Abstract:AIM: To investigate the anti-inflammatory and neurorestorative effects of neuroprotectin D1 (NPD1) in Aspergillus fumigatus (A. fumigatus) keratitis in C57BL/6 mice. METHODS: The left corneas of C57BL/6 mice were infected with A. fumigatus. Each mouse was injected intraperitoneally with 2 μg NPD1 at 1, 3, and 5d post infection (p.i.) and injected subconjunctivally with 5 μL NPD1 once a day. The severity of keratitis was observed by slit lamp and classified by clinical score at 1, 3, and 5d p.i. Hematoxylin and eosin (HE) staining was used to evaluate the histological changes and inflammatory cell infiltration of corneas at 3 and 5d p.i. Polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA), and Western blot were performed to detect the expression of IL-1β, MIP-2, CGRP, p-p38/p38 MAPK, Nrf-2, and HO-1. Immunofluorescence staining was utilized to assess the neutrophil infiltration and neural innervation. Flow cytometry assay was performed to test the number of total, M1 and M2 macrophages. RESULTS: In A. fumigatus infected C57BL/6 mice, NPD1 treatment ameliorated the severity of keratitis. Compared with the phosphate-buffered saline (PBS) control group, NPD1 treatment inhibited the infiltration of neutrophils and macrophages, increased the ratio of CD206+/CD86+ macrophages, reduced the phosphorylation level of p38 MAPK, and enhanced the expression of Nrf-2/HO-1 at 3d p.i. The number of corneal nerves and the mechanical sensitivity threshold of the NPD1 treatment group were significantly higher than the PBS group at 3 and 5d p.i. Meanwhile, the expression of IL-1β and MIP-2 in the NPD1 treatment group was significantly lower at 3 and 5d p.i. CONCLUSION: NPD1 improves the prognosis of A. fumigatus keratitis in mice by inhibiting the recruitment of neutrophils and macrophages, promoting M2 macrophage polarization and corneal nerve regeneration.

Abstract:AIM: To investigate the effect of intermittent fasting (IF) on diabetes-induced meibomian gland dysfunction (MGD) in a mice model. METHODS: The diabetic mice underwent an 8-week dietary intervention of ad libitum (AL) and IF diet. Meibomian gland (MG) proliferative potential, apoptosis, and ductal hyperkeratinization were assessed using immunofluorescence. Gene expression levels were evaluated by Western blot. Lipid accumulation was observed via LipidTox staining. Transmission electron microscopy (TEM) examined intracellular lipids and mitochondrial ultrastructure in acinar cells. Lipidomic and transcriptomic analyses compared MG gene expression and lipid profiles between groups. RESULTS: IF ameliorated diabetes-induced MGD. IF significantly improved diabetic MG proliferation, apoptosis and lipid metabolism imbalance, as well as improved the expression of the genes involved in lipid metabolism. Simultaneously, the results of lipidomics indicated that IF can effectively modify the types and content of lipids, especially ceramides and cholesterol esters. Transcriptomic results suggested that IF effectively ameliorated cell death and modulated ion channels signaling. IF could ameliorate cell death which might be mediated by the calcium ion signaling pathway to mitigate diabetes-induced MGD. CONCLUSION: These results provide direct evidence for the feasibility of dietary intervention to improve diabetes-induced MGD. IF can alter MG lipid composition and inhibit apoptosis in diabetic condition. The underlying mechanism may be associated with calcium ion signaling pathway.

Abstract:AIM: To investigate the role of pyruvate kinase M2 (PKM2) in high glucose (HG)-stimulated retinal endothelial cells and its underlying molecular mechanisms and signaling pathways in retinal angiogenesis. METHODS: Human retinal microvascular endothelial cells (HRMECs) were cultured and divided into the following groups: normal glucose (NG, 5.5 mmol/L), HG (30 mmol/L), HG with PKM2 knockdown (HG+shPKM2), and HG treated with the pharmacological activator TEPP46 (HG+TEPP46). Cellular viability, proliferation, migration, and tubeforming ability were assessed using CCK8, EdU, wound healing/Transwell, and Matrigel assays, respectively. The expression levels of PKM2, phosphorylated PKM2 (pPKM2, Y105), hypoxia-inducible factor-1α (HIF1α), and vascular endothelial growth factor A (VEGFA) were detected by Western blotting. The oligomerization status of PKM2 was analyzed via native gel electrophoresis. The subcellular localization of PKM2 was examined by immunofluorescence and nuclearcytoplasmic fractionation. RESULTS: Under HG stimulation, the expression level of PKM2 was significantly increased (P<0.05). Knockdown of PKM2 was found to markedly suppress cell viability, proliferation, migration, and tube formation in HRMECs (P<0.05). Mechanistic studies revealed that phosphorylation of PKM2 at the Y105 site was promoted by HG treatment, which induced its dissociation from a tetramer to a dimer, thereby driving its nuclear translocation. Upon entering the nucleus, PKM2 was shown to exert critical nonmetabolic functions; it was physically bound to HIF1α and acted as its coactivator, leading to significant upregulation of VEGFA expression (P<0.05). In contrast, the PKM2 activator TEPP46 effectively prevented dimerization and nuclear translocation of PKM2 by promoting its tetramerization. Consequently, the PKM2/HIF1α axismediated upregulation of VEGFA was blocked, ultimately resulting in the reversal of HGinduced angiogenesis. CONCLUSION: HG influences retinal endothelial cell function by inducing PKM2 phosphorylation, dimerization, and nuclear translocation. The shift in PKM2 phosphorylation and oligomerization status represents a key mechanism through which TEPP-46 reverses HG-induced angiogenesis.

