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International Eye Science—IES (Guoji Yanke Zazhi, ISSN:1672-5123) is a Chinese-English-mixed Ophthalmological publication indexed in Scopus, EMBASE, CA, IC, WPRIM of WHO, Chinese Core Journals, and China Core Periodical of Science and Technology. Its CST JCR IF in 2019 is 1.628, monthly.

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Research Progress of retinal microvascular fractal analysis in ophthalmic diseases

Mengke Liu, Zhengwei Zhang

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A fractal is a geometric structure whose constituent parts exhibit self-similarity with the whole at different scales. The branching pattern of the retinal vascular system demonstrates such fractal characteristics. With the widespread adoption of optical coherence tomography angiography (OCTA) in recent years, the application of fractal analysis has expanded to include the study of retinal microvasculature networks. This analytical approach has proven valuable in providing reference indicators for early diagnosis of both ocular and systemic diseases. Fractal dimension (FD), a measure reflecting the overall complexity of the retinal vascular system, has been demonstrated to correlate significantly with the onset and progression of various ocular and systemic conditions. This review summarizes recent advances in the assessment of retinal microvascular fractal characteristics using OCTA across several ocular diseases, including diabetic retinopathy, glaucoma, age-related macular degeneration, and high myopia.
Identification of active ingredients and possible mechanisms of YiJing Decoctionin treating DR based on LC-MS and network pharmacology

LUOLimei, HUANG Ting, ZHENG Yongzheng

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Objective This study aims to investigate the main active ingredients and potential mechanisms of YiJing Decoction in the treatment of early diabetic retinopathy.Methods Liquid-mass spectrometry technology was utilized to identify the active components of YiJing Decoction. By analyzing the ADME attributes, the primary active ingredients in YiJing Decoction were identified. Through the application of network pharmacology, potential targets for treating diabetic retinopathy with YiJing Decoction were determined. This was further enhanced by protein interaction (PPI) and gene ontology (GO) analysis. Subsequently, set analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway analysis were employed to forecast the key targets and networks involved in using YiJing Decoction to treat diabetic retinopathy. Finally, the identified core targets and pathways were validated.Results YiJing Decoction contains a total of 46 main active ingredients. The main active ingredient-core target network consists of 44 targets and 667 edges.The core targets of the PPI network include TNF, Alb, EGFR, STAT3, PTGS2, ESR1, PPARG, MMP9, TLR4, MAPK, and others.KEGG pathway analysis indicates that YiJing Decoction 's treatment of diabetic retinopathy primarily involves cancer signaling pathways, fluid shear stress, atherosclerosis, and neurodegeneration. The biological processes in these organisms mainly involve the regulation of inflammatory response, positive regulation of programmed cell death, and positive regulation of cell migration. Results from Western blot experiments confirmed that YiJing Decoction can inhibit the activation of STAT3 and ERK in a high-glucose environment in vitro.Conclusion The pharmacodynamic material basis of YiJing Decoction and its potential multi-component, multi-target, and multi-pathway pharmacological effects have been elucidated. It is hypothesized that the mechanism underlying its potential treatment of diabetic retinopathy may involve the inhibition of fundus inflammation by regulating multiple signaling pathways. This reaction is thought to be linked to the protection of endothelial cells, maintenance of the blood-retinal barrier, and repair of retinal neurovascular damage.
The effect of the relationship between scotopic pupil and optical zone diameter on visual quality after SMILE

zhongwenqian, Lu Zhenzhang, An Ning, Chen Yile, Li Jingying

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Objective：This study aims to investigate the relationship between scotopic pupil and optical zone on short-term subjective and objective visual quality following small incision lenticule extraction (SMILE). Methods：In this prospective cohort study, 98 patients (196 eyes) who underwent SMILE surgery from September 2021 to June 2022 were included. Participants were divided into two groups based on the ratio of scotopic pupil diameter to optical zone diameter: Group A (ratio > 1, 70 eyes), and Group B (ratio ≤ 1, 126 eyes). We assessed uncorrected visual acuity (UCVA), spherical equivalent (SE), subjective visual quality via a questionnaire, and total corneal high-order aberrations (corn-tHOA), as well as corneal spherical (corn-SA), coma (corn-COMA), and trefoil (corn-Tre) aberrations. The objective scatter index (OSI) was measured with central diameters of 4mm, 6mm and 8mm. Data were recorded preoperatively and at one month, three months postoperatively. The differences in refractive status, visual quality indexes between groups at various time points were analyzed and compared. Results：No significant differences in UCVA and SE were observed between the two groups at one month and three months postoperatively. Significant differences were noted in total corneal high-order aberrations at one month, as well as in total corneal high-order aberrations and spherical aberrations at three months. At three months after surgery, the most commonly reported symptoms in Group A were glare , starburst , hazy vision , and halo . In Group B, the most common symptoms were hazy vision, halo, starburst , and glare. Statistically signigicant differences were observed in the severity of glare and fluctuation between groups before and three months after surgery. However, there were no significant differences in the severity of halo, starburst, blurred vision, double vision, or focusing difficulty. Conclusion：When the diameter of dark pupils exceeds the optical region, SMILE may augment the postoperative corneal aberration, which is manifested in the increase of high-order corneal Aberrations within the postoperative cornea-centered 8mm range, the elevated incidence of postoperative glare, the severity of glare and visual fluctuation symptoms. However, the symptoms are mild and fall within the safe range.
Defocusing state and myopia control of single focus, defocus and orthokeratology in myopic children in a multispectral refraction topography

