additionally, the challenges faced by AI in the analysis of retinal vascular parameters were discussed, such as data standardization and insufficient sample diversity, and proposes directions for future research. By thoroughly analyzing the application of AI in retinal vascular parameter analysis, this article aims to offer new perspectives and methods for clinical diagnosis and early intervention of diseases, holding significant clinical significance and application prospects.

Abstract:Dry eye is a chronic ocular surface disease caused by multiple factors. It is caused by the instability of tear film and the imbalance of the microenvironment of ocular surface, and may be accompanied by ocular surface inflammation, damage, and abnormal nerve sensation. The instability of tear film is its core characteristic. Mucin is an important component of the tear film and plays a role in stabilizing the tear film. The reduction of its secretion and the change of its structure lead to the occurrence and development of dry eye. The intracellular Ca²⁺ signal is the key to controlling the secretion of water and enzymes by exocrine glands. A decrease in the Ca²⁺ signal can cause dry eye. Conjunctival goblet cells are the main cells that secrete mucin. By activating the intracellular PLC-IP3-Ca²⁺ pathway, RyRs pathway, cAMP signaling pathway, P2X receptor, BLT1 and ChemR23 receptors, cholinergic receptor, and ALX signaling pathway, the content of Ca²⁺ can be increased, and the replenishment of mucin granules can be accelerated, thereby relieving the symptoms of dry eye. The Ca²⁺ signaling pathway may be an important target for the treatment of dry eye. This article reviews the role of mucin in dry eye and the influence of the Ca²⁺ signal on the secretion of mucin by conjunctival goblet cells.

Abstract:Lactylation, a recently identified post-translational modification of proteins, is induced by lactic acid and can occur at multiple lysine residues in both histone and non-histone proteins. This modification plays a role in disease pathogenesis by affecting transcriptional regulation, mitochondrial metabolism, and immune inflammation. Significant advancements have been made in understanding the mechanisms of lactylation in various ophthalmic diseases, including retinal neovascularization, uveitis, melanoma, and myopia. This paper provides a comprehensive review of the relationship between lactic acid and lactylation, the regulatory mechanisms of lactylation, and the role of lactylation in different ocular diseases. Additionally, it addresses current research limitations and future directions, which is of great significance to elucidate the molecular mechanisms of lactylation in eye diseases and improving the diagnosis and targeted treatment of these conditions.

Abstract:AIM:To evaluate the clinical efficacy of lamellar keratectomy and corneal collagen crosslinking(LKCCC)in treating superficial fungal keratitis.

METHODS: Retrospective analysis. Totally 79 patients(79 eyes)with superficial fungal keratitis who underwent LKCCC in our hospital from January 2014 to October 2023 were included. After admission, routine antifungal drug treatment for 7 d showed no obvious improvement or progressive aggravation. The maximum diameter of corneal lesions in all patients was ≤7 mm, the maximum depth was no more than 50% of the corneal thickness at the location, and the remaining healthy corneal thickness was ≥300 μm. The follow-up time was 90 to 112 d.

RESULTS:Among the included 79 eyes, the lesions were located in the central region of the cornea in 6 eyes, in the paracentral region in 61 eyes, and in the peripheral region in 12 eyes. Hypopyon was observed in 5 cases. LKCCC was successfully administered in 79 eyes, cured in 76 eyes(96%), and failed in 3 eyes(4%). The healing time of corneal epithelium in 76 cured eyes was 3-15 d, of which 51 eyes(67%)healed within 7 d and 24 eyes(32%)healed within 3 d. The uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA)of 76 eyes of cured patients were statistically significant compared with those preoperatively(P<0.0167). Two of the 3 failed eyes were located at the edge of the lesion and recovered after re-keratectomy. One eye was located in the center of the lesion and recovered after being covered by bulbar conjunctival flap. At the last follow-up, no other complications were observed in all patients except superficial cloud and thinning of cornea.

CONCLUSION:LKCCC is a rapid and effective treatment for superficial fungal keratitis and can be considered a new treatment option.

Abstract:AIM: To observe the effect of phacoemulsification with corneoscleral limbus incision on cataract.

METHODS: Prospective study. A total of 84 cases(84 eyes)of cataract patients admitted to our hospital from October 2021 to December 2022 were randomly grouped into two groups using the random number table method. The control group consisted of 42 cases(42 eyes)that underwent phacoemulsification with upper transparent corneal incision, while the study group consisted of 42 cases(42 eyes)that underwent phacoemulsification with corneoscleral limbus incision. The uncorrected visual acuity, astigmatism, ocular surface function, corneal sensitivity, and complications were compared between the two groups.

