Abstract:AIM: To evaluate the ability of six advanced large language models (LLMs)—in providing accurate, comprehensive, and readable patient education on corneal refractive surgeries [laser in-situ keratomileusis (LASIK), keratorefractive lenticule extraction (KLEx), and photorefractive keratectomy (PRK)] in both English and Chinese. METHODS: This is a cross-sectional, comparative study. Twenty-six questions, compiled from authoritative ophthalmologic sources and covering four domains (procedure basics and eligibility; safety, risks and long-term stability; recovery and postoperative experience; and practical concerns), were administered in both English and Chinese via fresh chat sessions with each LLM, respectively. Five performance metrics were evaluated: accuracy, comprehensiveness, word count, readability, and reproducibility, using appropriate statistical tests. RESULTS: OpenAI o1 and DeepSeek-R1 consistently achieved the highest accuracy and most comprehensive responses, significantly outperforming ChatGPT-4o, Gemini Advanced, Claude Sonnet, and Tongyi Qwen (Friedman P<0.001). Although overall accuracy and comprehensiveness were similar across languages, Chinese responses were significantly longer. Readability varied among the models, with Claude Sonnet generally producing the most readable English texts. Reproducibility analysis revealed moderate consistency, reflecting inherent variability in outputs to identical prompts. CONCLUSION: Reasoning-augmented LLMs, particularly OpenAI o1 and DeepSeek-R1, demonstrate superior performance in delivering bilingual patient education for corneal refractive surgery, with high accuracy and comprehensiveness. However, variations in response length, readability, and reproducibility indicate that further refinement is necessary before these tools can be reliably integrated into clinical practice.

Abstract:AIM: To explore the effect of SP600125, a c-Jun N-terminal kinases (JNK) inhibitor, on epithelial-mesenchymal transition (EMT) in retinal pigment epithelial (RPE) cell caused by transforming growth factor-beta 2 (TGF-β2). METHODS: Human RPE cell line (ARPE-19) cells were treated with TGF-β2 and JNK inhibitor SP600125 in vitro. Cellular viability, migration and proliferation in ARPE-19 cells were examined by cell counting kit-8 (CCK-8) assay, wound scratch, and bromodeoxyuridine (BrdU) staining assay, respectively. Transforming growth factor-beta receptor 2 (TGF-βR2), Smad2/3, JNK, c-Jun, alpha-smooth muscle actin (α-SMA), N-cadherin, and vimentin proteins were analyzed by immunoblotting. Moreover, TGF-βR2 was detected by immunofluorescence assay. RESULTS: TGF-β2 significantly enhanced viability, migration, and proliferation in ARPE19 cells, induced phosphorylation of TGF-βR2, Smad2/3, JNK, and cJun, and upregulated αSMA, Ncadherin, and vimentin expression. SP600125 inhibited these cellular processes and reduced the expression/phosphorylation of the above proteins; notably, it blocked TGF-β2induced effects, including cell viability, migration, proliferation, phosphorylation of TGF-βR2, Smad2/3, JNK, and cJun, as well as upregulation of αSMA, Ncadherin, and vimentin. CONCLUSION: JNK inhibitor SP600125 suppresses TGF-β2-induced the increases in cell viability, migration, proliferation, and EMT in RPE cells via the TGFβR2/Smad2/3 and JNK/c-Jun signaling pathways.

