Abstract:AIM:To study the effects of electroacupuncture(EA)on choroidal blood flow, the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR)-hypoxia-inducible factor 1-alpha(HIF-1α)signaling pathway, and ocular biological parameters in form deprivation myopia(FDM)-induced guinea pigs.

METHODS:The guinea pigs were randomly divided into four groups:blank control group; FDM group(subjected to form deprivation to simulate myopia development); FDM+EA group(subjected to form deprivation and treated with EA stimulation); FDM+sham acupuncture group(subjected to form deprivation and given EA stimulation). EA treatments were performed at the Taiyang(EX-HN5)acupoint for the FDM+EA group and at sham acupoints in the FDM+sham group. Measurements included refractive error, axial length(AL), corneal curvature, vitreous diameter, choroidal thickness, and vascular density of the choroid layer. Additionally, the expression levels of PI3K, Akt, mTOR, and HIF-1α mRNA in the sclera were detected.

RESULTS:Eight animals were included in each group.After 4 wk of treatment, the refractive error of the FDM+EA group was significantly reduced compared to the FDM group(P<0.001). The vascular density of the choroid in the FDM+EA group was significantly increased compared to the FDM group(P<0.001). The expression levels of PI3K, Akt, mTOR, and HIF-1α mRNA in the FDM+EA group were significantly reduced compared to the FDM group(P<0.001).

CONCLUSION:EA can improve the vascular density of choroid, antagonize the expression of PI3K/Akt/mTOR-HIF-1α signaling pathway, effectively improve scleral hypoxia, reduce the diopter of myopic guinea pigs, and play a role in controlling the progression of myopia.

Abstract:Diabetic retinopathy(DR)is a common complication in patients with diabetes mellitus(DM)that seriously affects the vision and quality of life. Ongoing research suggests that glucose-lowering therapies not only improve glycemic control but may also exert protective effects on DM related ocular complications. Although preliminary clinical data support this viewpoint, further in-depth exploration is warranted to investigate the specific mechanisms and efficacy of these drugs in DR. Currently, relevant research is still in the developmental stage and certain unresolved scientific questions and clinical challenges still exist. This narrative review summarizes the applications and recent advances of new hypoglycemic drugs in DR, with a focus on glucagon-like peptide-1 receptor agonists(GLP-1RA), sodium-glucose cotransporter-2 inhibitors(SGLT2i), and dipeptidyl peptidase-4 inhibitors(DPP-4i), highlighting mechanistic evidence, available clinical findings, and future research directions to provide insights for DR management.

Abstract:AIM: To investigate the effects of electroacupuncture on scleral remodeling in guinea pigs with experimental myopia based on bone morphogenetic protein 2(BMP2)/Smad signaling pathway.

METHODS:A total of 80 two-week-old healthy guinea pigs were randomly divided into four groups: normal control(NC)group, lens-induced myopia(LIM)group, electroacupuncture(EA)group,and shame electroacupuncture(SHAM)group, with 20 guinea pigs in each group. The right eyes of guinea pigs in the LIM, SHAM, and EA groups had covered with -6.00 D lens to induce myopia. The EA group received electroacupuncture stimulation at the Taiyang and Hegu acupoints, while the SHAM group underwent stimulation at bilateral gluteal non-meridian areas. No intervention was performed on the NC group. Retinoscopy was used to measure the refractive error, and A-scan ultrasonography was used to measure the axial length. The changes in scleral structure were observed using hematoxylin-eosin(HE)staining. Real-time fluorescent quantitative polymerase chain reaction(qPCR)and Western blot(WB)were used to detect the mRNA and protein expression levels of BMP2/Smad signaling pathway-related molecules in the sclera of guinea pigs in each group.

RESULTS: After modeling for 2 and 4 wk, compared with the NC group, the degree of myopia and the axial length were increased in the LIM group(both P<0.05); compared with the LIM group, the degree of myopia and the axial length were decreased in the EA group(both P<0.05). HE staining showed thinned posterior scleral thickness in the LIM group, with a loose and disordered arrangement of collagen fibers. Compared with the LIM group, the posterior scleral thickness in EA group was increased and the collagen fibers were arranged relatively tightly and regularly.qPCR and WB results showed that, at both mRNA and protein relative expression levels, compared with the NC group, the LIM group exhibited significantly decreased expression of Collagen I, BMP2, bone morphogenetic protein type IA receptor(BMPRIA), bone morphogenetic protein type IB receptor(BMPRIB), bone morphogenetic protein type II receptor(BMPRII), Smad family member 1(Smad1), Smad family member 5(Smad5), Smad family member 9(Smad9), Smad family member 4(Smad4), and tissue inhibitor of metalloproteinase-2(TIMP-2), while the expression of matrix metalloproteinase-2(MMP-2)and alpha-smooth muscle actin(α-SMA)was significantly increased. Compared with the LIM group, the EA group showed significantly increased expression of Collagen I, BMP2, BMPRIA, BMPRIB, BMPRII, Smad1, Smad5, Smad9, Smad4, and TIMP-2, and significantly decreased expression of MMP-2 and α-SMA.

CONCLUSION:Electroacupuncture can improve scleral remodeling and histomorphological changes, and inhibit axial elongation by regulating the expression levels of molecules related to the BMP2/Smad signaling pathway in the sclera of guinea pigs with experimental myopia, thereby delaying the onset and progression of myopia.

Abstract:AIM: To explore the efficacy of intravitreal injection of aflibercept combined with modified macular grid laser photocoagulation and panretinal photocoagulation for treating diabetic macular edema(DME).

METHODS: This study was a retrospective study. The clinical data of DME patients admitted to the hospital from February 2022 to February 2025 were collected. According to different treatment methods, patients were divided into control group(treated with modified macular grid laser photocoagulation and panretinal photocoagulation alone)and combined group(treated with single intravitreal injection of aflibercept preoperative 3 d preoperatively on the basis of the control group). All patients were followed up for at least 6 mo after treatment. Changes in best-corrected visual acuity(BCVA), intraocular pressure(IOP)and retinal microcirculation parameters were compared between the two groups pre- and postoperatively. The postoperative complications of the two groups were recorded, and the quality of life of the two groups before and after treatment was observed.

