Abstract:AIM: To develop an automated diagnostic system for early detection of diabetic retinopathy (DR) using fundus images by identifying exudates, hemorrhages, and microaneurysms with advanced image processing and machine learning techniques. METHODS: Fundus images from the IDRiD dataset and additional Kaggle datasets were used. A wavelet-based band-pass filter was applied for edge enhancement of retinal features. Gaussian mixture model (GMM) clustering was used to segment and extract texture features. These extracted features were classified using machine learning algorithms, including a random forest classifier and a multilayer perceptron neural network. Performance metrics such as sensitivity, specificity, and accuracy were computed to evaluate the proposed model’s diagnostic effectiveness. RESULTS: The random forest-based classification system achieved a sensitivity of 95.08%, specificity of 86.67%, and overall accuracy of 95.20% in detecting DR lesions. The combination of wavelet-based edge enhancement, GMM clustering, and neural network-based feature classification demonstrated high reliability in lesion identification. CONCLUSION: The proposed method effectively detects early signs of DR from fundus images, offering a high-accuracy, automated, and scalable solution for assisting ophthalmologists. Its application can support large-scale screening programs, particularly in regions with limited access to specialized eye care.

Abstract:AIM: To explore the mechanism of carnosic acid (CA) in treating primary open angle glaucoma (POAG)-induced optic nerve injury using network pharmacology and bioinformatics analyses. METHODS: CA targets were predicted using SwissTargetPrediction and TARGET PREDICTION databases, while glaucoma-related targets were identified via GeneCards, OMIM, DisGeNET, and CTD. Differentially expressed genes (DEGs) were identified by analyzing the Gene Expression Omnibus (GEO) dataset GSE45570, which includes optic nerve head samples from 6 POAG patients and 6 controls. Key targets were derived by intersecting DEGs with CA and glaucoma targets. The expression of the key target gene, FABP3, was further validated in two independent GEO datasets: GSE13534 (lamina cribrosa cells) and GSE2387 (lamina cribrosa region samples). The expression was also validated at mRNA and protein levels using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot (WB) in experimental models. Molecular docking was used to assess binding affinity, and co-immunoprecipitation (Co-IP) confirmed the interaction. Functional enrichment and immune-infiltration correlation analyses were also performed. RESULTS: A total of 306 DEGs, 84 CA targets, and 15 715 glaucoma targets were identified. FABP3 was identified as the key target, which was significantly upregulated in POAG samples in both validation datasets (GSE13534 and GSE2387) and confirmed by qRT-PCR and WB assays. Molecular docking revealed a strong binding affinity between FABP3 and CA (docking score: -9.79 kcal/mol), which was validated by Co-IP. Functional enrichment analysis showed FABP3 was associated with mitochondrial function and immune-related pathways. Correlation analysis indicated FABP3 had a significant negative correlation with activated dendritic cells (aDCs). CONCLUSION: Our study suggests that CA may treat POAG by targeting FABP3, potentially by mitigating oxidative stress and modulating immune responses. This provides a pharmacological foundation and identifies FABP3 as a potential therapeutic target for POAG treatment.

Abstract:AIM: To investigate the therapeutic efficacy and underlying mechanisms of epigallocatechin gallate (EGCG), a major green tea catechin with potent antioxidant properties, in an N-methyl-N-nitrosourea (MNU)-induced mouse model of retinitis pigmentosa (RP). METHODS: C57BL/6 mice were randomly divided into control (PBS), MNU-induced RP, and MNU+EGCG pretreatment groups. EGCG (50 mg/kg, intraperitoneal) was administered daily for 3 consecutive days prior to a single MNU injection (50 mg/kg). Retinal function was evaluated by scotopic electroretinography (ERG). Retinal structure was assessed using optical coherence tomography (OCT) and hematoxylin-eosin staining, with outer nuclear layer (ONL) thickness measurement. Mechanisms were explored via RNA sequencing, reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) validation of oxidative stress- and inflammation-related genes, and immunohistochemistry for microglial activation, astrocytic gliosis, and apoptosis markers. RESULTS: Compared with the MNU group, EGCG pretreatment significantly preserved scotopic ERG a-wave and b-wave amplitudes (P<0.001). OCT and histological analysis showed that EGCG markedly attenuated MNU-induced thinning of total retina and ONL (P<0.005, P<0.001, respectively). RNA sequencing identified 1147 differentially expressed genes modulated by EGCG, with significant upregulation of antioxidant genes (Nrf2, Sod1, Gpx4, Cat1, Ho-1) and downregulation of pro-inflammatory genes. Immunohistochemistry confirmed that EGCG significantly reduced microglial activation, glial fibrillary acidic protein (GFAP) expression, and cleaved caspase-3-positive cells (P<0.01 to P<0.001). CONCLUSION: EGCG exerts robust neuroprotective effects in MNU-induced RP through enhancement of antioxidant defenses, suppression of neuroinflammation, and preservation of retinal structure and function. These findings suggest EGCG as a promising candidate for adjuvant antioxidant therapy in RP.

