Abstract:AIM: To investigate the pathological features of ocular surface squamous neoplasia (OSSN) and evaluate the synergistic therapeutic effects of interferon-α2b (IFNα2b) and 5-fluorouracil (5-FU) on cellular proliferation, migration, apoptosis, and cell cycle of human oral squamous carcinoma cell line Cal27. METHODS: Tissue specimens from OSSN were processed with hematoxylin-eosin (HE) and immunofluorescence (IF) staining to characterize pathological changes. We analyzed the expression levels of four pivotal proteins involved in 5-FU metabolism: interferon alpha receptor (IFNAR), thymidylate synthase (TS), thymidine phosphorylase (TP), and dihydropyrimidine dehydrogenase (DPD). Cal27 cell lines were treated with a spectrum of concentrations of IFNα2b and 5-FU, either in isolation or in combination. Then, cell activity was measured utilizing CCK-8 assay and dose-effect curves were calculated, while tumor cell migration was detected by cell scratch experiments. Cal27 cells were added with IFNα2b and 5-FU in a non-constant ratio drug combination design and the corresponding combination index (CI) and fraction affected (Fa) were calculated with CompuSyn software. Western blot assay was conducted to quantify the expression of TP, TS, and DPD. Cell cycle and apoptosis were measured with flow cytometry and terminal deoxynucleotidyl transferase-mediated dUTP nick and labeling (TUNEL) assay. RESULTS: Treatment with both IFNα2b and 5-FU inhibited cell proliferation. Except for the lowest and highest doses of 5-FU, CI values for all other groups were below 1, suggesting a synergistic interaction. Low concentrations of IFNα2b and 5-FU both diminished the relative mobility of Cal27 cells, instead, a stronger inhibitory effect was observed when the two drugs were co-applied. The expression levels of TP and DPD in Cal27 cells were dose-dependently increased at a low concentration of IFNα2b. Low-dose IFNα2b combined with 5-FU significantly inhibited cell proliferation in G0/G1 phase compared to 5-FU monotherapy. Medium and high doses of IFNα2b and all concentrations of 5-FU could induce apoptosis in a concentration-dependent manner. The susceptibility to 5-FU treatment and apoptosis rates of tumor cells were elevated with low doses of IFNα2b. CONCLUSION: Both IFNα2b and 5-FU, when administered individually or in combination, effectively suppress the proliferation and migration of Cal27 tumor cells, induce cell apoptosis and arrest cell cycle. Low doses of IFNα2b increase the antitumor effects of 5-FU on Cal27 potentially through up-regulating the expression of TP, demonstrating a synergistic effect between IFNα2b and 5-FU.

Abstract:AIM: To highlight the importance of microRNA (miRNA)-21-5p in directing the phosphatase and tensin homolog (PTEN) gene to control the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) pathway in retinal pigment epithelial (RPE) cells in humans subjected to photodamage. METHODS: Human adult RPE cell line-19 (ARPE-19) was cultured in vitro and randomly divided into control, damage, overexpression, negative, and PI3K/Akt blocker groups to establish a photodamage model of ARPE-19 cells. The models were subjected to 24h of light exposure, after which the corresponding indices were detected. The cell counting kit-8 assay quantified cell viability, while flow cytometry determined apoptosis rates. The miRNA-21 mimics and miRNA mimic NC were transfected into ARPE-19 cells using a transient transfection technique. Quantitative reverse transcription polymerase chain reaction (SYBR Green) and Western blotting analyzed expression levels of miRNA-21-5p, PTEN, p-PI3K/PI3K, p-mTOR/mTOR, and p-Akt/Akt. Statistical analyses comprised one-way analysis of variance and the Student-Newman-Keuls test for multiple group comparisons. RESULTS: The photodamage group demonstrated reduced cell survival rates than the control group (P<0.01). The overexpression group exhibited higher cell survival rates than the injury group (P<0.01). The negative group showed no difference in viability (P>0.05). The PI3K/Akt blocker group demonstrated lower cell viability, compared with the overexpression group (P<0.01). CONCLUSION: miRNA-21-5p significantly increases ARPE-19 cell survival after photodamage and inhibits light-induced ARPE-19 cell apoptosis, suggesting that it may play a protective role in RPE by activating the PI3K/Akt/mTOR pathway while downregulating PTEN expression.

