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 Sj?gren"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:Objective: To evaluate visual quality, safety and efficacy after optimized monovision Q-value-customized femtosecond laser-assisted in situ keratomileusis (Custom-Q FS-LASIK) for moderate myopia and myopia astigmatism with presbyopia. Methodes: This prospective study enrolled 80 eyes of 40 patients suffering moderate myopia with presbyopia. All patients underwent optimized monovision Custom-Q FS-LASIK. At 12 months post operation, we evaluated full range of visual acuity, uncorrected visual acuity, manifest refraction,total corneal higher order aberrations ( HOAs), Q value, modulation transfer function cut off frequency (MTF cut off), Strehl ratio (SR), objective scatter index (OSI), and near stereoacuity. The impact of surgery on patients' living quality and their satisfaction were evaluated based on National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL) scores at 1-year follow-up. Results: The forty patients included 12 males (30%) and 28 females (70%) with an average age of 46.03 ± 3.60 years (range: 40 to 53 years). One year postoperatively, the uncorrected binocular visual acuity of 20/20 or better at distance, near were all achieved in 97% of patients,The uncorrected binocular visual acuity of 20/30 or better at intermediate were achieved in 89% of patients.The spherical equivalent refraction (SEQ) in dominant eye within ±0.50D was 94%(R2=0.9878).SEQ in non-dominant eyes was -1.30 ± 0.48D, which was uncorrected compared to the expected value of -0.95 ± 0.30 D (the difference was -0.27±0.34D,P < 0.001). while in the nondominant eyes, the Q value became more negative than those before surgery (-0.33 ± 0.24 vs -0.21±0.09, P<0.001).The spherical aberration (SA) and longitudinal spherical aberration (LSA) both decreases significantly in non-dominant eyes (both P < 0.05). Besides, there were no significant changes in OSI, MTF cut off and SR in both dominant and non-dominant eyes (all P > 0.05), while the near stereoacuity was better after surgery while the near stereoacuity was better (p = 0.007). Additionally, the analyses of NEI RQL demonstrated that the satisfaction rate for the surgery was 94%, for visual acuity at distance and near were both 98%. 10.6 % of patients needed to wear low-diopter glasses when driving at night, and 12.7% of patients reported occasional halos under bright lights at night. Conclusions: Optimized monovision Custom-Q FS-LASIK demonstrated satisfactory safety and efficacy for correction of moderate myopia and myopia astigmatism with presbyopia. It achieved favorable subjective and objective visual quality as well as relative high level of patient satisfaction. However, we also observed a undercorrection in non-dominant eyes, indicating the further optimization of nomogram was needed.

Abstract:Objective: To explore the relationship between serum Delta-like ligand 4 (DLL4) and complement C1q/tumor necrosis factor-related protein 5 (CTRP5) with disease condition and visual disability of patients with diabetic retinopathy (DR). Methods: Totally 245 DR patients admitted from January 2022 to January 2024 were selected as the study subjects. They were assigned into the proliferative DR group (95 cases) and the non proliferative DR group (150 cases) based on their condition, and followed up for 1 year. Complying with the degree of visual disability, they were assigned into the visual disability group (39 cases) and the non visual disability group (206 cases). ELISA was used to detect serum DLL4 and CTRP5. The data and serum DLL4 and CTRP5 were compared among patients with different medical conditions and visual disabilities. Pearson method was used to explore the correlation between serum DLL4, CTRP5 and glucose and lipid metabolism indicators. Multivariate logistic regression was performed to explore the influencing factors of visual disability in DR. ROC curve was performed to explore the value of serum DLL4 and CTRP5 in predicting visual disability in DR. Results: The proliferative DR group had longer duration of DR, higher FPG, TG, TC, LDL-C, and serum DLL4 and CTRP5, and lower HDL-C than the non proliferative DR group (P<0.05). The serum DLL4 was unusually positively correlated with FPG, while the serum CTRP5 was prominently positively correlated with FPG, TG, TC, LDL-C, and prominently negatively correlated with HDL-C (P<0.05). The visual disability group had longer duration of DR and higher serum DLL4 and CTRP5 than the non visual disability group (P<0.05). The duration of DR and serum DLL4 and CTRP5 were influencing factors for visual disability in DR (P<0.05). The joint of serum DLL4 and CTRP5 had a higher value in predicting visual disability in DR patients than single indicator prediction (ZDLL4 - joint=3.018, PDLL4 - joint=0.003; ZCTRP5 - joint=2.784, PCTRP5 - joint=0.005). Conclusion: Serum DLL4 and CTRP5 are elevated in DR patients, and are closely related to the disease condition. The joint detection of serum DLL4 and CTRP5 has high value in predicting visual disability in DR patients.