Abstract:AIM: To investigate whether catalpol protects against diabetic retinal vascular endothelial injury by targeting the methyltransferase-like 3 (METTL3)-m6A-thioredoxin-interacting protein (TXNIP) axis and inhibiting nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activation. METHODS: A streptozotocin-induced diabetic mouse model (n=20 per group) was used to assess retinal function via electroretinogram (ERG) and vascular integrity via Evans Blue leakage. Human retinal vascular endothelial cells (HRVECs) were exposed to high glucose (HG, 30 mmol/L) with or without catalpol or the METTL3 inhibitor STM2457. NLRP3 inflammasome components (Western blot), oxidative stress (DCFH-DA probe), global m6A levels (Dot blot), and TXNIP expression were measured. The binding of catalpol to METTL3, NLRP3, TXNIP, and interleukin-1β (IL-1β) was analyzed via molecular docking and dynamics simulations. RESULTS: Catalpol treatment improved ERG amplitudes [a-wave, b-wave, oscillatory potentials (OPs)] and reduced vascular leakage in diabetic mice (P<0.05), while downregulating retinal vascular endothelial growth factor (VEGF), NLRP3, IL-1β, and IL-18 protein levels. In HG-stimulated HRVECs, catalpol inhibited the NLRP3-apoptosis-associated speck-like protein containing a CARD (ASC)-caspase-1 inflammasome, reduced reactive oxygen species, and suppressed METTL3 expression and global m6A methylation (P<0.05). It also attenuated HG-induced TXNIP upregulation. METTL3 inhibition by STM2457 mimicked all protective effects of catalpol. Molecular simulations confirmed stable binding of catalpol to METTL3, NLRP3, TXNIP, and IL-1β. CONCLUSION: Catalpol alleviates diabetic retinal vascular endothelial injury by inhibiting the NLRP3 inflammasome. This effect is mediated, at least in part, through downregulating METTL3-dependent m6A RNA methylation of TXNIP.

Abstract:AIM: To evaluate the effect of Fructus lycii (FL) aqueous extract on dry age-related macular degeneration (AMD) in mice via the nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE) signaling pathway and investigate the protective effect of FL-containing serum on hydrogen peroxide (H2O2)-treated human retinal pigment epithelial cells (ARPE-19) in vitro. METHODS: In vivo dry AMD mouse model was established by intraperitoneal injection of NaIO3 solution and treated with aqueous extract of FL. The pathological changes of mouse retinal tissues were observed by electron microscopy; the activity of superoxide dismutase (SOD) and catalase (CAT) in mouse serum was detected by colorimetric method. In vitro dry AMD model was established by H2O2 induction of ARPE-19 cells and treated with FL-containing serum. Methylthiazolyldiphenyl-tetrazolium bromide assay and scratch assay were performed to detect cell activity and proliferation ability. Expression of Nrf2, heme oxygenase-1 (HO-1), and glutamate-cysteine ligase catalytic subunit (GCLC) in retinal tissues and ARPE-19 cells were detected by Western blot and quantitative real-time polymerase chain reaction (Q-PCR). RESULTS: The in vivo study revealed severe deposits under the retinal pigment epithelium and thickened Bruch’s membrane in dry AMD mice. However, aqueous extract of FL reduced the formation of deposits and decreased the thickness of Bruch’s membrane. SOD and CAT activities were significantly reduced in the serum of dry AMD mice, and aqueous extract of FL upregulated SOD and CAT activities. In addition, gene and protein expression of Nrf2, HO-1, and GCLC were significantly downregulated in dry AMD mice, but significantly upregulated by FL aqueous extract treatment. In vitro studies showed that H2O2 inhibited the activity and proliferative capacity of ARPE-19 cells and downregulated the protein and gene expression of Nrf2, HO-1 and GCLC. However, in H2O2-treated ARPE-19 cells, FL-containing serum not only increased cell activity and proliferative capacity, but also upregulated protein and gene expression of Nrf2, HO-1, and GCLC. CONCLUSION: FL reduces oxidative stress in an animal model of dry AMD through the Nrf2/ARE signaling pathway and has a protective effect on dry AMD in vitro and in vivo, providing new insights into the therapeutic use of FL for dry AMD.

Abstract:AIM: To evaluate the effect of laser photocoagulation on transfection efficiency of lentivirus (LV) vectors injected intravitreally. METHODS: The rat retina was photocoagulated prior to intravitreal injection of LV vectors encoding red fluorescent protein. Rats given intravitreal injection or photocoagulation alone served as controls. The transduction efficiency was analyzed by fundus angiography, histopathology, and immunofluorescence staining. Potential adverse effect of laser photocoagulation was evaluated in choroid flat mounts by observing the morphology of retinal pigment epithelium (RPE) that formed the outer blood-retina barrier. RESULTS: Laser photocoagulation enhanced the retinal area transduced by LV vectors in fundus images and increased the maximum transduction thickness in histopathological sections. Choroid flat mounts showed the RPE transduced by LV vectors maintained normal morphology. CONCLUSION: Laser photocoagulation improves the transduction efficiency of LV vectors injected intravitreally, identifying this as a promising gene therapy strategy for inherited retinal dystrophies caused by gene mutations in RPE and photoreceptor cells.