Abstract:AIM: To explore the impact of insulin-like growth factor-1 receptor α (IGF-1Rα) on the differentiation fate of optic-cup-derived retinal stem cells (OC-RSCs) into retinal ganglion cells (RGCs) in vitro. METHODS: OC-RSCs were isolated from optic cups of rats on embryonic day 12.5, and high-purity OC-RSCs were obtained by conditioned culture and passage. Differentiation of OC-RSCs into RGCs under different serum concentrations was examined using flow cytometry, and the serum concentration with high interference with differentiation ratio was selected. Furthermore, the effect of blocking IGF-1Rα on the differentiation of OC-RSCs into RGCs was analyzed through immunocytochemistry and Western blotting. RESULTS: Immunohistochemical analysis revealed IGF-1Rα was highly expressed in rat embryos at day 12.5. OC-RSCs were isolated and purified, and high-purity OC-RSCs were obtained. When 2.5% serum was administered, the ratio of differentiated RGCs (Thy-1.1 positive) decreased significantly, and the results of immunoblotting also confirmed the blockade of IGF-1Rα reduced Thy-1.1 protein expression. CONCLUSION: IGF-1Rα blocking can reduce the differentiation of OC-RSCs into RGCs.

Abstract:AIM: To assess tomographic changes and subclinical edema detection in Fuchs’ endothelial corneal dystrophy (FECD) through Scheimpflug tomography in a group of phakic patients contemplating cataract surgery. METHODS: A retrospective study was conducted on 30 phakic eyes from patients diagnosed with FECD but without clinical edema, and 59 phakic eyes from a control group without corneal alterations. Comprehensive ophthalmic examinations were conducted, including slit-lamp biomicroscopy, corneal specular microscopy (CSM), and Scheimpflug tomography. RESULTS: The study encompassed 30 phakic eyes with FECD (mean age 59.8±13.1y) and 59 control eyes (mean age 61.3±7.7y). The best-corrected visual acuity was higher in the control group compared to the FECD group [0 (0, 0.08) vs 0.05 (0, 0.15) logMAR; P=0.042]. CSM revealed significant differences between the FECD and control groups in several parameters: number of analyzed cells (26±13 vs 135±42, P<0.001), cell density (2049±376 vs 2479±225 cells/mm2, P<0.001), mean cell area [463 (434, 544) vs 397 (383, 431) μm2; P<0.001], coefficient of variation (54.8%±18.7% vs 41.0%±7.2%, P<0.001), and hexagonal cells [0 (0, 47%) vs 47% (40%, 53%), P<0.001]. Although often used as a clinical parameter for detecting edema, central corneal thickness measured by CSM showed no significant difference between the FECD and control groups (530±57 vs 546±30 μm, P=0.179). Significant differences were noted in various Pentacam measurements between the groups. Specifically, parameters like loss of parallel isopachs (13 vs 0 eyes, P<0.001), displacement of the thinnest point (11 vs 0 eyes, P<0.001), posterior focal depression (25 vs 7 eyes, P<0.001), and increased light scatter [21.4 (17.6; 23.9) vs 18.0 (16.8, 21.8), P=0.01] were significantly more prevalent in FECD eyes, reflecting the presence of subclinical edema and loss of corneal transparency. CONCLUSION: Scheimpflug tomography allows for an objective assessment of FECD, offering the capability to detect subclinical edema at an early stage, monitor disease progression, and serve as a predictor of corneal decompensation following cataract surgery.

Abstract:AIM: To compare the 12-month outcomes of visual performance and patient satisfaction of a higher-order aspheric monofocal intraocular lens (IOL) and a conventional monofocal IOL. METHODS: Prospective, randomized, comparative, double-blinded study including 22 patients who underwent bilateral cataract surgery with implantation of the Tecnis Eyhance ICB00 IOL in one eye (ICB00 group) and the Tecnis ZCB00 IOL in the fellow eye (ZCB00 group). Uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), distance-corrected intermediate (DCIVA), uncorrected near (UNVA), and distance-corrected near visual acuities (DCNVA) were evaluated during a 12-month follow-up. Contrast sensitivity, defocus curves, and reading text size were also evaluated. Patient satisfaction was assessed with a questionnaire at the 6-month postoperative visit. RESULTS: Mean postoperative logMAR UDVA was 0.01±0.12 and -0.02±0.10 in ICB00 and ZCB00 groups, respectively (P=0.37). Mean logMAR UIVA was 0.32±0.19 and 0.45±0.16 in ICB00 and ZCB00 groups, respectively (P=0.010). Differences between groups in UNVA did not reach statistical significance (P=0.16). The intermediate reading acuity at 66 cm (P=0.02) and 80 cm (P=0.04) was significantly better in the ICB00 group. Postoperative contrast sensitivity results did not differ significantly between groups (P>0.05). Patients reported high overall satisfaction, with 62% of patients using spectacles for reading in everyday life. CONCLUSION: The eyes of patients implanted with the enhanced monofocal IOL evaluated have significantly better visual acuity for intermediate distances with the same contrast sensitivity as a conventional monofocal IOL.