Abstract:AIM: To identify differentially expressed genes (DEGs) in rabbits with traumatic proliferative vitreoretinopathy (PVR) using high-throughput sequencing (HTS). METHODS: Thirty-six rabbits were randomly allocated to the control group and the PVR group induced by scleral puncture. On the 28th day following modeling, fundus B-ultrasound and fundus photography were performed on all rabbits, and hematoxylin-eosin (HE) staining was conducted on retinal tissues. RNA sequencing (RNA-Seq) combined with bioinformatics analysis was used to screen PVR-associated DEGs. Gene Ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were carried out for the identified DEGs. S100A6, EDNRB and CEBPD were randomly selected for quantitative reverse transcription polymerase chain reaction (RT-qPCR) validation to verify the reliability of the RNA-Seq results. RESULTS: Fundus B-ultrasound, fundus photography and retinal HE staining confirmed the successful establishment of the traumatic PVR rabbit model. A total of 1587 DEGs were screened, of which 1094 were significantly up-regulated and 493 were significantly down-regulated. GO function enrichment analysis showed that these DEGs were mainly enriched in immune response, extracellular region and inflammatory response. KEGG pathway enrichment analysis showed that DEGs were mainly involved in the cytokine-cytokine receptor interaction and hematopoietic cell lineage pathway. RT-qPCR results showed that S100A6, CEBPD and EDNRB were significantly increased in PVR group. CONCLUSION: A large number of genes exhibit significant differential expression in rabbits with traumatic PVR, among which S100A6, CEBPD and EDNRB may play an important role in traumatic PVR.

Abstract:AIM: To evaluate 3% diquafosol ophthalmic solution on ocular surface parameters and the alterations of lipid and muco-aqueous layer in tear film of patients with visual display terminal (VDT)-associated dry eye disease (DED). METHODS: This study included patients with VDT-associated DED. It was a prospective single-arm interventional clinical trial. Patients were provided with 3% diquafosol ophthalmic solution for 3mo and were followed up in 1, 2 and 3mo after treatment. Tear breakup time (TBUT), ocular surface staining score, and ocular surface disease index (OSDI) score were ocular surface characteristics. Lipid layer thickness (LLT), tear meniscus height (TMH), and mucin mRNA expression levels (MUC1, MUC4, MUC5AC, MUC16, and MUC20) were used to measure changes in the tear film. The LipiView interferometer was used to measure the partial blink rate (PBR). RESULTS: Sixty-eight eyes of 68 participants (54 females; mean age 25.12±4.10y; mean spherical equivalent -4.35±2.69 D) were enrolled. Compared with the pre-treatment, OSDI scores and TBUT improved significantly at all follow-up time points (all P<0.01), and TMH increased significantly at 1 and 3mo (P<0.01, P<0.001, respectively). Conjunctival lissamine green staining improved only at 2mo (P<0.05), while corneal fluorescein staining showed no significant changes. Overall LLT remained unchanged, but the PBR<1 subgroup exhibited significant LLT elevation at 3mo (P<0.05), unlike the PBR=1 subgroup. Conjunctival mRNA expression of MUC1, MUC5AC, MUC16, and MUC20 was significantly upregulated at 1 and 3mo (all P<0.01), and MUC4 expression increased significantly only at 1mo (P<0.001). CONCLUSION: In patients with VDT-associated DED, 3% diquafosol ophthalmic solution dramatically reduced symptoms and enhanced tear film stability by promoting ocular surface muco-aqueous secretion. Patients with better blinking habits (PBR<1) demonstrate greater LLT improvement than those with poorer habits.

Abstract:AIM: To evaluate ocular surface characteristics and dry eye symptoms in primary biliary cholangitis (PBC) patients with seasonal allergic conjunctivitis (SAC). METHODS: This retrospective case-control study included 73 PBC patients: 38 with SAC (PBC+SAC group, 38 eyes) and 35 controls (35 eyes). All the participants underwent comprehensive ocular surface assessment and ocular surface disease index (OSDI) scoring. The severity of ocular allergy in PBC+SAC group was indicated by total ocular symptom score (TOSS), and correlation analysis was carried out between TOSS and ocular parameters. RESULTS: Age (59.60±10.69y vs 58.72±11.13y, P=0.629) and gender distribution (34 vs 32 females, P=0.713) did not differ significantly between groups. Compared to controls, the PBC+SAC group had higher dry eye prevalence (65.79% vs 28.57%, P=0.002), higher OSDI score [median: 34.3 (interquartile range, IQR: 26.05, 43.6) vs 21.2 (IQR: 15.15, 31.2), P<0.001], shorter non-invasive tear film breakup time [NIBUT, median: 4.16s (IQR: 2.52, 6.48) vs 6.88s (IQR: 4.81, 9.28), P<0.001], more severe upper meibomian gland loss (P<0.001), higher corneal fluorescein staining score [median: 1 (IQR: 0, 1) vs 0 (IQR: 0, 0.25), P<0.001], and higher rates of meibomian gland duct thinning (60.53% vs 31.43%, P=0.004) and distortion (73.68% vs 25.71%, P=0.001). TOSS was positively correlated with OSDI score (r=0.484, P<0.001) in PBC+SAC group but not with other ocular parameters (all P>0.05). CONCLUSION: PBC patients with SAC have higher dry eye prevalence and more severe dry eye symptoms, mainly evaporative dry eye with obvious upper meibomian gland morphological abnormalities. Allergic symptom severity is positively correlated with dry eye discomfort, suggesting allergic inflammation may exacerbate ocular surface burden in PBC patients.

