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Abstract:AIM: To evaluate the impact of high-intensity light on ocular length and structural thickness in chick model of the early lens-induced myopia (LIM) by optical coherence tomography (OCT). METHODS: Four-day-old chicks were monocularly covered with −10 D lenses for a period of 2d, exposed to either high-intensity light (HL, 10 000 lx) or normal-intensity light (NL, 500 lx) for 12h per day. A two-dimensional visualized swept-source OCT system was used to measure anterior chamber depth (ACD), lens thickness, vitreous chamber depth, axial length, retinal thickness and choroidal thickness. The refractive error was measured with retinoscopy. RESULTS: After 2d of treatment, the LIM eyes under NL condition experienced a greater myopic shift (P=0.028) and greater axial elongation (P=0.033) than those exposed to HL. ACD significantly increased in LIM eyes under NL condition when compared with baseline, while no statistical difference of ACD was found between day 2 and day 0 in LIM eyes under HL condition. LIM eyes all experienced the thinning of retinal thickness and choroidal thickness (all P<0.05), with no statistically significant differences between NL and HL group. CONCLUSION: HL could reduce the development of LIM at an early stage. Under NL, hyperopic defocus appears to induce a deepening of ACD at the early stage; this effect could potentially be mitigated by HL. At an early stage, HL may have no significant effects on the changes in retinal and choroidal thickness in LIM eyes.

Abstract:AIM: To investigate the histological and anatomical characteristics of the lacrimal duct system (LDS) in rabbits and rats and compare with that in humans to establish a suitable animal for LDS studies. METHODS: New Zealand white rabbits (1.8–2 kg) and SD rats (250–300 g) were selected. Following tests were executed on their LDS, including anatomical measurements; computed tomographic dacryocystography; hematoxylin and eosin, Masson’s trichrome, Periodic Acid-Schiff staining, and scanning electron microscope. RESULTS: Although there were anatomical similarities between the rats and humans in LDS, the size of LDS was too small and the epithelial types differed from that of humans in LDS. The rabbit only had a lower lacrimal punctum and a lacrimal canaliculus, while they had the same types of lacrimal epithelium as human’s and the size was suitable for clinical probing and intubation. CONCLUSION: Histologically, the lacrimal canaliculi of both rabbits and rats resemble those of humans, making both species applicable for biological studies targeting the lacrimal canaliculi. Nevertheless, the epithelial types of the lacrimal sac and nasolacrimal duct in rats differ significantly from humans, whereas those in rabbits are consistent with humans. Therefore, rabbits are more appropriate for biological research involving the nasolacrimal duct and lacrimal sac.

Abstract:AIM: To identify biomarkers and potential therapeutic targets related to angiogenesis and RNA modification in diabetic retinopathy (DR). METHODS: The Gene Expression Omnibus (GEO) datasets GSE12610, GSE87433, and GSE111465, which contain retinal samples from diabetic and normal mice, were analyzed to identify differentially expressed genes (DEGs). The DEGs were then intersected with angiogenesis- and RNA modification-related genes (A&RMRGs) obtained from GeneCards and other databases to identify differentially expressed A&RMRGs in DR. Hub genes were subsequently identified from the protein-protein interaction (PPI) network built on the enrichment results. Their diagnostic value was then estimated by receiver operating characteristic (ROC) analysis, and their expression levels were tested for associations with immune cell infiltration. Regulatory networks of hub genes were constructed using MicroRNA Target Prediction Database (miRDB), ChIPBase, and the Comparative Toxicogenomics Database (CTD). To validate the bioinformatic findings, hub gene transcript levels were quantified with reverse transcription quantitative polymerase chain reaction (RT-qPCR) in high-glucose-treated rat retinal microvascular endothelial cells (rRMECs). RESULTS: Forty-two A&RMRGs showed differential expression in the diabetic retina, with Gene Ontology (GO)/Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment implicating RNA modification and immune-inflammatory regulation, alongside Gene Set Enrichment Analysis (GSEA) evidence of activated RNA-silencing and fatty-acid-transport programs and suppressed neuronal and retinoid-cycle programs. Seven hub genes (Wdr3, Crebbp, Sdad1, Stat3, Gnl2, Nhp2, and Hsp90aa1) were selected, all of them were upregulated in DR. The DR retina showed higher levels of central memory CD8+ T cells and lower levels of monocytes, Tregs, and CD56bright natural killer (NK) cells. Monocyte infiltration was inversely associated with Stat3 expression (r=-0.604, P<0.001), and central memory CD8+ T cell levels were positively associated with Nhp2 expression (r=0.539, P=0.003). A total of 60 miRNAs, 43 transcription factors (TFs), and 47 drugs may regulate RNA modification of angiogenesis-associated genes in DR. Gnl2 [area under the ROC curve (AUC)=0.914, 95% confidence interval (CI): 0.810–1.000) and Stat3 (AUC=0.964, 95%CI: 0.892–1.000) showed high diagnostic value. Exposure of rRMECs to high glucose led to a marked rise in Stat3 expression and a fall in Sdad1, leaving the transcript levels of the remaining five hub genes unchanged. CONCLUSION: These findings identify Stat3 as a point of convergence between RNA modification, immune dysregulation, and angiogenesis, nominating the hub genes as candidate biomarkers and the associated drug–gene interactions as repurposing leads.