Abstract:AIM: To investigate the optimal timing and therapeutic effects of cataract surgery in patients with moderate to severe thyroid-associated ophthalmopathy (TAO). METHODS: Data from TAO patients who underwent cataract surgery between 2014 and 2024 were analyzed. patients were categorized into two groups based on the hospital where their cataract surgery was performed: an external hospital surgery group and an in-house hospital surgery group. Patients in external hospital presenting with complications within six months postoperatively were assessed for clinical features, imaging, thyroid function, and outcomes. Patients who underwent surgery at West China Hospital were evaluated for clinical status, imaging, laboratory findings, and manifestations. RESULTS: In the external hospital group (n=31), common symptoms included eyelid swelling (64.52%) and diplopia (51.61%), with restricted eye movement in all patients. Most patients were in the active stage (87.10%) and exhibited various complications, such as dysthyroid optic neuropathy (DON) in 4 patients, misdiagnosis of glaucoma in 1 patient, and enucleation due to fungal infection in 1 patient. In the West China Hospital group (n=30), 2 patients were in the active stage, and 28 were in the inactive stage. Postoperative visual acuity improved in 36 eyes, except for in 2 eyes with DON. Active TAO patients with mature cataracts had effective inflammation control and no complications at the 6-month follow-up. CONCLUSION: In patients with moderate to severe active TAO complicated by cataracts, delaying cataract surgery until 6mo of TAO control should be considered if cataracts are stable. Simultaneous anti-inflammatory treatment and cataract surgery should be performed for mature/hypermature cataracts, and TAO management should be continued after surgery.

Abstract:AIM: To investigate the role of adipokines in primary open angle glaucoma (POAG) by comparing the levels of these molecules in the aqueous humor among POAG patients and cataract patients with or without metabolic disorders. METHODS: In this cross-sectional study, aqueous humor samples of 22 eyes of POAG patients (POAG group), 24 eyes of cataract patients without metabolic disorders (cataract group), and 24 eyes of cataract patients with metabolic disorders (cataract+metabolic disorders group) were assessed for 15 adipokines by Luminex bead-based multiplex array. The correlation between aqueous humor adipokines and clinical indicators of POAG was analyzed and compared across the groups. RESULTS: The analysis revealed that the levels of adiponectin, leptin, adipsin, retinol-binding protein 4 (RBP4), angiopoietin-2, angiopoietin-like protein 4 (ANGPTL4), chemokine (C-C motif) ligand 2 (CCL2), interleukin-8 (IL-8), and interleukin-18 (IL-18) in the aqueous humor of the POAG group were significantly higher than those in the cataract group. Additionally, the level of angiopoietin-2 in the POAG group was higher than in the cataract+metabolic disorders group. However, no significant correlation was found between the levels of adipokines in the POAG group and intraocular pressure (IOP), severity of POAG, or the use of glaucoma medications. CONCLUSION: This study demonstrates significant differences in aqueous humor adipokine levels between POAG and cataract patients. The findings suggest that the levels of aqueous humor adipokines may reflect the inflammatory states in POAG and systemic metabolic abnormalities.

Abstract:AIM: To investigate decisional conflict among patients diagnosed with primary angle-closure suspect (PACS) or primary angle-closure (PAC) who are considering laser peripheral iridotomy (LPI) treatment. METHODS: A total of 111 individuals diagnosed with PACS or PAC were selected through convenient sampling from March 2023 to December 2023. These participants then completed a general information questionnaire and the Decision Conflict Scale. Data analysis was performed using multiple linear regression to reveal factors influencing decisional conflict. RESULTS: The mean Decisional Conflict Score among patients with PACS or PAC was 48.58±10.01, with 99.1% of these individuals reporting experiencing decisional conflict. Multiple linear regression analysis revealed that females (P=0.002) and patients with a shorter duration of the disease (P=0.006) had higher levels of decisional conflict. Additionally, patients diagnosed during medical visits (P=0.049), those who refused LPI treatment (P=0.032), and individuals facing significant economic burdens related to medical expenses (P=0.005) exhibited higher levels of decisional conflict. Furthermore, patients who preferred to make medical decisions independently (P=0.023) and those who favored involving family members in decision-making (P=0.005) experienced increased levels of decisional conflict. CONCLUSION: Patients with PACS or PAC who undergo LPI treatment often encounter significant decisional conflict. Healthcare professionals should thoroughly assess a range of factors that influence this conflict, including gender, duration of disease, method of diagnosis acquisition, LPI treatment, economic burden of medical expenses, and patient preferences regarding medical decision-making. By considering these variables, tailored decision support can be developed to address individual patient needs, ultimately reducing decisional conflict and optimizing the quality of decisions made regarding treatment options.