Abstract:AIM: To evaluate the corneal biomechanical properties in patients with angioid streaks (AS), and to compare these parameters with those of healthy subjects. METHODS: A retrospective study was conducted, enrolling AS patients and healthy participants as controls. The collected corneal tomographic parameters included flat keratometry, steep keratometry, mean keratometry, maximum keratometry, topographic cylinder value, central corneal thickness, and the total deviation value of the Belin-Ambrósio enhanced ectasia display measured with Pentacam tomography. Corvis ST was used to measure corneal biomechanical parameters, non-contact tonometry intraocular pressure (IOPnct), and biomechanically corrected intraocular pressure (bIOP). RESULTS: The study comprised 18 eyes from 10 male and 8 female AS patients with a mean age of 48.83±10.66y, and the controls included 31 eyes from 12 male and 19 female healthy participants with a mean age of 47.87±10.69y. All corneal tomographic parameters were comparable between the two groups (all P>0.05), and no corneal ectasia was observed in any AS patient. Compared with the controls, AS patients exhibited statistically significant increases in applanation 1 (A1) time and stiffness parameter A1 (SP-A1), along with significant decreases in applanation 2 (A2) velocity, deformation amplitude (DA), DA ratio (2 mm), and Corvis biomechanical index (CBI; all P<0.05), which indicated higher corneal stiffness in AS. The IOPnct value in AS was significantly elevated, while no significant difference was found in the bIOP value compared to controls (P=0.031 and P=0.095, respectively). CONCLUSION: Eyes with AS exhibit normal corneal tomographic characteristics and increased corneal stiffness.

Abstract:AIM: To introduce a novel technique for stabilizing the capsular bag in cataract surgery. METHODS: This retrospective observational case series included eyes with unstable capsular bag that underwent cataract surgery. A standard capsular tension ring (CTR) with 10-0 Prolene sutures was inserted into the capsular bag and fixated to the sulcus to stabilize the bag, enabling in-the-bag intraocular lens (IOL) implantation. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and slit-lamp examination were performed preoperatively and at 1 and 6mo postoperatively. RESULTS: Of the 17 eyes from 15 patients (mean age 51.20±19.60y, male/female=11/6), 8 had subluxation due to Marfan syndrome, 3 due to trauma, 5 due to zonular weakness, and 1 due to acute angle closure glaucoma. The preoperative mean CDVA (logMAR) was 0.56±0.67 (mean spherical equivalent: −6.39±4.78 D). At 1mo postoperatively, the mean CDVA improved to 0.21±0.37 (mean spherical equivalent: −0.35±1.07 D). At 6mo, the mean CDVA was 0.32±0.39, and the mean spherical equivalent was −0.34±0.99 D. All patients showed significant visual improvement at both postoperative visits (P<0.05), with stable IOLs in all cases. CONCLUSION: This technique offers a viable surgical option in complex cataract cases with zonulysis.

Abstract:AIM: To assess the effectiveness and safety of VISULAS® green laser selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with pseudoexfoliative syndrome glaucoma (PEXG) and pseudoexfoliative syndrome ocular hypertension (PEXS-OHT). METHODS: This prospective, single-center, interventional study included 20 eyes from 20 patients diagnosed with PEXG or PEXS-OHT. Patients underwent 180° SLT using the VISULAS® green laser, a diode-pumped, frequency-doubled Nd:YVO4 laser with a 532 nm wavelength. IOP was measured at baseline and post-treatment at 1, 3, and 6mo. Medications regimen was stable through the study. Primary outcomes included mean IOP reduction, while secondary outcomes assessed visual and structural parameters, and safety. RESULTS: The mean age of participants was 72.2±6.6y, with 65% of the eyes being left eyes and 35% right eyes. At baseline, the mean IOP was 22.9±2.9 mm Hg. A significant reduction in IOP was observed at all follow-up intervals: 18.5±3.1 mm Hg at 1mo (18.8% reduction, P=0.001), 19.0±4.2 mm Hg at 3mo (16.7% reduction, P=0.002), and 18.2±4.5 mm Hg at 6mo (19.8% reduction, P=0.001). Subgroup analysis showed greater IOP reduction in patients with Shaffer grade 4 angles, phakic eyes, and those with PEXS-OHT compared to PEXG. No significant changes were detected in visual acuity, visual field index, mean deviation, or retinal nerve fiber layer thickness. At 1h post-procedure, 20% of eyes showed an IOP spike >5 mm Hg that resolved without intervention except for one patient. CONCLUSION: SLT with the VISULAS® green laser is an effective and safe treatment for PEXG and PEXS-OHT, achieving significant IOP reduction without increasing medication burden or causing severe complications. These findings suggest its potential as an alternative or adjunct therapy in managing pseudoexfoliative glaucoma.