RESULTS: There was a statistically significant difference in uncorrected visual acuity between the two groups of patients before and after surgery, as well as over time(both P<0.05). The uncorrected visual acuity of both groups showed a decreasing trend before and after surgery at 4 and 12 wk(both P<0.05). There were statistically significant differences in preoperative and postoperative astigmatism and corneal fluorescein staining(FLS)scores between the two groups of patients, as well as at different time points(both P<0.05). The astigmatism and FLS scores of the two groups of patients showed a trend of first increasing and then decreasing before and after surgery at 4 and 12 wk(both P<0.05). There was a statistically significant difference in breakup time of tear film(BUT)between the two groups of patients before and after surgery(both P<0.05); the BUT of both groups of patients showed a trend of first decreasing and then increasing before and after surgery at 4 and 12 wk(both P<0.05). There was a statistically significant difference in the Schirmer Ⅰ test(SⅠt), upper corneal sensitivity, and central corneal sensitivity between the two groups of patients before and after surgery, as well as at different times(all P<0.05). The SⅠt, upper corneal sensitivity, and central corneal sensitivity of the two groups of patients showed a trend of first decreasing and then increasing before and after surgery at 4 and 12 wk(all P<0.05). There was no significant difference in the total incidence of complications between the control group(12%, 5/42)and the study group(14%, 6/42; χ²=0.105, P=0.746).

CONCLUSION: Compared to the phacoemulsification with upper transparent corneal incision, the phacoemulsification with corneoscleral limbus incision can reduce the adverse effects on uncorrected visual acuity, astigmatism, ocular surface function, and corneal sensitivity in patients with cataract, and does not increase the incidence of complications.

Abstract:AIM: To investigate the correlation between the expression of serum lipocalin 2(LCN2), chemokine like receptor 1(CMKLR1), and C-C motif chemokine ligand 11(CCL11)and the severity of disease in patients with type 2 diabetes mellitus(T2DM)and dry eye(DE).

METHODS:A prospective selection of 97 patients(194 eyes)diagnosed with T2DM and DE at our hospital from May 2022 to May 2024 was made as the DE group, which was further divided into mild(47 cases, 94 eyes), moderate(34 cases, 68 eyes), and severe(16 cases, 32 eyes)subgroups based on the severity of dry eye. Additionally, 97 patients(194 eyes)of T2DM without DE were selected as non-DE group, and 97 healthy volunteers(194 eyes)who underwent physical examination during the same period were chosen as control group. Serum levels of LCN2, CMKLR1, and CCL11 were measured in all participants. Spearman correlation analysis was used to assess the relationship between serum levels of LCN2, CMKLR1, and CCL11 and the severity of DE in T2DM patients; multivariate Logistic analysis was used to analyze the factors affecting the severity of T2DM patients with DE. The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of serum LCN2, CMKLR1 and CCL11 levels for moderate to severe dry eye in T2DM patients.

RESULTS: Serum levels of LCN2, CMKLR1, and CCL11 increased progressively from the control group to the non-DE group and then to the DE group(all P<0.05). Within the DE group, these levels also increased progressively from the mild to moderate and then to the severe subgroups(all P<0.05). Spearman correlation analysis showed that serum levels of LCN2, CMKLR1, and CCL11 were positively correlated with the severity of disease(r_s=0.604, 0.591, 0.559, respectively; all P<0.05). Stepwise forward multivariate Logistic analysis showed that Schirmer's test(SⅠt), tear break-up time(BUT), serum levels of LCN2, CMKLR1 and CCL11 were the factors affecting the severity of T2DM patients with DE; ROC curve analysis indicated that the combined diagnosis of serum LCN2, CMKLR1, and CCL11 for the progression of T2DM with DE to moderate-to-severe stages had an area under curve(AUC)value of 0.896, which was significantly higher than that of individual diagnoses of LCN2, CMKLR1, and CCL11(Z=2.925, 2.704, 3.483, respectively; P=0.003, 0.007, <0.001).

CONCLUSION: Serum LCN2, CMKLR1 and CCL11 levels are increased in T2DM patients with DE, and are positively correlated with the severity of DE. The combination of the three has a high diagnostic value for moderate to severe DE.