Abstract:AIM: To screen for differentially expressed genes in retinoblastoma (RB) gene chips using GEO2R and validate them clinically. METHODS: The expression profile chip data (GSE110811) was downloaded from the public gene chip database Gene Expression Omnibus (GEO). The GEO2R chip analysis platform was used to identify differentially expressed genes between RB and adjacent normal tissues. According to the International Intraocular Retinoblastoma Classification (IIRC) system, 35 children diagnosed with RB from our hospital and other hospitals were enrolled as the RB group, and 35 healthy children who underwent physical examinations in our hospital were enrolled as the control group. The relative expression levels of Sprouty RTK signaling antagonist 2 (SPRY2) and estrogen-related receptor beta (ESRRB) in the serum of patients were detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The diagnostic value of SPRY2 and ESRRB in RB was evaluated by receiver operating characteristic (ROC) curves. Analysis of the relationship between SPRY2/ESRRB expression and clinicopathological features, as well as its correlation with the tumor marker CA199. RESULTS: In the GSE110811 chip, the expression levels of two genes, 16780069 (SPRY2) and 16786783 (ESRRB), showed the most significant differences between RB and normal tissues. The relative expression levels of SPRY2 and ESRRB in the serum of children in RB group (22 males, age 1.64±1.08y) were significantly lower (P<0.05) than those in control group (25 males, age 1.54±0.95y). The area under the ROC curve for SPRY2 was 0.735 (95%CI: 0.616-0.854), while that for ESRRB was 0.880 (95%CI: 0.800-0.960). There were statistically significant differences in the expression of SPRY2 and ESRRB with respect to choroidal invasion, optic nerve invasion, differentiation degree, and clinical staging (P<0.05). In RB group, the expression levels of SPRY2 and ESRRB decreased gradually with increasing CA199 levels, showing a negative correlation (rSPRY2=-0.593, rESRRB=-0.423; both P<0.05). CONCLUSION: The expression of SPRY2 and ESRRB is closely related to the occurrence and development of RB and negatively correlated with the tumor marker CA199. They have the potential to serve as diagnostic biomarkers for RB.

Abstract:AIM: To evaluate the efficacy and safety of cyclosporine 1% (CsA) eye drops in patients affected by pediatric blepharokeratoconjunctivitis (PBKC). METHODS: This was a retrospective, single arm study of pediatric patients with PBKC. All patients received topical CsA 1% eye drops, administered three times daily for 2mo and then tapered during the third month. In the first treatment week, chloramphenicol and betamethasone eye drops were also given three times daily. Patients were examined at baseline (T0), 4wk (T1), 3mo (T2), and 12mo (T3). At each visit, slit-lamp evaluation of the anterior segment and anterior segment photography were performed. Disease activity and damage were assessed using the modified Hamada bimodal scoring system. Mean PBKC scores across time points were compared using one-way ANOVA, followed by Tukey’s HSD post-hoc test. RESULTS: Thirty-six pediatric patients with PBKC were enrolled, six are excluded for incomplete follow-up, leaving 30 patients (11 males, 19 females; mean age 7.71±3.86y) for analysis. The baseline activity score was 1.60±0.62 and decreased significantly at all time points (T1: 0.53±0.51; T2: 0.34±0.76; T3: 0.47±0.86; P<0.001). Damage scores declined by 52% at T1, 53% at T2, and 70% at T3, with significant reductions at T2 and T3 versus baseline (P<0.01). No adverse events occur during the follow-up. CONCLUSION: CsA 1% eye drops effectively control the signs and symptoms of PBKC in pediatric patients and demonstrate a favorable safety profile, supporting their used as a valid therapeutic option in clinical practice.

