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:Abstract Objective 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 20 XT patients and 10 healthy controls. Comprehensive bioinformatics analyses were conducted, including the identification of oxidative stress-related differentially expressed genes (OSRDEGs), functional enrichment analysis (Gene Ontology and Kyoto Encyclopedia of Genes and Genomes), protein-protein interaction (PPI) network construction, and receiver operating characteristic (ROC) curve analysis. Key hub genes were validated using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Results 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 (0.7 < AUC < 0.9). RT-qPCR validation confirmed the significant differential expression of?TNF,?CD4, and?IL6. Conclusion This study highlights the role of oxidative stress in the pathogenesis of concomitant exotropia. The identified hub genes provide new directions for investigating the molecular mechanisms underlying concomitant exotropia.

Abstract:Objective: 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 prediction model based on the influencing factors, so as to provide reference for clinical individualized treatment.Method: A retrospective analysis was conducted on the clinical data of 1250 DR patients (1250 eyes) who received anti VEGF treatment in the hospital from July 2022 to August 2025. The patients were randomly divided into a training set (n=875) and a validation set (n=375) 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 month 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. The correction curve and the receiver operating characteristic (ROC) curve were drawn to verify and evaluate the model. The decision curve was adopted to evaluate the actual clinical benefits of the nomogram model.Result: There was no statistical significant difference in the general information of patients between the training set and the validation set (P>0.05). Multivariate Logistic regression analysis showed that the classification of diabetic macular edema (DME) - serous retinal detachment, macular fovea retinal thickness (CMT) before treatment, best corrected visual acuity (BCVA) before treatment, destruction 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 (OR>1, P<0.05). A nomogram risk model was drawn 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 drawn. 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 validation set thresholds within the range of 0.06 to 0.99 was greater than 0.Conclusion: DME classification serous retinal detachment, 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 column chart risk prediction model constructed based on this has high predictive power and can provide reference for the early development of targeted intervention strategies in clinical p

Abstract:Objective: To analyze the clinical efficacy of basic fibroblast growth factor (bFGF) eye drops combined with fluorometholone eye drops in the treatment of severe dry eye syndrome with corneal injury. Method: A retrospective analysis was conducted on 104 patients (104 eyes) 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, they were divided into two groups: a control group of 50 eyes were treated with conventional artificial tears and fluorometholone eye drops; 54 eyes in the observation group were treated with conventional artificial tears+bFGF eye drops combined with fluorometholone eye drops for a course of 8 weeks. The ocular surface disease index (OSDI), tear film rupture time (BUT), corneal fluorescein sodium staining (FL) score, and tear inflammatory factors [interleukin-1 β (IL-1 β) and interleukin-18 (IL-18)] were compared between the two groups before and 4 and 8 weeks after treatment. Statistics on the occurrence of adverse reactions in the eyes of two groups during the treatment period. Result: After 4 and 8 weeks 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<0.001). The OSDI, FL, and IL-1 β 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 bFGF eye drops and fluorometholone eye drops can effectively improve dry eye symptoms in patients with severe dry eye syndrome and corneal injury, improve tear film stability and corneal injury repair, and inhibit ocular surface inflammation, with acceptable safety.

Abstract:Aim：Observation on two different surgical methods in treating lens subluxation of varying degrees with cataracts. Methods: Prospective observational study. A total of 40 patients with lens subluxation complicated by cataracts who were treated in Yulin Hospital of Traditional Chinese Medicine from May 1, 2021 to April 30, 2024 were included in the study. The surgical method was determined according to the range of zonular abnormalities or injuries. If the zonular abnormality or injury range is ≤6 clock hours and the capsular bag is intact and stable with no aggravation of the zonular injury after completion of phacoemulsification, the triple procedure of phacoemulsification and lens aspiration combined with capsular tension ring (CTR) implantation plus intraocular lens (IOL) implantation is adopted (CTR group); if the zonular abnormality or injury range is ＞6–9 clock hours, or if the stability of the lens capsular bag is poor and the zonular injury range is aggravated during the operation, phacoemulsification and lens aspiration combined with scleral-sutured intracapsular IOL fixation is performed (Suture group). The uncorrected visual acuity, best-corrected visual acuity, spherical equivalent, intraocular pressure, corneal endothelial cell count, anterior chamber depth and complications of all patients were recorded at 1 month, 3 months, 6 months and 12 months after surgery, respectively. Results: A total of 40 cases (40 eyes) were included in study, including 21 cases (21 eyes) in CTR group (aged 60.62±1.65 years, 15 males and 6 females) and 19 cases (19 eyes) in Suture group (aged 64.26±1.69 years, 15 males and 4 females).Based on preoperative and intraoperative evaluations, there were 21 cases in the CTR group and 19 cases in the Suture group. The median range of zonular injury in the CTR group was 4.0 (2.5) clock hours, while that in the Suture group was 7.0 (1.5) clock hours (P＜0.001). 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 months after surgery (t=0.24, P=0.81). There was no significant difference in the spherical equivalent between the two groups 12 months after surgery (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, the postoperative IOL horizontal tilt was 3.06°±1.47°, and the IOL horizontal decentration was 0.25±0.10 mm, both of which were significantly smaller than those in the Suture group (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 transscleral sutured intrascleral IOL fixation is performed. Both approaches can achieve favorable postoperative outcomes. Comprehensive preoperative and intraoperative evaluations help determine the appropriate surgical method.

Abstract:Objective: To compare the differences in postoperative tear inflammatory mediator levels and ocular surface health recovery between transepithelial photorefractive keratectomy with smart pulse technology (SPT-TPRK) and femtosecond laser-assisted laser 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 (30 patients, 60 eyes) and an FS-LASIK group (30 patients, 60 eyes) based on the surgical procedure. Tear samples were collected preoperatively and at 1 week, 1 month, 3 months, and 6 months 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: At 1 week 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 month postoperatively and were lower in the SPT-TPRK group than in the FS-LASIK group at 3 and 6 months 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 week 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). From 1 month postoperatively onwards, no statistically significant differences were observed in BUT or OSDI scores between the two groups (all 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 < 0.05). Conclusion: Both SPT-TPRK and FS-LASIK induce elevated inflammatory mediator levels and decreased ocular surface function postoperatively. SPT-TPRK is associated with a more intense but rapidly resolving early inflammatory response, whereas FS-LASIK results in a more pronounced and persistently elevated NGF response. Postoperative tear film stability and subjective discomfort in patients undergoing SPT-TPRK and FS-LASIK are closely correlated with inflammatory mediator levels.

Abstract:Secondary macular edema following cataract surgery in diabetic patients is a critical 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 superimposed 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: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: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 methods, which depend on manual interpretation of fundus images by ophthalmologists, face 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 examines key challenges in current applications, such as data quality, model interpretability, system integration, and obstacles to clinical translation. Finally, future directions are discussed, including the development of lightweight models, multi-disease joint prediction, and the establishment of interdisciplinary collaborative frameworks, with the aim of supporting the clinical adoption of DL-based DR screening.