maoxinyao, lin jiang, wangrui, zhoushiping, fuxuemei, wangqiong, zengxuemei

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Abstract Objective: To observe the defocus state and myopia control in myopic children wearing single-vision, defocus, and orthokeratology lenses using a multispectral refraction topography (MRT). Methods: This clinical retrospective study involved 290 myopic patients aged 8–14 years old with an equivalent spherical lens (SE) of ?7.00D to ?0.50D, treated at the Aier Eye Hospital of Chengdu from June 2022 to December 2023. Patients who volunteered for the study, were assigned to three groups A total of 97 patients were provided with single-vision spectacle lenses (SVL group), 95 received individualized ocular refraction customization (IORC group), and 98 orthokeratology lenses (OK group). Simultaneously, the three groups were further categorized into low (?3.00D to ?0.50D), moderate (?6.00D to ?3.25D), and high myopia (?7.00D to ?6.25D) groups according to their degree of SE (the right eye was selected as test eye). We used a multispectral refraction topography (MRT) to compare the defocus changes of the retina in four quadrants (upper, lower, nasal, temporal quadrants (RDV-S, RDV-I, RDV-N, RDV-T) and three eccentric regions (0~15o, 15o~30o, 30o~45o, RDV-15, RDV-30, RDV-45) in the three groups. A one-way analysis of variance was used for intergroup comparisons and a paired t-test was used for intragroup comparisons. Univariate and multivariate linear regression analyses were used to analyze the factors related to changes in the AL at one year after intervention. Results: There was a significant difference in 1-year equivalent spherical lens and axial length growth among patients in the SVL, IORC, and OK groups before and after intervention (P < 0.05). The pairwise comparison of 1-year equivalent spherical lens and the difference of ocular axis growth in patients with low myopia was significantly different among SVL, IORC, and OK groups (P <0.05); however, there was no significant difference between the IORC and OK mirror groups (P >0.05). Further, there were significant differences between moderate myopia treatment 1 a (P < 0.05), and high myopia (HM) interval treatment 1 a, OK lens group compared with the IORC and SVL groups, (P < 0.05), whereas the IORC and SVL groups showed no significant differences (P > 0.05). In addition, there were significant differences in the four quadrants and three eccentric regions RPRE among myopia groups (P < 0.05). Pin-wise comparison of the growth difference of 1 a eccentric D-RDV-15 in low myopia group showed significant differences between the SVL, IORC, and OK groups (P < 0.05), but no significant differences between the IORC and OK groups (P > 0.05). Moderate myopia interval treatment 1a eccentric D-RDV-30 in the SVL group was compared with that of IORC and OK groups. The difference was statistically significant (P < 0.05).Further the IORC and OK groups showed no significant differences (P > 0.05); the high myopia treatment 1 a eccentric D-RDV-15, there was a significant difference among OK, IORC, and SVL groups (P < 0.05) but there was no significant difference between the IORC and SVL groups (P > 0.05). Univariate and multivariate linear regression model analysis showed that the changes in D-TRVD, D-RDV-45, RDV-N, and D-RDV-I correlated with the increase in the difference in 1a AL. Conclusion: MRT can be used to guide the clinical control of myopia. Myopia development is related to the peripheral retinal defocus state, and the difference of defocus quantity in the inferior nasal side at 30o~45o eccentricity may be a factor regulating the rapid progression of myopia.
Risk Factors and Nomogram Model Construction for Type 2 Diabetes Mellitus Secondary to Dry eye syndrome

Zhou Wen, PingGongXun

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Objective: To investigate the risk factors for dry eye syndrome secondary to type 2 diabetes mellitus (T2DM) and to develop a nomogram model for early risk prediction.Methods: A total of 347 T2DM patients treated in our hospital between March 2020 and April 2024 were enrolled and randomly divided into training and validation sets at a 7:3 ratio. Demographic data, glycemic parameters, and clinical treatments were compared between non-dry eye syndrome (control group) and dry eye syndrome to type 2 diabetes mellitus (dry eye group) in the training set. Statistically significant indicators were incorporated into multivariate logistic regression to identify independent predictor for secondary dry eye. These factors were then used to construct a nomogram model using R software, which was subsequently validated using the validation set. Results: The percentage of patients with secondary dry eye syndrome in 242 cases of T2DM was 64.46% (156/242). Multifactorial logistic regression revealed that blood glucose variability, glycosylated serum protein, retinopathy, meibomian gland functional status, duration of T2DM, and meibomian gland opening blockage belonged to the independent predictor for secondary dry eye (OR > 1, P < 0.05). A column-line graph prediction model was constructed based on the above six indicators, and the area under the ROC curve was verified to be 0.994 (95% CI:0.989~0.999) and 0.990 (95% CI:0.977~0.999), respectively. The slopes of the calibration curves were similar, as tested by the Hosmer-Lemeshow test χ2 = 1.461, 1.566, P = 0.993, 0.992. The column-line graphical model could provide good utility for clinical decision-making.Conclusion: Glycemic variability, glycated serum protein, retinopathy, meibomian gland dysfunction, T2DM duration, and meibomian gland orifice obstruction significantly increase the risk of dry eye secondary to T2DM. The constructed nomogram model serves as a valuable tool for early risk assessment and intervention, potentially improving patient outcomes. Future studies should validate this model across diverse populations and clinical settings.
Research development of animal models for viral ocular diseases

Zhang Shuang, Tao Yong

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With the application and popularization of the polymerase chain reaction, many ocular diseases with unknown etiology in the past have been confirmed to be related to viral infections; From the classic herpes simplex keratitis to the cytomegalovirus intraocular infection which is gradually recognized by people at present, various viral ocular diseases have received increasing clinical attention. Ocular viral infections are complicated with various types of viruses causing different clinical manifestations. Since it is difficult to obtain corresponding tissue specimens from patients with viral ocular diseases, establishing an effective animal model is a crucial foundation for studying the characteristics of the disease course, the pathogenesis, and the pre-clinical evaluation of drugs. Based on the literature on animal models related to viral ocular diseases in recent years, this paper comprehensively summarizes the animal models of various diseases from the anterior segment to the posterior segment of the eye caused by different viruses and introduces in detail the types of viruses, viral loads, and the methods of virus challenge on various models; Besides, it conducts a comparative evaluation from multiple dimensions such as the model stability, advantages and disadvantages of the models, and their application situations, so as to provide a basis for subsequent basic research on related diseases and drug transformation.
Correlation between axial length and eye damage in children and adolescents

Zeng Chengjie, Yang Qian, Meng Xiangjun

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Myopia has become a common eye disease in China and around the world. The myopia rate among children and adolescents in China has been continuously increasing, and it shows the characteristics of younger age and higher severity, seriously threatening eye health. According to recent studies, myopia is closely related to the axial length of the eye. During the progression of myopia, the excessively long eye axis would lead to changes in ocular structure like the sclera, retina, and choroid etc., thereby increasing the onset risk of diseases such as posterior staphyloma of the sclera and retinal detachment, and ultimately resulting in severe vision impairment. By reviewing the related literature at home and abroad in recent years, the paper systematically sorted out the relationship between the changes in axial length of the eye and fundus damage, discussed deeply the interacting mechanisms of the two, aiming at providing reference for the prevention and treatment of myopia in children and adolescents, with the expectation of reducing the occurrence of complications of myopic fundus lesions, which has important practical significance for protecting the eye health of children and adolescents.
Concepts and advances of apparent accommodation