RESULTS: Totally 300 DME patients(300 eyes)were enrolled, including 150 patients(150 eyes)in the combined group(80 males and 70 females, with a mean age of 58.89±6.19 y)and 150 patients(150 eyes)in the control group(86 males and 64 females, with a mean age of 57.88±5.91 y). At 1, 3, and 6 mo after surgery, BCVA of both groups was better than before surgery(all P<0.01), and the BCVA of the combined group was better than that of the control group at all time points after surgery(P<0.001). The IOP of the control group was higher than that of the combined group at 1 mo after surgery(P<0.001), while there was no statistical significant difference in IOP between the two groups at other postoperative time points(all P>0.05). At 1, 3, and 6 mo after surgery(all P<0.01), the resistance index(RI)of the central retinal artery in both groups of affected eyes was lower than before surgery. The end-diastolic velocity(EDV)and peak systolic velocity(PSV)of blood flow in both groups were higher than before surgery. The leakage area of retinal neovascularization(RNV), parafoveal macular thickness(PMT), foveal macular thickness(FMT), central retinal thickness(CRT), and foveal avascular zone area(FAZ)in both groups were lower than before surgery(all P<0.01), and the RI of the combined group was lower than that of the control group at all time points after surgery. The EDV and PSV of the combined group were higher than those of the control group at all time points after surgery(all P<0.001). The RNV leakage area, PMT, FMT, CRT, and FAZ were all smaller than those in the control group(all P<0.01). After surgery, the scores of the National Eye Institute Visual Function Related Quality of Life Questionnaire(NEI-VFQ-25)in both groups were increased, and the combined group was higher than the control group(P<0.001). The postoperative macular edema elimination rate and visual acuity improvement or retention rate of the combined group were higher than those of the control group, and the incidence of postoperative complications was lower than control group(P<0.05).

CONCLUSION:Intravitreal aflibercept combined with modified macular grid laser photocoagulation and panretinal photocoagulation achieves significant efficacy in the treatment of DME patients, which can promote the improvement of retinal microcirculation, enhance the visual acuity, effectively stabilize postoperative IOP, reduce the occurrence of postoperative complications, and ultimately improve the quality of life.

Abstract:AIM: To evaluate the early postoperative retinal microstructural changes using optical coherence tomography(OCT)in patients with pituitary adenomas(PA)with different degrees of preoperative optic chiasm compression following endoscopic endonasal transsphenoidal surgery.

METHODS:This was a prospective cohort study. A total of 65 patients(130 eyes)initially diagnosed with PA in the hospital from September 2022 to October 2025 were enrolled. Based on the degree of preoperative optic cross-compression, the patients were divided into mild compression group and severe compression group. Both groups of patients underwent endoscopic endonasal transsphenoidal surgery for the first time.Best-corrected visual acuity(BCVA), mean deviation(MD)of visual field, and retinal microstructural changes between the two groups were compared.

RESULTS:Eight patients(16 eyes)were lost to follow-up during the follow-up period, and a total of 57 patients(114 eyes)were finally included. According to the degree of chiasm compression evaluated by preoperative MRI,it was divided into 30 cases(60 eyes)in the mild compression group and 27 cases(54 eyes)in the severe compression group. There was no difference in the age, gender, and course of the two groups patients(P>0.05). The average length, width, height, and suprasellar extension height of patients in the severe compression group were greater than those in the mild compression group, and theoptic chiasm thickness was smaller than that of the mild compression group(all P<0.05). There was a difference in the MD value of the two groups of patients before and 1 mo after surgery(all P<0.05). OCT results showed that, compared with preoperative findings, the temporal circum papillary retinal nerve fiber layer(CP-RNFL)of the mild compression group was thickened in the early postoperative period, and the thickness of the nasal and superior regions of the inner macular ring, the nasal ganglion cell layer(GCL)of the outer ring, the superior inner plexiform layer(IPL)of the inner ring, and the superior macular ganglion cell complex(mGCC)of the inner ring were increased. The thickness of the temporal and inferior GCL in the inner ring, the superior IPL in the outer ring, the nasal and temporal IPL in the inner ring, as well as the temporal and inferior mGCC in the inner ring were decreased. Compared with preoperative status, the thickness of macular GCL in all quadrants, IPL in all quadrants(except the inner ring temporal and outer ring nasal regions), and mGCC in all quadrants(except the inner ring temporal, outer ring temporal and inferior regions)were reduced in the severe compression group.In terms of postoperative early changes relative to baseline, the difference values of the inner ring nasal and superior GCL, outer ring nasal GCL, inner ring superior and outer ring temporal IPL, as well as inner ring superior mGCC in the severe compression group were significantly lower than those in the mild compression group(all P<0.05).

CONCLUSION:Both groups presents varying degrees of improvement in visual function in the early postoperative period compared with preoperative levels. In terms of retinal microstructures, patients with milder optic chiasm compression demonstrates a greater recovery potential at the early postoperative stage.

Abstract:Glaucoma is a chronic neurodegenerative disorder characterized by progressive optic nerve damage and visual field loss. Its pathogenesis is complex and has not yet been fully elucidated. In recent years, accumulating evidence has suggested that microglia, as important resident immune cells in the retina, play a critical role in glaucoma-related neuroinflammation, retinal ganglion cell(RGC)injury, and disease progression. Notably, the role of microglia in glaucoma does not appear to be unidirectionally deleterious; rather, it may exhibit marked temporal heterogeneity and dual effects. Early microglial responses may help maintain tissue homeostasis and promote debris clearance, whereas persistent or excessive activation may aggravate RGC damage through the release of pro-inflammatory mediators, amplification of intercellular signaling, and remodeling of the local immune microenvironment. Meanwhile, with the development of optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA), researchers have been able to visualize and quantify macrophage-like cells(MLCs)in vivo at the vitreoretinal interface(VRI). MLCs are considered to be associated with retinal immune activation; however, their precise cellular identity and the specific significance in glaucoma remain to be further clarified. This review summarizes the mechanisms of microglia in neuroinflammation underlying glaucoma and their relationship with RGC injury, and further discusses the potential origins of MLCs, the methodology of en face OCT/OCTA imaging, and recent advances in their potential application as imaging biomarkers, aiming to provide a reference for the early identification and monitoring of glaucoma, as well as for the pressure-independent intervention strategies.