Abstract:AIM: To investigate the functions of microRNA-26a-5p (miR-26a-5p) in the high glucose (HG)-induced rat retinal Müller cells (rMC-1) apoptosis and its possible mechanism. METHODS: rMC-1 cells were transfected with miR-26a-5p mimics or phosphatase and tensin homolog (PTEN) siRNA under HG conditions. Cell apoptosis was analyzed by propidium iodide (PI) and annexin V fluorescein isothiocyanate (FITC) staining. PTEN/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway activation was assessed by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blot. Inflammatory cytokines, interleukin (IL)-1β, IL-6, were measured by enzyme-linked immunosorbent assay (ELISA). The miR-26a-5p-PTEN interaction was validated by dual-luciferase assay. RESULTS: HG significantly suppressed miR-26a-5p expression and induced apoptosis in rMC-1 cells. Overexpression of miR-26a-5p attenuated HG-induced apoptosis by directly targeting PTEN, as confirmed by dual-luciferase reporter assay, which demonstrated that miR-26a-5p directly binds to the PTEN 3’-UTR, resulting in a 50% reduction in luciferase activity (P<0.01). Consistent with this, miR-26a-5p overexpression downregulated PTEN expression, enhanced PI3K/Akt phosphorylation, and suppressed the secretion of IL-1β and IL-6 (all P<0.01). CONCLUSION: Upregulation of miR-26a-5p protects rMC-1 from HG-induced apoptosis by targeting PTEN via regulating the PI3K/Akt pathway and inflammatory responses. miR-26a-5p may be a potential therapeutic target for diabetic retinal neurodegeneration.

Abstract:AIM: To evaluate the diagnostic utility of meibomian gland uneven atrophy (UA) in identifying Demodex infestation among patients with meibomian gland dysfunction (MGD) and to compare its diagnostic performance with that of cylindrical dandruff (CD). METHODS: Patients with MGD were prospectively enrolled and stratified into four groups (n=25/group) based on the presence/absence of CD and UA. Comparative analyses and multivariate adjustments were performed using Demodex detection confirmed by in vivo confocal microscopy and light microscopy. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 100 patients were recruited. The median age was 31.0y (range: 21.0–45.0y; Q1, Q3: 27.0–37.0y), including 29 males and 71 females. Demodex counts per eyelash and positivity rates were highest in the CD+UA+ group, followed by CD+UA−, and CD−UA+, and then CD−UA−. UA was associated with a 5.521-fold increased likelihood of Demodex positivity [95% confidence interval (CI): 2.098–14.531, P=0.001]; CD conferred a 6.460-fold increased risk (95%CI: 2.454–17.002, P<0.001). Incorporating UA status significantly improved model fit (Δχ²=14.096, P<0.001). The areas under the ROC curve (AUC) for CD (in UA–), UA (in CD–), and CD+UA (CD–UA– and CD+UA+) were 0.776, 0.762, and 0.865, respectively. CD and UA demonstrated comparable sensitivity (CD: 87.5%, UA: 86.7%) and specificity (CD: 65.6%, UA: 65.7%), which improved to 90.9% and 82.1%, respectively, when both were combined. CONCLUSION: UA is a significant predictor of Demodex infestation, with diagnostic performance comparable to CD. Combined assessment of CD and UA offers high sensitivity and good specificity, providing a novel and practical tool and substantially reducing misdiagnosis.

