Abstract:

Abstract:AIM: To develop and evaluate the diagnostic accuracy of deep learning (DL) models in differentiating keratoconus (KC) from normal eyes with regular astigmatism. METHODS: A comparative cross-sectional study was conducted at the Cornea and Diagnostic Department of Al-Shifa Trust Eye Hospital, Pakistan. Galilei dual Scheimpflug-based corneal topography was performed to obtain four corneal maps: anterior axial curvature, posterior axial curvature, corneal thickness, and posterior elevation. Four convolutional neural network models were developed and trained on corneal maps to classify eyes as KC and normal. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. RESULTS: A total of 5602 corneal maps were extracted from 1411 eyes (790 KC and 621 normal) of 827 participants, including KC (472) and normal (355) groups, aged 10 to 40y. The DL models achieved the highest accuracy with DenseNet-121 (99.2%), ResNet-50 (99.0%), Inception-V3 (98.6%), and EfficientNet-B0 (98.1%). DenseNet-121 and ResNet-50 achieved an AUC of 1.00. External validation on an independent dataset of 85 participants (150 eyes with 1050 extracted corneal maps) confirmed excellent accuracies for EfficientNet-B0 (98.1%), DenseNet-121 (98.3%), and ResNet-50 (97.1%). CONCLUSION: All DL models demonstrate excellent diagnostic accuracy for KC detection, highlighting the potential for clinical implementation and optimized KC management with greater precision.

Abstract:AIM: To characterize the composition and functional features of the aqueous humor microbiome in common ocular diseases, including myopia, cataract, primary open angle glaucoma (POAG), and Posner-Schlossman syndrome (PSS). METHODS: We performed metagenomic sequencing on 176 aqueous humor samples from patients with cataract (n=37), POAG (n=66), PSS (n=35), and myopia patients (n=38, as controls). Taxonomic profiling, functional annotation, and diversity analyses were conducted to characterize microbial communities, with adjustments for age and gender where appropriate. Associations between microbial features and clinical parameters were evaluated using correlation analyses. RESULTS: We identified 6635 bacterial, 141 archaeal, 96 eukaryotic, and 108 viral operational taxonomic units (OTUs) in the aqueous humor. The microbiome was dominated by Actinomycetota and Pseudomonadota at the phylum level. Compared to myopia controls, POAG and PSS patients showed significantly reduced alpha diversity after age adjustment (P<0.05), whereas cataract patients showed no significant difference. Additionally, we identified disease-specific microbial signatures including enrichment of Cytomegalovirus (CMV) in PSS. Functional analysis revealed enrichment of distinct metabolic pathways. Finally, correlations were observed between microbiota/pathway abundance and clinical phenotype, though none remained significant after multiple testing correction. CONCLUSION: This study provides a preliminary characterization of the aqueous humor microbiome in patients with POAG, PSS, cataract, and myopia controls. The identified microbial signatures and functional pathways offer new insights into potential microbiome-mediated mechanisms in ocular pathophysiology and may inform future diagnostic and therapeutic strategies.

Abstract:AIM: To explore whether pyroptosis, an inflammatory type of programmed cell death, participates in the initiation and progression of myopia, and to further elucidate its regulatory role in scleral remodeling. METHODS: Scleral tissues from form-deprivation myopia (FDM) mouse models were subjected to transcriptome sequencing to screen inflammatory and cell death-related molecular characteristics. Differentially expressed gene analysis and pathway enrichment analysis were adopted to identify pyroptosis-related signaling pathways. Meanwhile, human scleral fibroblasts were treated with complement component 3a (C3a) to construct an in vitro inflammatory cell model. Western blot, immunofluorescence staining, lactate dehydrogenase (LDH) release assay and transmission electron microscopy were applied to detect extracellular matrix (ECM) alterations and the expression levels of core pyroptosis markers including NOD-like receptor family pyrin domain-containing protein 3 (NLRP3), caspase-1 and N-terminal gasdermin D (GSDMD-N). RESULTS: Transcriptomic results revealed that inflammatory response, immune regulation, and pyroptosis-related pathways were significantly enriched in myopic scleral tissues, accompanied by synchronous activation of inflammasome signaling. In vitro inflammatory intervention downregulated the expression of type I collagen and upregulated matrix metalloproteinase-2 (MMP-2), suggesting aggravated ECM degradation. The levels of interleukin-1β (IL-1β), interleukin-18 (IL-18), cell membrane permeability, as well as NLRP3, caspase-1, and GSDMD-N were obviously increased in activated fibroblasts. Immunofluorescence and ultrastructural observations further confirmed gasdermin protein-mediated cell membrane damage and typical pyroptotic morphological changes. CONCLUSION: In vivo animal experiments and in vitro cellular studies collectively verify that the activation of inflammasome-caspase-1-GSDMD signaling axis is involved in myopia-related scleral remodeling. Pyroptosis acts as a key mechanistic bridge linking inflammatory response and scleral structural weakening, which offers novel molecular targets for the intervention and suppression of myopia progression.