Abstract:AIM: To investigate correlation of clinical, optical coherence tomography (OCT), and immunohistochemistry (IHC) in idiopathic and secondary epiretinal membrane (ERM). METHODS: Retrospective review of patients undergoing pars plana vitrectomy with membrane peeling (PPV-MP). Excised membranes were evaluated by IHC staining for glial fibrillary acidic protein (GFAP), α-smooth muscle actin (α-SMA), cytokeratin, pigment, and fibrosis grading. Pre-operative and post-operative OCTs, and clinical follow-up information at least 3mo were collected. RESULTS: This study analyzed 104 eyes of 104 patients, of whom 83 (79.8%) had idiopathic ERM (iERM) and 21 (20.2%) had secondary ERM (sERM). Mean age at the time of surgery was 67.3±10.5y. OCT demonstrated greater foveal distortion (P=0.012), intraretinal (IR) spaces (P=0.009), and ellipsoid zone (EZ) discontinuity (P=0.022) in sERMs. Poorer pre-operative BCVA for all cases correlated with foveal distortion (P=0.011), loss of parallelism (P=0.014), IR spaces (P=0.027), and EZ disruption (P=0.012). Poorer post-operative BCVA for all cases was associated with foveal distortion (P=0.027). GFAP was expressed in nearly all ERMs (99%). Pigment was expressed more in sERM (61.9%) compared with iERM (21.7%; P=0.005) and associated with poorer post-operative BCVA (P=0.035) and ERM dehiscence (P=0.008). Fibrosis severity correlated with poorer pre-operative BCVA (P=0.027). GFAP intensity correlated with longer symptom duration (P=0.002). CONCLUSION: The high prevalence of many cell types not distinguished for iERM versus sERM suggests a common pathway of formation with local influences rather than an etiologic cell type or substrate location.

Abstract:AIM: To compare the visual performances of extended depth of focus (EDOF) lenses, diffractive bifocal intraocular lenses (IOLs) and their combination. METHODS: This was a prospective, consecutive observational comparative study performed from Dec 2020 to Dec 2021. Cataract patients who meet the indications for multifocal IOLs implantation were divided into three groups, including binocular diffractive bifocal IOL (Human Optics Diff-aAY) implantation group, binocular EDOF IOL (Tecnis Symfony ZXR00) group and mix-and-match group (Symfony in one eye and Diff-aAY in the other). Follow-ups were scheduled at 1d, 3d, 2wk, and 6mo. Visual acuities (VA) at different distances were examined at every follow-up. At 6mo, optic path difference (OPD) scans, and questionnaire answers were evaluated. RESULTS: Thirty patients (60 eyes) were included in the binocular Diff-aAY group [age 63 (59-68), 11 males], 29 patients (58 eyes) in the binocular Symfony group [age 62 (56.75-68), 15 males] and 27 patients in mix-and-match group [age 65 (51-71), 11 males]. There was no significant difference in binocular uncorrected distance VA, uncorrected intermediate VA, or uncorrected near VA among the three groups (P=0.082, 0.151, and 0.703, respectively) at the last follow-up. The mix-and-match group had a superior Strehl ratio (SR; P=0.025) and modulation transfer function (MTF; P<0.05) and an inferior root mean square (RMS; P<0.05) in OPD scan. The three groups reported comparable level of postoperative satisfaction (P=0.141) and spectacle independence (P=0.278). Mild subjective dysphotopsia was more common (22.22%) in mix-and-match group (P=0.030). CONCLUSION: Bilateral Symfony, bilateral Diff-aAY, and the combination of these two IOLs are all remarkable regarding all range vision, objective visual quality, and spectacle independence.