Abstract:AIM: To explore and summarize outcomes of a modular surgical approach for the personalized management of angle-closure glaucoma (ACG) secondary to nanophthalmos. METHODS: This was a retrospective interventional case series involving consecutive patients with nanophthalmos and ACG. All patients were treated with a modular surgical approach tailored to their specific disease characteristics, which included the following surgical combinations: Procedure I [phacoemulsification (phaco)+goniosynechialysis (GSL)], Procedure II [Procedure I +irido-zonulo-hyaloid-vitrectomy (IZHV)], Procedure III [phaco +IZHV+Ahmed glaucoma valve (AGV) implantation], and Procedure IV (Procedure III+scleral window creation). RESULTS: A total of 92 eyes from 62 patients were enrolled, with a median age of 52 (range: 23-72)y and a median axial length of 19.89 (range: 14.84-20.99) mm. According to the patients’ distinct clinical characteristics, 14, 26, 22, and 30 eyes underwent Procedures I, II, III, and IV, respectively. The median follow-up duration was 13 (range: 12-36)mo. At the final follow-up visit, all patients achieved a sustained intraocular pressure (IOP) below 21 mm Hg without the administration of anti-glaucoma medications. Postoperative complications included malignant glaucoma (MG, 9 eyes), uveal effusion (UE, 5 eyes), suprachoroidal hemorrhage (1 eye), fibrin membrane formation (4 eyes), uveitis (1 eye), macular edema (1 eye), and impaired corrected distance visual acuity (CDVA, 6 eyes). Univariate analysis revealed that younger age was associated with a higher risk of MG (OR: 1.06, P=0.04), UE (OR: 1.07, P=0.046), and impaired CDVA (OR: 1.11, P=0.02). CONCLUSION: The modular surgical approach yields favorable and consistent clinical prognoses, while reducing the incidence of complications, in the challenging clinical scenario of ACG secondary to nanophthalmos.

Abstract:AIM: To evaluate the effectiveness and safety of superselective ophthalmic artery thrombolysis (SOAT) for central retinal artery occlusion (CRAO) beyond 24h after onset. METHODS: This was a retrospective cohort study of CRAO patients treated from January 2019 to July 2025. Patients were divided into four groups by treatment (SOAT/conservative) and onset-to-treatment time (<24h/>24h). Main outcome measures were best-corrected visual acuity (BCVA, logMAR) and central macular thickness (CMT) assessed via spectral-domain optical coherence tomography (SD-OCT), recorded at baseline, 3d and 1mo after treatment. Ocular/systemic adverse events were documented. RESULTS: A total of 109 CRAO participants were enrolled, including 74 males (67.89%) and 35 females (32.11%), with a mean age of 52.30±11.76y. Underlying diseases were hypertension (78 cases, 71.56%), diabetes (40 cases, 36.70%), arterial atherosclerosis with plaque formation (81 cases, 74.31%), hyperlipidemia (14 cases, 12.84%), and hypercholesterolemia (16 cases, 14.68%). Four groups included 25, 28, 26, and 30 cases in Groups 1 (SOAT<24h), 2 (SOAT>24h), 3 (conservative <24h), and 4 (conservative >24h), respectively. In <24h cohort, BCVA improved significantly in both Group 1 (2.36±0.53 to 1.71±0.81 logMAR, P<0.05) and Group 3 (2.42±0.40 to 1.92±0.76 logMAR, P<0.05). In >24h cohort, thrombolysis improved BCVA (1.84±0.88 to 1.31±0.53 logMAR, P<0.05), while conservative treatment showed no significant change (2.04±0.74 to 1.92±0.73 logMAR, P=0.808). Clinically significant improvement (≥0.3 logMAR) was more frequent with SOAT in both time windows (P<0.05). SOAT significantly reduced CMT in both <24h (256±25.65 to 209±21.22 μm, P<0.001) and >24h groups (242±23.33 to 204±27.22 μm, P<0.001), while conservative treatment had no significant effect on CMT (all P>0.05). Adverse events included orbital swelling (11.3%), new cerebral infarction (7.55%), dizziness/headache (7.55%), and nausea/vomiting (5.66%). No intracranial hemorrhage occurred. CONCLUSION: SOAT provides meaningful visual and anatomical benefit even beyond 24h after symptom onset. However, potential ocular and systemic adverse events necessitate careful patient selection and individualized risk assessment.