Abstract:AIM: To compare changes in the corneal surface and endothelium, and to investigate their relationship with the horizontal length (HL), vertical length (VL), and depth of pterygium. METHODS: This study analyzed 34 eyes with unilateral primary pterygium and compared them to the 34 fellow eyes. Topographic values, wavefront aberrations, and specular microscopy findings were assessed. In addition, correlation analyses were conducted between the HLs and VLs, as well as the depth of pterygium. RESULTS: The mean age of the patients was 60.18±11.36y (38.2% females). Uncorrected visual acuity (UCVA) was lower, and corneal astigmatism was higher in the pterygium group (P=0.006 and P<0.001, respectively). Simulated keratometry 1 (simK1) measurements showed significant corneal flattening in the pterygium group (P=0.038). Notably, the HL of the pterygium (r=0.646, P<0.001) demonstrated a stronger correlation with corneal astigmatism than the VL (r=0.449, P=0.008). No significant correlation was observed between depth (r=-0.007, P=0.971) and corneal astigmatism. Furthermore, significant increases were noted in total higher-order aberrations (HOA; P=0.013), trefoil (P=0.002), tetrafoil (P=0.001), and high-order astigmatism (P<0.001) in the pterygium group. Mean point spread function (PSF) values were also significantly impaired in the pterygium group (P=0.007). Regarding endothelial parameters, the median endothelial cell density (ECD) was 2448.50 (2176.00-2750.25 cells/mm²) in pterygium group, and 2554.00 (2252.50-2890.00 cells/mm²) in the control group (P=0.289). No correlation was found between HS or VL and specular microscopy findings. However, a negative correlation was observed between depth and hexagonality (r=-0.381, P=0.026), and between depth and central corneal thickness (CCT; r=-0.422, P=0.013). CONCLUSION: The effect of pterygium on corneal aberrations is more strongly associated with its HL than with its VL. Depth do not affect aberrations, and pterygium has no significant effect on the ECD.

Abstract:AIM: To evaluate various corneal topographic patterns in keratoconus (KCN) and their association with disease progression. METHODS: A retrospective cohort study was conducted on 636 eyes of 335 KCN patients (396 males, 240 females) with a mean age of 30.95±7.95y. Participants underwent two ocular examinations, including corneal tomography using the Pentacam-HR. Topographic patterns were classified based on axial curvature, and KCN progression was defined as a change of ≥1.00 D in maximum keratometry (Kmax). Accordingly, evaluated eyes were categorized into progressive, regressive, and stable groups. RESULTS: The most common topographic pattern was asymmetric bowtie with inferior steepening (AB-IS, 27.4%) in both males (26.8%) and females (28.3%). In the regressive group, asymmetric bowtie with skewed radial axes (21.3%) was most frequent, while AB-IS (31.3%) and inferior steepening (IS, 25.9%) dominated the stable and progressive groups, respectively. Significant differences were observed in corneal parameters across patterns: the oval pattern exhibited the most negative spherical equivalent and the lowest corrected visual acuity, whereas the irregular pattern showed the highest Kmax values in the first examination (P<0.05). The asymmetric bowtie with superior steepening (AB-SS) pattern also exhibited the least curvature. In terms of changes in topographic parameters over time, variations were observed in certain parameters across different patterns. Notably, the irregular pattern exhibited the most significant changes in Kmax between the two examinations. Although the AB-SS tended to regressed, the AB-IS and IS patterns showed a tendency toward progression (P<0.05). Changes in most components of the KCN screening indices also varied significantly across patterns (P<0.05). CONCLUSION: Corneal topographic patterns in KCN exhibit distinct characteristics and progression rates. Understanding these patterns can aid in predicting disease progression and tailoring treatment strategies.