Abstract:AIM: To analyze the clinical utility and value of the ultra-wide-field swept-source optical coherence tomography angiography(UWF-SS-OCTA)technique in changes of blood flow density and thickness in the central and peripheral regions of the retina and choroid in patients with nonproliferative diabetic retinopathy(NPDR)with or without diabetic kidney disease(DKD).

METHODS: Cross-sectional study. Totally 50 cases(50 eyes)of diabetes mellitus(DM)that visited our hospital between June 2023 and June 2024 were included. They were divided into three groups: NPDR combined with DKD group(DKD group, n=20), NPDR without DKD group(NDKD group, n=20), and DM without retinopathy group(DM group, n=10, which served as control). In order to investigate the impact of DKD on ocular microangiopathy in NPDR patients, the retina and choroid within 24 mm×20 mm of the scan were separated into central and peripheral areas using the 3×3 nine-grid partition option that comes with UWF-SS-OCTA, and the parameters were then quantitatively assessed.

RESULTS:The central and peripheral blood flow density of the choroidal capillary layer(CCP)was statistically significant between the DM group and the DKD group(t=3.93, P=0.0003; t=3.34, P=0.0016), and between the NDKD group and the DKD group(t=-3.06, P=0.003; t=-2.55, P=0.013), but there was no statistically significant difference between the DM group and the NDKD group(t=1.44, P=0.157; t=1.26, P=0.21). The mid-large choroidal vessel(MLCV)showed a progressive decline in central and peripheral blood flow density in the DM, NDKD, and DKD groups(F=13.74, 19.03, all P<0.0001). The DM, NDKD, and DKD groups saw a progressive decrease in central and peripheral choroidal thickness(CT; F=10.72, P=0.0001; F=13.12, P<0.001).

CONCLUSION:CCP, MLCV, and CT can be used as visual indicators to identify impaired renal function in patients with NPDR. UWF-SS-OCTA can support the development of precise and noninvasive monitoring and treatment technology for diabetic ocular microangiopathy, while also offering a scientific foundation for the joint management of DR and DKD.

Abstract:AIM:To study the relationship between ocular parameters and lens thickness(LT)in myopic patients with different anterior chamber depth(ACD).

METHODS:Cross-sectional study. A total of 118 myopic subjects(236 eyes)underwent posterior chamber phakic implantable collamer lens(Phakic-ICL)implantation in the refractive department of our hospital from May 2022 to May 2024 were selected. Ocular parameters examined before surgery included uncorrected visual acuity(UCVA), subjective refraction, best corrected visual acuity(BCVA), contactless intraocular pressure(IOP), ACD, white-to-white(WTW), horizontal sulcus-to-sulcus(STS_H), vertical sulcus-to-sulcus(STS_V), and LT. ACD without corneal thickness was measured by Pentacam, and subjects were divided into three groups: shallow anterior chamber group(2.8 mm≤ACD≤3.2 mm), middle anterior chamber group(3.2 mm3.4 mm). The differences in WTW, STS_H, STS_V, and LT among groups were compared, and the correlation between the above parameters under different ACD groups was analyzed, as well as the multiple linear regression analysis was used to research LT with the above ocular parameters.

RESULTS:There was no statistically significant difference in LT between the middle ACD group and the deep ACD group(P=1.00), while there were statistically significant differences in LT between shallow and middle ACD groups(P<0.0167); there were statistical significant differences in WTW, STS_H and STS_V among different ACD groups(F=226.36, 15.58, 11.92, all P<0.01), but the differences were varied after pairwise comparison. There was a weak negative correlation between LT and ACD only in the shallow ACD group and overall data of patients(r=-0.231, P<0.05; r=-0.222, P<0.01). There was no correlation in LT and ocular parameters between the middle ACD group and deep ACD group(all P>0.05); moderate correlations were discovered among WTW, STS_H and STS_V in different ACD groups and overall data(all P<0.01); in the overall data of patients, ACD had weak to low correlations with WTW, STS_H, STS_V and LT(all P<0.01). Through multiple linear regression analysis, it was found that only the shallow ACD group and the overall data had statistically significant independent variables that were linearly correlated with LT, and their equations were as follows: LT_S=5.492-0.167×WTW+0.267×STS_V-0.448×ACD; LT_T=3.884-0.303×ACD, the corrected R² of equations showed low values, revealed 0.141 and 0.056, respectively.