Abstract:Abstract Objective: To observe the clinical efficacy of preoperative comprehensive treatment in cataract patients with diabetes. Methods: 60 patients who were admitted to our hospital from May 2023 to December 2024 and were diagnosed as cataract complicated with diabetes by slit lamp microscopy, Schirmer test, clinical symptoms, laboratory tests, etc., and had different degrees of dry eye symptoms at the same time, were selected as the research objects. According to different preoperative dry eye treatment schemes, the patients were divided into two groups: the control group (30 cases) received only eye medication [artificial tears], and the experimental group (30 cases) received comprehensive preoperative dry eye treatment [artificial tears+meibomian gland clean massage+Chinese medicine fumigation+health guidance]. The tear film rupture time (BUT), corneal fluorescence staining (FL), ocular surface disease index (OSDI) score, tear river height (TMH) and non-invasive tear film rupture time (NIBUT) were compared between the two groups before and after 4 weeks of treatment, and the meibomian gland loss, tear film lipid layer thickness and basic eye symptoms were evaluated. Results: After 4 weeks of preoperative treatment, the BUT of the experimental group increased from (4.09± 1.13) s to (10.35± 1.46) s, and that of the control group increased from (4.15 ±1.05) s to (8.26 ±1.36) s, with significant differences between the two groups (t=5.737, P < 0.001). The FL score of the experimental group decreased from (6.83± 0.46) to (2.86± 0.38), and that of the control group decreased from (6.79 ±0.39) to (5.32±0.43), with significant difference between the two groups (t=23.480, P < 0.001). After 4 weeks of treatment, the NIBUT of the experimental group increased from (5.19 ±1.12) s to (9.36 ±1.47) s, and that of the control group increased from (5.21± 1.04) s to (7.18 ±1.25) s (t = 6.188, P<0.001). The proportion of thin tear film lipid layer in experimental group was significantly lower than that in control group (all P<0.05); The clinical symptoms of the eyes in both groups of patients decreased after treatment, and the experimental group was lower than the control group (both P<0.05). Conclusion: Pre operative dry eye comprehensive treatment can improve dry eye symptoms and tear film stability of cataract patients with diabetes from multiple dimensions, and provide an effective plan for perioperative management of cataract patients.

Abstract:Abstract Objective: To investigate the differences in morphological structure and retinal blood perfusion between the affected eye and the contralateral healthy eye in patients with idiopathic macular epiretinal membrane (IMEM) before and after surgery, and to evaluate the association of these parameters with functional and anatomical outcomes to inform prognostic assessment. Methods: A prospective, observational cohort study was conducted at Zhejiang Provincial People’s Hospital between January 2023 and December 2024. Thirty consecutive patients diagnosed with unilateral IMEM were enrolled; the fellow eye served as an internal control. All participants underwent standardized ophthalmic evaluations, including best-corrected visual acuity (BCVA), optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), and color fundus photography. Key quantitative parameters assessed included central macular thickness (CMT), foveal avascular zone (FAZ) area, vessel density in the inner capillary plexus (ICP), superficial capillary plexus (SCP), deep capillary plexus (DCP), and choroidal capillary perfusion area (CCPA). Measurements were obtained preoperatively and at 1 and 3 months postoperatively. Correlation analyses were performed between baseline and longitudinal imaging/functional metrics and postoperative BCVA and CMT. Results: At baseline, IMEM-affected eyes demonstrated significantly reduced BCVA, DCP density, and FAZ area, alongside significantly increased CMT and CCPA (P< 0.05), compared with contralateral controls. Following vitrectomy with membrane peeling, CMT decreased significantly at both 1 and 3 months (P < 0.05) postoperatively; BCVA improved significantly by 3 months, and DCP density showed partial but statistically significant recovery at 3 months (P < 0.05). No significant change in FAZ area was observed postoperatively (P > 0.05). Correlation analyses revealed that 3-month BCVA was negatively associated with 3-month CMT. Preoperative DCP density and FAZ area were negatively correlated with 1-month CMT, whereas preoperative CMT and 1-month ICP/SCP densities were positively correlated with 1-month CMT. Furthermore, 3-month CMT was negatively associated with preoperative DCP and positively associated with preoperative CMT. Conclusion:In patients with IMEM, the affected eyes exhibit significantly reduced DCP density and FAZ area, alongside increased CMT and CCPA. Following vitrectomy with membrane peeling, foveal thickness decreased progressively, DCP density demonstrated partial restoration, and BCVA improved gradually. Preoperatively, smaller CMT and larger DCP and FAZ were associated with more favorable surgical outcomes; postoperatively, smaller ICP/SCP densities—combined with a larger FAZ—also correlated with better functional recovery.