Abstract:AIM: To evaluate the clinical presentation, nasal endoscopic findings, and surgical outcomes of probing surgery (PS) or bicanalicular silicone tube intubation (BCI) performed under nasal endoscopic guidance (NEG) in pediatric patients with congenital nasolacrimal duct obstruction (CNLDO), regardless of previous surgical history. METHODS: This retrospective cross-sectional study included CNLDO patients with data on demographics, fluorescein dye disappearance test (FDDT) results, dacryoscintigraphy findings, prior surgeries, and outcomes of NEG-PS or NEG-BCI. NEG-BCI using Crawford stents was performed intraoperatively in complex cases. Intraoperative and postoperative complications were recorded. Surgical success was evaluated clinically and with FDDT at postoperative months 1 and 6. Stents were retained for a minimum of 12wk, with follow-up for at least 6mo after removal. RESULTS: Of the 67 pediatric patients (67 eyes, mean age 37.4±17.5mo), 44 (65.7%) were female. Preoperative FDDT was graded 3+ in 85.1% of cases, and dacryoscintigraphy confirmed obstruction in 92.5%. Nine patients (13.4%) had a history of PS. At 6mo, surgical success was achieved in 96.6% (28/29) of the NEG-PS group and 71.1% (27/38) of the NEG-BCI group (P=0.009). All cases with probe exit through the inferior meatus (IM) were successful, whereas exits through the inferior concha (IC) or submucosal IM (SM) were significantly associated with failure (P<0.001). CONCLUSION: NEG allows intraoperative classification of CNLDO and selection of surgical method based on real-time anatomical findings. Probe exit through the IM predicts a high likelihood of success, whereas IC or SM exits are risk factors for failure. Incorporating NEG into routine practice may improve surgical precision and reduce the need for repeated procedures.

Abstract:AIM: To evaluate the short-term results of 360° selective laser trabeculoplasty (SLT) in the treatment of patients with previously failed deep sclerectomy (DS). METHODS: Patients with open angle glaucoma with prior failed DS and insufficient postoperative intraocular pressure (IOP) control were enrolled. Preoperative and postoperative IOP were measured using a Goldmann applanation tonometer. One hundred non-overlapping laser shots were applied over 360°. IOP was measured before SLT and 1h after SLT. Follow-up was scheduled at the first week and at the first, third, and sixth months thereafter. RESULTS: A total of 22 eyes (13 patients) were included in the study with a male:female ratio of 1:1 and a mean age of 51.73±13.51y (28-73y). The mean IOP prior to SLT was 18.41±5.24 mm Hg, which decreased to 15.91±3.56 (P=0.071), 15.05±4.53 (P=0.097), 13.91±2.67 (P<0.001) and 13.95±1.84 mm Hg; (P<0.001) at 1wk, 1, 3, and 6mo of follow-up, respectively. This change was statistically significant at the 3mo and 6mo follow-up. The number of anti-glaucoma medications dropped significantly throughout the follow-up period (P=0.014). CONCLUSION: 360° SLT can be an effective complementary treatment after failed DS to decrease IOP and anti-glaucoma medications, thus improving patient compliance and tolerance.

Abstract:AIM: To investigate the effect of intravitreal injection of dexamethasone (DEX) implants on the corneal morphology of young adults with central retinal vein occlusion (CRVO). METHODS: This was a retrospective study. The information of all patients was collected from the hospital information system. Patients diagnosed with CRVO were included. Corneal morphometric analysis was performed 1, 3, 6, and 12mo after the intravitreal injection of DEX. Corneal endothelial cell density (ECD), hexagonal cell ratio (HEX), and coefficient of variation (CV), central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (ACV) were evaluated. RESULTS: The mean age of the 80 patients (80 eyes) with CRVO was 33.10±3.26y. The mean disease duration was 4.94±2.12mo. The ECDs before and 1, 3, 6, and 12mo after DEX injection were 2718.22±333.14, 2692.74±324.84, 2577.55±365.27, 2624.30±345.53 cells/mm², and 2604.00±321.19 cells/mm², respectively. No difference was found in ECD at 1, 6, and 12mo after the injection compared with baselines. The ECD of patients was lower than baseline at three months (P<0.05), whereas the HEX and CV were not statistically significant compared with baseline (P>0.05). At the 12-month follow-up, a trend toward a decrease was observed in the CCT compared with baselines among the enrolled patients, but without significant difference (P>0.05). The parameters of the anterior chamber (ACD, ACA, and ACV) did not change significantly compared with baselines (P>0.05). No significant difference was found in corneal morphology between single and repeated DEX implant injections. CONCLUSION: In young adults with CRVO, intravitreal injection of DEX can temporarily decrease ECD. However, the remaining corneal endothelial morphological characteristics and anterior chamber parameters are unaffected.