Abstract:Amphiregulin(AREG)is a member of the epidermal growth factor family. As a key ligand of the epidermal growth factor receptor(EGFR), it can activate signaling pathways such as PI3K/Akt, ERK1/2, and STAT3, participating in biological processes such as cell proliferation, apoptosis inhibition, and inflammatory immune regulation. AREG is closely related to ocular diseases and plays an important role in corneal repair, improvement of retinal damage, and regulation of ocular axial length. This article summarizes the structure, distribution, and biological functions of AREG, focusing on its regulatory mechanisms in ophthalmic diseases: participating in dry eye disease associated with Sjögren's syndrome by driving epithelial thickening and chronic inflammation; promoting corneal repair through an immune-epithelial coordination mechanism; abnormally activating the EGFR/PI3K pathway leading to lens opacity; regulating ocular axial length elongation through the retinal-scleral signal axis; modulating microglial polarization affecting the progression of diabetic retinopathy; and enhancing ocular tumor drug resistance through epigenetic modification. This article systematically reviews the molecular regulatory mechanisms of AREG in ophthalmic diseases, aiming to explore its potential for clinical application in ophthalmic diseases.

Abstract:Secondary macular edema following cataract surgery in diabetic patients is a major complication that impairs postoperative visual acuity. It is not only closely associated with the pathological basis including microvascular lesions and inflammatory responses intrinsic to diabetic patients, but also influenced by factors such as ocular tissue trauma and postoperative inflammatory stress induced by cataract surgery. This review summarizes the relevant pathogenesis and analyzes that the superposition mechanism of these two factors is mainly manifested by the amplification of inflammatory reactions,the imbalance of vasoactive factors,and impaired blood circulation,aiming to provide a theoretical basis for the prevention and management of this complication in such patients in clinical settings.

Abstract:Glaucoma is one of the leading causes of blindness worldwide. Elevated intraocular pressure is a major factor contributing to glaucomatous optic neuropathy. However, the complete mechanisms underlying glaucomatous damage remain incompletely understood. In recent years, the emergence of new technologies such as ultra-widefield optical coherence tomography angiography(UWF-OCTA)and retinal oximetry has provided increasing evidence that retinal vascular and hemodynamic factors are closely associated with the pathogenesis of glaucoma. UWF-OCTA primarily detects the movement trajectory of red blood cells in retinal vessels, enabling rapid scanning and reconstruction of the retinal microvascular network, which can be quantified to assess changes in retinal blood perfusion and vascular morphology. Retinal oximetry, utilizing multispectral imaging(MSI)and laser speckle flowgraphy(LSFG), allows non-invasive measurement of parameters such as retinal arterial and venous oxygen saturation, directly reflecting tissue metabolic demand and blood oxygen delivery efficiency. The multimodal complementary approach provides valuable insights for investigating the correlation between retinal and choroidal vascular and hemodynamic factors and glaucomatous damage. This review aims to summarize the basic principles of UWF-OCTA and retinal oximetry, as well as their current advancements in glaucoma research.

Abstract:The neurovascular unit(NVU)is a sophisticated functional network comprising neurons, glial cells, and microvessels. NVU's homeostatic imbalance plays a pivotal role in the pathogenesis of glaucoma. The disease mechanism can be attributed to disruptions within the interactive network among retinal ganglion cells, glial cells, and microvessels. Current research has increasingly focused on multi-target synergistic interventions aimed at restoring global NVU homeostasis. This provides novel avenues for neuroprotective strategies in glaucoma. This review summarizes the structural and functional alterations in these cellular components and discusses the interplay of multiple pathogenic mechanisms, including oxidative stress and inflammation, excitotoxicity, neurovascular uncoupling, dysregulation of intercellular communication, and impaired clearance of metabolic waste.

Abstract:Retinal vein occlusion(RVO)is the second most common retinal vascular disease in China and is frequently accompanied by systemic cardiovascular and cerebrovascular disorders. Dyslipidemia serves as a key risk factor for RVO. Dyslipidemia drives the progression of RVO through multiple pathological mechanisms, including vascular endothelial injury, hemodynamic abnormalities, oxidative stress, and inflammatory responses. It is also closely associated with complications such as macular edema and neovascularization. This review systematically summarizes current research on the role of dyslipidemia in the pathogenesis of RVO and its clinical significance. By analyzing the associations between lipid profile indicators and RVO, this article aims to emphasize the importance of managing primary diseases and systemic risk factors, and to provide a theoretical basis for early comprehensive systemic interventions targeting dyslipidemia in patients with RVO.

Abstract:Diabetic retinopathy(DR)is the most common microvascular complication of diabetes and a leading cause of vision loss among the working-age population. Conventional screening models rely on manual interpretation of fundus images by ophthalmologists, facing limitations including uneven distribution of medical resources and subjectivity in diagnosis. In recent years, deep learning(DL)technology, with its strengths in image recognition and feature learning, has emerged as a novel and efficient automated approach for early DR screening. This article provides a systematic review of DL applications in DR screening, covering technical principles, mainstream algorithms, dataset construction, model training strategies, and the potential for integrating multi-modal data. It further provides an in-depth analysis of key challenges in current applications, such as data quality, model interpretability, system integration, and obstacles to clinical translation. What's more, future directions are discussed, including the development of light weight models, multi-disease joint prediction, and the establishment of interdisciplinary collaborative frameworks, aiming to support the clinical adoption of DL-based DR screening.

Abstract:Retinal ganglion cells(RGCs), as pivotal neurons in visual signal transduction, are critically implicated in various blinding eye diseases through their apoptosis. Consequently, research on RGC protection is of high significance in this domain. This review delineates the mechanisms by which traditional Chinese medicine(TCM)modulates RGC apoptosis. Focusing on the multi-target and multi-pathway attributes of active herbal constituents in Chinese herbal medicine, it systematically examines their influence on apoptosis-related genes and signaling pathways. The review aims to synthesize recent advances in TCM interventions for RGC apoptosis, elucidating the mechanisms and potential therapeutic benefits of active herbal components in inhibiting cell apoptosis and protecting neural function. However, current research still has limitations. The multi-component, multi-pathway mechanisms of TCM have not been fully clarified at the molecular level, and high-quality clinical evidence is lacking. Future studies should integrate systems pharmacology, gene editing, and other technologies to further elucidate molecular targets, complemented by standardized clinical trials to verify their efficacy and safety.