TANG Li, WANG Chenjing, YUE Hongyun

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Apparent accommodation originates from the residual accommodation function after the absence of classic lens accommodation, serving as a critical theoretical framework in the study of visual function after refractive cataract surgery. Different from Von Helmholtz’s theory, which focuses on lens deformation, it evaluates the overall accommodation capability of the eye excluding the lens, with its mechanisms remaining debated. Apparent accommodation refers to the character that pseudophakic eyes retain a certain degree of refractive accommodation after natural lens removal or intraocular lens (IOL) implantation, despite the loss of physiological accommodation. Integrating both subjective and objective examination methods is crucial for understanding apparent accommodation, which not only advances the study of depth perception but also provides insights into binocular visual coordination in pseudophakic eyes. This paper systematically reviews the historical development of apparent accommodation and the advances in assessment techniques, which have gradually contributed to the re-evaluation and expansion of classical theories of physiological accommodation. Recent studies attempt to decipher the synergistic effects between pupil, corneal, and central cognitive processing by integrating optical parameter measurements with neural adaptation. This reflects a shift in the field from a singular anatomical explanation to a more interdisciplinary and multi-dimensional model.
Yinqiao Powder Affects Macrophage Polarization-Mediated Herpes Simplex Keratitis through the cGAS-STING-IRF3 Molecular Pathway

Yao Ning, Zhao Rongli, Yang Xuemei, Liu Yuhuan, Ding Yaqin, Dai Yan

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Objective: This study aimed to investigate the specific molecular mechanism of Yinqiao Powder in affecting macrophage polarization in herpes simplex keratitis (HSK) through the cyclic GMP-AMP synthetase (cGAS)-stimulator of interferon genes (STING)-Interferon regulatory factor 3 (IRF3) molecular pathway. Methods: Human corneal epithelial cells (HCE-T) were divided into control, HSK, and HSK + Yinqiao Powder groups. Cell viability was detected by MTT assay, and apoptosis was detected by TUNEL assay. M0 macrophages were grouped as Ctrl, HSV-1, HSV-1 + oe-cGAS, HSV-1 + Yinqiao Powder, and HSV-1 + oe-cGAS + Yinqiao Powder. ELISA was used to detect the concentrations of Arg-1 and iNOS in cell supernatants, and Western blotting was used to detect the relative protein expressions of cGAS, STING, and IRF3. Conditional medium (CM) from each group of M0 macrophages was collected to intervene in HCE-T cells and divided into Ctrl-CM, HSV-1-CM, HSV-1 + oe-cGAS-CM, and HSV-1 + Yinqiao Powder-CM groups. MTT assay was used to detect cell viability, and TUNEL assay was used to detect apoptosis. Balb/c mice were divided into control, model, and drug groups. The model and drug groups were inoculated with HSV-1 on the cornea of Balb/c mice using the corneal scratch method to construct an HSK mouse model, and the drug group was treated with Yinqiao Powder. The incidence and mortality of the three groups were compared on days 1, 3, 5, 7, and 14 after modeling. ELISA was used to detect the levels of Arg-1 and iNOS in the serum of the three groups, and Western blotting was used to detect the protein expressions of cGAS, STING, and IRF3 in corneal tissues. Results: Compared with the control group, the HCE-T cell viability in the HSK group was decreased but apoptosis was increased, which was reversed by Yinqiao Powder intervention. Compared with the Ctrl group, the Arg-1 concentration in the cell supernatant of the HSV-1 group was decreased, the iNOS concentration was increased, and the protein expressions of cGAS, STING, and IRF3 were decreased. Compared with the HSV-1 group, the Arg-1 concentration was increased, the iNOS concentration was decreased, and the protein expressions of cGAS, STING, and IRF3 were enhanced in the HSV-1 + oe-cGAS group and the HSV-1 + Yinqiao Powder group, and the same results were obtained in the HSV-1 + oe-cGAS + Yinqiao Powder group. Compared with the Ctrl-CM group, the HCE-T cell viability was decreased and apoptosis was increased in the HSV-1-CM group, which was reversed by overexpressing cGAS in macrophages or intervening with Yinqiao Powder. In vivo experiments found that Yinqiao Powder intervention could improve the pathological progression of keratitis. Conclusion: Yinqiao Powder inhibits M1 polarization of macrophages through the cGAS-STING-IRF3 molecular pathway, thereby delaying the progression of HSK.

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Virtual reality technology in ocular trauma teaching for medical students

Zheng Chao, Ma Jiyuan, Zhang Guoheng, Fei Fei, Sun Jiaxing, Zhang Shuai, Zhou Jian, Dou Guorui

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AIM：To explore the application effect of Virtual Reality (VR) technology in the teaching of ocular trauma for medical students. METHODS：In this study, 90 medical students who participated in the teaching practice of Ophthalmology between November 2022 and April 2024 were included as trainee subjects. Using a test-control method, 45 students in the test group participated in traditional classroom ocular trauma theory lectures combined with VR virtual simulation experiments, and 45 students in the control group participated in traditional classroom ocular trauma theory lectures only. After the teaching practice, the two groups were compared in terms of their theoretical assessment scores, learning ability (Self-Directed Learning Rating Scale evaluated), questionnaire surveys on satisfaction with the quality of teaching, and statistical analyses using t-test or chi-square test. RESULTS：The theoretical knowledge and case analysis scores of the trainees in the test group were significantly higher than those of the control group, and the differences were statistically significant [theoretical knowledge scores, (57.27±2.78) versus (53.91±3.20), and case analysis scores, (35.71±3.73) versus (32.67±5.52), both P<0.05]. The self-directed learning scale scores of the participants in the test group were higher than those of the control group (P<0.05), and the satisfaction with teaching quality of the participants in the test group was higher than that of the control group (P<0.05). CONCLUSION：VR-enabled teaching of ocular trauma can effectively improve medical students" mastery of basic knowledge and practical skills, enhance students" self-directed learning ability and improve teaching satisfaction.