Abstract:AIM: To investigate the levels of the triglyceride-glucose (TyG) index and sex hormone-binding globulin (SHBG) in patients with type 2 diabetes mellitus (T2DM) with diabetic retinopathy (DR), and to explore their correlations with biochemical parameters and the homeostasis model assessment of insulin resistance (HOMA-IR) in DR patients. METHODS: Patients with T2DM and healthy individuals were enrolled. Age and body mass index (BMI) of the participants were collected, TyG of the subjects was calculated using the formula, SHBG level of the subjects was detected, and blood biochemical indexes were measured at the same time. The changes of each index among the groups were statistically analyzed, and the relationship between TyG, SHBG, DR and each index was analyzed. RESULTS: A total of 150 patients with T2DM and 64 healthy individuals as normal controls (NC, 28 males and 36 females, mean age 54.49±10.10y) were enrolled following ophthalmic evaluation. Patients were categorized into non-DR group (42 males and 36 females, mean age 56.68±8.02y) and DR group (35 males and 37 females, mean age, 53.83±11.10y). TyG levels were significantly elevated in both non-DR (7.25±0.62) and DR groups (8.02±0.82) compared to controls (6.85±0.48), with the DR group demonstrating higher TyG values than the non-DR group (P<0.05). The level of SHBG (nmol/L) in DR group (25.05±14.06) was lower than that in control group (41.90±22.6) and non-DR group (36.27±20.00; P<0.05). TyG exhibited significant inverse correlations with SHBG (r=-0.455) and high density lipoprotein (HDL; r=-0.430) levels (P<0.05). It was positively correlated with BMI, fasting blood glucose (FBG), 2h postprandial blood glucose (PBG), fasting C-peptide (FCP), glycated hemoglobin A1c (HbA1c), HOMA-IR, total cholesterol (TC) and triglycerides (TG) (r=0.406, 0.768, 0.386, 0.393, 0.475, 0.250, 0.242, 0.888, respectively, P<0.05). SHBG was negatively correlated with BMI, FBG, FCP, HbA1c and TyG (r=-0.440, -0.304, -0.407, -0.209, -0.455, respectively, P<0.05), and positively correlated with age, TG and HDL (r=0.238, 0.034, 0.227, respectively, P<0.05). Further multiple regression analysis showed that SHBG was negatively correlated with TyG (P=0.006). CONCLUSION: Elevated TyG index, reduces SHBG levels, and their negative correlation in the DR group suggest potential roles of TyG and SHBG in the pathogenesis and progression of DR. Combined assessment of SHBG and TyG may provide valuable insights for DR prediction and diagnosis.

Abstract:AIM: To describe novel variants in the G protein-coupled receptor kinase 1 (GRK1) gene associated with Oguchi disease and to analyze the different multimodal imaging results. METHODS: Five members of a single family were enrolled, including two confirmed cases of Oguchi disease and three carriers with novel variants in the GRK1 gene. All subjects underwent a comprehensive ophthalmological examination, including color vision testing, visual field testing, wide-field retinography, fundus autofluorescence, macular optical coherence tomography (OCT), and full-field electroretinography (ERG). RESULTS: The study found that both cases of Oguchi disease showed positive Mizuo-Nakamura phenomenon, moderate retinal thickening and packing of the three outermost hyper-reflective bands in the parafoveal region. After establishing a clinical diagnosis of Oguchi disease in patients IV-II and IV-III, molecular analysis revealed a similar genotype in the patients, both carrying two heterozygous variants in the GRK1 gene, the variants c.1055_1056delAC, p.(Tyr352CysfsTer32) and c.699+2T>C. Genetic testing also revealed that individual III-I was a heterozygous carrier of the novel variant c.1055_1056delAC in the GRK1 gene. In addition, the novel intronic variant c.699+2T>C was detected in the same gene in the heterozygous state in individuals III-II and IV-I. Family segregation showed that Oguchi disease was transmitted in an autosomal recessive pattern in this family. CONCLUSION: Two novel variants in the GRK1 gene are reported that are linked to Oguchi disease in a naïve Algerian family. The common findings observed on the OCT scans of our affected patients include packing of the three outer hyper-reflective bands, and thickening of the retina in the parafoveal region. These features are present not only in the affected patients but also in the carriers of the disease.