Abstract:Carotid artery stenosis(CAS)can significantly impair ocular hemodynamics, resulting in ischemic injury involving the retina, choroid, and optic nerve. The severity of CAS can be accurately evaluated using multimodal imaging techniques, including carotid ultrasonography and magnetic resonance angiography. Moderate to severe CAS is closely associated with ocular ischemic syndrome, retinal arterial and venous occlusions, retinal structural alterations(such as retinal ischemic perivascular lesions, thinning of the retinal nerve fiber layer, and subretinal drusenoid deposits), ischemic optic neuropathy, and changes in choroidal blood flow. Carotid endarterectomy and carotid artery stenting may improve ocular perfusion and alleviate ischemic manifestations; however, postoperative complications such as retinal artery embolism require careful monitoring. This review summarizes recent advances in the understanding of the relationship between CAS and ocular ischemic diseases.

Abstract:Neuromyelitis optica spectrum disorder(NMOSD)is an autoimmune disorder characterized primarily by inflammatory demyelination of the central nervous system, the pathogenesis of which remains incompletely elucidated. Recent research has demonstrated that the nuclear factor-kappa B(NF-κB)signaling pathway plays a pivotal role in the pathophysiology of NMOSD. Aberrant activation of the NF-κB pathway can induce the activation of various cell types, including retinal ganglion cells(RGCs), immune cells, glial cells, and blood-brain barrier endothelial cells, subsequently inducing the release of pro-inflammatory cytokines, resulting in myelin damage, and ultimately contributing to the onset and progression of NMOSD. Inhibitors targeting the NF-κB signaling pathway can specifically downregulate the expression of pro-inflammatory cytokines and modulate immune responses, demonstrating substantial potential for clinical application as therapeutic targets. Current in-depth research on the NF-κB pathway in NMOSD not only reveals its complex pathogenic mechanisms, but also provides a new theoretical basis and direction for precision therapy. Future studies may focus on developing cell-specific NF-κB inhibitors to enhance therapeutic precision, combining nanodrug delivery systems to improve drug penetration across the blood-brain barrier, and exploring biomarkers related to this pathway to advance clinical stratification and personalized treatment.

Abstract:Stress granules(SGs)are membraneless ribonucleoprotein condensates formed in the cytoplasm via liquid-liquid phase separation(LLPS)under various stress conditions. Their assembly mainly depends on phosphorylation of eukaryotic translation initiation factor 2α(eIF2α), which is central to the integrated stress response, but can also occur independently of this pathway. Their dynamics are driven by the low-complexity domains characteristic of RNA-binding proteins(RBPs), while the intracellular protein quality control system mediates their disassembly.Although the role of SGs in neurodegenerative diseases has been extensively reported, but their functions in ocular diseases—particularly glaucoma, age-related macular degeneration(ARMD), and diabetic retinopathy(DR)—are still in the exploratory stage. This review summarizes recent research progress on SGs in these major blinding eye diseases, focusing on the expression and functional changes of key RBPs(such as G3BP1/2, TIA-1, TDP-43, and FUS)and the regulatory mechanisms of LLPS-related signaling pathways, including PERK-eIF2α, Nrf2, mTOR, and the NLRP3 inflammasome. This review aims to provide new insights into the molecular mechanisms of blinding ocular diseases and to offer a theoretical basis for the development of therapeutic strategies targeting SG dynamics.

Abstract:AIM:To identify key oxidative stress-related genes and pathways in the medial rectus(MR)muscle of patients with concomitant exotropia(XT).

METHODS:RNA sequencing was performed on MR muscle specimens obtained from XT patients and healthy controls.Comprehensive bioinformatics, including the identification of oxidative stress-related differentially expressed genes(OSRDEGs), functional enrichment analysis, protein-protein interaction(PPI)network construction, and receiver operating characteristic(ROC)curve were used to analyze OSRDEGs and signaling pathways. Key hub genes were validated using reverse transcription-quantitative polymerase chain reaction(RT-qPCR).

RESULTS:A total of 24 XT patients \〖6 males, 18 females, age 29.5(21.5, 42.5)y\〗 and 14 healthy controls \〖4 males, 10 females, age 42.0(28.0, 55.0)y\〗 were enrolled.A total of 319 OSRDEGs were identified. Functional enrichment analysis revealed significant associations with the reactive oxygen species metabolic process, response to oxidative stress, and the p53 signaling pathway. PPI network analysis identified five hub genes(IL6, TNF, CD4, PTPRC,and ITGAM).ROC curve analysis demonstrated high diagnostic accuracy of CD4, PTPRC, and ITGAM(AUC>0.9)in distinguishing XT patients from healthy controls, while IL6 and TNF showed moderate diagnostic accuracy(0.7TNF,CD4, and IL6(all P<0.05).

CONCLUSION:Oxidative stress may play a vital role in the pathogenesis of XT. The identified hub genes provide new directions for investigating the molecular mechanisms underlying XT.

Abstract:AIM: To observe the clinical efficacy of two different surgical methods in treating lens subluxation of varying degrees with cataracts.

METHODS: Prospective observational study. Patients with lens subluxation and cataracts who were treated in Yulin Hospital of Traditional Chinese Medicine from May 1, 2021 to April 30, 2024 were included. The surgical method was determined according to the range of zonular abnormalities or injuries. If the zonular abnormality or injury range was ≤6 clock hours and the capsular bag was intact and stable with no aggravation of the zonular injury after completion of phacoemulsification, the triple procedure of phacoemulsification combined with capsular tension ring(CTR)implantation plus intraocular lens(IOL)implantation was adopted(CTR group); if the zonular abnormality or injury range is >6-9 clock hours, or if the stability of the lens capsular bag was poor and the zonular injury range was aggravated intraoperatively, phacoemulsification combined with scleral-sutured intracapsular IOL fixation was performed(Suture group). Visual acuity(LogMAR), spherical equivalent, intraocular pressure, corneal endothelial cell count, anterior chamber depth and complications of all patients were recorded at different time points after surgery, respectively.