Abstract:Objective:To investigate the comorbidity status of myopia and depressive symptoms among middle school students, identify key influencing factors, and establish a prediction model, thereby providing empirical evidence for the comprehensive intervention of these two conditions.Methods: A total of 2,476 students from 3 middle schools in Feidong County were recruited between 2022 and 2024. Myopia was defined as uncorrected visual acuity ≤ 5.0 with spherical equivalent refraction < -0.50 diopters (D). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), with a score ≥ 16 indicating the presence of depressive symptoms. A database was established and data were entered using EpiData software. Pearson's chi-square test, multivariate Logistic regression analysis were performed to identify influencing factors and screen variables with R statistical software (version 4.5.2). Finally, a Stacking ensemble prediction model was constructed using Python 3.13 software. A Stacking ensemble learning prediction model was constructed based on the aforementioned analytical results.Results: The overall detection rate of myopia-depressive symptom comorbidity among the studied students was 14.54%. Univariate analysis showed that 26 variables were significantly associated with the comorbidity (all P < 0.05), including family structure, grade level, sugar-sweetened beverage intake, exercise frequency, school bullying, and parental physical or verbal abuse. Multivariate logistic regression analysis identified the following risk factors: higher grade levels (8th grade: OR = 1.9143, 95%CI: 1.1096–3.3024; 9th grade: OR = 1.7884, 95%CI: 1.0506–3.0444; 11th grade: OR = 2.1847, 95%CI: 1.198–3.984; 12th grade: OR = 3.4606, 95%CI: 1.825–6.5621), daily consumption of sugar-sweetened beverages more than once (OR = 3.1383, 95%CI: 1.7112–5.756), low frequency of moderate-to-vigorous exercise on weekends and holidays (mostly achievable: OR = 3.3115, 95%CI: 1.009–10.8685), alcohol consumption (OR = 4.4021, 95%CI: 2.7383–7.0766), daily sedentary time exceeding 10 hours (OR = 1.8594, 95%CI: 1.2141–2.8476), lack of puberty education (OR = 3.0098, 95%CI: 2.0659–4.3848), and exposure to parental physical or verbal abuse (OR = 2.405, 95%CI: 1.1484–5.0364). Protective factors included no experience of school bullying (OR = 0.0055, 95%CI: 0.0002–0.1602), no history of severe injury (OR = 0.3118, 95%CI: 0.1823–0.5332), outdoor activities during class breaks (OR = 0.1672, 95%CI: 0.0752–0.3719), and moderate after-school homework duration (2–3 hours per day: OR = 0.4802, 95%CI: 0.262–0.8801). The constructed Stacking prediction model demonstrated good discriminative ability, with an area under the receiver operating characteristic curve (AUC) of 0.855, a sensitivity of 81.5%, and a specificity of 74.0%. Key predictive factors included alcohol consumption status, location of recess activities, unhealthy lifestyle composite index (interaction term between sedentary duration and sugar-sweetened beverage intake frequency), academic stress index (interaction term between sedentary duration and homework duration), and after-school homework duration.Conclusion: The comorbidity of myopia and depression among middle school students is jointly influenced by multiple factors such as lifestyle, academic pressure, and family/campus environment. It is advocated to implement a three-level intervention system that includes restricting the sale of sugar-sweetened beverages, conducting psychological screening for sedentary students, and carrying out family-school-medical collaborative management of drinking behaviors. This model can be applied to school health screening and the early identification of high-risk groups in community adolescent health management. It is suitable for middle school students in regions with similar economic levels, but not applicable to students receiving special education or those with severe organic diseases.