Abstract:AIM: To explore the genetic variants of trabeculodysgenesis under ultrasound biomicroscopy (UBM) and its association with surgical outcomes in patients with primary congenital glaucoma (PCG). METHODS: In this prospective case series, consecutive patients with PCG underwent microcatheter-assisted trabeculotomy (MAT) and followed for at least 24-month after surgery. All participants underwent UBM and whole-exome sequencing prior to MAT and were classified into two groups with severe trabeculodysgenesis or mild trabeculodysgenesis under UBM. Surgical success was defined as a postoperative IOP of ≤21 mm Hg with at least a 20% reduction from preoperative IOP without additional medical or surgical therapy. RESULTS: Severe trabeculodysgenesis was observed in 23 (40%) eyes of 14 patients (median age: 57mo, range: 3–169mo; 11 males) with 8 carrying causative CYP1B1 variants, while mild trabeculodysgenesis occurred in 34 eyes (60%) of 18 patients (median age: 23.5mo, range: 3–110mo; 12 males) without any causative variants. The success rate of MAT was 0 in patients with causative CYP1B1 gene variants and 75.0% in those without (P<0.001). Cox regression survival analysis showed that carrying CYP1B1 gene variants [ORCYP1B1=0.356 (95%CI: 0.132, 0.962), P=0.042] and having severe trabeculodysgenesis [ORType=0.116 (95%CI: 0.034, 0.403), P=0.001] were associated with a higher risk of surgical failure. CONCLUSION: PCG patients with severe trabeculodysgenesis under UBM are prone to harbor causative CYP1B1 gene variants, which could serve as a valuable predictor of potential Schlemm’s canal dysgenesis and MAT prognosis. Genetic screening in patients with severe trabeculodysgenesis under UBM is beneficial for genetic counseling and may help reduce the incidence of complex cases.

Abstract:AIM: To investigate the relationship between choroidal thickness (CT) and primary open angle glaucoma (POAG) in highly myopic eyes across different categories of myopic atrophic maculopathy (MAM). METHODS: This observational analytical case–control study enrolled highly myopic patients. All participants underwent comprehensive ophthalmic examinations. CT was measured in peripapillary and macular regions using optical coherence tomography (OCT). Each eye was classified for POAG status and MAM category. Stepwise logistic regression was performed to identify factors independently associated with POAG. RESULTS: Among 248 highly myopic subjects, 37 (18 males, mean age 68.25±7.16y) had POAG (25 bilateral, 12 unilateral) and 211 (97 males, mean age 67.09±7.63y) were non-glaucomatous. Age and sex did not differ significantly between groups (both P>0.05). Seventy-eight patients had unilateral high myopia and 170 bilateral, yielding 418 highly myopic eyes, of which 58 (13.88%) had POAG. POAG prevalence across MAM categories (no lesion to complete macular atrophy) was 7.14%, 16.28%, 14.07%, 17.86%, and 17.14%, respectively (P=0.44). In the diffuse chorioretinal atrophy subgroup, POAG eyes showed significantly thicker CT in central, inner nasal, outer superior, inner superior, and inner inferior macular regions, and thinner central corneal thickness (all P<0.05). Stepwise logistic regression showed that only parafoveal inferior CT was independently associated with POAG in this subgroup (OR=1.017; 95%CI: 1.005–1.028; P<0.01). No significant CT–POAG association was found in other MAM categories. CONCLUSION: Increased macular CT is independently associated with POAG in highly myopic eyes with diffuse chorioretinal atrophy. This implies distinct pathogenic mechanisms underlying POAG development across different MAM categories in high myopia.

Abstract:AIM: To investigate optic nerve vascularization in patients with anterior ischemic optic neuropathy (AION) during the first 3mo after onset, using comprehensive ophthalmic assessments combined with optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A). METHODS: A prospective longitudinal observational study was performed with a 3-month follow-up. Clinical data recorded included age, sex, laterality of ocular involvement, AION subtype, previous history of ischemic events, cardiovascular risk factors such as high blood pressure, dyslipidemia, diabetes mellitus, smoking status, obstructive sleep apnea, and systemic treatments received. Functional, structural, and vascular examinations, including best corrected visual acuity (BCVA), visual field, OCT, and OCT-A, were performed at baseline, 1, and 3mo. RESULTS: Twenty-two subjects included 12 patients with AION and 10 healthy controls were enrolled. Mean age was 63.75±8.32y in the AION group and 61.80±5.04y in the control group (P=0.365). Gender and laterality distributions were comparable. AION patients showed significantly decreased optic nerve head perfusion at baseline (P=0.024) and 1mo (P=0.033). OCT revealed early thickening and subsequent atrophy of the peripapillary retinal nerve fiber layer and macular layers. OCT-A vascular parameters correlated significantly with 1-month BCVA (r=0.800, P≤0.05) and 3-month structural outcomes (r=0.807-0.835, P≤0.05). CONCLUSION: Vascular parameters derived from OCT-A can act as predictive markers for medium-term visual and structural outcomes in patients with ischemic optic neuropathy.