Abstract:AIM: To investigate the potential impact of lipidaemic and clinical factors on the development of proliferative vitreoretinopathy (PVR) following uncomplicated primary rhegmatogenous retinal detachment (RRD) surgery in nondiabetic individuals. METHODS: This was a retrospective, single-center, case-control study of consecutive patients who underwent primary RRD surgery. The study group comprised 145 patients who developed PVR within 3y of follow-up, while the control group comprised 161 patients with RRD who did not develop PVR. Cox regression analysis was utilized to identify independent associations between various risk markers and the occurrence of PVR. RESULTS: The mean age of patients was 52.31y (SD=13.29), and 54.25% (n=166) were male. The median time to PVR formation after surgery was 150d. Multivariate Cox regression indicated that cigarette smoking status [hazard ratio (HR): 0.43, 95% confidence interval (CI): 0.31-0.60, P<0.001], retinal detachment (RD) not involving the macula (HR: 0.52, 95%CI: 0.37-0.73, P<0.001), apolipoprotein A1 (ApoA1; HR: 1.01, 95%CI: 1.01-1.02, P<0.001) and apolipoprotein E (ApoE; HR: 3.81, 95%CI: 1.64-8.85, P=0.002) were independent predictors of PVR. CONCLUSION: Apart from macular involvement and smoking, the lipidaemic factors ApoA1 and ApoE are risk factors of PVR after primary RRD surgery.

Abstract:AIM: To establish and validate a multidimensional predictive model of postoperative visual recovery after idiopathic macular hole (IMH) surgery. METHODS: Retrospective cohort study. Examinations within a three-month period, both pre- and postoperative, included assessments of best corrected visual acuity (BCVA), intraocular pressure (IOP), and morphological parameters of IMH with optical coherence tomography (OCT). Then, a series of indices were derived, including the IMH index (MHI), diameter hole index (DHI), macular hole closure index (MHCI), hole form factor (HFF), and tractional hole index (THI). Subfoveal anatomical damage (macular hole inferior volume, Vi) was calculated based on the basal diameter (BD), minimum diameter (MD), and height at the narrowest point (HMD) of IMH. Pearson correlation analysis was utilized to discern significant correlations between postoperative BCVA and the multiple indices examined. A subsequent linear correlation analysis was performed. RESULTS: The study involved 51 eyes from 51 patients (mean age 66.90±6.07y) diagnosed with IMH. Preoperative BCVA was 1.22±0.76 logMAR and improved to 0.88±0.38 logMAR after surgery (P<0.001). The correlation analysis results showed significant correlations between postoperative BCVA and preoperative BCVA (P<0.001), BD (P=0.042), MD (P=0.001), MHI (P=0.047), THI (P=0.004), and Vi (P=0.007). The multidimensional model integrating THI, Vi, and preoperative BCVA significantly outperformed traditional predictors (MD, BD, and height) in terms of postoperative visual recovery prediction. THI, reflecting posterior vitreous traction mechanics, independently predicted anatomical reset potential (β=-0.06, P=0.022), while Vi, quantifying subfoveal photoreceptor disruption, was correlated with structural-functional recovery (β=0.01, P=0.046). Preoperative visual acuity served as a critical surrogate for retinal functional reserve (β=0.15, P=0.020). Redundant morphometric parameters (MHI, DHI, MHCI, HFF) were excluded, as their predictive contributions were subsumed by THI/Vi or mediated by preoperative vision. CONCLUSION: The combination of biomechanical traction (THI), subfoveal anatomical damage (Vi), and preoperative BCVA represents a clinically applicable framework for predicting postoperative visual recovery after IMH surgery. This model can be used as a practical tool to guide surgical planning, facilitating the identification of high-risk patients who may benefit from additional techniques (such as an internal limiting membrane flap) while optimizing resource allocation for standard cases.

Abstract:AIM: To investigate efficacy and ocular surface safety of 3 kinds of different correction methods for correction of high myopia in adolescents. METHODS: A prospective, randomized, controlled clinical trial was conducted. From January 2022 to December 2022, 62 adolescents with high myopia (124 eyes) were recruited, with spherical refractive errors ranging from -6.00 to -7.50 diopters (D) and refractive astigmatism ≤1.50 D. All participants were randomly assigned to three groups: the orthokeratology combined with single-vision spectacle lenses (OK+SVLs) group (20 cases, 40 eyes), the peripheral defocus rigid gas permeable contact lenses (Defocus RGPCL) group (22 cases, 44 eyes), and the single-vision spectacle lenses (SVLs) group (20 cases, 40 eyes). All of them were followed up for 1.5y. The observation indicators included refractive error, axial length (AL), tear break-up time (BUT), percentage of hexagonal corneal endothelial cells (CEC), CEC density, and ocular surface adverse reactions. RESULTS: The three groups had mean age of 14.84±1.87y, 14.57±1.91y, and 14.80±1.52y, respectively. No statistically significant differences were found in age, gender, corneal curvature, AL, and spherical equivalent among the groups (all P>0.05). At the 6mo, 1, and 1.5y follow-ups after spectacle lens wear, the improvements in refractive error in the OK+SVLs and Defocus RGPCL groups were significantly superior to those in the SVLs group (F=4.221, P=0.017; F=7.226, P=0.001; F=16.140, P<0.001), while no significant difference was observed between the OK+SVLs and Defocus RGPCL groups (all P>0.05). Intergroup comparisons of AL changes revealed statistically significant differences at all follow-up time points (F=3.493, P=0.034; F=9.930, P<0.001; F=20.570, P<0.001), with no notable difference between the OK+SVLs and Defocus RGPCL groups (all P>0.05). After 1.5y of lens wear, the intergroup comparison of BUT showed a statistically significant difference (F=5.783, P=0.004), whereas no significant differences were found in the percentage of hexagonal CEC and CEC density among the three groups (all P>0.05). No severe complications were observed in the two contact lens groups; only 5 eyes presented with grade 1 or 2 bulbar conjunctival hyperemia and corneal epithelial staining. All adverse reactions were well controlled by temporary lens discontinuation or medication, and resumed lens wear subsequently, with no statistically significant difference in the incidence of adverse reactions between the two contact lens groups (P>0.05). CONCLUSION: Orthokeratology lenses and peripheral defocus RGPCL yield better visual acuity correction and superior image quality, which can minimize retinal image aberrations induced by high refractive errors. Both interventions achieve satisfactory corrective vision and effective myopia control effects in adolescents with high myopia, with no significant adverse reactions observed during the follow-up period, indicating a high level of wearing safety for clinical application.