CONCLUSION:Among different ACD groups, there was no correlation or linear relationship between LT and WTW, STS_H and STS_V; in the shallow ACD group and the overall data, LT had a weak negative correlation with ACD, and its corrected R² was low. Therefore, there is no linear relationship between LT and ocular diameter parameters under different ACD.

Abstract:AIM: To analyze the prevalence, severity, types, and correction of astigmatism in children, and provide scientific evidences for the prevention and treatment of refractive errors.

METHODS: This cross-sectional study included 29 153 children aged 6-12 years from Xi'an and Lantian County, Shaanxi Province, China. Visual acuity and non-cycloplegic refraction were measured. Astigmatism was defined as an absolute cylindrical power ≥0.5 D in the right eye. Differences in astigmatism severity, type distribution, and refractive correction were analyzed across age, gender, and region.

RESULTS:The prevalence of astigmatism increased with age, peaking at 11 years old(62.88%). Boys(57.10%)had a higher prevalence than girls(54.86%), and the municipal areas(58.29%)had a higher prevalence than county areas(51.75%). Mild astigmatism was the most common(63.82%), with moderate astigmatism increasing with age. The highest prevalence of high astigmatism was observed in 11-years-old children(9.68%). Compound myopic astigmatism(59.28%)and mixed astigmatism(25.16%)were the most frequent types. With increasing age, compound myopic astigmatism increased, while simple myopic, simple hyperopic, and compound hyperopic astigmatism decreased. Mixed astigmatism increased from ages 6 to 7, but declined from ages 7 to 12. For astigmatic axis types, with-the-rule astigmatism was the most prevalent(81.06%)and increased with age, peaking at 11 years(85.74%). Against-the-rule astigmatism showed a declining trend, while oblique astigmatism remained relatively stable. Distribution differences in astigmatism types and axes by gender and region were observed. Significant differences in astigmatism severity, types, and axis types across different ages, genders, and regions were observed(all P<0.05). The overall refractive correction rate for children with astigmatism was only 40.18%.

CONCLUSION: The overall prevalence of astigmatism among children aged 6-12 years in Shaanxi Province was 56.02%, with higher prevalence observed in boys and in municipal areas. Age, gender, and region significantly influenced the prevalence of astigmatism. Notably, less than half of the children with astigmatism received refractive correction, highlighting the need for increased attention from parents and relevant authorities.

Abstract:AIM: To explore the therapeutic effects of diquafosol sodium eye drops combined with sodium hyaluronate eye drops on dry eye syndrome after cataract surgery.

METHODS:This study is a prospective randomized controlled study. Totally 360 patients(360 eyes)with dry eye syndrome after cataract surgery admitted to the ophthalmology department of our hospital from November 2022 to October 2024 were selected as the research subjects, and they were randomly divided into a control group(n=180)and an observation group(n=180). The control group received postoperative treatment with sodium hyaluronate eye drops, while the observation group received postoperative treatment with diquafosol sodium eye drops combined with sodium hyaluronate eye drops. Both groups of patients were treated for 4 wk. The clinical efficacy, dry eye clinical symptom score and ocular surface disease index(OSDI)questionnaire, Schirmer's test(SⅠt), tear film break-up time(BUT), corneal fluorescence staining(FL)score, hexagonality(HEX), coefficient of variation(CV)of corneal endothelial cells were compared between the two groups before and after treatment, and the occurrence of adverse reactions during treatment in both groups was recorded.

RESULTS:Both groups were followed up for 4 wk, and no cases were lost. The total clinical effective rate of the observation group was 93.9%, which was higher than 84.5% of the control group(P<0.05). After treatment for 4 wk, the clinical symptom score, OSDI scores and FL scores in both groups decreased, and the observation group had lower scores than those of the control group(all P<0.001); both SⅠt and BUT increased in both groups, and the observation group had a higher value than those of the control group(all P<0.001). After treatment for 4 wk, the HEX in both groups increased(P<0.05), and those in the observation group were higher(P<0.05); the CV of the two groups decreased(P<0.05), and the observation group was lower(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).

CONCLUSION:Compared to sodium hyaluronate eye drops alone, diquafosol sodium eye drops combined with sodium hyaluronate eye drops have a better therapeutic effect on patients with dry eye syndrome after cataract surgery. It can significantly improve the patient's eye symptoms, promote the recovery of eye surface function, stabilize the tear film, and regulate corneal endothelial cell status.