Abstract:AIM: To investigate the optimal anti-vascular endothelial growth factor (VEGF) treatment time in patients with diabetic macular edema (DME) scheduled for cataract surgery. METHODS: The study was designed to include 4 groups. Twenty-six eyes of 26 patients with diabetes but no retinopathy (DR; group 1), 17 eyes of 17 patients with DR but no DME (group 2), and 19 eyes of 19 patients with DME who received anti-VEGF therapy concurrently with cataract surgery (group 3), and 21 eyes of 21 patients who received anti-VEGF therapy for DME 1wk before cataract surgery (group 4). The patients’ best corrected visual acuity, intraocular pressure, central and mean macular thickness (CMT and MMT) values were noted on the day of surgery, postoperative day 1, week 1, and month 1. RESULTS: There was a significant increase of CMT after cataract surgery in groups 1, 2, and 3 (P<0.001, P=0.044, and P=0.034, respectively) but not in group 4 (P=0.948). The change in MMT was the same as CMT (P=0.009, P=0.006, P=0.011, and P=0.172, respectively). There was a higher increase in CMT and MMT ​​in group 2 compared to group 1 at the 1st month after surgery (P=0.002 and P=0.001, respectively). CONCLUSION: In eyes with DME undergoing cataract surgery, preoperative anti-VEGF treatment may be more effective than simultaneous intravitreal anti-VEGF with surgery.

Abstract:AIM: To describe the optical coherence tomography (OCT) features in the fellow eyes of individuals with full-thickness macular holes (FTMHs). METHODS: This multicenter retrospective study included observational and validation groups, incorporating fellow eyes of patients diagnosed with idiopathic FTMH. OCT images were categorized according to International Vitreomacular Traction Study (IVTS) and Gass classification. Age- and sex-related cataract patients were served as control groups. Vertical and horizontal OCT images were chosen for further measurement. OCT parameters including foveal floor width (FFW), central foveal thickness (CFT) and FFW/CFT ratio were assessed and compared between observational and control groups and were validated by validation group. Receiver operating characteristic (ROC) curves were plotted for OCT parameters in identifying macular holes (MHs). RESULTS: A total of 73 patients were included in the observational group, comprising 51 females and 22 males, with an average age of 65.5±7.3y and an axial length of 23.9±0.8 mm. The validated group consisted of 47 patients, including 31 females and 16 males, with an average age of 65.0±7.4y and an average axial length of 23.6±0.8 mm. In the observational group, 16.4% of the fellow eyes associated with FTMHs also exhibited MHs, while in the validated group, this prevalence was 12.7%. The 45.2% in the observational group and 44.6% in validated group of these fellow eyes displayed abnormalities including vitreomacular adhesion (VMA), vitreomacular traction (VMT), and MHs. Statistically significant differences were observed in FFW, CFT, and FFW/CFT ratio between control and observational group, as well as validated group (P<0.01), no matter in the vertical or horizontal layer. ROC curves revealed the area under the curve (AUC) for FFW and the FFW/CFT ratio was 0.85 and 0.90, respectively. CONCLUSION: In the case of unilateral idiopathic MHs, it was important to carefully monitor the condition of the fellow eye. The FFW and FFW/CFT ratio may be good metrics for predicting MHs.