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Clinical analysis of 112 cases of giant papillary conjunctivitis in contact lenses wearers

Rui-Bo Zhao, Jian-Jun Li

Abstract: (17229) HTML (0) PDF (225.96 KKB) (1742)

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AIM:To investigate giant papillary conjunctivitis patients who can not be divorced from contact lenses change to frequent replacement type contact lenses and rigid gas permeable contact lenses and observe the condition of giant papillary conjunctivitis with or without changes.And to investigate the efficacy of desensitizing agents at the same time.METHODS:Totally 112 cases(208 eyes) who were diagnosed with giant papillary conjunctivitis in our center were randomly divided into four groups:Group 1(Ⅰ group) of 68 eyes were treated with frequent replacement type contact lenses combined with mingmuqing eye drops;Group 2(Ⅱ group)of 56 eyes were treated with frequent replacement type contact lenses combined with desensitizer eye drops;Group 3(Ⅲ group) of 52 eyes were treated with rigid gas permeable contact lenses combined with mingmuqing eye drops;Group 4(Ⅳ group)of 32 eyes were treated with rigid gas permeable contact lenses combined with desensitizer eye drops.RESULTS:Condition of giant papillary conjunctivitis patients in all the 4 groups were significantly improved,data of 4 groups were no statistically significant difference(P>0.05).CONCLUSION:The giant papillary conjunctivitis caused by contact lenses wearing can get effective control and cure of the disease without affecting wearing of contact lenses if the replacement of rigid gas permeable contact lenses or frequent replacement type contact lenses can be introduced timely.
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Effect of anti-vascular endothelial growth factor therapy on intraocular inflammatory cytokine levels in the treatment of proliferative diabetic retinopathy

Jin-Xiu Luo, Zi-Zhong Hu, Qing-Huai Liu, Yuan Fang

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AIM: To explore the effects of anti-vascular endothelial growth factor(VEGF)agents(Conbercept)before pars plana vitrectomy(PPV)on inflammatory cytokine levels of patients with proliferative diabetic retinopathy(PDR).
METHODS: A total of 49 patients(49 eyes)who diagnosed with PDR at the First Affiliated Hospital with Nanjing Medical University from June 2017 to January 2018 were recruited and randomly divided into two groups. A total of 25 cases(25 eyes)who did not receive intravitreal injection before PPV were included in no-intravitreal injection of Conbercept(IVC)group, and 24 cases(24 eyes)who received IVC 5～7d before PPV were included in IVC group. The vitreous samples were collected from all the patients at the start of PPV. Levels of VEGF-A, monocyte chemotactic protein-1(MCP-1)and inflammatory cytokines in the vitreous humor were measured using Luminex technology.
RESULTS: Compared with the no-IVC group, the level of VEGF-A decreased significantly(P<0.001), the concentration of IL-6(P=0.004), IL-8(P=0.002), IL-18(P=0.04)and TNF-α(P=0.03)increased remarkably in the IVC group. The other inflammatory cytokines in the vitreous humor showed no significant difference between the IVC and no-IVC groups.
CONCLUSION: IVC before PPV can effectively decrease the concentration of VEGF-A, but had limited influence on the level of inflammatory cytokines in the vitreous humor of patients with PDR.
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Selection of intraocular lens calculation formula for cataract surgery in glaucoma patients

He-Lin Zhu, Jian Zhang, Hong Yan

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Glaucoma and cataracts are the leading causes of blindness, and surgery is an important treatment option. Patients with glaucoma have clinical characteristics such as high intraocular pressure, shallow anterior chamber and short axial length, and the ocular structure is often altered after anti-glaucoma surgery like trabeculectomy. These changes also lead to differences in the accuracy of intraocular lens(IOL)refractive calculation between cataract surgery after anti-glaucoma surgery or combined glaucoma and cataract surgery and alone cataract surgery. Meanwhile glaucoma patients' individual clinical characteristics and structural changes caused by anti-glaucoma surgery have shown differences in the impact on the predictive accuracy of IOL diopters and the type of refractive drift. This article reviews the latest research advances in the causes of refractive error(RE), the characteristics of refractive drift, and the selection of the most appropriate IOL formula for glaucoma patients undergoing cataract surgery or cataract surgery after anti-glaucoma surgery or combined glaucoma and cataract surgery.
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Current situation and prospect of minimally invasive glaucoma surgery in childhood glaucoma

Xiao-Jie Zhou, Ren-Yi Wu

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Childhood glaucoma is a kind of refractory glaucoma. Minimally invasive glaucoma surgery(MIGS)provides a safe and effective treatment option for childhood glaucoma. Most of the published studies tend to be with circumferential ab interno trabeculotomy, showing that its safety and effectiveness in the treatment of childhood glaucoma are comparable to non-MIGS circumferential ab externo trabeculotomy. Studies on KDB, trabectome and Xen-gel stent are relatively limited, but they may have advantages in some specific cases. While considering the advantages of each MIGs operation, it is also necessary to weigh the long-term effect of each operation method. In addition, more prospective and comparative researches, larger sample size and longer follow-up time are needed to verify the safety and effectiveness of MIGs in the treatment of childhood glaucoma.
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Clinical efficacy of femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation

Lei Guo, Xian-Jun Liang, Xi-Qiao Zhang, Yan-Xue Xu, Ying-Jie Lin

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AIM: To evaluate the clinical efficacy of femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation.
METHODS:The retrospective study enrolled 22 cases(26 eyes)of cataract patients who underwent femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation from August 2020 to August 2021. Follow-up to 3mo after surgery, the changes of far, intermediate and near visual acuity, aberration, Strehl ratio(SR)and modulation transfer function cutoff(MTF-cutoff)frequency were compared. Defocus curve at 1mo postoperatively was made, and the visual quality and satisfaction were evaluated after 3mo of surgery.
RESULTS: The visual acuity of all patients was better than 0.1(LogMAR)at the far, intermediate and near distance at 1d, 1wk, 1 and 3mo postoperatively, and it was significantly improved compared with those before surgery(all P<0.01). The defocus curve transitioned smoothly between +0.5 and -3.0D at 1mo after surgery, and visual acuity was better than 0.63. The total aberration and spherical aberration in the whole eye were significantly lower after surgery than before, and the SR and MTF-cutoff were significantly improved at 1d and 1wk after surgery(all P<0.05). With high satisfaction and good visual quality, patients could watch at far, intermediate and near distance without wearing glasses at 3mo after surgery.
CONCLUSION: Femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation gave patients a comfortable and satisfactory full-course vision.
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Pars plana vitrectomy combined with inverted internal limiting membrane flap technique for treating macular hole retinal detachment in high myopia