Abstract:AIM: To compare the application of two distinct suspension suture fixation techniques in intraocular lens implantation.

METHODS: Retrospective study. A total of 60 patients(60 eyes)who underwent intraocular lens suspension surgery at ophthalmology department of our hospital between January 1, 2021, and December 1, 2023 were included. Patients were divided into two groups based on the suturing techniques: the control group(n=30)received sub-scleral flap suture fixation, while the intervention group(n=30)underwent Z-shaped suture fixation. A 6 mo postoperative follow-up was conducted to assess surgical duration, visual acuity and quality, ocular structure, clinical efficacy, postoperative expose rate of sutures, diopters and decentration of intraocular lens.

RESULTS:The mean operative time was significantly longer in the intervention group(50.5±3.1 min)compared to the control group(40.9±2.8 min; P<0.01). At 6 mo postoperatively, both groups demonstrated significant improvements in uncorrected and best-corrected visual acuity compared to preoperative values(both P<0.01), and there were no statistically significant differences in the uncorrected and best corrected visual acuity between the two groups(all P>0.05); at 6 mo postoperatively, the visual quality of the intervention group was better than that of the control group(P<0.05). While both groups exhibited a significant reduction in corneal endothelial cell count postoperatively(both P<0.01), there was no significant difference between the groups(P>0.05). The overall efficacy rate and suture exposure rate were comparable between the groups at 6 mo postoperatively(P=0.542 and P>0.05, respectively). However, significant differences were observed in postoperative diopters and intraocular lens decentration between the two groups(both P<0.01).

CONCLUSION:Although both suture fixation techniques yielded satisfactory clinical outcomes in intraocular lens implantation, the Z-shaped suture fixation demonstrated superior performance in terms of visual quality and preservation of ocular structural integrity.

Abstract:AIM: To analyze the influencing factors of capsular constriction syndrome(CCS)in cataract patients after phacoemulsification(Phaco)combined with intraocular lens(IOL)implantation.

METHODS: Retrospective study. The data of 2 900 cataract patients(2 900 eyes)in our hospital's information system from January 2021 to January 2024 were collected. All patients were treated with Phaco combined with IOL implantation, and the incidence of CCS within 30 wk after surgery was recorded. Patients were categorized into CCS(116 cases, 116 eyes)and N-CCS group(2 784 cases, 2 784 eyes)based on the occurrence of CCS. The basic data of the two groups were compared, and the influencing factors of CCS within 30 wk after Phaco combined with IOL implantation in cataract patients were analyzed by multivariate Logistic regression.

RESULTS: Among 2 900 patients(2 900 eyes)included, 116 cataract patients(116 eyes)developed CCS within 30 wk after Phaco combined with IOL implantation, with an incidence rate of 4.00%. The single factor and multi-factor Logistic regression analysis showed that the complicated diabetes, high myopia, complicated glaucoma, and axial length(AL)>30 mm were the risk factors for the occurrence of CCS after Phaco IOL implantation in cataract patients(all P<0.05).

CONCLUSION: Attention should be paid to cataract patients with diabetes, high myopia, glaucoma and AL>30 mm, which will increase the risk of CCS within 30 wk after Phaco combined with IOL implantation in cataract patients.

Abstract:AIM: To evaluate the efficacy of 3% diquafosol sodium ophthalmic solution in treating dry eye syndrome following cataract surgery and its impact on tear film stability.

METHODS: This prospective clinical study was conducted at Xi'an Aier Eye Hospital, Northwest University from January 2021 to January 2024. A total of 124 patients(124 eyes)who underwent cataract phacoemulsification were enrolled and randomly assigned to either the study group(62 cases, 62 eyes)or the control group(62 cases, 62 eyes)using a random number table. The study group received 3% diquafosol sodium ophthalmic solution four times daily for 1 mo, while the control group was treated with sodium hyaluronate eye drops four times daily for 1 mo. Clinical efficacy, tear film breakup time(BUT), Schirmer I test(SⅠt), corneal fluorescein staining(FL)score, inflammatory factors \〖interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α)\〗 levels in tears, and adverse reactions were compared between the two groups.

RESULTS: After treatment, the effective rate was 93.5% in the study group and 87.1% in the control group, with no significant difference between the two groups(P>0.05). The study group showed significantly higher BUT, SⅠt values compared to the control group, while FL score, and inflammatory factor levels in tears were significantly lower at 1 mo after treatment(all P<0.05). The incidence of adverse reactions did not differ significantly between the two groups(P=0.198).