Abstract:AIM: To explore the protective effects and underlying mechanisms of curcumin in preventing and treating diabetic retinopathy in the C57BL/6J diabetic mouse model. METHODS: The C57BL/6J diabetic mouse models were established through streptozotocin (STZ) induction and randomly assigned into five groups: Control, Model, Cal (0.15 g/kg●d), Cur-H (0.2 g/kg●d), and Cur-L (0.05 g/kg●d; n=10/group). Treatment was administered by oral gavage for 12wk. Upon completion of the observation period, retinal function was evaluated by electroretinography (ERG), retinal thickness and structural changes were assessed via optical coherence tomography (OCT), retinal vascular density and leakage were analyzed using optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA), the number of acellular capillaries in retinal flat mounts was counted, histopathological changes were observed with hematoxylin and eosin (HE) staining, and protein expression levels of components involved in the Hippo signaling pathway-Yes-associated protein (Hippo-YAP) signaling pathway and endothelial-to-mesenchymal transition (EndMT) were quantified by Western blot. RESULTS: In diabetic mice, ERG amplitudes were significantly reduced, retinal thinning was observed, and the number of non-perfusion areas and acellular capillaries increased. Additionally, the phospho-large tumor suppressor kinase 1 (p-LATS1)/2/LATS1/2 and p-YAP/YAP ratios were diminished, vascular endothelial (VE)-cadherin expression was reduced, and α-smooth muscle actin (α-SMA) expression was elevated (all P<0.05). In the high-dose curcumin group, ERG amplitudes were significantly improved, retinal structure was restored, vascular density was increased, and acellular capillaries were reduced. Furthermore, the p-LATS1/2/LATS1/2 and p-YAP/YAP ratios were normalized, VE-cadherin expression was upregulated, and α-SMA expression was suppressed (all P<0.05). CONCLUSION: Curcumin offers protective effects on the retinas of diabetic mice, likely through the modulation of the Hippo-YAP signaling pathway and the inhibition of EndMT. These findings provide support for the use of curcumin as a promising adjunctive therapy for diabetic retinopathy.

Abstract:AIM: To prepare ultraviolet (UV)-crosslinked hydrogel serving as a biocompatible orbital filler, and to explore its biological characteristics as well as its efficacy in expanding orbital soft tissue. METHODS: A novel medical hydrogel was fabricated via UV-induced photopolymerization. Its biosafety was assessed through cytotoxicity test, hemolysis assay and cell apoptosis detection. In vivo imaging examinations were conducted to observe the regulatory effect of the prepared hydrogel on orbital tissue development. RESULTS: The target hydrogel was successfully synthesized by photopolymerization, which possessed typical three-dimensional network structure, favorable hydrophilicity, appropriate swelling behavior and satisfactory mechanical performance. Biosafety evaluations confirmed its good biocompatibility with no obvious cytotoxicity, hemolytic reaction or abnormal cell apoptosis observed. In vivo implantation in juvenile rabbit orbits caused no evident pathological changes in major visceral organs. Imaging findings verified that the hydrogel could promote orbital tissue development, exerting reliable orbital expansion effects with favorable biological safety. CONCLUSION: The UV-crosslinked medical hydrogel prepared in this study has stable physicochemical properties and excellent biocompatibility. It can effectively expand orbital tissue.

Abstract:AIM: To compare Visual Functioning Questionnaire-25 (VFQ) response data in patients with age-related macular degeneration (AMD) to patients with cataracts. METHODS: In total 415 individuals with early or intermediate AMD and 236 patients with visually significant cataracts who completed the VFQ-25 from a single academic eye center registry between July 2014 and May 2022 were identified. The effect of disease (AMD versus cataract) on VFQ composite score was analyzed using univariate and multivariable linear regression, controlling for age, race/ethnicity, history of transient ischemic attack (TIA)/stroke, and visual acuity. RESULTS: AMD patients were older than the cataract group (76.0±7.4y vs 73.2±5.9y, P<0.001). There was no difference in sex between groups with both being predominantly female (63% for AMD vs 61% for cataracts, P=0.801). The VFQ composite score was higher in the AMD group (88.8±10.7 vs 82.8±14.5, P<0.001). All vision-related and socio-emotional subscales had significantly higher scores among AMD compared to cataract patients. When adjusted for age, race/ethnicity, history of TIA/stroke, better-eye visual acuity, and worse-eye visual acuity, patients with cataracts had a 3.3-point lower VFQ composite score (95%CI: -5.3 to -1.4, P<0.001) compared to patients with AMD. CONCLUSION: Patients with early or intermediate AMD report higher visual functioning compared to patients with cataracts in composite score and all VFQ subscale categories in both unadjusted and adjusted analyses.