Abstract:AIM: To assess the differences in corneal optical density (COD) between young patients with dry eye and healthy controls, as well as to evaluate the correlations with tear film parameters. METHODS: This cross-sectional study involved 30 patients with dry eye and 60 age-matched controls (aged 18–35y). All participants underwent a thorough ophthalmic evaluation, including visual acuity testing, refraction, the Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), the Schirmer’s test, corneal staining, and Pentacam densitometry. RESULTS: The groups were matched for age (21.93±2.88y vs 20.80±2.27y) and sex (females: 60.0% vs 63.3%; P>0.05). No statistically significant differences were found in refraction parameters, best-corrected visual acuity, or mean keratometry when comparing the two groups (all P>0.05). Patients with dry eye exhibited significantly poorer tear parameters including OSDI (25.5±10.6 vs 8.3±6.6, P<0.001), TBUT (6.2±2.2s vs 12.9±6.4s, P<0.001), and Schirmer score (20.9±11.2 vs 26.0±11.4 mm, P=0.02). Dry eye patients displayed a significantly higher average COD in the midperipheral zone (6–10 mm) for both the anterior (18.81±2.15 vs 17.25±1.66, P<0.001) and central layers (11.56±1.35 vs 10.78±0.90, P=0.002) compared to the controls. The anterior COD in the 6–10 mm zone (β=0.329, P<0.001) and the middle COD in the 6–10 mm zone (β=0.267, P=0.006) showed a statistically significant direct relationship with OSDI. CONCLUSION: Young patients with dry eye exhibit increased COD, especially in the anterior and middle corneal layers, which correlates with symptom severity. These results imply that corneal densitometry could act as an objective measure of dry eye severity, supplementing traditional clinical evaluations.

Abstract:AIM: To compare in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in evaluating demarcation line depth (DLD) after corneal collagen cross-linking (CXL) performed under different ultraviolet (UV) energy levels in keratoconus. METHODS: This was a retrospective case series. This study included 216 participants (328 eyes) who underwent CXL with either high (7.2 J/cm²) or low (1.8 J/cm²) UV energy. DLD was assessed by IVCM and AS-OCT at 3, 6, and ≥12mo postoperatively. The high-energy group consisted of participants with progressive keratoconus who received CXL treatment, while the low-energy group included participants with refractive errors who underwent femtosecond laser-assisted in situ keratomileusis (FS-LASIK) Xtra. RESULTS: The high-energy group included 111 participants (144 eyes, mean age 23.39±7.30y, 68 males), and low-energy group included 105 participants (184 eyes, mean age 22.95±5.84y, 53 males). At 3 and 6mo, as well as at the final follow-up, visibility of the demarcation line was consistently superior with IVCM compared with AS-OCT (all P<0.001). At 3mo, the mean DLD measured by IVCM was 382.2±91.12 μm in the high-energy group and 192.53±58.76 μm in the low-energy group, while AS-OCT recorded 354.74±78.82 μm and 196.51±55.57 μm, respectively. Both modalities demonstrated significantly deeper demarcation line with higher UV energy (P<0.05), and no significant difference was observed between IVCM and AS-OCT measurements within each energy group (P>0.05). Furthermore, a significant monotonic temporal trend toward shallower IVCM-detected DLD was observed in both energy groups. CONCLUSION: Compared with AS-OCT, IVCM provides clearer and more reliable visualization of the corneal stromal demarcation line after CXL. While both modalities yield comparable depth measurements, IVCM maintains higher visibility across different energy levels and during follow-up at various time points, making it a preferred modality for postoperative assessment in clinical practice.