CONCLUSION: The 3% diquafosol sodium ophthalmic solution significantly improves tear secretion and tear film stability in patients with dry eye syndrome after cataract surgery, effectively alleviating dry eye symptoms. It is a safe and effective treatment method.

Abstract:AIM:To explore the relationship between the amplitude of diurnal variations in the choroidal vascular index(CVI)and annual changes in spherical equivalent(SE)and axial length in school-aged children.

METHODS: Prospective study. Totally 39 cases(39 eyes)of Chinese school-age children aged 7 to 12 that diagnosed as emmetropia and myopia and error of refraction at optometry clinics of Eye Hospital, Wenzhou Medical University from July to August 2021 were selected. While 33 cases(33 eyes)were finally included, with 6 cases of loss to 1 a follow-up. A total of 16 cases(16 eyes)with annual growth of SE<0.5 D and 17 cases(17 eyes)with annual growth of SE≥0.5 D were divided into a non-progression group and progression group, respectively. Swept-source optical coherence tomography(SS-OCT)and custom choroidal analysis software were used to longitudinally observe diurnal variations in CVI of subjects, and the association between CVI diurnal amplitude and annual changes in SE and axial length was analyzed.

RESULTS:It showed no significant correlation between the CVI diurnal amplitude at 1 mm from the fovea and annual changes in SE of the non-progressive group(P=0.65), while in the progression group, the CVI diurnal amplitude at 1 mm from the fovea was negatively correlated with annual changes in SE(P=0.048). However, no significant correlation was identified between CVI diurnal amplitude and annual changes in axial length in either group(all P>0.05). The diurnal amplitude of the CVI at the 1 mm foveal center had an effect on annual SE progression(P=0.039). Conversely, the diurnal amplitude of axial length, the annual changes in axial length, and the maximum or minimum time of CVI demonstrated significant associations with SE progression(all P> 0.05).

CONCLUSION: Diurnal variations in CVI amplitude are associated with SE progression in school-aged children, providing a basis for further understanding the choroid-related changes in the process of myopia onset and progression.

Abstract:AIM: To investigate the efficacy of endonasal endoscopic dacryocystorhinostomy(EES-DCR)combined with RS-type lacrimal drainage tube placement and dilatation stent in the treatment of chronic dacryocystitis in patients with small lacrimal sac.

METHODS: A total of 298 patients(298 eyes)of chronic dacryocystitis with small lacrimal sac admitted to our hospital from December 2018 to December 2023 were retrospectively analyzed. They were divided into two groups according to different treatment modalities, 149 patients(149 eyes)in the control group underwent EES-DCR combined with RS-type lacrimal drainage tube placement, and 149 patients(149 eyes)in the observation group were combined with expansion stents on the basis of the control group. The efficacy of the two groups at 6 mo postoperatively, the changes in ocular indexes \〖Schirmer I test(SⅠt), tear film break-up time(BUT), and degree of tear overflow\〗 at 3 mo postoperatively, the changes in the degree of pain at 3 and 6 mo postoperatively, and the occurrence of complications were compared.

RESULTS: The efficacy of the observation group was better at 6 mo postoperatively(P<0.05). Compared with the preoperative period, the BUT was significantly higher and the degree of SⅠt and tear overflow was significantly lower in the two groups at 3 mo postoperatively, and it was better in the observation group(both P<0.05). There were differences in visual analogue scale(VAS)scores between the two groups at each time point(F_interaction=181.032, P_interaction<0.001; F_time=138.215, P_time<0.001; F_{between groups}=41.343, P_{between groups}<0.001). Compared with the preoperative period, the postoperative VAS scores of patients in both groups were reduced(observation group: t_{3 mo postoperatively}=22.086, t_{6 mo postoperatively}=35.192, both P<0.001; control group: t_{3 mo postoperatively}=19.031, t_{6 mo postoperatively}=36.960, both P<0.001). VAS scores were smaller in the observation group than in the control group at 3 mo postoperatively(t=5.124, P<0.001). Complications were not statistically different between the two groups at 6 mo pastoperatively(P>0.05).

CONCLUSION: EES-DCR combined with RS-type lacrimal drainage tube placement in the treatment of chronic dacryocystitis in patients with small lacrimal sac has a better effect, effectively improves the patient's ocular condition and relieves pain.