Abstract:AIM: To compare the safety, efficacy, and technical demands of four lenticuledissection techniques—dry dissection, continuous curvilinear lenticulorrhexis (CCL), wet dissection, and Viscoatassisted dissection—in small incision lenticule extraction (SMILE), and to identify the method that minimizes tissue damage while preserving corneal clarity and early visual quality. METHODS: Twentyeight eyes undergoing SMILE were assigned to four groups: dry dissection (n=10), CCL (n=5), wet dissection (n=10), and Viscoatassisted dissection (n=3). Surgical interfaces were evaluated with in vivo confocal microscopy and the anterior and posterior lenticule surfaces were examined by scanning electron microscopy. Two masked observers scored surface quality using four predefined criteria (surface relief, regularity of surface structure, proportion of irregular surface, and location of irregular area). Intraoperative dissection time, operatorreported technical difficulty, and early postoperative corneal clarity/interface reaction were recorded. RESULTS: Mean anterior surface scores were: dry 10.87±1.28; CCL 13.60±0.51; wet 13.67±0.48; Viscoat 4.22±0.44. Mean posterior surface scores were: dry 10.87±1.53; CCL 13.60±0.63; wet 14.10±0.48; Viscoat 4.33±0.50. Lenticules obtained via CCL and wet dissection showed significantly better surface quality than those from dry dissection and Viscoatassisted dissection (all P<0.01). Wet dissection produced surface quality comparable to CCL while being technically easier to perform; dissection times were similar between dry (48.8±3.58s) and wet (48.4±1.71s) techniques (P=0.123). Viscoatassisted cases demonstrated transient early postoperative corneal opacity that resolved as the viscoelastic was absorbed in 2wk; no significant early interface residue or lasting opacity was observed after wet dissection. CONCLUSION: Wet dissection achieves lenticule surface quality comparable to CCL but with lower technical difficulty and without significant early postoperative adverse effects, making it a safe, effective, and easily adoptable option for lenticule separation in SMILE. Lenticule surfacequality scoring provides a practical surrogate for assessing tissue damage across dissection methods.

Abstract:AIM: To assess the long-term safety of orthokeratology (ortho-k) in myopic children by evaluating changes in corneal endothelial morphology and central corneal thickness (CCT) after prolonged ortho-k lens wear. METHODS: This study included 65 myopic children (130 eyes). The ortho-k group comprised 39 children who had worn ortho-k lenses for more than 10y. The control group included 26 children who wore single-vision spectacles for myopia correction. Clinical data and adverse events were documented throughout the follow-up period. Endothelial cell density (ECD), coefficient of variation (CV) of cell area, percentage of hexagonal cells (%SIX), and CCT were measured at baseline and at the final follow-up visit. RESULTS: The 39 participants (18 males, 21 females) enrolled in the ortho-k group completed the 10-year follow-up examinations successfully. The ages ranged from 7 to 12 (9.24±1.26)y. In the control group, 26 participants (13 males, 13 females) were successfully recalled and completed their 10th year examinations. The ages ranged from 7 to 12 (9.62±1.68)y. In the ortho-k group, ECD was 3119.86±202.07 cells/mm² at baseline and 3057.42±264.52 cells/mm² at the 10-year follow-up (P=0.058). CV was 30.78%±6.70% and 32.45%±7.87% (P=0.053). %SIX was 62.23%±13.07% and 60.31%±11.59% (P=0.234). CCT decreased by 8±4 μm at the 6-month visit and remained stable thereafter (538.85±43.61 μm at 6mo vs 540.78±41.44 μm at 10y, P=0.528). At the 10-year follow-up, no significant between-group differences were observed in ECD, CV, %SIX, or CCT (all P>0.05). CONCLUSION: This 10-year retrospective study demonstrates that long-term ortho-k lens wear has no significant adverse effects on corneal endothelial morphology or CCT compared with spectacle wear. Ortho-k shows excellent long-term safety with regard to corneal endothelial parameters and CCT, comparable to that of conventional spectacle correction in myopic children.

Abstract:AIM: To compare the effect of orthokeratology (OK) and defocus incorporated multiple segment (DIMS) lenses on axial length (AL) elongation in bilateral myopic anisometropic children. METHODS: This retrospective study enrolled bilateral myopic anisometropic children categorized into two groups: OK lenses and DIMS lenses. The eyes with more myopia (MM) were divided into MM eyes and the fellow eyes with less myopia (LM) into LM eyes. According to the myopia degree in MM eyes, the subjects were further assigned to -0.50 to -3.00 D subgroup and -3.25 to -6.00 D subgroup. The t-test was used to analyze the changes in AL elongation between groups and AL differences in both eyes, and the relationship between AL changes and baseline data was evaluated by Pearson linear correlation analysis. RESULTS: Totally 202 children (8-14y) were divided into OK group with mean age 10.97±1.91y (46 males and 50 females) and DIMS group with mean age 11.05±2.06y (58 males and 48 females). After 1y, the changes of AL in OK-MM eyes (0.14±0.18 mm) were significantly slower than that in OK-LM eyes (0.20±0.19 mm) and DIMS-MM eyes (0.19±0.18; P<0.001, P=0.037). The OK-LM eyes and DIMS-LM eyes, DIMS-MM eyes and DIMS-LM eyes showed no statistically significant difference in AL changes (P=0.337, 0.381). In the -0.50 to -3.00 D subgroups, DIMS-LM eyes had better effect of AL control than OK-LM eyes, the changes of AL in OK-MM eyes and DIMS-MM eyes were no statistically significant. In the -3.25 to -6.00 D subgroups, the results were similar in total group. The change of AL in four subgroups was negatively correlated with age (P<0.05). CONCLUSION: OK lens can reduce binocular anisometropia; DIMS lens has similar effect on the control of binocular myopia in children with myopic anisometropia. The OK lenses are more effective than DIMS lenses with higher degrees of myopia, while DIMS lens retard AL elongation more effectively than OK lens when the spherical equivalent refraction of MM eyes is lower than -3.00 D.