Abstract:AIM: To evaluate the three-dimensional choroidal vascularity index (3D-CVI) in amblyopic eyes of preschool children compared with age-matched healthy controls using swept-source optical coherence tomography angiography (SS-OCTA). METHODS: A cross-sectional case-control study was conducted. Children aged between 4y and less than 7y diagnosed with hyperopic amblyopia were consecutively recruited between January 1, 2021 and May 30, 2024. Age-matched controls were selected from healthy children without ocular or systemic diseases. All participants underwent SS-OCTA scanning, and choroidal parameters—including 3D-CVI, choroidal vessel volume (CVV), and choroidal thickness (CT)—were analyzed in both foveal and parafoveal regions. Comparative and correlational analyses were conducted to examine differences between groups and to explore the relationship between best-corrected visual acuity (BCVA) and 3D-CVI. RESULTS: A total of 80 eyes (40 amblyopic and 40 age-matched controls) were included. 3D-CVI was significantly lower in the amblyopic group compared to controls in both the foveal [0.318 (0.2885-0.3525) vs 0.381 (0.3460-0.4212), P<0.05] and parafoveal [0.331 (0.2982-0.3589) vs 0.386 (0.3538-0.4293), P<0.05] regions. Similarly, CT was significantly higher in the amblyopic group than in the control group in both the foveal (438±67.3 vs 369±74.1 µm, P<0.001) and parafoveal regions (419±59.0 vs 353±67.5 µm, P<0.001), whereas CVV did not differ significantly between the two groups in either region (P>0.05). Furthermore, multivariate regression analysis showed that BCVA was positively associated with foveal 3D-CVI (P=0.024), whereas no such association was found in the parafoveal region. CONCLUSION: Hyperopic amblyopic eyes in preschool children show significantly lower foveal and parafoveal 3D-CVI compared to normal controls, suggesting a potential reduction in 3D-CVI during early refractive development. Lower foveal 3D-CVI is also associated with poorer BCVA, suggesting that 3D-CVI may serve as a valuable parameter for monitoring structural changes in hyperopic amblyopia.

Abstract:AIM: To evaluate nanosilver eye patches versus Atrauman nanosilver dressings for ocular surface trauma. METHODS: This randomized non-inferiority trial (November 2024–April 2025) enrolled 60 patients assessed pre-treatment and on days 1, 7, and 14 post-treatment. The patients were then randomized into treatment (nanosilver eye patches) and control groups (Atrauman nanosilver dressings). Outcomes included wound healing, comfort (Ocular Comfort Index, OCI), and safety. Statistical analyses used t-tests, non-inferiority tests, and Chi-square tests. RESULTS: Patient baseline characteristics were comparable between groups, with a mean age of 60.633±10.934 in the treatment group versus 64.933±9.606 in controls, and similar gender distribution (20/10 vs 17/13 male/female). Both groups showed comparable baseline OCI scores (treatment group: 6.100±2.187 vs control group: 6.267±2.303, P=0.775). Following treatment, scores increased significantly at day 1 (treatment group: 9.367±2.251; control group: 9.067±2.212, both P<0.001 vs baseline). Marked improvement was observed by day 7 (treatment group: 4.067±1.929; control group: 3.900±1.918, P<0.001 vs baseline), with complete resolution at day 14 (0.467±0.860 vs 0.467±1.008, P<0.001). The non-inferiority criterion was met. The treatment group showed greater improvement in Grade A wound healing rates (76.67% to 93.33%) compared to controls (80.00% to 86.67%) between 1 and 7d post-treatment. By 14d post-treatment, all patients achieved Grade A healing in both groups, with no Grade C cases observed throughout the study period. No adverse events were reported. CONCLUSION: Nanosilver eye patches are non-inferior to Atrauman dressings, offering effective, safe emergency care for ocular trauma.