Abstract:AIM: To evaluate the structural and functional outcomes of accelerated epithelium-off corneal collagen cross-linking (CXL) in patients with keratoconus (KC) 1y after treatment. METHODS: This retrospective study included patients who underwent an accelerated epi-off CXL for progressive KC at the Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia, between January and December 2023. The protocol consisted of epithelial removal, riboflavin 0.1% instillation for 3min, and ultraviolet-A (UVA) irradiation at 9 mW/cm2 for 10min. Pentacam HR was used to assess keratometric parameters (Kmax, Kmean), curvature-based indices [index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, index of height asymmetry (IHA), index of height decentration, minimum sagittal curvature (Rmin)], pachymetry-based indices [central corneal thickness (CCT), average pachymetric progression index, maximum Ambrósio relational thickness], Belin/Ambrósio deviation, and the ABCD progression system preoperatively and at 12mo. RESULTS: A total of 45 eyes from 45 patients (mean age: 29.1±6.2y) were included in the study. One year after CXL treatment, only Kmax front (55.20 to 55.00 D) showed a statistically significant decrease among the keratometric parameters. A statistically significant reduction was observed in all curvature-based indices, except for IHA, which did not reach statistical significance, whereas Rmin (6.11 to 6.14 mm) showed a statistically significant increase. Additionally, CCT, anterior radius of curvature (ARC), and best-corrected distance visual acuity (BCVA) also demonstrated statistically significant increase. CONCLUSION: Accelerated epi-off CXL results in significant structural and functional improvements in KC at the 1-year follow-up. Decreased Kmax and curvature indices, increased Rmin, CCT, and ARC, and improved BCVA indicate better corneal regularity, biomechanical stability, and functional vision, with ABCD analysis confirming disease stabilization.

Abstract:AIM: To compare the visual, refractive, and optical performance of two diffractive trifocal intraocular lenses (IOLs) with analogous designs but different light distribution profiles. METHODS: A total of 54 eyes from 48 patients undergoing cataract surgery received either the Gemetric™ (GM; Hoya Surgical Optics, Singapore) or the Gemetric™ Plus (GMP; Hoya Surgical Optics) IOLs. Preoperative demographics were comparable between the two groups. Generalized estimating equations (GEE) were utilized for statistical analysis to adjust for inter-eye correlations. RESULTS: A total of 48 patients (54 eyes) were included in the analysis, of which 30 patients (33 eyes) received the GM IOL and 18 patients (21 eyes) the GMP IOL. The mean age was 59.6±6.1y (range: 48–72) in the GM group and 61.6±5.8y (range: 49–69) in the GMP group (P=0.339). At 3mo postoperatively, there were no statistically significant differences in uncorrected distance visual acuity (VA) and uncorrected near vision at 40 cm. However, the GM group showed statistically significantly better outcomes in corrected distance VA (P=0.003) and uncorrected intermediate VA at 66 cm (P=0.033). Conversely, uncorrected near VA at 33 cm was significantly superior in the GMP group (P=0.048). The objective assessment of optical quality showed improved distance and intermediate performance with the GM, while the GMP performed better at near, consistent with the patients’ measured visual outcomes. CONCLUSION: Adjusting light distribution in otherwise identical trifocal IOLs results in distinct clinical and optical advantages, allowing surgeons to tailor IOL selection to patients’ specific visual demands.

Abstract:AIM: To assess the refractive outcomes and effect of the macular status in eyes with proliferative diabetic retinopathy (PDR) and significant vitreous hemorrhage received with combined phacoemulsification and pars plana vitrectomy (phacovitrectomy). METHODS: This retrospective case-control study recruited 176 eyes, including 86 PDR eyes with severe vitreous hemorrhage, who received phacovitrectomy with intraocular lens implantation, and 90 eyes who underwent phacoemulsification only for cataracts (control group). Postoperative follow-up visits documented best-corrected visual acuity (BCVA) and refractive outcomes at each examination. Postoperative refractive outcomes were quantified as spherical equivalents. The primary outcome measure was the refractive prediction error (PE). The PE and absolute prediction error (AE) were employed as key metrics. Additionally, the number and percentage of patients achieving refractions within ±0.25 diopters (D), ±0.50 D, ±0.75 D, ±1.00 D, and ±2.00 D of the target refractive outcome were documented. RESULTS: The overall mean age was 64.4±10.5y. There were 98 (55.7%) female and 78 (44.3%) male patients. In the PDR eyes with the phacovitrectomy surgery, mean PE (-0.008±0.872 D) and AE (0.662±0.563 D) by ultrasound biometry showed no statistically significant differences as compared to the control group (PE: 0.117±0.621 D, P=0.277; AE: 0.506±0.375 D, P=0.118). Subgroup analysis showed that the PE was significantly different in eyes with macular thickening (-0.471±0.955 D) compared to those without macular thickening (0.161±0.781 D, P=0.002). The PE was negatively correlated with macular thickening in multivariate model analysis [β=-0.568, 95% confidence interval: -0.987 to -0.150, P=0.008]. CONCLUSION: Combined phacovitrectomy for PDR with severe vitreous hemorrhage exhibits no ultrasound biometry discrepancies as compared to those received phacoemulsification alone. However, the patients with macular thickening show a noticeable myopic shift.