Abstract:AIM: To evaluate the long-term refractive and visual outcomes in infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB), laser photocoagulation (LPC), or combined IVB+LPC therapy, and to assess disease severity on refractive development over five years. METHODS: This retrospective cohort study analyzed data from infants diagnosed with ROP between 2013 and 2018. Patients were categorized into four groups: IVB (n=44), LPC (n=41), IVB+LPC (n=17), and regressed ROP (RROP, n=50). A subgroup analysis was performed for Type 1 ROP and aggressive ROP (AROP). Primary outcomes included spherical equivalent (SE), astigmatism, and visual acuity (logMAR), measured at 6-month intervals up to 60mo. RESULTS: The study included 152 patients (76 females). The mean birth weight was 1256.1±555.6 g, and the mean week of birth was 29.1±2.9wk. RROP infants had the highest SE, closest to emmetropia. The IVB+LPC group showed the most significant myopic shift compared to other groups (P<0.05). In Type 1 ROP, SE was lower in the IVB+LPC group initially, but by 60mo, the difference was not significant. Astigmatism was higher in the LPC group at later time points (36–60mo). However, no differences in visual acuity were observed at the final follow-up among treatment groups. CONCLUSION: Refractive outcomes vary more in Type 1 ROP than AROP. IVB+LPC results in greater myopia; LPC is associated with increased astigmatism. Individualized refractive follow-up is essential, particularly for Type 1 ROP.

Abstract:AIM: To observe the clinical features and the surgical outcomes of the high myopic (HM) patients with epiretinal membranes (ERM). METHODS: This was a retrospective study enrolled HM patients diagnosed with ERM who underwent vitrectomy between May 2012 and November 2021. Three groups were divided according to axial length (AXL): 26–<28 mm (n=43), 28–<30 mm (n=22), and ≥30 mm (n=11). Baseline characteristics and postoperative visual and anatomical outcomes were analyzed. RESULTS: Totally 76 consecutive eyes of 73 HM patients (27 males), with a mean age of 60.5±9.2y (range: 38–84y) were enrolled. The initial best-corrected visual acuity (BCVA) of the three groups was not significantly different (P=0.498). Longer AXL was associated with a higher incidence of both inner and outer macular retinoschisis (MRS), ellipsoid zone (EZ) disruption, and foveal retinal detachment (all P<0.05). Only the eyes in the 26–<28 mm group showed a significant improvement in postoperative BCVA. BCVA was improved in 77.6% of the eyes. Among the eyes with BCVA not improved, 58.8% belonged to the group 26–<28 mm. The postoperative macular hole was seen in 1 (1.32%) eye. Multivariate linear regression analysis indicated that initial BCVA (P<0.001) and epiretinal proliferation (P=0.010) influenced the final BCVA. CONCLUSION: AXL is not significantly associated with visual recovery. Early operative intervention might have better visual and anatomical outcomes in HM-ERM patients.