RESULTS: A total of 40 cases(40 eyes)were included in study, including 21 cases(21 eyes)in CTR group(age 60.62±1.65 y, 15 males and 6 females)and 19 cases(19 eyes)in Suture group(age 64.26±1.69 y, 15 males and 4 females).The median range of zonular injury in the CTR group was 4.0(2.75, 5.25)clock hours, while that in the Suture group was 7.0(6.5, 8.0)clock hours(P<0.001), and there were no significant differences in other basic data between the two groups. The visual acuity of patients in both groups significantly improved one month after surgery. The CTR group showed an improvement of 0.72±0.45 logMAR compared with preoperative values(t=5.44, P<0.001), and the Suture group showed an improvement of 1.11±1.01 LogMAR compared with preoperative values(t=4.09, P=0.001). There was no significant difference in visual acuity between the two groups 12 mo after surgery(t=0.24, P=0.81). There was no significant difference in the spherical equivalent between the two groups at 1, 12 mo after surgery(both P>0.05). The corneal endothelial cell count in the Suture group was significantly lower than that in CTR group after surgery(t=3.75, P=0.001). In the CTR group, at postoperative 6 mo, IOL horizontal tilt was 3.06°±1.47°, and the IOL horizontal decentration was 0.25±0.10 mm, both of which were significantly lower than those in the Suture group(both P<0.001). There was no significant difference in the total incidence of complications between the two groups(23.8% vs 36.8%, χ²=0.807, P=0.369).

CONCLUSION:For cases with zonular abnormalities or injury involving ≤6 clock hours, where the capsular bag remains intact and stable after phacoemulsification, the triple procedure of phacoemulsification combined with CTR implantation and IOL implantation is adopted. In cases with zonular abnormalities or injury involving >6-9 clock hours, or when intraoperative capsular bag stability is poor and zonular injury worsens, phacoemulsification combined with scleral-sutured intracapusular IOL fixation is performed. Both approaches can achieve favorable postoperative outcomes. Comprehensive preoperative and intraoperative evaluations help determine the appropriate surgical method.

Abstract:AIM:To analyze the influencing factors for posterior capsular opacification(PCO)in patients after phacoemulsification combined with intraocular lens(IOL)implantation, and to construct a nomogram prediction model based on these factors.

METHODS:This was a retrospective cohort study conducted using convenience sampling. The model group comprised cataract patients who underwent phacoemulsification combined with IOL implantation at the hospital from January 2019 to March 2021. The external validation group included the same cohort of patients treated between April 2021 and March 2022. Patients were categorized into those with PCO and those without PCO based on the occurrence of PCO during follow-up. Clinical characteristics were compared between the PCO-positive and PCO-negative subgroups within the model group. Multivariate Logistic regression analysis was performed to identify factors influencing postoperative PCO in cataract patients, followed by the construction of a nomogram prediction model. The calibration curve was used to validate the model's performance in the model group, and the decision curve was employed to assess its clinical predictive efficacy.

RESULTS:The study model cohort included 256 patients(256 eyes), comprising 47 cases(47 eyes)with postoperative PCO and 209 cases(209 eyes)without PCO. Significant differences were observed in patient age, surgical history, comorbidities(diabetes, glaucoma, high myopia), operative duration, anesthesia method, and type of IOL material(all P<0.05). Multivariate Logistic regression analysis revealed that surgical history, age, hydrophilic IOL material, comorbid glaucoma, and operative duration were all influencing factors for postoperative PCO in cataract patients(all P<0.05). The external validation cohort comprised 112 cataract patients(112 eyes), including 22 cases(22 eyes)with postoperative PCO and 90 cases(90 eyes)without PCO. Statistical analyses showed no significant difference between the predicted and actual postoperative PCO probabilities(χ²_A=3.214, P_A=0.920; χ²_B=10.979, P_B=0.203), with C-index values of 0.904(0.855-0.952)and 0.908(0.846-0.970), respectively. Decision curve analysis demonstrated that the predictive model provided significant net benefit for clinical decision-making when the predicted risk threshold exceeded 0.04 in the model cohort and 0.02 in the external validation cohort. The ROC curve results demonstrated that the risk scores for PCO postoperatively in cataract patients from the training cohort and external validation cohort were 0.904(0.861-0.937)and 0.913(0.872-0.945), respectively, indicating that the predictive model exhibits good discriminative power.

CONCLUSION:Age, history of ocular surgery, comorbid glaucoma, operative duration, and hydrophilic IOL material are influencing factors for PCO after phacoemulsification combined with IOL implantation. The nomogram prediction model constructed based on these factors provides valuable guidance for the prevention and management of PCO in clinical practice.

Abstract:AIM: To analyze the efficacy of phacoemulsification(PHACO)with intraocular lens(IOL)implantation combined with goniosynechialysis(GSL)in the treatment of primary angle-closure glaucoma(PACG)with cataract and their effects on changes in retinal microstructural.

METHODS: Patients with PACG and cataract admitted to the hospital between January 2021 and June 2023 were retrospectively collected. According to the treatment modality, patients were divided into a group receiving PHACO+IOL+GSL(Group A)and a group receiving PHACO+IOL+trabeculectomy(Group B). Best-corrected visual acuity(BCVA), intraocular pressure(IOP), anterior chamber depth, foveal avascular zone(FAZ)perimeter, area, circularity index, and complications were compared between the two groups preoperatively and at different postoperative time points.

RESULTS: A total of 259 eyes of 259 patients with PACG and cataract were included and divided into two groups. Group A comprised 131 eyes of 131 patients(68 males, 63 females)with a mean age of 65.29±5.88 y; Group B comprised 128 eyes of 128 patients(70 males, 58 females)with a mean age of 65.39±6.42 y. At 1 wk and 3 mo postoperatively, IOP in Group B was significantly lower than that in Group A(both P<0.001). Anterior chamber depth at 3 mo postoperatively was significantly increased compared with preoperative values in both groups(both P<0.001), with no statistically significant difference between the groups(P>0.05). At 1 wk and 3 mo postoperatively, FAZ perimeter and FAZ circularity index in Group A were significantly greater than those in Group B(all P<0.01). The total incidence of complications in Group A was lower than that in Group B, and the difference was statistically significant(P<0.05).

CONCLUSION: Both PHACO+IOL+GSL and PHACO+IOL+trabeculectomy are effective in treating PACG with cataract. During the 3-month postoperative follow-up period, the former demonstrates a more pronounced effect in promoting retinal microstructural recovery and reducing the incidence of complications, whereas the latter is more effective in short-term IOP control.