Abstract:AIM: To evaluate the incidence and clinical features of delayed reversible loss of light perception (D-RLLP) following vitreoretinal surgery, including vitrectomy or silicone oil (SO) removal, and to identify risk factors influencing its recovery time. METHODS: This study retrospectively reviewed 19 029 cases (19 029 eyes) of vitreoretinal surgery performed between October 2016 and March 2024. Based on strict temporal criteria, postoperative loss of light perception was classified as immediate postoperative loss of light perception (IP-LLP), D-RLLP, and delayed permanent loss of light perception (D-PLLP). The incidence of reversible loss of light perception (RLLP) and its clinical features were evaluated. A multiple linear regression model was constructed to identify the independent predictors of the recovery time of D-RLLP. RESULTS: Among 19 029 vitreoretinal surgeries, 113 eyes (0.59%) experienced postoperative loss of light perception (LLP), including 32 eyes (28.32%) with IP-LLP, 78 eyes (69.03%) with D-RLLP, and 3 eyes (2.65%) with D-PLLP. The overall incidence of D-RLLP was 0.41% (78/19 029). D-RLLP incidence was significantly higher following SO removal (0.89%, 33/3703) than general vitrectomy (0.29%, 45/15 326; P<0.001). In 78 D-RLLP cases, the median recovery time was 47min (interquartile range: 28–71min), with 25.64% recovering in ≤30min, 64.10% in 30–60min, and 10.26% requiring >60min. Multivariate regression identified a history of hypertension (B=18.63, P=0.046) and intraocular pressure difference (B=1.77/min per mm Hg, P=0.011) as independent predictors of prolonged recovery time. CONCLUSION: D-RLLP is a rare clinical event following vitreoretinal surgery, with a median recovery time of 47min, and the vast majority of affected eyes recovered within 1h. SO removal displayed a significantly higher RLLP incidence than vitrectomy. Importantly, a history of hypertension and greater intraocular pressure difference correlated significantly with an extended recovery time.

Abstract:AIM: To investigate clinical characteristics, comorbidities, seasonal onset, and antihypertensive medication use among acute primary angle-closure (APAC), chronic primary angle-closure glaucoma (CPACG), and primary angle-closure suspect (PACS) patients. METHODS: A retrospective cross-sectional study of 484 Chinese patients was conducted. Baseline demographics, hypertension and diabetes prevalence, antihypertensive medication use, and seasonal onset patterns were compared across primary angle-closure disease (PACD) subtypes. Seasonal variation was assessed using the von Mises distribution, with subgroup analyses stratified by systemic conditions and medication use. RESULTS: CPACG patients were older (median 71 vs 67y in APAC, P<0.001) with higher hypertension (47.74% vs 31.16%, P=0.003) and diabetes prevalence (20.60% vs 10.05%, P=0.014). Multivariate analysis showed hypertension [odds ratio (OR)=1.85] and diabetes (OR=2.00) were significant predictors of CPACG vs APAC. A modest but significant seasonal peak of APAC onset was identified in early June. Subgroup analyses revealed significant shifts in seasonal patterns according to hypertension (P=0.023), diabetes (P<0.001), and calcium channel blocker (CCB) use (P=0.025). Angiotensin-converting enzyme inhibitors (ACEIs) use was absent in APAC patients but present in CPACG and PACS groups; CCB use was highest in APAC patients, though differences were not statistically significant. CONCLUSION: Vascular and metabolic comorbidities are more prevalent in CPACG than APAC, suggesting their role in CPACG pathogenesis. The early-summer peak in disease onset points to possible environmental triggers. Seasonal variation in APAC onset appears to be influenced by systemic vascular conditions and antihypertensive medication use, supporting a multifactorial interaction between environmental, systemic, and pharmacologic factors in APAC.