Wen-Kui Zhu, Wen-Shuai Li, Pei-Shan Xu

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AIM: To investigate the clinical efficacy of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane flap technique in the treatment of macular hole retinal detachment(MHRD)in high myopia.
METHODS: A retrospective clinical study was conducted. A total of 63 patients(64 eyes)with high myopia and MHRD who treated at our hospital from October 2017 to October 2021 were selected as research subjects. They were divided into two groups according to different surgery, with 34 cases(35 eyes)who received PPV combined with inverted internal limiting membrane flap technique in group A, and 29 cases(29 eyes)received PPV combined with internal limiting membrane peeling in group B. The patients were followed up for 6mo. The two groups were compared in terms of the hole closure rate, the reduction rate of retinal detachment and best corrected visual acuity(BCVA)before operation and at 1wk, 1, 3 and 6mo after operation, and the postoperative complications were recorded.
RESULTS: The hole closure rate within 6mo after operation was significantly higher in group A than in group B(P<0.05), but there was no statistically significant difference in the reduction rate of retinal detachment(P>0.05). The BCVA of the two groups was significantly improved over time after operation(P<0.05). There was no statistically significant difference in BCVA between the two groups before operation and at 1wk, 1, 3 and 6mo after operation(P>0.05). Complications were observed in the two groups, but there was no statistically significant difference in the incidence of complications between the two groups(P<0.05).
CONCLUSION: PPV combined with inverted internal limiting membrane flap technique is safe and effective in the treatment of MHRD in high myopia, which can effectively improve the patients' BCVA and the hole closure rate without influence on intraocular pressure.
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Risk factors associated with neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy

Xue Zu, Guang-Zheng Dai, Tie-Zhu Lin

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AIM: To investigate the risk factors associated with neovascular glaucoma(NVG)after pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).
METHODS: The PDR patients who received 23G PPV treatment at Shenyang He Eye Specialist Hospital from October 2015 to September 2020 and were followed up for at least 12mo with complete data were retrospectively collected. The patients were divided into two groups according to the occurrence of NVG during follow-up. The preoperative and intraoperative variables between two groups were compared. The cumulative hazard ratio for NVG was evaluated.
RESULTS: A total of 151 PDR patients(169 eyes)with a mean follow-up of 18.07±12.55(1～79)mo were included, of which 30(17.8%)eyes developed NVG, the mean time of occurrence was 6.27±4.01(1～17)mo, and 50%(15 eyes)of NVG occurred within 5mo after vitrectomy. The cumulative hazard ratios of NVG at postoperative 3, 6 and 12mo were 4.8%, 12.6% and 18.1%, respectively. Multivariate logistic regression analysis showed that preoperative best corrected visual acuity(OR=3.077, 95%CI: 1.203～7.869, P=0.019), preoperative iris rubeosis(OR=7.897, 95%CI: 1.313～47.498, P=0.024), and contralateral NVG(OR=22.108, 95%CI: 1.562～312.861, P=0.022)were risk factors with the occurrence of NVG, while the number of intraoperative retinal laser photocoagulation(OR=0.772, 95%CI: 0.666～0.893, P=0.001)was the protective factor with the occurrence of NVG.
CONCLUSIONS: The incidence of NVG in PDR eyes after PPV was 17.8%, of which 50% occurred within 5mo after surgery. PDR eyes with poor baseline visual acuity, iris rubeosis, and contralateral NVG are prone to postoperative NVG, and sufficient intraoperative retinal laser photocoagulation has a certain protective effect. PDR eyes after PPV should be closely followed up for 1a.
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Expression of CTRP9 in serum of patients with diabetic retinopathy and diabetic macular edema

Hai-Xia Jing, Shu Zhang, Hui-Ling Bai, Qin Liu, Xiao-Yan Zhu

Abstract: (11804) HTML (0) PDF (498.90 KKB) (1297)

Abstract:

AIM: To investigate the expression and correlation of C1q/tumor necrosis factor related protein 9(CTRP9)levels in the serum of patients with different stages of diabetic retinopathy(DR)and diabetic macular edema(DME).METHODS: A total of 135 patients with type 2 diabetes who were admitted to Gansu Provincial Hospital from April 2021 to April 2022 were selected as the experimental group. According to the results of non-mydriatic fundus photography, they were divided into non-DR(NDR)group(n=45), non-proliferative DR(NPDR)group(n=45), proliferative DR(PDR)group(n=45); according to the results of optical coherence tomography, DR patients were divided into DME group(n=51), non-DME group(n=39). In addition, other 45 healthy subjects who matched the age and sex of the experimental group were selected as normal control group. The clinical data and biochemical index test results of subjects in each group were recorded and compared, the correlation between serum CTRP9 level and other biochemical indexes was analyzed, and the risk factors affecting the occurrence of DR and DME were explored.RESULTS: There were significant differences in serum CTRP9 levels among subjects in normal control group, NDR group, NPDR group and PDR group(P&#x003C;0.001), and normal control group &#x003E; NDR group &#x003E; NPDR group &#x003E; PDR group. There was significant difference in serum CTRP9 level between DME group and non-DME group(P&#x003C;0.001), and non-DME group &#x003E; DME group. Spearman rank correlation analysis showed that the level of serum CTRP9 in DR patients was negatively correlated with the course of diabetes(rs=-0.251, P&#x003C;0.05), the level of serum CTRP9 in DME patients was negatively correlated with fasting blood glucose(FBG)(rs=-0.370, P&#x003C;0.05)and glycosylated hemoglobin(HbA1c)(rs=-0.421, P&#x003C;0.05). Logistic multivariate regression analysis showed that the course of diabetes(OR=1.194, 95%CI: 1.068～1.335,P=0.002)and the level of serum CTRP9(OR=0.936, 95%CI: 0.907～0.966,P&#x003C;0.001)were risk factors for DR. The level of serum CTRP9 was a risk factor affecting the occurrence of DME(OR=0.838, 95%CI: 0.778～0.903, P&#x003C;0.001).CONCLUSION: The reduction of CTRP9 level is a risk factor for the occurrence of DR and DME, which may be of great significance to the risk assessment of both DR and DME.
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Surgery management and progress of familial exudative vitreoretinopathy associated retinal detachment