Abstract:AIM: To compare visual motor integration (VMI) in non-amblyopic children with and without horizontal strabismus. METHODS: VMI, visual perception, and motor coordination were evaluated in non-amblyopic children aged 6 to 17 years old using the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI), together with its supplementary Developmental Tests of Visual Perception and Motor Coordination. RESULTS: Forty-five non-amblyopic children with horizontal strabismus (23 males, 22 females; mean age: 126.0±33mo) and 45 children without strabismus (22 males, 23 females; mean age: 126.2±34mo) were enrolled. Children with horizontal strabismus exhibited significantly lower mean Beery-VMI scores (P<0.001), visual perception scores (P<0.001), and motor coordination scores (P<0.001) compared with controls, even after adjustment for confounding variables including sex, age, regular sports participation, number of siblings, and stereopsis. CONCLUSION: Non-amblyopic children with horizontal strabismus demonstrate significantly poorer performance in Beery-VMI, visual perception, and motor coordination compared with children without strabismus.

Abstract:AIM: To assess the correlation between cardiac diastolic function and retinal/choroidal vascular features in patients with coronary heart disease (CHD). METHODS: This observational clinical cohort study included 206 CHD patients (412 eyes). Optical coherence tomography (OCT) and OCT angiography (OCTA) images were obtained from each participant using the AngioVue Imaging System. Each patient also underwent echocardiography to evaluate cardiac diastolic function. RESULTS: Several correlations were found between cardiac diastolic function and fundus vascular features in CHD patients. Left ventricular end-diastolic diameter (LVED), interventricular septal thickness in diastole (IVSD), left ventricular posterior wall thickness in diastole (LVPWD), and early (E) to atrial (A) wave velocity (E/A ratio) positively correlated with retinal thickness, while early (E) diastolic mitral inflow velocity to early (E’) diastolic mitral annular velocity (E/E’ ratio) and pulmonary arterial systolic pressure (PASP) negatively correlated. Significant associations were noted for LVED and PASP across several retinal regions, excluding the foveal central subfield. Vessel density in superficial capillary plexus (SCP) and deep capillary plexus (DCP) layers had negative correlations with IVSD, LVPWD, and E/E’ ratio, but a positive correlation with E/A ratio. The choriocapillaris (CC) layer’s vessel density positively correlated with the E/A ratio and negatively with the E/E’ ratio. LVPWD and E/A ratio positively correlated with choroidal perfusion, while E/E’ ratio showed a negative correlation. LVED, pulmonary artery diameter (PA), and PASP showed no significant associations with retinal or choroidal perfusion. CONCLUSION: In CHD patients, macular retinal/choroidal thickness, vascular density across different layers, and perfusion may serve as useful and sensitive predictors of fundus circulatory disturbances resulting from impaired cardiac diastolic function.

Abstract:AIM: To evaluate the association between pro-inflammatory dietary patterns, as quantified by the dietary inflammatory index (DII), and the prevalence of glaucoma. METHODS: This population-based study used data from the National Health and Nutrition Examination Survey (2005-2008). DII scores were calculated based on nutrient data derived from dietary questionnaires. The association between DII scores and glaucoma risk was assessed using sample-weighted, covariate-adjusted multivariable logistic regression models, with further stratified analyses performed across subgroups. RESULTS: A total of 5659 eligible participants aged 40-85y were included, of whom 383 (6.7%) had glaucoma and 5276 (93.3%) did not. After adjustment for covariates, participants in the highest DII tertile had a 1.35-fold increased risk of glaucoma [odds ratio (OR)=1.35, 95% confidence interval (CI): 1.03-1.79], with a significant linear trend (P for trend=0.034). Restricted cubic spline analysis further verified the association between DII scores and glaucoma risk (P=0.043). In subgroup analyses, a significant positive association between higher DII scores and elevated glaucoma risk was observed in males (OR for tertile 3 vs 1=1.48, 95%CI: 1.02-2.15; P for trend =0.049), participants with diabetes (OR=1.56, 95%CI: 1.04-2.34; P for trend =0.028), and participants with obesity (OR=1.66, 95%CI: 1.07-2.58; P for trend =0.023). CONCLUSION: A pro-inflammatory diet, reflected by higher DII scores, is positively associated with an increased risk of glaucoma among U.S. adults. These findings suggest that anti-inflammatory dietary interventions may serve as a potential preventive strategy against glaucoma.