Abstract:AIM: To evaluate the surgical outcomes of a simplified slipknot pupilloplasty technique for repairing mydriasis, with a focus on postoperative visual recovery, pupil morphological stability, knitting efficiency and knot security. METHODS: This prospective case series included patients with mydriasis due to trauma, glaucoma attack or iatrogenic damage, who underwent pupilloplasty (with or without intraocular lens implantation) from October 2022 to July 2025. Postoperative follow-ups were performed at 1, 3, 6, and 12mo. All cases had a minimum follow-up period of 3mo (range 3–12mo). Parameters recorded included best-corrected visual acuity (BCVA, logMAR), pupil diameter, and intraocular pressure (IOP). RESULTS: A total of 32 consecutive patients (32 eyes, 21 males) were included. The mean age was 57.9±15.9y (21 to 85y). The simplified slipknot technique resulted in significant visual improvement: the mean preoperative logMAR BCVA was 1.15±0.79 (range, 0.22 to 2.5), which improved to 0.35±0.32 (range, 0 to 1.398) postoperatively. Postoperative pupil diameter remained stable, with a mean of 3.0±0.5 mm (range, 2.5 to 4 mm). The duration of the pupilloplasty was 4.3±0.5min and there was no loosening or shedding of the line knot in any case. CONCLUSION: The simplified slipknot technique has a similar treatment effect and safety as the traditional technique but requires a shorter time and is easier to perform in pupilloplasty surgery. It causes minimal trauma to intraocular tissues, and is easy to popularize.

Abstract:AIM: To evaluate the long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy during cataract surgery in eyes with diabetic macular edema (DME). METHODS: This was a retrospective clinical study. Patients with DME scheduled for cataract surgery were included. Prior to surgery, DME was considered adequately controlled, defined as a central subfield thickness (CST) of ≤300 μm without evidence of significant intraretinal or subretinal fluid on optical coherence tomography. Participants were divided into two groups: 18 patients underwent cataract surgery alone, and 10 received both cataract surgery and anti-VEGF therapy concurrently. The study compared the timing of the initial postoperative anti-VEGF injection and the frequency of injections over 5y. Postoperative outcomes, particularly improvements in best-corrected visual acuity (BCVA) and changes in CST, were also examined. RESULTS: A total of 28 patients were enrolled, with 10 patients undergoing combined cataract surgery and anti-VEGF therapy (3 males, 62.8±4.4y), while 18 patients (7 males, 70.0±13.6y) underwent cataract surgery alone. The combined therapy group had a significantly longer interval before the initial postoperative anti-VEGF injection (12.2±5.7wk) compared to the cataract-only group (4.4±1.6wk). The combined therapy group also required significantly fewer total anti-VEGF injections over 1, 3, and 5y, with the most notable difference in the first year. There was significant improvement in BCVA from pre- to postoperative stages across all eyes. However, there was no statistically significant difference in postoperative BCVA and CST between the groups. CONCLUSION: Concurrent anti-VEGF therapy during cataract surgery is associated with lower early postoperative DME recurrence and a longer interval to the first postoperative anti-VEGF injection. This combined approach may reduce early treatment burden.

Abstract:AIM: To assess the functional and anatomical outcomes in patients with maculopathy related to an optic disc pit (ODP-M), managed with or without surgery. METHODS: This retrospective monocentric study, included 52 patients (52 eyes) with ODP-M. Of these, 52% (n=27) were managed conservatively, while 48% (n=25) underwent surgery. Primary outcomes included changes in best-corrected visual acuity (BCVA) and anatomical parameters [central macular thickness (CMT), sub-foveal choroidal thickness (SFCT)], as well as the rate of fluid resolution. RESULTS: The mean age was 33.8±22.3y (range: 5–82y), with 27 females and 25 males. Median follow-up duration was 18.0mo [interquartile range (IQR) 7.0–41.5] for the non-surgical group and 15.0mo (IQR 9.0–48.0) for the surgical group. The surgical group demonstrated significantly greater BCVA improvement (mean change: -0.40±0.56 logMAR) compared with the non-surgical group (mean change: -0.03±0.19 logMAR; P=0.006). SFCT remained stable in the non-surgical group (mean change: +4.6±36.4 μm, P=0.74), and showed a greater decrease in the surgical group [mean change: -24.6 μm, 95% confidence interval (CI) -51.4 to +2.2 μm; P=0.06]. CMT decreased significantly in the surgical group (mean change: -392.2±287.9 μm, P<0.001), whereas it remained stable in the non-surgical group (mean change: -79.7±233.4 μm, P=0.09). Spontaneous subretinal fluid reduction was observed in 25.9% (n=7) of non-surgical eyes, compared with 72.0% (n=18) of surgical eyes (P<0.001), including complete fluid disappearance in 40.0% (n=10) of surgical cases. CONCLUSION: Surgical intervention appears more effective than conservative management in achieving subretinal fluid reduction and BCVA improvement in eyes with ODP-M.