Zi-Wei Zhao, Jie Peng, Pei-Quan Zhao

Abstract: (11170) HTML (0) PDF (475.18 KKB) (1366)

Abstract:

Familial exudative vitreoretinopathy(FEVR)is a hereditary disorder of retinal angiogenesis, of which the most typical clinical feature is the peripheral avascular area. The progression of the disease can lead to retinal detachment(RD), followed by secondary complications such as cataracts, glaucoma, corneal opacification, and even bulbi phthisis. As one of the main reasons for the RD in Asian children and juvenile, FEVR-associated retinal detachment(FEVR-RD)is mainly treated by surgery, including pars plana vitrectomy, scleral bucking, and combined with retinal photocoagulation or anti-vascular endothelial grouth factor(VEGF)sometimes. The surgery of FEVR-RD requires careful pre/intra-operative evaluation to determine the best surgical procedure and its outcome, including the nature of the affected eye, the stage, the fibrosis of fiber proliferation and the anterior complications, and the anatomy and prognosis of eyes in different stages vary greatly. Adult patients with rhegmatogenous RD have a higher rate of post-operative retina reattachment compared to young patients with tractional RD. In young or advanced patients, surgery is difficult and the prognosis is less optimistic, thus the surgery strategy is controversial. This article reviews the surgical outcomes and progress of FEVR-associated RD.
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Femtosecond laser-assisted cataract phacoemulsification combined with Toric intraocular lenses implantation in correction of high myopia cataract and corneal astigmatism

Wei Fan, Guang-Bin Zhang

Abstract: (9966) HTML (0) PDF (433.14 KKB) (1186)

Abstract:

AIM: To measure the indexes including postoperative distance, middle, near visual acuity and near stereopsis vision of patients with high myopia cataract and corneal astigmatism by femtosecond laser, which can quantify the diameter of capsulorhexis opening, and to evaluate the availability and necessity of Toric intraocular lenses(IOL)in high myopia.
METHODS: Prospective case-control study. Patients with binocular high myopia cataract and corneal astigmatism who undergone femtosecond laser-assisted cataract surgery in our hospital were selected, and they were divided into two groups, with 20 cases(40 eyes)in group A(Toric IOL)and 20 cases(40 eyes)in group B(IQ IOL). Indexes, including preoperative corneal astigmatism and spherical equivalent and best-corrected distance visual acuity, uncorrected middle visual acuity, uncorrected near visual acuity, residual refractive astigmatism, near stereopsis acuity, total high-order aberration and total spherical aberration, were measured postoperatively at 7d, 1 and 3mo.
RESULTS: The uncorrected middle and near visual acuity, Titmus near stereopsis acuity and residual astigmatism at 7d, 1 and 3mo after surgery were significantly improved in the Toric IOL group than the non-Toric group(all P<0.05). The dependence on glasses was reduced. The postoperative best-corrected distance visual acuity, total high-order aberration and total spherical aberration of the two groups showed no statistically significant differences(all P>0.05).
CONCLUSIONS: The implantation of Toric IOL in patients with high myopia cataract and corneal astigmatism can effectively correct corneal astigmatism, improve postoperative uncorrected middle and near visual acuity and near stereopsis visual function, reduce postoperative dependence on glasses and enhance binocular stereopsis visual function.
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Application value of new assistive technology in keratopathy-associated cataract surgery

Zhen-Bo Zhao, Li-Wei Ma, Kai-Li Tang, Yu-Xi Ding, Dong Han, Jing Wang

Abstract: (9758) HTML (0) PDF (493.57 KKB) (1560)

Abstract:

Keratopathy-associated cataract, that is, on the basis of corneal disease, and later the development of lens opacity, seriously damage visual quality. In order to avoid corneal transplantation for some patients, partial visual quality can be restored. A comprehensive and accurate evaluation of the effect of corneal opacity on visual function is of great improtance for determining cataract surgery alone. Due to the opacity of the cornea, the operation is very difficult and challenging. Therefore, it is of clinical value to develop and use new assistive technologies, including capsule staining, endoillumination, pupil dialation technology, femtosecond laser assisted technology, etc., avoiding problems such as limited visibility and decreased light flow caused by corneal opacity and facilitating cataract surgery. This article reviews progress of assistive technologies for keratopathy-associated cataract, hoping to guide clinical application.
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Research progress on optical coherence tomography imaging indicators of macular edema secondary to retinal vein occlusion

Mei Sun, Xiao-Feng Hao, Li-Ke Xie, Qi Jin

Abstract: (8835) HTML (0) PDF (470.25 KKB) (1348)

Abstract:

Retinal vein occlusion(RVO)is the second most common cause of visual loss classified under retinal vascular disorders after diabetic retinopathy, and its complication, macular edema(ME), is the leading cause of vision loss. Currently, the first-line treatment for RVO-ME is the intravitreal injection of anti-vascular endothelial growth factor drugs, which can improve retinal morphology and patients' vision. Optical coherence tomography(OCT)can clearly image retinal structures, and some specific imaging features found by OCT have become biomarkers for evaluating the prognosis of RVO patients. The recent findings of biomarkers are reviewed, such as central retinal thickness, choroidal thickness, disorganization of retinal inner layers, hyperreflective foci, integrity of external limiting membrane and ellipsoid zone, central macular volume, prominent middle limiting membrane, paracentral acute middle maculopathy, highly reflective line, to provide references for selecting the best treatment for RVO.
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Recent advances in treatment of retinitis pigmentosa

Ming Ai, Ming Sun, Dai Li

Abstract: (8729) HTML (0) PDF (412.02 KKB) (1789)

Abstract:

Retinitis pigmentosa(RP) is a group of inherited retinal disorders characterized by the progressive photoreceptor and pigment epithelial cells dysfunction.It is the common cause of blindness in the whole worldwide.Until now it is not clear about its exact pathogenesis and etiology,so effective treatments are still little.This paper looks back on lots of the recent domestic and abroad related documents,eapecially abroad,and then reviews research advances in treatment of RP.
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Applicability comparison between Chinese dry eye questionnaire and ocular surface disease index questionnaire among college students