Abstract:AIM: To compare the clinical outcomes of the current V4c model of the myopic implantable Collamer lens (ICL) with those of laser in situ keratomileusis (LASIK) for the correction of myopia ranging from −2.0 to −18.0 diopters (D). METHODS: This prospective, non-randomized study enrolled participants who underwent either LASIK or implantation of the ICL V4c at Bolor Melmii Eye Hospital. In the LASIK group, participants received Intralase LASIK (I-LASIK) using the Intralase FS-200 femtosecond laser and the MEL-80 excimer laser. Each group comprised the same number of participants and eyes (38 participants, 73 eyes). RESULTS: A total of 146 eyes from 76 participants were analyzed. Among the LASIK group, 76.3% were female, with a mean age at surgery of 29.76±5.95y (range, 20–43y). In the ICL group, 92.1% were female, with a mean age of 31.59±8.32y (range, 20–49y). Preoperative best-corrected visual acuity (BCVA) did not differ significantly between the LASIK and ICL groups (P=0.68). Postoperatively, the ICL group consistently demonstrated better BCVA (20/20 or better) at all follow-up points, with statistically significant differences observed at 1d (56.2% vs 30.1%, P=0.003) and 3mo (54.8% vs 32.9%, P=0.012). The mean BCVA improvement also favored the ICL group for up to 6mo postoperatively. A higher proportion of eyes in the ICL group achieved uncorrected distance visual acuity (UDVA) of 20/20 or better at 1mo (50.7% vs 41.1%, P=0.319) and 6mo (57.5% vs 43.8%, P=0.136), although these differences were not statistically significant. Predictability was comparable between the groups, except at 6mo, where fewer ICL-treated eyes were within ±0.5 D of the intended correction (49.3% vs 64.4%, P=0.094). Nevertheless, both groups achieved identical outcomes within ±1.0 D (90.4%, P=1.000). Between 1 and 6mo, 78.1% of eyes in the ICL group showed a change in spherical equivalent refraction of no more than 0.5 D, compared to 65.8% in the LASIK group. Refraction stability, defined as a change of less than 1.0 D, remained good in both groups throughout all follow-up periods. CONCLUSION: Both LASIK and ICL implantation leads to significant improvements in visual outcomes, with early postoperative gains observed in both groups. However, the ICL group demonstrates greater long-term improvement in BCVA compared to the LASIK group, particularly among participants with higher degrees of myopia. Visual outcomes in both groups stabilized by 6mo postoperatively.

Abstract:AIM: To quantitatively evaluate the influence of four posterior chamber morphological features—wide iris-ciliary angle (ICA), concave iris (CI), anteriorly positioned ciliary body (APCB), and ciliary body cyst (CBC)—on vault after implantable Collamer lens (ICL) implantation. METHODS: In this retrospective paired study, 925 eyes from 506 patients were analyzed. Participants were matched 1:1 based on ICL size, horizontal/vertical sulcus-to-sulcus (STS) diameters, and lens thickness. Posterior chamber morphology was assessed using ultrasound biomicroscopy (UBM). Actual vault measurements were compared against vault values predicted using the Zhu formula. Statistical analyses included paired t-tests and Bland-Altman agreement assessment. RESULTS: Eyes with wide ICA (n=82) and CI (n=26) exhibited significantly lower actual vault (mean difference: −137.93 and −145.00 μm, respectively; P<0.001) compared to controls. Conversely, the APCB group (n=77) showed higher vault (mean increase: 222.60 μm; P<0.001), while CBC (n=36) had no significant impact (P=0.054). Bland-Altman analysis revealed systematic prediction errors: wide ICA and CI groups had underestimated vault (mean bias: −165.4 and −175.0 μm), whereas APCB showed overestimation (mean bias: +212.4 μm). Notably, 31.71% of wide ICA and 36.36% of APCB cases exceeded prediction errors of ±300 μm. CONCLUSION: Posterior chamber morphology, particularly wide ICA, CI, and APCB, significantly affects postoperative vault. These features introduce systematic deviations in vault prediction, highlighting the need for integrating morphological parameters into ICL sizing algorithms to optimize surgical outcomes and reduce complications.

Abstract:AIM: To analyze the correlation between ocular biometric parameters and cycloplegic refractive shift (ΔSE) and to provide evidence for clinical decision-making regarding cycloplegic refraction in pediatric myopia management. METHODS: This retrospective study enrolled myopic patients aged 5-17y between July 2022 and November 2023. Data collected included age, gender, pre-cycloplegic spherical equivalent (SE1), axial length (AL), average corneal curvature (K), lens thickness (LT), anterior chamber depth (ACD), central corneal thickness (CCT), positive relative accommodation (PRA), negative relative accommodation (NRA), and post-cycloplegic spherical equivalent (SE2). Only right eyes were analyzed. Participants were divided into three groups by ΔSE: Group A (ΔSE≤0.25 D), Group B (0.25<ΔSE<0.75 D), and Group C (ΔSE≥0.75 D). Based on SE2, subjects were classified into pre-myopia (−0.50