Abstract:AIM: To identify optical coherence tomography (OCT) features present at the diagnosis of neovascular age-related macular degeneration (nAMD) that could predict retinal atrophy (RA) and visual performance in patients treated with intravitreal aflibercept. METHODS: OCT data collected at the time of nAMD diagnosis (T0), after the first (T1) and third (T2) intravitreal aflibercept injection, and 5y post-diagnosis (T3) were analyzed. The study included 46 eyes from patients undergoing treatment. The association of OCT features with RA and visual acuity (VA) development over time were evaluated. RESULTS: Patients with RA at T3 exhibited worse VA (35.19±5.7 vs 8.90±2.3, P<0.001) and a lower rate of improvement or stability at T2 (90.48% vs 56.00%, P=0.019) and T3 (85.71% vs 8.00%, P<0.001). The development of RA at T3 was linked with type 2 macular neovascularization (MNV; 4.76% vs 36.00%, P=0.013), thinner outer nuclear layer (ONL, 88.89±7.82 µm vs 71.38±14.14 µm, P=0.033), presence of intraretinal fluid (IRF, 42.86% vs 80.00%, P=0.014), presence of IRF without subretinal fluid at T0 (SRF, 4.76% vs 32.00%, P=0.027), and reduced central foveal thickness at T3 (CFT, 190.14±22.79 µm vs 124.32±14.35 µm, P<0.001). The presence of SRF with or without IRF at the diagnosis was comparable between the two groups (90.48% vs 68.00%; P=0.084). CONCLUSION: Type 2 MNV, reduces ONL and CFT, and IRF presence at baseline may signal a higher risk of RA in treatment-naive nAMD patients, underscoring the importance of these OCT features in early risk assessment and management strategies.

Abstract:AIM: To report the refractive and surgical outcomes of scleral buckling (SB) with or without pars plana vitrectomy (PPV) in patients with pseudophakic rhegmatogenous retinal detachment (PRRD). METHODS: A consecutive case series of patients with pseudophakia who underwent retinal detachment (RD) surgery was enrolled. The SB procedures were selected to initially treat primary pseudophakic PRRDs and SB-PPV for more complex cases, according to preoperative findings. Eyes with anterior chamber intraocular lens, proliferative vitreoretinopathy anterior to equator, previous invasive glaucoma surgery, severe degenerative myopia or macular hole, and <6mo follow-up were excluded from outcomes analysis. The primary clinical outcome measures were the single surgery anatomic success (SSAS) and final surgery anatomic success (FSAS) rates. Secondary outcome measures were postoperative visual acuity and refractive error. RESULTS: A total of 81 consecutive patients (81 eyes) were enrolled for analysis, comprising 66 (81%) men and 15 (19%) women with a mean age of 58y (range, 33-86y) and the mean final follow-up period was 21.0±19.6mo. A total of 62 PRRDs (n=62; 76.5%) were repaired with an initial SB, and 19 PRRDs (n=19; 23.5%) were repaired with a combined SB-PPV. The SSAS and FSAS rates were 92.6% (75/81) and 100% (81/81), respectively. All initial failures had retinal reattachment after the secondary PPV. The mean final postoperative best-corrected visual acuity (BCVA) was 0.42±0.33 logMAR (visual acuity 20/55) and final mean refractive error was -1.48±1.40 diopters. The patients who underwent initially SB-PPV had a significantly longer duration of RD and a higher giant retinal tear rate (P<0.05) preoperatively. SSAS was 56/62 (90.3%) and 19/19 (100%), and the mean postoperative refractive error was -1.30±1.32 D and -1.53±1.38 D for the patients in the SB and SB-PPV groups, respectively. There was no statistically significant difference for those who had SSAS and postoperative refractive errors between the 2 groups. The postoperative BCVAs of the patients with SSAS were not significantly better in the SB group (median, 20/40) than in the SB-PPV group (median 20/50). In the SB group, patients with macula-on had better visual acuity postoperatively than patients with macula-off (P=0.000). CONCLUSION: The initial surgical procedures of SB with or without PPV according to the preoperative findings achieve a high reattachment rate and an acceptable refractive error for primary pseudophakic RRD management.

Abstract:AIM: To evaluate the efficacy and safety of intravitreal low-dose (1 mg) triamcinolone acetonide (TA) in Chinese acute nonarteritic anterior ischemic optic neuropathy (NAION) patients. METHODS: Twenty-eight eyes of 28 patients with acute NAION (<30d of visual acuity loss) were enrolled and given intravitreal TA (IVTA) once. Visual field (VF), best corrected visual acuity (BCVA), retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, radial peripapillary capillary (RPC) density, and intraocular pressure (IOP) were evaluated at baseline and 7d, 1, 3, and 6mo after IVTA. RESULTS: VF and BCVA were significant improved during the follow-up according to the mean deviation (MD), visual field index (VFI), and Early Treatment Diabetic Retinopathy Study (ETDRS) scores (all P<0.001). There was no significant difference between the group that received an injection less than 14d after illness onset and the group that received an injection more than 14d after illness onset. The RNFL thickness, GCC thickness and RPC density were significantly decreased (all P<0.001). Temporary ocular hypertension was present in five eyes. CONCLUSION: Low-dose IVTA may be an alternative safe treatment option for some NAION patients in the acute stage. However, optic nerve atrophy still existed.