Abstract:AIM: To explore the influencing factors of poor response to anti-vascular endothelial growth factor(VEGF)treatment in patients with diabetic retinopathy(DR), and to build a predictive model based on the influencing factors, so as to provide reference for clinical individualized treatment.

METHODS: A retrospective analysis was conducted on the clinical data of DR patients who received anti-VEGF treatment in the hospital from July 2022 to August 2025. The patients were randomly divided into a training set and a validation set in a 7:3 ratio. Patients in the training set were divided into a poor response group(n=266)and a good response group(n=609)based on their treatment response 1 mo after 3 sessions of anti-VEGF therapy. The basic information of patients was collected. The influencing factors of poor response to anti-VEGF treatment in DR patients were analyzed through univariate and multivariate Logistic regression. A nomogram prediction model was constructed based on the influencing factors. Based on the identified influencing factors, a nomogram prediction model was constructed. The model was validated and evaluated by calibration curves and receiver operating characteristic(ROC)curves. Decision curve analysis was adopted to assess the clinical net benefit of the nomogram model.

RESULTS:This study included 1 250 DR patients(1 250 eyes), 875 training subjects(age 60.82±10.54 y, 262 males and 613 females), and 375 validation subjects(age 59.70±10.61 y, 100 males and 275 females). Among the patients in the training set, there were 266 cases(266 eyes, age 61.33±9.92 y, 82 males, 184 females)with poor response and 609 cases(609 eyes, age 60.59±10.80 y, 180 males, 429 females)with good response. No statistically significant differences were observed in baseline patient characteristics or treatment response rate between the training set and validation set(P>0.05). Multivariate Logistic regression analysis showed that the classification of diabetic macular edema(DME)-serous retinal detachment, central macular thickness(CMT)before treatment, best corrected visual acuity(BCVA)before treatment, disruption of ellipsoidal zone(EZ), glycosylated hemoglobin(HbA1c)before treatment, and neutrophil count before treatment were all risk factors for poor response to anti-VEGF treatment in DR patients(all OR>1, P<0.05). A nomogram risk model was plotted based on risk factors. The C-index of the training set for predicting poor response to anti-VEGF treatment was 0.880(95%CI: 0.855-0.904), and that of the validation set was 0.867(95%CI: 0.828-0.906). The ROC curves were plotted. The area under the curve(AUC)of the prediction model in the training set and validation set was 0.884(95%CI: 0.859-0.908)and 0.880(95%CI: 0.841-0.919), respectively, suggesting that the model had good discrimination. The decision curve showed that the net benefit rate of the training set and the verification set threshold in the range of 0.06-0.99 was greater than 0. Within the threshold probability range, this model for clinical decision-making can obtain positive net benefits.

CONCLUSION: DME serous retinal detachment subtype, pre-treatment CMT, pre-treatment BCVA, EZ disruption, pre-treatment HbA1c, and pre-treatment neutrophil count levels are all risk factors for poor anti-VEGF treatment response in DR patients. The nomogram risk prediction model constructed based on it has high predictive power and can provide a reference for the early development of targeted intervention strategies in clinical practice.

Abstract:AIM: To analyze the clinical efficacy of recombinant bovine basic fibroblast growth factor(rb-bFGF)eye drops combined with fluorometholone eye drops in the treatment of severe dry eye syndrome with corneal injury.

METHODS: A retrospective analysis was conducted on patients with severe dry eye syndrome and corneal injury after cataract phacoemulsification surgery admitted to the hospital from January 2022 to December 2024. According to different treatment plans for dry eye syndrome, patients were divided into two groups: a control group was treated with conventional artificial tears and fluorometholone eye drops for a course of 8 wk; an observation group were treated with conventional artificial tears+rb-bFGF eye drops combined with fluorometholone eye drops for a course of 8 wk. The ocular surface disease index(OSDI), tear film breakup time(BUT), corneal fluorescein staining(FL)score, and tear inflammatory factors \〖interleukin-1 β(IL-1β)and interleukin-18(IL-18)\〗 were compared between the two groups before and 4 and 8 wk after treatment. The occurrence of adverse reactions in the eyes of two groups during the treatment period was statistically analyzed.

RESULTS:This study included a total of 104 patients(104 eyes), with a control group of 50 patients(age 61.38±4.35 y, 28 males and 22 females)and an observation group of 54 patients(age 60.75±4.52 y, 27 males and 27 females). After 4 and 8 wk of treatment, the OSDI, FL, and IL-1 β and IL-18 in tears of both groups were lower than before treatment, and the BUT was higher than before treatment(all P<0.05). The OSDI, FL, and IL-1β and IL-18 in tears of the observation group were lower than those of the control group, and the BUT was higher than that of the control group(all P<0.001). During the follow-up period of treatment, there was no statistical significant difference in the incidence of eye adverse reactions between the two groups of patients(P>0.05).

CONCLUSION: The combination of rb-bFGF eye drops and fluorometholone eye drops can effectively improve dry eye symptoms in patients with severe dry eye syndrome and corneal injury, promote tear film stability and corneal injury repair, inhibit ocular surface inflammation, and has acceptable safety.

Abstract:AIM: To compare the differences in postoperative tear inflammatory mediator levels and ocular surface health recovery between patients undergoing transepithelial photorefractive keratectomy with smart pulse technology(SPT-TPRK)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).

METHODS:Patients undergoing corneal refractive surgery at the Department of Ophthalmology, the First Affiliated Hospital of Henan Medical University, from July 2024 to February 2025 were enrolled and divided into an SPT-TPRK group and an FS-LASIK group based on the surgical procedure. Tear samples were collected preoperatively and at 1 wk, 1, 3, and 6 mo postoperatively. Levels of tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6), matrix metalloproteinase-9(MMP-9), intercellular cell adhesion molecule-1(ICAM-1), and nerve growth factor(NGF)were measured using enzyme-linked immunosorbent assay. Tear film break-up time(BUT)and ocular surface disease index(OSDI)questionnaire were also assessed.