Abstract:AIM: To develop and validate a clinician-friendly logistic regression prediction model for self-reported visual impairment (VI) in middle-aged and older adults (≥45y) with diabetes. METHODS: Leveraging data from the China Health and Retirement Longitudinal Study (CHARLS), a model for VI among adults aged ≥45y with diabetes were developed. Feature selection involved LASSO regression and subsequent multivariable logistic regression. Eight machine learning algorithms were explored and compared for predictive performance. Logistic regression for its consistent performance, interpretability, and clinical usability was finally selected. A nomogram and interactive web-based tool were constructed to facilitate application. RESULTS: Totally 1918 participants (45.83% males) in CHARLS 2011 with aged ≥45y were analyzed in the training cohort and 1553 in CHARLS 2015 were in validation cohort. Among all participants in the training cohort, 39.6% reported VI. Seven variables were found to be independently associated with VI. The optimal model, logistic regression model, achieved area under the curve (AUC) of 0.702 and 0.706 in the training and validation cohorts, respectively. The model’s potential for clinical application was supported by calibration and decision-curve analyses; the resulting nomogram and web calculator provided individualized risk prediction. CONCLUSION: We developed a clinically interpretable logistic regression model to predict the risk of VI in adults aged ≥45y with diabetes. The accompanying nomogram and web tool may assist with early identification and targeted vision care.

Abstract:AIM: To systematically summarize the efficacy and safety of flavonoids in the treatment of dry eye disease (DED), and review their mechanisms of action, and provide a scientific foundation for clinical translation. METHODS: To retrieve papers published from the establishment of the database through May 12, 2025, eight databases were searched: the Chinese National Knowledge Infrastructure (CNKI), the China Biomedical Literature Database (CBM), the Wanfang Database, the China Science, Technology Journal Database, PubMed, the Cochrane Library, Embase, and the Web of Science. Two independent researchers conducted the literature selection and information extraction processes, utilizing the SYRCLE tool to assess the risk of bias. The results of eligible studies were subjected to narrative analysis. RESULTS: A total of 11 animal studies were included in this review, encompassing research conducted in China, the United States, Republic of Korea, and Japan. These studies involved six flavonoid-rich substances, such as Buddleja officinalis and purple corn extract (PCE), as well as four individual flavonoids including quercetin and daidzin, etc. The findings indicated that flavonoids have the potential to enhance tear secretion. Following interventions with quercetin eye drops and PCE administered at varying doses and time intervals, a significant increase in tear secretion was observed, which approached normal levels. Additionally, these interventions demonstrated a capacity to mitigate damage to the corneal epithelium. For instance, maqui berry extract (MBE) were found to improve corneal fluorescein staining scores while reducing damage to the corneal surface. Flavonoids significantly alleviate dry eye symptoms in animal models by enhancing tear secretion and mitigating corneal epithelial damage. The observed efficacy is attributed to a range of mechanisms, including anti-inflammatory, antioxidant, hormonal regulation, and anti-apoptotic effects. CONCLUSION: The consistent therapeutic outcomes noted in both mouse and rat models further underscore the translational potential of these compounds. Consequently, flavonoids are regarded as highly promising natural agents for ocular health. However, additional pharmacokinetic studies and clinical trials are necessary to confirm their efficacy and safety in human subjects with dry eye syndrome.

Abstract:In China, the high incidence rate of myopia has become an important factor affecting children’s visual health. In the contemporary social environment, prolonged use of electronic products and reduced outdoor activities have become important causes of the development of myopia in children, which reflects the significant influence of light on myopia. This review was performed by searching PubMed data sets including research articles and reviews utilizing the terms “light”, “myopia”, and “hyperopia reserve”, and the review was concluded in October 2024. This article analyzes the impact of light on myopia, including light intensity, light wavelength, light frequency, light distribution, light rhythm, exposure time, and the impact of light exposure on hyperopia reserve, in order to provide new ideas for the prevention, control, and treatment of myopia, and to provide theoretical support for the development of more scientific and effective intervention measures.

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