Abstract:AIM: To explore choroidal thickness (CT) and choroidal vascularity index (CVI) changes around the macula and optic nerve head (ONH) using swept-source optical coherence tomography (SS-OCT) after small-incision lenticule extraction (SMILE) and evaluate their associations with accommodation and aberrations. METHODS: Participants were divided into more myopic group (43 eyes) and less myopic group (33 eyes) according to refractive error. SS-OCT, negative relative accommodation (NRA), and positive relative accommodation (PRA) were analyzed before and 1d, 1wk, and 1mo postoperatively. Root mean square higher-order aberrations (RMS HOAs), spherical aberrations (SAs), and coma were compared preoperative, 1wk, and 1mo postoperatively. RESULTS: After surgery, RMS (0.29±0.26) and Coma (0.16±0.19) all increased. In the more myopic group, central and T1 macular CT (247.58±63.81 and 276.45±62.52 μm) increased. NRA (0.41±0.51) and PRA (0.10±1.30) decreased, and SAs (0.21±0.21) increased. In the less myopic group, all regional and mean macular CT increased. NRA was correlated with mean and inferior CTs and mean ONH CVI. SE was correlated with macular CT, CVI, and ONH CT. Mean macular and ONH CTs were associated with RMS HOA, SA, and coma. Macular T2 CT was a significant predictor of SA. Macular T2 and N1 CT were correlated with coma. CONCLUSION: More variations in accommodation and aberrations and fewer choroid thickens on macular and ONH are found in more myopic eyes after SMILE. Choroidal values are associated with accommodation and aberrations during SMILE. Choroid parameters on SS-OCT varies in eyes with different refractive errors after SMILE and has an association with accommodation and visual quality.

Abstract:AIM: To assess the variations in photoreceptor cell packing density (PCPD) across the retina among young healthy individuals with emmetropia, low and moderate myopia. METHODS: High-resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) systems were utilized for retinal imaging with a large sampling window of 700 μm×700 μm. The study cohort included 14 emmetropic [spherical equivalent (SE) ranged +0.5 to -0.5 D], 15 low myopic (SE ranged -0.5 to -3 D) and 21 moderate myopic (SE ranged -3 to -6 D) healthy young adults. Photoreceptors at 3° temporal, 6° superior and inferior 6° were captured. Statistical analysis was then performed to obtain PCPD and cell spacing. RESULTS: The average age of participants was 22.54±2.86 (ranged 20–30y) with no difference among 3 groups. At 3° temporal, the emmetropic group exhibited the highest PCPD of 15 186.16±2050.54 cells/mm2, while the low and moderate myopic groups had PCPD of 14 009.15±1073.01 and 13 466.92±1121.71 cells/mm2, respectively. At 3° temporal, the emmetropic group also had the smallest cell spacing at 6.66±0.26 mm, compared to 6.85±0.26 and 6.91±0.28 mm for the low and moderate myopic groups, respectively. Compared to the emmetropic group, at 3° temporal, the myopic groups showed significantly reduced PCPD (low myopia: P=0.032; moderate myopia: P=0.001). At 6° inferior, the moderate myopic group exhibited a significant decrease in PCPD (P=0.013), while at 6° superior, there were no significant statistical differences in PCPD for the low and moderate myopic groups (P>0.05). In comparison to the emmetropic group, only the moderate myopic group showed significantly increased cell spacing at all three positions (temporal 3°: P=0.011, superior 6°: P=0.046, inferior 6°: P=0.013). Correlation analysis revealed a positive correlation between PCPD and axial length changes (P<0.05). CONCLUSION: Reduced PCPD and increased cell spacing strongly correlated with refractive error in mild to moderate myopic eyes, especially at 6° inferior to the fovea and the decreased PCPD in the macular region of myopic patients may be associated with increased axial length-induced retinal stretching.