Ruo-Jun Geng, Jing-Jing Wei, Kai-Li Yang, Shao-Pei Wang, Sheng-Wei Ren

Abstract: (8682) HTML (0) PDF (1.17 MKB) (1584)

Abstract:

AIM: To evaluate the applicability of Chinese dry eye questionnaire in college students using the ocular surface disease index(OSDI)questionnaire as a reference.
METHODS: Cross-sectional study. A total of 711 college students from Nanyang Medical College were enrolled in the study and assessed for dry eye condition using OSDI questionnaire and Chinese dry eye questionnaire. The response rate of each question in the two questionnaires was counted. Cronbach α was calculated to evaluate the internal consistency of both questionnaires. Correlation between the total scores of the two questionnaires was analyzed to evaluate the criterion validity. Based on OSDI scores, the discriminant validity of Chinese dry eye questionnaire was evaluated; receiver operating characteristic(ROC)curves was plotted for Chinese dry eye questionnaire scores, area under the ROC curve(AUC)was calculated, and diagnostic thresholds and corresponding sensitivity and specificity were also analyzed.
RESULT: The response rates of the 12 questions on the OSDI questionnaire were 33.2%-100.0%, while it was 100.0% for each question on the Chinese dry eye questionnaire. The Cronbach α values of OSDI questionnaire and Chinese dry eye questionnaire were 0.905 and 0.789, respectively. The Chinese dry eye questionnaire score was positively correlated with the OSDI score(r_s=0.712, P<0.001). According to OSDI questionnaire scores, dry eye severity was divided into normal group, mild dry eye group, moderate dry eye group and severe dry eye group. The scores of Chinese dry eye questionnaire in these groups were 4.00(2.00, 6.00), 9.00(7.00, 11.00), 12.00(9.00, 14.00)and 16.00(13.50, 22.00), respectively, which increased with the severity of dry eye, and the overall difference was statistically significant(P<0.001), as well as pairwise comparison between groups(P<0.05). The AUCs of Chinese dry eye questionnaire in distinguishing normal population from dry eye population, mild dry eye from moderate dry eye, moderate dry eye from severe dry eye were 0.862, 0.661 and 0.769, respectively, and the diagnostic thresholds were 6.5, 11.5 and 14.5, respectively.
CONCLUSION:Chinese dry eye questionnaire has an equivalent reliability, validity, discriminant ability and better response rate for dry eye screening and epidemiological survey among college students in China compared with OSDI questionnaire.
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Diquafosol sodium combined with intense pulsed light in the treatment of meibomian gland dysfunction dry eye after corneal refractive surgery

Mei-Mei Zhang, Shen Wang, Jing Zhang, Chen Li, Shan-Shan Ge, Jia Yu, Yue-Hua Zhou

Abstract: (8670) HTML (0) PDF (1.47 MKB) (1527)

Abstract:

AIM: To observe the therapeutic effect of the diquafosol sodium combined with intense pulsed light(IPL)on meibomian gland dysfunction(MGD)dry eye after refractive surgery.
METHODS:A total of 64 patients(128 eyes)with MGD dry eye diagnosed within 6mo after laser corneal refractive surgery in our hospital from March 2021 to December 2021 were selected. They were randomly divided into control group and experimental group. A total of 33 patients(66 eyes)in the control group were treated with sodium hyaluronate combined with IPL, and 31 patients(62 eyes)in the experimental group were treated with diquafosol sodium combined with IPL. Ocular symptom scores were performed before each IPL treatment in both groups to examine non-invasive tear breakup time(NIBUT), tear meniscus height, lipid layer grade of tear film, meibomian gland deletion rate and uncorrected visual acuity.
RESULTS:After IPL treatment, ocular symptom scores and meibomian gland deletion rate score of two groups were decreased continuously. NIBUT, tear meniscus height and lipid layer grade of tear film were increased continuously, and there was no significant change in uncorrected visual acuity. NIBUT of patients in the experimental group was better than that in the control group before the third IPL treatment(6.24±0.27s vs. 5.51±0.24s, P=0.046).
CONCLUSIONS:Both diquafosol sodium and sodium hyaluronate combined with IPL showed good therapeutic effect on MGD dry eye, but there was no significant difference in the short-term efficacy between the two groups.
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Relationship among fasting plasma glacose coefficient of variation and macular morphology and microcirculation in patients with nonproliferative diabetic retinopathy

Shu-Ying Fu, Yan-Min Dong

Abstract: (8655) HTML (0) PDF (1.78 MKB) (1192)

Abstract:

AIM: To investigate the relationship among the fasting plasma glucose coefficient of variation(FPG-CV)and macular morphology and microcirculation in patients with nonproliferative diabetic retinopathy(NPDR).
METHODS: A retrospective analysis of 82 cases(82 eyes)with NPDR admitted to our hospital from February 2018 to June 2022 was the research object, and another 82 cases(82 eyes)of non-diabetic retinopathy(NDR)patients during the same period were selected as the control group, and the clinical data of the two groups of patients were analyzed. Multivariate Logistic regression was used to analyze the risk factors affecting the incidence of NPDR, and the back propagation(BP)neural network model was established and evaluated. Pearson correlation was used to analyze the correlation among FPG-CV and macular morphology and microcirculation in patients.
RESULTS: The results of multivariate Logistic regression analysis showed that the disease duration ≥7.2a, glycated hemoglobin A1c(HbA1c)≥7.7%, triglyceride(TG)≥1.9 mmol/L, microalbuminuria(MALB)≥24.5 mg/L, FPG-CV ≥9.8%, superficial capillary plexus-vessel density(SCP-VD)<27.6%, deep capillary plexus-vessel density(DCP-VD)<47.7%, foveal avascular zone(FAZ)area ≥0.38 mm², central retinal thickness(CRT)≥197.7 μm and subfoveal choroidal thickness(SFCT)<227.7 μm were risk factors for NPDR(P<0.05). The number of hidden layer nodes is 5, and the receiver operating characteristic(ROC)curve, calibration curve and clinical decision curve show that the prediction model has good discrimination, accuracy and validity. The results of Pearson correlation analysis showed that FPG-CV was negatively correlated with SCP-VD, DCP-VD and SFCT(P<0.05); FPG-CV was positively correlated with FAZ area and CRT(P<0.05).
CONCLUSION: The course of disease, HbA1c, TG, MALB, FPG-CV, SCP-VD, DCP-VD, FAZ area, CRT and SFCT are all related to the pathogenesis of NPDR. With the increase of FPG-CV, the indexes of macular morphology and microcirculation changed. FPG-CV was negatively correlated with SCP-VD, DCP-VD and SFCT and positively correlated with FAZ area and CRT.
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Evaluation of macular microvasculature alterations in patients with proliferative diabetic retinopathy after vitrectomy by swept-source optical coherence tomography angiography