RESULTS:A total of 60 patients(120 eyes)were enrolled in this study. There were 30 patients(60 eyes)in the SPT-TPRK group, including 17 males(34 eyes)and 13 females(26 eyes), with an average age of 23.13±3.82 y, and 30 patients(60 eyes)in the FS-LASIK group,including 16 males(32 eyes)and 14 females(28 eyes), with an average age of 24.77±4.63 y. At 1 wk postoperatively, tear levels of TNF-α, IL-1β, IL-6, MMP-9, and ICAM-1 in the SPT-TPRK group were significantly higher than those in the FS-LASIK group(all P<0.05). However, these levels decreased rapidly from 1 mo postoperatively and were lower in the SPT-TPRK group than in the FS-LASIK group at 3 and 6 mo postoperatively. NGF concentrations in the FS-LASIK group were significantly higher than those in the SPT-TPRK group at all postoperative time points(all P<0.05)and declined more slowly. At 1 wk postoperatively, BUT was significantly lower and OSDI scores significantly higher in the SPT-TPRK group compared to the FS-LASIK group(both P<0.05). At 1 mo postoperatively, no statistically significant differences were observed in BUT or OSDI scores between the two groups(both P>0.05). Correlation analysis revealed that all inflammatory mediator levels were significantly negatively correlated with BUT and significantly positively correlated with OSDI scores(all P<0.001).

CONCLUSION:Both SPT-TPRK and FS-LASIK induce elevated inflammatory mediator levels and decreased ocular surface function postoperatively. The early inflammatory response is more intense but resolves rapidly after SPT-TPRK, whereas NGF elevation is more pronounced and declines slowly after FS-LASIK.Postoperative tear film stability and subjective discomfort in patients undergoing SPT-TPRK and FS-LASIK are closely correlated with inflammatory mediator levels.

Abstract:AIM: To investigate the efficacy of soft corneal contact lenses combined with autologous serum for postoperative repair of corneal foreign bodies.

METHODS:The prospective study included 102 patients(102 eyes)who were scheduled to undergo corneal foreign body surgery in the hospital from January 2023 to December 2024. The patients were randomly divided into two groups by the random number table method: a control group of 51 patients(51 eyes)who received soft contact lens treatment after surgery and a combination therapy group of 51 patients(51 eyes)who received soft contact lens combined with autologous serum treatment after surgery. Corneal epithelial healing status, visual analog scale(VAS)score, ocular surface disease index(OSDI)score, tear film function, interferon gamma(IFN-γ), tumor necrosis factor alpha(TNF-α), and interleukin-17(IL-17)levels, regular morphology of corneal wounds, and the occurrence of complications between two groups of patients were compared.

RESULTS:This study included 102 patients(102 eyes)who completed the full course of treatment and were followed up for 1 mo after surgery. There were 30 males and 21 females in the combination therapy group, with an age range of 20-64 y(mean age 40.89±5.86 y), with an average depth of 0.21±0.04 mm for foreign bodies embedded in the cornea. There were 32 males and 19 females in the control group, with an age range of 21-63 y(mean age 41.22±5.81 y). All 102 patients completed the full course of treatment and were followed up for 1 mo after surgery, with no cases lost to follow-up or dropped out. There were 32 males and 19 females in the control group, with an age range of 21-63 y and a mean age of 41.22±5.81 y. The average depth of foreign body embedding in the cornea was 0.22±0.03 mm(P>0.05). The total effective rate of the combination therapy group was higher than that of the control group(all P<0.05). The postoperative corneal epithelial healing time in the combination therapy group was shorter than that in the control group(4.15±0.66 vs 5.07±0.79 d, P<0.05). The VAS and OSDI scores of the combination therapy group were lower than those of the control group on postoperative days 1 and 7(both P<0.05). One month after surgery, the combination therapy group had a higher tear secretion test(SIt)and tear film breakup time(BUT)than the control group(all P<0.05). The levels of IFN-γ, TNF-α, and IL-17 in the tears of the combination therapy group were lower than those of the control group(all P<0.05), and the surface asymmetry index(SAI)and surface regularity index(SRI)of the combination therapy group were lower than those of the control group(all P<0.05). The incidence of complications in the combination therapy group was lower than that in the control group(P<0.05).

CONCLUSION:The combination of soft contact lenses and autologous serum can effectively shorten the corneal epithelial healing time, alleviate early postoperative ocular pain and ocular surface discomfort symptoms, improve tear film secretion, stability and other tear film functions, and reduce the levels of local ocular inflammatory factors. Meanwhile, the combined therapy can optimize the regularity and symmetry of the corneal surface after surgery and decrease the incidence of complications. Its overall repair efficacy is superior to that of soft contact lenses alone.

Abstract:AIM: To evaluate the differences and agreement among five ophthalmic devices including calipers, Pentacam HR, IOL Master 700, OPD Scan Ⅲ, and CIRRUS HD-OCT in measuring the corneal white-to-white(WTW)diameter prior to implantable collamer lens(ICL)implantation, and to provide evidence for optimal ICL size selection.

METHODS:This retrospective study included high myopia patients who underwent ICL V4c implantation in the hospital between November 2023 and June 2024. Preoperative WTW measurements were obtained using calipers, Pentacam HR, IOL Master 700, OPD Scan Ⅲ, and CIRRUS HD-OCT. Differences and agreement of measurements among the devices were compared.

RESULTS:A total of 249 high myopia patients(498 eyes)were enrolled in this study, including 85 males(170 eyes)and 164 females(328 eyes). The patients' age ranged from 18 to 38 y, with a mean age of 30.2±5.8 y. The mean WTW values measured by calipers, Pentacam HR, IOL Master 700, OPD Scan Ⅲ, and CIRRUS HD-OCT were 11.24±0.31, 11.55±0.35, 11.88±0.37, 11.69±0.38, and 11.56±0.41 mm, respectively. No significant difference was found between Pentacam HR and CIRRUS HD-OCT(P>0.05), while significant differences were observed among all other measurement method pairs(P<0.05). All measurement methods showed significant positive correlations(P<0.01). Bland-Altman analysis demonstrated that only the comparison between Pentacam HR and OPD Scan Ⅲ, Pentacam HR and CIRRUS HD-OCT, and OPD Scan Ⅲ and IOL Master 700 had 95% limits of agreement within ±0.50 mm.

CONCLUSION:Systematic differences exist among the five devices in measuring WTW, with IOL Master 700 yielding the largest value and caliper the smallest. Caliper measurements demonstrate poor agreement with automated devices and should not be considered interchangeable. In contrast, Pentacam HR, OPD Scan Ⅲ, and CIRRUS HD-OCT, OPD Scan Ⅲ and IOL Master 700 demonstrate relatively good agreement and may serve as alternative references for ICL sizing in clinical practice.