Abstract:AIM: To evaluate refraction and ocular biological characteristics in children with unilateral congenital ptosis. METHODS: In this cross-sectional study, 200 Chinese children (3-15y) with unilateral congenital ptosis were evaluated. Cycloplegic refraction and ocular biological measurements were taken from Oct. 2020 to Aug. 2022. RESULTS: In patients with congenital ptosis, the prevalence of with-the-rule astigmatism and oblique astigmatism was significantly high. The cornea was flatter in ptotic eyes [K1 (42.37±1.62 vs 42.78±1.51 D), K2 (43.8±1.86 vs 44.2±1.64 D), corneal power (Km; 43.09±1.68 vs 43.49±1.53 D), all P<0.001]. Axial length (AL) was longer in ptotic eyes (22.55 vs 22.51 mm, P=0.012). The white-to-white (WTW) was significantly smaller in ptotic eyes (11.49 vs 11.65 mm, P<0.001). The central corneal thickness (CCT) was greater in ptotic eyes (553.50 vs 545.00 µm, P<0.001). No significant differences were found in anterior chamber depth (AD), lens thickness (LT) and vitreous thickness (VT) between ptotic and fellow eyes (P>0.05). In addition, the incidence of amblyopia in ptosis eyes was 32.0%, which was significantly higher than that in the normal population. CONCLUSION: Ptotic eyes have longer AL, flatter, thicker and smaller corneas than fellow eyes. The congenital ptosis increases the risk of amblyopia. The results suggest that regular examinations of refractive status and ocular biological parameters such as AL, are essential for children with unilateral congenital ptosis.

Abstract:AIM: To explore the prevalence of pterygium and pinguecula and their risk factors. METHODS: This population-based cross-sectional study was conducted on geriatric population aged 60 and over in Tehran, Iran from Jan 2019 to Jan 2020. Selected subjects were interviewed and subjected to optometric and ophthalmic examinations. RESULTS: The age and sex standardized prevalence of pterygium and pinguecula was 3.64% [95% confidence interval (CI): 2.94%–4.49%] and 55.57% (95%CI: 52.89%–58.22%), respectively. The prevalence of pterygium was 4.52% (95%CI: 3.5%–5.81%) in men and 2.79% (95%CI: 1.97%–3.94%) in women and the prevalence of pinguecula was 64.56% (95%CI: 60.92%–68.03%) in men and 46.72% (95%CI: 43.74%–49.72%) in women. According to the results of multiple logistic regression, pinguecula had a significant correlation with male sex [odds ratio (OR): 2.21, 95%CI: 1.63–2.99] and education level (OR: 0.52, 95%CI: 0.35-0.77) and pterygium had a significant relationship with male sex (OR: 2.2, 95%CI: 1.38–3.52), socioeconomic status (SES, OR: 0.5, 95%CI: 0.26–0.97), education level (OR: 0.22, 95%CI: 0.08–0.61). CONCLUSION: The prevalence of pinguecula and pterygium in this study are lower than other studies. Sex, SES, and education level are the risk factors of the prevalence of pinguecula and pterygium.

Abstract:AIM: To evaluate the effects of refractive errors and binocular vision anomalies on the quality of life (QOL) of university students. METHODS: This cross-sectional analytical study was conducted on university students using simple random sampling. Objective refraction, ocular alignment, vergence and accommodative performance were measured and assessed in all participants. Data on QOL were collected using the College of Optometrists in Vision Development-Quality of Life (COVD-QOL) Questionnaire. The effect of mentioned parameters on the QOL were evaluated. RESULTS: Totally 726 students with mean age of 21.35±1.88y were evaluated in this study, 51.5% of whom were female. Esophoria was caused significantly lower QOL in the domains of somatic symptoms and occupational-physical symptoms (P<0.05); Besides, esotropia decreased QOL in domains of somatic symptoms P=0.002 and psychological factors (P=0.023). Students with accommodation insufficiency experienced more symptoms in all domains (P<0.05) except for psychological factors (P=0.07). Increasing in the near point of convergence and accommodation and decreases QOL and increasing accommodative facility increases QOL (all P<0.05). Myopia and astigmatism cause decrease in QOL (both P<0.05), but hyperopic students had better QOL in comparison with others (P<0.05). CONCLUSION: Screening programs and treatment of refractive errors and binocular vision anomalies, especially phoria and accommodative insufficiency, positively impact the QOL and academic achievements of university students.