Abstract:AIM: To investigate the potential of optical coherence tomography angiography (OCTA) for detecting subclinical microvascular damage, possibly before ocular complications develop, in treatment-naive Cushing’s disease (CD) patients. METHODS: This retrospective cross-sectional study included 48 newly diagnosed, treatment-naive CD patients and 48 healthy controls. Ophthalmological examinations, including best-corrected visual acuity, intraocular pressure, optical coherence tomography (OCT), and OCTA were conducted. Retinal and choroidal vessel density (VD) parameters were assessed in the macular and peripapillary regions. Correlations between VD and systemic hormone levels were analyzed. RESULTS: Age (47.3±13.3y vs 43.4±15.8y; P=0.053) and gender distribution (CD: 35 females, 13 males; controls: 34 females, 14 males; P=1.000) did not significantly differ. Patient group exhibited significant reductions in radial peripapillary capillary (RPC; P<0.05) and choriocapillaris (CC) VD across all quadrants (P<0.05) compared to controls. Nasal deep capillary plexus (DCP) VD was also significantly decreased (P=0.035). Subfoveal choroidal thickness (SFCT; P=0.459) did not differ significantly, but nasal choroidal thickness (CT) at 1500 µm (P<0.040) and 3000 µm (P<0.031) was markedly increased. Notably, hormonal correlations revealed associations between ACTH and temporal CC VD (r=0.367, P=0.009), plasma cortisol and superior RPC VD (r=0.303, P=0.034), and urinary free cortisol with superior, and nasal RPC (r=-0.404, P=0.004, r=-0.317, P=0.027) and nasal DCP VD (r=-0.287, P=0.045). CONCLUSION: High endogenous cortisol levels in CD patients primarily affect the peripapillary region and the nasal part of the macula. VD changes occur before pachyvessel formation, choroidal thickening, and the development of pachychoroid spectrum disorder.

Abstract:AIM: To analyze the etiologies, disease course, clinical characteristics, and surgical management patterns of non-traumatic corneal perforation in China. METHODS: This multicenter, retrospective study reviewed medical records from patients with non-traumatic corneal perforation treated at 16 tertiary hospitals in China from 2019 to 2021. Data collected included demographics, etiology, disease duration, perforation location, visual acuity on admission, and surgical procedures. RESULTS: A total of 796 eyes from 791 patients were included, comprising 271 women (34.2%) and 520 men (65.7%), with a mean age of 58.4±15.6y (range, 0.38–92y). Infectious keratitis was the leading cause (62.6%), followed by postoperative complications (12.8%) and autoimmune diseases (8.7%). Fungal infections were more prevalent in rural areas, while autoimmune-related perforations were more common in females. Autoimmune cases more frequently presented with a chronic disease course and better visual acuity at admission compared to infectious causes (P<0.001). Among infectious causes, viral keratitis exhibited the highest proportion of chronic cases (65.7%). Perforation location varied significantly by etiology, with infectious cases predominantly central and autoimmune cases more often peripheral or limbal (P<0.001). Overall, 88.3% of eyes presented with poor visual acuity on admission. Most eyes (90.0%) required surgical intervention. Penetrating keratoplasty was the most common procedure, especially for central perforations, while lamellar keratoplasty was preferred for peripheral and autoimmune-related cases. CONCLUSION: This nationwide, multicenter study provides a comprehensive epidemiologic characterization of non-traumatic corneal perforation. Infectious keratitis was identified as the predominant etiology. Distinct patterns in disease progression, perforation location, and surgical intervention were observed across etiologic subgroups. These findings underscore the relevance of etiology-stratified assessment and support the need for tailored clinical management strategies.

Abstract:Vernal keratoconjunctivitis (VKC) is a chronic bilateral ocular allergic disease affecting mainly children and adolescents. Perilimbal pigmentation (PLP) has been noted as a new sign of VKC in pigmented race of Asian and African origin. To analyze the etiology, clinical significance, and pathophysiology of PLP, and to explore the possible association between ultraviolet (UV) exposure and the presence of PLP in VKC. A PubMed search of articles between January 1983 and January 2024 on VKC with PLP was performed. PLP takes the appearance of spotty pigmentation in the interpalpebral conjunctiva. Activation and proliferation of the melanocytes in the limbus in the status of inflammation had been proposed as possible pathogenesis of PLP. However, the clinical significance of PLP in the process of VKC were still controversial. VKC with PLP were mostly seen in pigmented races in equatorial region with hot, dry climates and strong UV. The regionality of VKC patients with PLP and the interpalpebral distribution of pigmentation suggest possible association of PLP with UV. Elucidating this issue will help to prevent and treat this regional and racial specific VKC.