Abstract:AIM: To investigate the influencing factors of persistent high intraocular pressure(IOP)after surgery in patients with primary angle-closure glaucoma(PACG)and cataract.

METHODS: A retrospective analysis was conducted on the clinical data of patients with PACG and cataract who underwent standard phacoemulsification combined with intraocular lens implantation(Phaco+IOL)or phacoemulsification combined with goniosynechialysis in the Ophthalmology Department of the hospital from February 2022 to May 2025. According to whether the IOP was persistently higher than 21 mmHg after 3 mo of medication postoperatively, the patients were divided into the high IOP group and the normal IOP group. The demographic characteristics, preoperative, intraoperative and postoperative data of the two groups were compared, and Logistic regression analysis was used to analyze the influencing factors of postoperative high IOP.

RESULTS: A total of 106 patients(106 eyes)with PACG and cataract were included. The normal IOP group consisted of 85 patients(35 males and 50 females), with an average age of 58.42±6.37 y, and the high IOP group consisted of 21 patients(10 males and 11 females), with an average age of 60.53±6.94 y. Clinical data analysis showed that there were no statistically significant differences between the two groups in terms of age, gender, body mass index(BMI), comorbidity with hypertension, preoperative IOP(whether <21 mmHg), anterior chamber depth, corneal diameter, lens nucleus hardness, surgical method, surgical time, postoperative neovascularization, suturing method, and medication use(all P>0.05). However, there were statistically significant differences between the two groups in terms of diabetes, high myopia, intraoperative complications, and postoperative inflammatory responses(all P<0.05). Logistic regression analysis showed that combined diabetes(OR=1.997, 95% CI: 1.174-3.397, P=0.011), high myopia(OR=1.590, 95% CI: 1.049-2.409, P=0.029), intraoperative complications(OR=3.416, 95% CI: 1.641-7.110, P=0.001), and moderate/severe postoperative inflammatory response(OR=2.813, 95% CI: 1.209-6.547, P=0.016)were the influencing factors for persistent high IOP in patients with PACG and cataract after surgery.

CONCLUSION: The occurrence of persistent high IOP after PACG and cataract surgery is influenced by multiple factors, including the presence of diabetes, high myopia, intraoperative complications, and moderate/severe postoperative inflammatory response.

Abstract:AIM: To summarize and analyze the pathogen distribution and treatment experience in infants and young children with acute dacryocystitis, so as to explore an effective treatment strategy for this clinical emergency.

METHODS: Retrospective study. Infants with acute dacryocystitis who were treated at Hebei Eye Hospital from January 2015 to October 2023 were enrolled.Post-diagnosis,dacryocystic pus specimens were collected for bacterial culture,and antibiotic eye drops were administered for dacryocystic instillation and irrigation. The selection of antibiotics was adjusted based on antimicrobial susceptibility testing results.For patients aged ≥3 mo after acute inflammation control,dacryocystorhinostomy was performed. For patients <3 mo, dacryocystorhinostomy was performed after reaching 3 mo of age.

RESULTS: Thirty-four infants(34 eyes)with acute dacryocystitis were included in the study, comprising 18 males and 16 females, with an average age of 38.1±4.4 d. The pathogen detection rate was 88%(30 cases), with gram-positive cocci being the primary pathogens in 23 cases(77%), including Staphylococcus aureus in 12 cases(40%), Streptococcus pneumoniae in 4 cases(13%), Group A Streptococcus in 3 cases(10%), Staphylococcus epidermidis in 2 cases(7%), and Staphylococcus haemolyticus in 2 cases(7%). Gram-negative bacilli were detected in 7 cases(23%), including Escherichiacoli in 4 cases(13%), Citrobacter freundii in 2 cases(7%), and Stenotrophomonas maltophilia in 1 case(3%). Gram-positive cocci were more sensitive to vancomycin, rifampin, levofloxacin, and amikacin; Gram-negative bacilli were more sensitive to levofloxacin, tobramycin, aztreonam, and amikacin. Among the 34 patients, an average of 1-4 drug irrigation treatments were administered, with acute inflammation well controlled. Subsequent dacryocystoplasty successfully treated 33 cases, while 1 patient failed to achieve patency.

CONCLUSION: Gram-positive cocci constitute the primary causative agents of acute dacryocystitis in infants and young children. Levofloxacin and amikacin ophthalmic preparations can be used as empirical treatment for early-stage acute dacryocystitis in infants and young children. Sensitivity antibiotic eye drops administered via dacryocyst instillation and irrigation can effectively control acute inflammation, preparing for subsequent lacrimal duct probing.

Abstract:AIM: To explore the clinical efficacy of thunder-fire moxibustion combined with botulinum toxin type A in the treatment of refractory blepharospasm.

METHODS:Prospective study. Patients diagnosed with refractory blepharospasm in the hospital from January 2022 to January 2025 were randomly divided into two groups. The control group received botulinum toxin type A injection alone, while the thunder-fire moxibustion group received thunder-fire moxibustion prior to the botulinum toxin type A injection,with the control group as the baseline intervention. The clinical efficacy, blepharospasm severity before and after treatment, disability degree \〖blepharospasm disability index(BSDI)score\〗, and adverse reactions were compared between the two groups.

RESULTS:Sixty patients(120 eyes)with refractory blepharospasm were enrolled. The thunder-fire moxibustion group consisted of 30 patients, including 13 males and 17 females, with a mean age of 62.39±6.82 y. The control group consisted of 30 patients, including 12 males and 18 females, with a mean age of 62.72±6.95 y. The total effective rate was 93%(28/30)in the thunder-fire moxibustion group, which was significantly higher than 70%(21/30)in the control group(P<0.05). After treatment, the severity and frequency grade of blepharospasm in the thunder-fire moxibustion group were significantly better than those in the control group(P<0.05). The BSDI scores in both groups decreased after treatment, with a significantly greater reduction in the thunder-fire moxibustion group(both P<0.05). The incidence of adverse reactions was similar between the two groups(P>0.05).

CONCLUSION: The combination of thunder-fire moxibustion and botulinum toxin type A can significantly enhance the therapeutic efficacy for refractory blepharospasm, effectively alleviate the severity of symptoms and degree of disability.