Feng-Tao Ji, Hui Wang, Ke Wei, Yong-Rong Li, Wei Dai, Zhi-Min Wang, Rong-Feng Liao

Abstract: (8640) HTML (0) PDF (936.23 KKB) (1447)

Abstract:

AIM: To investigate the changes in retinal and choroidal blood flow after pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).
METHODS: A cross-sectional study was conducted on 35 patients(35 eyes)who were diagnosed as monocular PDR and received 23GPPV in ophthalmology department of the Second People's Hospital of Hefei between September 2020 and July 2022. All eyes underwent swept-source optical coherence tomography angiography(SS-OCTA)examination. Retinal and choroidal vascular parameters within 3mm×3mm of macular zone were measured by built-in analyzer, and its correlation with postoperative best corrected visual acuity(BCVA)was analyzed.
RESULTS: The follow-up was 1～22(average 9.72±6.67)mo. At the last follow-up, flow area(FA)of intermediate capillary plexus(ICP)layer in paranasal foveal region was significantly reduced in PPV eyes(0.31±0.06mm²)compared with contralateral eyes(0.38±0.05mm²), and FA of deep capillary plexus(DCP)in temporal foveal region was significantly lower in PPV eyes(0.19±0.08mm²)than contralateral eyes(0.27±0.07mm²; all P<0.05). Choroidal vascularity index(CVI)were lower in PPV eyes than contralateral eyes in parafoveal subregions except temporal region(P<0.05). After PPV, BCVA had a certain correlation with the density and FA of middle and deep retinal vessels.
CONCLUSIONS: Eyes with severe PDR may be prone to having a decrease in the DCP and parafoveal choroidal perfusion in the parafoveal regions after PPV than contralateral eyes.
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Suture guided gonioscopy-assisted transluminal trabeculotomy combined with phacoemulsification in the treatment of primary open angle glaucoma

Shan Zhong, Hui Yang, Shi He, Wen-Jing He

Abstract: (8625) HTML (0) PDF (467.79 KKB) (1423)

Abstract:

AIM: To investigate the clinical efficacy of suture-guided gonioscopy-assisted transluminal trabeculotomy(GATT)combined with phacoemulsification in the treatment of primary open angle glaucoma(POAG).
METHODS: A total of 84 patients(84 eyes)with POAG and cataract who underwent surgery in our hospital from January 2021 to July 2022 were selected and randomly divided into two groups. There were 43 cases(43 eyes)in the combined group who underwent suture-guided GATT combined with phacoemulsification, and 41 cases(41 eyes)in the simple group who underwent suture-guided GATT. The two groups were followed up for 3mo to compare the surgical success rate, intraocular pressure, topical intraocular pressure-lowering drugs, visual acuity and postoperative complications.
RESULTS: There was no significant difference in overall success rate between the combination and simple groups at 3 mo after surgery(88% vs. 85%, P>0.05). The intraocular pressure levels and topical intraocular pressure-lowering drugs at 1wk, 1 and 3mo after surgery in the two groups were significantly lower than those before surgery(all P<0.05), but there was no significant difference between the two groups(all P>0.05). The visual acuity at 1wk, 1 and 3mo after surgery of patients in the combined group was significantly better than that in the simple group(P<0.01). During the follow-up period, the incidence of anterior chamber hemorrhage and transient hypertension in the combined group was significantly lower than that in the simple group(P<0.05).
CONCLUSION: Both suture-guided GATT combined with cataract phacoemulsification and suture-guided GATT are effective treatment for POAG, however, suture-guided GATT combined with phacoemulsification has a lower incidence of anterior chamber hemorrhage and transient ocular hypertension.
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Research advances in contact lens associated bacterial keratitis

Yu-Lin Yan, Yan-Ning Yang, Shan-Shan Wan

Abstract: (8549) HTML (0) PDF (512.03 KKB) (1403)

Abstract:

Contact lens(CL)is currently one of the most common methods of vision correction, with more than 140 million users worldwide and the demand is rising yearly as constantly development of materials and features. Wearing CL can lead to a variety of complications such as dry eye, corneal abrasions, giant papillary conjunctivitis, and infectious keratitis is one of the most severe complications. According to research, bacteria account for 80%～95% of the pathogens that cause CL-associated infective keratitis, it may have been related to the bacterial composition, virulence mechanism, biofilm formation and the combined effect of the lens itself and the process of use, which is prone to introducing pathogens, reducing antimicrobial capacity of the cornea and tears and causing ocular surface hypoxia and ocular surface inflammation. Overnight and prolonged lens wear, irregular lens purchase, use and care procedures can also be risk factors for bacterial infections. This article reviews the studies on the pathogenesis, risk factors, diagnosis, treatment and prevention of CL-related bacterial keratitis.
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Research progress on corneal nerves and substance P in viral keratitis

Yi Mu, Hong Zhang

Abstract: (8491) HTML (0) PDF (490.87 KKB) (1208)

Abstract:

Diseases like viral keratitis can harm corneal nerves, which are necessary for maintaining the health and functionality of the cornea. Recent research has shown that corneal nerve pathology affects the infected eye as well as the contralateral one, and that aberrant changes in sympathetic nerves can be seen, with the exception of sensory nerves that correspond to corneal sensation. However, apart from in vivo confocal microscopy and corneal sensation, there have been no additional prognostic indicators that allow clinicians to assess the severity of corneal nerve damage. While multiple functions of corneal nerves are mediated by neuropeptides, substance P, the first topical neuropeptide used in ocular clinical practice, was proved to regulate the process of viral infections, and it is involved in bilateral corneal pathologies through pro-inflammatory and neurotrophic functions in viral keratitis, so it may be used as a diagnostic biomarker or a therapeutic target. Therefore, this review summarized the changes and roles of corneal nerves as well as substance P in viral keratitis, which may serve as a reference for further study into associated mechanisms and clinical applications.
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Volume 25,2025 Issue 7

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