Abstract:AIM: To determine the diagnostic precision of combined Scheimpflug tomography and biomechanical analysis with optical coherence tomography (OCT) for detection of subclinical keratoconus (SCKC). METHODS: All subjects in this prospective, cross-sectional study underwent Scheimpflug tomography (Pentacam HR), air-puff tonometry (Corvis ST), and spectral-domain optical coherence tomography (Cirrus HD SD-OCT). The diagnosis of SCKC and keratoconus (KCN) were based on the Oculus Pentacam classification. Combined diagnostic models were developed using stepwise logistic regression (SLR). The Kruskal-Walli's test evaluated group differences. Diagnostic accuracy was assessed by calculating the area under the curve (AUC). RESULTS: A total of 137 participants comprising 73 females and 64 males, including 48 with KCN, 36 with SCKC, and 53 with normal corneas. The mean age for each group was 31.39±10.82y, 29.25±7.33y, and 30.45±8.03y, respectively. Most examined tomography, biomechanical, and pachymetry indices showed significant differences between KCN, SCKC, and normal eyes (P<0.05). Single tomographic biomechanical index (TBI) data was the most effective in identifying SCKC, achieving an AUC of 0.978 (P<0.001) with 100% sensitivity and 84.91% specificity. Combining SD-OCT and Pentacam HR data, the SLR model yielded superior accuracy for SCKC detection, with an AUC of 0.966 (86.11% sensitivity and 96.13% specificity). The highest accuracy for SCKC identification was attained by integrating data from all three devices, resulting in 0.990 accuracy (91.67% sensitivity; 100% specificity). CONCLUSION: While current parameters accurately identify KCN, they are less effective for SCKC. Integrating Scheimpflug-based biomechanical and tomographic analysis with SD-OCT improves SCKC detection, supporting more accurate screening and earlier identification in patients with otherwise normal findings.

Abstract:AIM: To report the 18-month clinical outcomes of the progressively higher fluence pulsed light (7.2 to 10 J/cm2) epithelium-on accelerated corneal crosslinking (PFPL M Epi-On ACXL) protocol for progressive keratoconus. METHODS: This was a prospective, non-randomized interventional study. Fluence was assigned based on preoperative pachymetry: 7.2 J/cm2 (≤420 μm), 8.6 J/cm2 (420–459 μm), or 10 J/cm2 (≥460 μm). Riboflavin solutions (Paracel I and II), pulsed ultraviolet-A (UVA) irradiation (1s on/off), and consistent procedural timing (13min irradiation) were applied using the KXL I system. Uncorrected and best-corrected distance visual acuity (UDVA, CDVA), maximum keratometry (Kmax), higher-order aberrations (HOAs), and anterior segment optical coherence tomography (OCT) demarcation line depth were analyzed at baseline, 6, 12, and 18mo. RESULTS: Totally 32 eyes of 32 patients aged over 26y with progressive keratoconus underwent PFPL M Epi-On ACXL were included. All groups demonstrated long-term stability in UDVA and CDVA. The 10 J/cm2 group showed the greatest improvement in CDVA (+0.17 decimal), significant corneal flattening (Kmax reduction: −1.03 D), and the most substantial HOAs reduction (−0.30 µm). No significant differences were observed between the 7.2 and 8.6 J/cm2 groups. OCT showed fluence-dependent demarcation line depths: 250±30 µm in the 10 J/cm2 group. No adverse events were observed.