Abstract:AIM: To investigate the occurrence of eye asthenopia in Chinese adults and pinpoint the factors contributing to it using a 17-item Asthenopia Survey Questionnaire (ASQ-17). METHODS: A total of 2509 Chinese adults aged 18 and above from 30 regions in China participated in a cross-sectional online survey in February 2020. The survey utilized the ASQ-17, which had been proven reliable and validated for assessing asthenopia-related symptoms experienced in the past two weeks among the Chinese population. Data on demographics and living conditions, including age, gender, humidity, air quality in their residential areas, frequency of heightened anxiety or depression, daily duration of near vision activity, sleep duration, sleep quality, and history of eye surgery, were collected. Principal component analysis and multivariate logistic regression were employed to identify independent factors associated with asthenopia. RESULTS: Out of the 2502 participants, with an average age of 31±8y included in the analysis, asthenopia was prevalent in 35.2% of cases. Multivariate analysis revealed that the most influential risk factor was poor sleep and mental well-being, which encompassed shorter daily sleep duration, lower sleep quality, and more frequent feelings of heightened anxiety or depression [odds ratio (OR): 2.07, 95% confidence interval (CI): 1.88–2.29, P<0.001]. This was followed by each additional 2h of daily near vision activity relative to 4h (OR: 1.33, 95%CI: 1.21–1.45, P<0.001), and lower humidity and worse air quality in the residential area (OR: 1.10, 95%CI: 1.02–1.21, P=0.019). CONCLUSION: Asthenopia is a common issue among Chinese adults, and preventative measures should focus on improving sleep and mental well-being. Further research targeting physiological exposure, different age groups or longitudinal studies to establish causality are needed to explore the role of sleep and mental status as an influencing factor.

Abstract:AIM: To evaluate the effects of microlens design of peripheral defocus modifying spectacle lenses (PDMSLs) and non-microlens design of PDMSLs on controlling myopia progression in children and adolescents. METHODS: A systematic search was carried out in the PubMed, Cochrane Library, Embase, CNKI, and Web of Science databases. The search targeted randomized controlled trials (RCTs) and cohort studies (CTs) that explored the effects of PDMSLs on myopia control among children and adolescents. The Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale were employed to evaluate the risk of bias in the included studies. The published biases of the included studies were evaluated using Egger’s test. RESULTS: Nine studies (7 RCTs, 2 CTs) were included, involving 4332 participants in the PDMSLs group and 7317 participants in the single vision lenses (SVLs) group. Meta-analysis showed that PDMSLs with microlens design had lower change in spherical equivalent refraction (SER) than SVLs at 6, 12, 18, and 24mo after wearing glasses, with reductions of 0.19 D (95%CI: 0.14 to 0.24, P<0.00001), 0.36 D (95%CI: 0.25 to 0.46, P<0.00001), 0.43 D (95%CI: 0.32 to 0.55, P<0.00001), and 0.51 D (95%CI: 0.33 to 0.69, P<0.00001), respectively. The changes in axial length (AL) were also lower in PDMSLs compared to SVLs, with reductions of -0.09 mm (95%CI: -0.13 to -0.04, P=0.0002), -0.15 mm (95%CI: -0.21 to -0.08, P<0.00001), -0.27 mm (95%CI: -0.34 to -0.20, P<0.00001), and -0.29 mm (95%CI: -0.38 to -0.20, P<0.00001), respectively. There was no significant difference between the non-microlens group and SVLs in controlling the changes of SER and AL in myopia (both P>0.05). CONCLUSION: The synthesized evidence indicates superior myopia management outcomes with microlens design of PDMSLs compared to both SVLs and non-microlens design of PDMSLs in children and adolescents.

Abstract:AIM: To gain insight into the future research directions in scleral contact lenses (SCLs) through a comprehensive bibliometrics study. METHODS: The publications related to SCLs were screened from the Web of Science Core Collection (WOSCC) database. All bibliographic information was extracted and used to conduct a performance analysis. CiteSpace and VOSviewer were employed to visualize annual publication counts, journals, authors, countries, institutions, collaboration networks, keywords, and references. RESULTS: A total of 498 articles were included in our analysis and the number of publications about SCLs showed a significant yearly increase. These publications predominantly emanated from 523 institutions across 38 countries, with the United States and Australia leading in frequency. Totally 1361 authors were identified, among whom Vincent J. Stephen exhibited the highest number of publications, while Jacobs S. Deborah received the most citations. Notably, the journal Contact Lens & Anterior Eye emerged as the primary publisher of studies, and it also boasted the highest citation rate. “Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty” was the most cited paper published in eye & contact lens in 2005. The most prevalent keywords encompassed “keratoconus”, “scleral contact lenses”, “management”, “contact lenses”, “scleral contact lens”, “ocular surface disease”, “dry eye”, and “contact lens”. CONCLUSION: Although SCLs have demonstrated significant potential in ophthalmological care, the results offer valuable insights pertinent to future research directions and clinical practice. Greater emphasis should be placed on developing enhancements in design, materials, and fitting technique, as well as on reducing the complications associated with SCLs.

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