Abstract:Diabetic retinopathy (DR) remains the leading cause of vision impairment in patients with diabetes. Current anti-vascular endothelial growth factor (VEGF) therapies are limited by inadequate response in some patients and the necessity for repeated intravitreal injections, underscoring the urgent need for novel therapeutic targets. Angiopoietin-like protein 4 (ANGPTL4), a multifunctional secreted protein, has emerged as a critical regulator in the pathogenesis and progression of DR, positioning it as a promising interventional target. This review systematically elaborates on the biological characteristics of ANGPTL4, with a focus on its expression dynamics, molecular mechanisms, and regulatory networks in the development of DR. Furthermore, we discuss the prospects of ANGPTL4-targeted therapeutic strategies, aiming to offer new insights and directions for understanding DR pathogenesis, advancing multi-target drug development, and improving clinical management.

Abstract:Myopic traction maculopathy (MTM) is a common vision-threatening complication in patients with high myopia. With the global increase in high myopia, the prevalence of MTM has been rising worldwide, leading to a growing burden of disease, economic costs, and social impact. The emergence and development of optical coherence tomography (OCT) have provided robust technical support for the staging of MTM. Based on the evolving understanding of its pathological mechanisms and natural course, various staging systems have been proposed and applied in clinical practice, offering crucial guidance for the personalized management of MTM patients. Additionally, innovations and refinements in surgical techniques and materials, such as pars plana vitrectomy (PPV), posterior scleral reinforcement, and macular buckling (MB), have expanded the therapeutic options for MTM. This article systematically reviews the staging systems and treatment strategies for MTM, focusing on the role of OCT-based staging in guiding individualized treatment plans. It also summarizes the current evidence on the efficacy and safety of existing and emerging surgical approaches, including PPV, MB, and their combined procedures. The review further proposes that future research should focus on developing predictive models integrating multimodal data to clarify surgical timing and indications, as well as conducting large-scale, multicenter randomized controlled trials to explore the selection of PPV, MB, or combined surgeries. The review aims to discuss personalized treatment for MTM, providing theoretical foundations and practical directions for optimizing clinical management for MTM patients.

Abstract:Thyroid hormone (TH) is an iodine-containing tyrosine derivative secreted by the thyroid gland, which can promote glycolipid metabolism and participate in various physiological and pathological processes of the body by regulating biological behaviors such as cell proliferation, differentiation, and apoptosis. Recent studies have found that abnormal expression of TH in eye tissues such as the orbit, retina, and sclera can affect the differentiation of soft tissue fat in the orbit, the oxidative stress of the retina, and the degradation of extracellular matrix (ECM) of posterior scleral cells, thereby participating in the occurrence and development of eye diseases such as Graves' ophthalmopathy (GO), age-related macular degeneration (AMD), diabetic retinopathy (DR), and myopia. This article reviews the mechanism of action of TH in ophthalmic diseases and related research progress, with the aim of providing theoretical basis for the prevention and treatment of ophthalmic diseases.

Abstract:Retinoblastoma is the most common primary intraocular malignancy in infants and young children, posing a serious threat to both vision and life. It is generally classified into heritable and non-heritable forms. Studies have shown that retinoblastoma cells most likely originate from cone precursor cells, and their development is closely associated with the inactivation of the RB1 gene. In addition to RB1, other genes such as MYCN, TP53, and PRMT1 are also involved in the initiation and progression of retinoblastoma. Dysregulation of multiple signaling pathways, including RB/E2F, WNT, and PI3K/AKT, collectively drives tumor cell survival, proliferation, invasion, and metastasis. The treatment of retinoblastoma has evolved from a primary emphasis on enucleation to a comprehensive and individualized approach that prioritizes globe preservation and visual protection, incorporating local therapies, chemotherapy, and radiotherapy. Novel therapeutic strategies such as targeted therapy, immunotherapy, and gene therapy are also under active investigation. In recent years, long non-coding RNAs (lncRNAs), as key regulators of gene expression, have gained increasing attention for their roles in the pathogenesis of retinoblastoma. They show promise as novel diagnostic biomarkers and may provide new insights and strategies for the treatment of the disease. This review summarizes the research progress in the areas outlined above.