Abstract:AIM: To investigate morphological changes in the cornea and meibomian glands using in vivo confocal microscopy (IVCM) in patients with type 2 diabetes (T2DM) and to analyze the correlation of these changes with disease duration (DD). METHODS: Patients with T2DM who visited the ophthalmology and endocrinology departments of our hospital from May 2023 to December 2023 were selected. According to DD, they were divided into the short-DD (≤10y) and long-DD (>10y) groups. The control group consisted of age-matched non-diabetes patients. All underwent Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), Schirmer I test (SIT), and IVCM imaging. Corneal nerve parameters, including corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and meibomian gland metrics, including density of meibomian gland acinar units (MGAUD), the longest diameter of the meibomian gland acini (MGALD), the shortest diameter of meibomian gland acini (MGASD), the area of meibomian gland acinar units (MGAUA), were analyzed using ImageJ and ACCMetrics. RESULTS: A total of 130 patients with T2DM were included in this study, among which 68 were male (52.3%, age 30-76y) and 62 were female (47.7%, age 30-76y), the average age of the group was 55.54±11.65y. Significant differences (P<0.001) were observed in OSDI, TBUT, SIT, CNFD, CNBD, CNFL, MGALD, MGASD, MGAUD, and MGAUA between diabetes groups and controls. DD positively correlated with OSDI, MGALD, and MGASD (P<0.05), and negatively correlated with TBUT, SIT, CNFD, and CNFL (P<0.05). No correlation was found between DD and CNBD, MGAUD, or MGAUA (P>0.05). CONCLUSION: T2DM patients exhibit greater corneal nerve and meibomian gland damage than age 30-76y non-type 2 diabetes patients. Prolonged DD exacerbates these morphological changes.

Abstract:AIM: To evaluate the comparative effects of a combined trehalose-sodium hyaluronate (TD) formulation versus sodium hyaluronate (SH) monotherapy on postoperative ocular surface recovery following eyelid surgery, with additional analysis across surgical subgroups. METHODS: This retrospective comparative study included patients who underwent eyelid surgery for ectropion, entropion, or eyelid reconstruction between August 2021 and July 2024. Patients were divided into two treatment groups based on the postoperative tear substitutes used: Group SH treated with 0.15% SH eye drops, and Group TD treated with a combination of 3% trehalose and 0.15% SH. Postoperatively, patients received either 0.15% SH alone or a combination of 3% trehalose and 0.15% SH four times daily for 3mo. Ocular surface parameters—including tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), Oxford staining score, meibomian gland loss (MGL), and central corneal epithelial thickness (CCET)—were assessed at baseline and 3mo. Subgroup analyses were performed by surgical indication. RESULTS: A total of 114 patients were included in the study (mean age: 70.3±12.1y; 25 females). Group SH comprised 57 patients (15 females, mean age: 69.2±11.4y), while the Group TD also included 57 patients (10 females, mean age: 71.5±12.8y). Both groups showed significant improvement across all parameters; however, the TD group demonstrated superior outcomes in TBUT (mean difference: +0.77s, 95%CI: 0.12–1.42, P=0.036), Oxford score (mean difference: –0.39, 95%CI: –0.75 to –0.03, P=0.036), and MGL (mean difference: –2.02%, 95%CI: –3.78% to –0.26%, P=0.025). Subgroup analysis revealed that the TD formulation resulted in significantly better outcomes in patients undergoing reconstruction (P<0.05 for all parameters) and in most measures within ectropion and entropion subgroups. No significant differences were found in OSDI between groups, despite objective improvements favoring the TD group. CONCLUSION: This study is the first to comparatively assess trehalose-based tear supplementation across distinct oculoplastic surgery subgroups. The combination of TD significantly enhanced postoperative ocular surface parameters—especially in complex reconstructive settings—compared to SH alone. These findings highlight the potential of tailored, antioxidative tear film strategies in optimizing recovery after eyelid surgery.