Abstract:AIM: To quantify the impact of the measurement of non-cycloplegic refraction on estimates of refraction and classification of refractive status in young adults. METHODS: This cross-sectional analysis included 825 young adults (mean age 26.6±3.3y; 56.7% female) from the Guangzhou Twin Eye Study. All participants underwent both non-cycloplegic and cycloplegic autorefraction. Error in refraction was defined as the difference between cycloplegic and non-cycloplegic spherical equivalent refraction (SER). RESULTS: Using a cut-off of -0.50 D for non-cycloplegic refraction to diagnose myopia, the prevalence of myopia was overestimated (90.2% vs 87.0%), resulting in the identification of 3.2% (26/825) pseudo-myopes. After increasing the threshold to -0.75 D, the overall prevalence (87.5%) was approximately equivalent to that with cycloplegic refraction, 9 of the 26 pseudo-myopes would have been re-classified correctly as emmetropes, but 13 genuine myopes would have been re-classified incorrectly as emmetropes. Lack of cycloplegia resulted in a significant myopic shift compared to cycloplegic refraction. Notably, 25.6% of participants exhibited a clinically significant myopia refractive shift of ≥0.50 D, and 5.7% demonstrated a large shift of ≥1.00 D. CONCLUSION: At a threshold of -0.75 D, the calculated prevalence of myopia is close to that obtained with cycloplegic refraction. However, threshold adjustment does not solve the mis-classification problem, because while it will eliminate some pseudo-myopes, it will also eliminate some genuine myopes. Our study confirms that non-cycloplegic refraction leads to significant measurement errors in young adults, highlighting the necessity of cycloplegia for accurate epidemiologic assessment of myopia prevalence.

Abstract:AIM: To analyze research landscapes, hotspots, and trends in artificial intelligence (AI) applied to ophthalmic optical coherence tomography angiography (OCTA) from 2015 to 2024, aiming to reveal global collaborations and guide future research. METHODS: We retrieved publications from Web of Science Core Collection using AI and OCTA-related search terms. After screening, 237 articles were analyzed with CiteSpace (version 6.3.R1) for co-citation, collaboration, and keyword burst analysis. RESULTS: Annual publications grew rapidly since 2017. China (94 publications) and the US (86 publications) were the most productive and influential countries. Research focused on: deep learning algorithms and vessel segmentation, ocular disease diagnosis including diabetic retinopathy and glaucoma, and automated vascular quantification and multimodal imaging. Key limitations included small sample sizes and limited algorithm generalizability. CONCLUSION: The integration of AI with OCTA has significantly advanced the automation and precise quantitative analysis of ophthalmic vascular imaging, demonstrating substantial potential for diagnosing various retinal and choroidal diseases. Future efforts should focus on developing more robust and interpretable AI models, conducting large-scale, multi-center clinical validation, and establishing standardized imaging and analysis protocols to ultimately realize the widespread adoption of AI-OCTA technology in routine clinical practice.

Abstract:The optimal extent of vitreous removal in modern vitreoretinal surgery remains controversial. While extensive vitrectomy has traditionally been performed to minimize traction and reduce postoperative complications, emerging evidence challenges its routine use across all indications. This narrative review critically evaluates whether extensive vitreous removal provides superior outcomes compared to limited, vitreous-sparing approaches. Current data do not demonstrate a consistent or clinically meaningful advantage of extensive vitrectomy. Although broader vitreous removal may reduce residual traction, it is associated with increased intraoperative manipulation and a higher risk of iatrogenic retinal injury, particularly during peripheral vitreous shaving. In contrast, limited vitrectomy appears sufficient in macular surgery and selected cases of rhegmatogenous retinal detachment, especially with advances in microincisional techniques, high-speed cutters and improved visualization systems. In complex tractional diseases, however, more extensive dissection may still be required. Overall, the available evidence supports a selective, pathology-driven approach rather than routine extensive vitreous removal, reflecting a shift toward more precise and minimally invasive vitreoretinal surgery.