Abstract:Descemet’s membrane detachment (DMD) is defined as the detachment of Descemet’s membrane that occurs spontaneously or secondary to intraocular surgery. This review focuses on the characteristics and incidence of DMD following phacoemulsification and glaucoma surgery, and aims to compare DMD cases after phacoemulsification (PCE) and different types of glaucoma surgery in terms of incidence, risk factors, clinical manifestations, diagnosis and management strategies. The reported incidence of DMD after PCE ranges from 0 to 5%, and the complication is less frequently observed following glaucoma surgery. Patients with DMD may be asymptomatic or present with severe visual impairment caused by corneal edema, which is associated with the size and location of the detachment. The management of DMD varies according to the primary surgical procedure (PCE or glaucoma surgery), as well as case-specific factors including visual acuity, corneal clarity, and the size and location of the detachment. Longitudinal observational studies are warranted to investigate the underlying cellular mechanisms of DMD. Retrospective studies can be conducted to clarify the incidence and identify all potential risk factors for DMD following glaucoma surgery. In addition, it is crucial to explore all possible risk factors to reduce and prevent this complication.

Abstract:With the acceleration of global aging, the incidence of retinal vein occlusion (RVO) has risen markedly. Its pathogenic mechanisms are closely linked to iron dyshomeostasis and microglial polarization and age-related degenerative changes in retinal microvessels. We systematically summarize the regulatory mechanisms of ferroptosis—an iron-dependent, lipid peroxidation-driven form of cell death, and elucidate the central pathway by which iron overload exacerbates retinal injury through the synergy of hypoxia-reoxygenation (H/R). Specifically, iron metabolic imbalance catalyzes the production of reactive oxygen species (ROS) via the Fenton reaction, which drives the polarization of microglia toward the proinflammatory M1 phenotype and activates the acyl-CoA synthetase long-chain family member 4 (ACSL4)-mediated lipid peroxidation cascade. This review proposes novel insights for combinatorial therapeutic strategies targeting key ferroptotic pathways (e.g., the SLC7A11/GPX4 axis) and modulating microglial polarization, while also addressing the translational challenges associated with iron chelators (deferoxamine), lipid peroxidation inhibitors (liproxstatin-1), and targeted delivery systems for RVO.

Abstract:AIM: To report on the clinical outcomes of rescuing dislocated Akreos intraocular lenses (IOLs) with a closed continuous-loop suture technique (CCS). METHODS: A retrospective review of patients who underwent CCS for rescuing dislocated IOL between June 2017 and March 2023. The clinical primary outcomes were best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL positioning, and complications, assessed both preoperatively and for at least 3mo postoperatively. RESULTS: Nine patients (9 eyes) were reviewed with an average age of 48.67y (range, 18-67y), and a follow-up period averaging 11.67mo (ranging from 3 to 36mo). Post-surgery, the IOLs were well-centered and stable. The preoperative BCVA was 1.03±0.79 logMAR, improving to 0.5±0.48 logMAR at the last follow-up (P<0.05). Preoperative IOP of 20±6.84 mm Hg and postoperative IOP 16.11±5.65 mm Hg (P=0.182). The mean corneal endothelial cell density decreased from 2177±587 to 2080±581 cells/mm² in five patients (P=0.71) and the endothelial cell loss rate is 4.56%. CONCLUSION: CCS is an effective, safe, and minimally invasive method for rescuing and stabilizing dislocated Akreos IOLs.

Abstract:AIM: To analyze the clinical and multimodal imaging characteristics of acute central serous chorioretinopathy (CSC) with or without fibrinous exudation. METHODS: Retrospective case-control study. Patients diagnosed with acute CSC with fibrinous exudation (FE group) and without fibrinous exudation (non-FE group) were consecutively included. The clinical data and multimodal images including color fundus photography, fundus autofluorescence, spectral-domain optical coherence tomography (OCT), fundus fluorescein angiography, and indocyanine green angiography at presentation were recorded. Treatment method, follow-up outcomes including best-corrected visual acuity (BCVA) and OCT characteristics were also documented. RESULTS: The FE group (n=8, 8 eyes, 6 males) had a mean age of 47.50±7.27y, and the median symptom duration was 26.50d. The non-FE group (n=20, 20 eyes, 16 males) had a mean age of 40.40±4.36y, and the median symptom duration was 7.00d. Compared to the non-FE group, the FE group exhibited significantly older age (P=0.004), longer self-reported symptom duration (P=0.02), and poorer baseline and follow-up BCVA (P=0.011, P=0.003). After more than one month follow-up, visual improvement was statistically significant in the non-FE group (P=0.017), but not in the FE group (P=0.157). Multimodal imaging results found higher prevalence of pigment epithelial detachment (PED; P=0.029) and larger subfoveal choroidal thickness (P<0.001) in the FE group, while there was no significant difference in central macular thickness between the groups. The leakage start time was earlier in the FE group (14.50±2.33s) than in the non-FE group (22.67±1.24s, P<0.001). The expanding dot sign was the most common leakage pattern of fibrinous CSC. Late leakage area usually expanded to more than 1/2 disc diameter (DD) in the FE group, while it was less than 1/2 DD in the non-FE group. CONCLUSION: Fibrinous exudation in acute CSC is a multimodal imaging biomarker indicative of severe choroidal vasculopathy and retinal pigment epithelium barrier failure. Recognizing this entity and understanding its potential mechanisms are crucial for managing patient prognosis and may guide future targeted interventions.

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