Abstract:AIM: To identify pathogenic variants in families with congenital stationary night blindness (CSNB) accompanied by early-onset high myopia (eoHM) using whole-exome sequencing (WES), and to evaluate the clinical value of electrophysiological and genetic testing for the differential diagnosis of CSNB, which is frequently misdiagnosed as amblyopia. METHODS: The study cohort comprised families clinically diagnosed with eoHM. Probands and available family members underwent comprehensive ophthalmic examinations. Pathogenic variants were identified via WES, in silico analysis, co-segregation analysis, Sanger sequencing and classified according to the American College of Medical Genetics and Genomics (ACMG) guidelines. Genotype-phenotype correlations were analyzed within the context of CSNB, supplemented by a review of relevant literature utilizing databases including HGMD, PubMed, CNKI, and Wanfang. RESULTS: Among 42 families with eoHM, five were identified with CSNB. The probands aged 2–5y, with spherical equivalents (SE) ranging from −6.00 to −11.00 D and best-corrected visual acuity (BCVA) between 0.15 and 0.6. No organic ocular abnormalities were observed. Initially diagnosed as high myopia and refractive amblyopia, they received optical correction and amblyopia therapy. Electroretinogram (ERG) revealed diminished rod responses and a negative waveform under dark-adapted 3.0 ERG conditions. Seven pathogenic variants were identified in CACNA1F, NYX, and TRPM1, including two novel variants. All five probands were ultimately diagnosed with CSNB-associated eoHM. In Family 1, the proband carrying a CACNA1F variant (c.1873C>T; p.Arg625Ter) exhibited slow myopic progression without fundus changes over 9y of follow-up. A literature review highlighted significant genetic and clinical heterogeneity in CSNB-related eoHM. CONCLUSION: This study reveals marked genetic and clinical heterogeneity in CSNB-related eoHM. TRPM1 and NYX variants (complete CSNB) cause earlier and more severe myopia than CACNA1F variants (incomplete CSNB). Characteristic ERG patterns differentiate subtypes. Reduced BCVA in eoHM may indicate inherited retinal disorders, not just refractive errors. Children with eoHM and reduced BCVA need systematic electrophysiological and genetic evaluations to prevent misdiagnosis and enable personalized care.

Abstract:Primary open angle glaucoma (POAG) is a chronic, blinding ocular disorder characterized by progressive degeneration of retinal ganglion cells (RGCs). Its incidence and prevalence of blindness continue to increase with global population aging. Non-pathologic high myopia (HM) has been established as an independent risk factor for POAG, and the two conditions share similar structural changes in the lamina cribrosa (LC) during the early phase of optic nerve injury. This review summarizes the common and distinct pathological alterations of LC in POAG and HM, with the aim of clarifying its central role in the initiation and progression of optic nerve damage. Elucidating these similarities and differences may facilitate early detection and targeted intervention strategies for at-risk individuals from a structural perspective.

Abstract:This scoping review aims to focus on the association between topical anti-glaucoma medication and limbal stem cell deficiency through a comprehensive analysis from the available relevant case reports, research articles and experimental studies. By understanding the potential risks associated with long-term anti-glaucoma medication use and their impact on corneoscleral limbus, precautions can be taken to balance between the risk of glaucoma progression and limbal stem cell deficiency. All relevant publications from 2000 to 2023 were included and evidence of strong emerging potential link between topical glaucoma eyedrops and the disruption of limbal stem cell homeostasis were found. Prolong use of topical glaucoma medication with preservatives were found to have a negative effect on limbal stem cells. The frequent use of topical preservative-free prostaglandin analogues and beta-blockers, commonly prescribed for glaucoma, is associated with morphological alterations in the corneoscleral limbus. These changes appear to be mediated through an inflammatory process, leading to disruption of the corneoscleral limbal niche which eventually results in limbal stem cell deficiency. With the advancement of glaucoma surgical treatment, it is possible for glaucoma treatment to shift towards earlier surgical modality to reduce topical anti-glaucoma burden leading to limbal stem cell deficiency.

Abstract:Breast cancer is the leading malignancy among women worldwide, with endocrine therapy (e.g., selective estrogen receptor modulators, aromatase inhibitors) serving as a cornerstone of treatment; although these therapies are effective against hormone-sensitive breast cancer, they alter patients’ systemic hormone profiles, which may disrupt the balance of the ocular surface microbiota that maintains ocular homeostasis. This review systematically examines the mechanisms of mainstream breast cancer endocrine therapies, the dynamics of the ocular surface microbiota, the association between hormonal imbalance and ocular surface homeostasis, as well as the relationship between ocular surface flora alterations, and therapy-related ocular complications, integrating evidence from oncology, endocrinology, and ophthalmology to propose research frameworks and prevention strategies for therapy-related ocular complications.

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