Abstract:Primary open angle glaucoma (POAG) is a complex neurodegenerative disorder involving genetic susceptibility, environmental factors, and systemic abnormalities, whose pathogenesis has not been fully elucidated. Based on baseline intraocular pressure (IOP), POAG is classified into two subtypes: high-tension glaucoma (HTG) and normal-tension glaucoma (NTG). This review summarizes and integrates recent research advances, focusing on the roles of systemic disorders including cardiovascular, endocrine, neurodegenerative, and autoimmune diseases, as well as obstructive sleep apnea-hypopnea syndrome (OSAHS), in the onset and progression of POAG from an integrated eye-brain-body axis perspective. Current evidence suggests that optic nerve damage in POAG involves multiple interconnected pathological pathways, such as IOP-related mechanical stress, hemodynamic disturbances, impaired neurovascular coupling, microvascular dysfunction, oxidative stress, and chronic inflammation. Among them, dysfunctions of the eye–brain axis, gut–eye axis, and ocular lymphatic–glymphatic system serve as key regulatory networks that mediate and integrate the aforementioned pathological processes. The two subtypes display distinct pathogenic features: HTG is primarily driven by elevated IOP, whereas NTG relies more on IOP-independent mechanisms and is more susceptible to systemic influences. This integrative perspective deepens our understanding of POAG pathogenesis and provides a novel theoretical foundation for early diagnosis, multidimensional intervention, and precision therapy.

Abstract:Retinal vascular diseases (RVDs) are leading causes of vision impairment and blindness, often associated with systemic diseases such as diabetes and hypertension. Despite treatment advancements, managing RVDs, particularly retinal vein occlusion (RVO), remains challenging due to the lack of a definitive cure and reliance on controlling complications. Microglia, the retina’s resident immune cells, play a crucial role in maintaining retinal health, regulating inflammation, and modulating angiogenesis. In pathological conditions, microglia adopt heterogeneous and context-dependent activation states, contributing to both inflammatory injury and vascular repair. Studies suggest that modulating microglial activation and their secreted cytokines may provide novel therapeutic strategies for RVDs. This review examines the role of microglia in RVDs and their potential as therapeutic targets, exploring strategies such as inhibiting microglial activation, regulating pro-angiogenic factor secretion, and targeting specific signaling pathways. Future research should focus on understanding the specific roles of microglial subtypes, their contributions to disease progression, and developing targeted therapies for early diagnosis and treatment of RVDs.

Abstract:AIM: To explore the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of Posner-Schlossman syndrome (PSS). METHODS: A retrospective review was conducted on participants diagnosed with PSS and uncontrolled intraocular pressure (IOP) who underwent GATT between 2023 and 2024. Clinical outcome measures including visual acuity, IOP, gonioscopic findings, complications, and relapses were collected for postoperative visits: 1d, 1wk, 1, 3, 6mo and 1y. RESULTS: Eleven participants (mean age 43.00±13.82y, 5 females and 6 males) were enrolled. Nine participants were followed up for 12mo after the surgery, 1 participant underwent trabeculectomy to decrease the uncontrolled IOP, another participant was followed up for 6mo because of loss of follow-up. The mean IOP before GATT was 33.64±6.21 mm Hg (range: 23–46 mm Hg). The mean number of antiglaucoma medications prior to surgery was 2.73±0.66. At 6mo after the surgery, the mean IOP decreased to 17.36±6.17 mm Hg (47.15%±17.35% reduction). Nine participants were followed up for 12mo, and their mean IOP decreased to 16.22±2.49 mm Hg, with an average IOP reduction of 46.83%±16.93% (P<0.01). The number of anti-glaucoma medications significantly decreased to 0.91±0.83 at the last follow-up (P<0.05). Two eyes were considered treatment failures due to reintervention and uncontrolled IOP. The preoperative IOP of qualified success cases were significantly lower than that of failed cases. The most common complications were intraoperative anterior chamber blood reflux (100%) and IOP spikes (45.45%), both of which resolved within 1wk. During the follow-up period, 7 participants experienced recurrent attacks of PSS. Nevertheless, peak IOP during relapse was significantly reduced compared to preoperative values (P<0.05). CONCLUSION: GATT seems to be a reliable and effective method for the management of PSS with uncontrolled IOP. Higher preoperative IOP maybe the factor of surgical failure. Although it may not prevent relapse of PSS, it might potentially reduce the peak IOP. Longer-term follow-up and a larger sample size are recommended for more in-depth analysis.

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