Abstract:AIM: To investigate the effects of cataract surgery on the axial length/corneal radius (AL/CR) ratio and choroidal thickness (CT) in school-age children and to analyze the underlying mechanisms. METHODS: This prospective cohort study enrolled school-age children who underwent phacoemulsification with intraocular lens (IOL) implantation between September 2024 and February 2025. The right eyes of bilateral cases and the affected eyes of unilateral cases were classified as Group A. Within this group, eyes implanted with trifocal IOLs were designated as Subgroup A1, whereas those receiving monofocal IOLs were designated as Subgroup A2. The contralateral healthy eyes of the unilateral cases formed Group B. Axial length (AL) and corneal curvature were measured using the IOL Master 700. CT was assessed using swept-source optical coherence tomography. RESULTS: A total of 50 eyes from 32 patients (Subgroup A1, n=21, 8.38±2.36y; Subgroup A2, n=11, 7.55±2.16y; Group B, n=18, 8.22±2.44y) were included in the study. Preoperatively, AL was markedly shorter in Group A compared to Group B (P<0.05), but there was no notable difference in the AL/CR ratio (P=0.144). During the follow-up period, neither the AL/CR ratio nor CT demonstrated any notable changes within Group A (all P>0.05). Conversely, Group B showed a considerable increase in the AL/CR ratio and a pronounced reduction in CT, both statistically significant (all P<0.05). No notable differences were observed between Subgroups A1 and A2 in any of the measured parameters. Correlation analysis revealed meaningful negative correlations between AL, AL/CR ratio, and central subfield choroidal thickness (CSCT) in Group A at 1mo postoperatively and at the final follow-up (P<0.05). Still, no correlation was found among the changes in these parameters over the follow-up period. CONCLUSION: In the early postoperative period, operated eyes of school-aged children show a stable AL/CR ratio and CT. Although a stable structural negative correlation between these two parameters is observed in operated eyes, the longitudinal coordinated relationship is disrupted, which may be related to the loss of accommodative function. Longer-term follow-up is needed to corroborate these findings.

Abstract:AIM: To compare the 24-month clinical results of the Keiki Mehta body pressure (BP) glaucoma implants (KMI) versus the Ahmed glaucoma valve implants (AGVI; FP-7Model) in neovascular glaucoma (NVG). METHODS: Patients with NVG and uncontrolled intraocular pressure (IOP) exceeding 21 mm Hg despite maximum-tolerated antiglaucoma medications were included in this retrospective study and treated with either KMI, or AGVI. Preoperative and postoperative IOP (at the 1d, 1, 3, 6, 12, and 24mo), number of glaucoma medications needed, success rate, postoperative complications, and visual acuity were evaluated. RESULTS: The study enrolled 41 patients, comprising 19 (11 males) in the KMI group (mean age: 58.8±10.6y) and 22 (11 males) in the AGVI group (mean age: 60.2±16.8y). Preoperative IOP was similar between the groups (P=0.077). Postoperative IOP at the 1st day and 1st month were lower in the KMI group compared to the AGVI group (P=0.003 and P=0.001, respectively). No significant difference was found between the groups at other time points. In both groups, 1st day and 24th month values were lower than baseline values (all P<0.001). At the end of 24mo, the number of antiglaucoma agents required, the success rate and total complications rate were similar between the groups (P=0.444, P=0.843, P=0.233, respectively). CONCLUSION: KMI may be an alternative to AGVI in the management of NVG. To the best of our knowledge, this study is the first to compare the results of AGVI versus KMI for the treatment of NVG.

Abstract:AIM: To describe a case series of solitary punctate chorioretinitis (SPC), a subtype of punctate inner choroidopathy (PIC) characterized by solitary macular lesions. METHODS: This retrospective, consecutive case series included patients diagnosed with SPC over a 5-year period, all of whom had a minimum follow-up of 6mo. Baseline and multimodal imaging data were analyzed to assess clinical presentations and prognosis. RESULTS: All patients (n=17) were Chinese and myopic, with a female predominance (12/17, 70.6%). The mean age was 31y (range, 18–42y). The median refractive error of the affected eyes was -4.6 diopters (D; range, -14.5 to -0.75 D). Ophthalmoscopically, the lesions presented as solitary, yellow-white dots in the macula. On fundus fluorescein angiography (FFA), most lesions (15/17, 88.2%) appeared hyperfluorescent, with slight leakage observed in 3 cases (17.6%). Indocyanine green angiography (ICGA) revealed hypofluorescence in nearly all cases (16/17, 94.1%). Following a three-month course of oral glucocorticoids, most lesions (11/17, 64.7%) showed reduction or resolution. During follow-up, five patients (29.4%) developed secondary macular neovascularization (MNV), indicating a more severe disease course. Recurrences were observed in six patients. At the final visit, focal choroidal excavation was present in four patients (23.5%). CONCLUSION: SPC is a rare subtype of PIC, characterized by a favorable prognosis, although late recurrences are possible. Accurate diagnosis necessitates differentiating it from MNV. Early intervention with oral glucocorticoids appears to be an effective therapeutic strategy.

Abstract:AIM: To investigate the genetic mutation profiles of gene-related retinal detachment (RD) and evaluate the utility of The American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) pathogenicity classification system with emphasis on variants of uncertain significance (VUS) in a young Chinese cohort. METHODS: A consecutive cohort of 28 patients under 30y with RD and clinical features suggesting genetic etiology was enrolled between September 2024 and August 2025 at Zhongshan Ophthalmic Center. All patients underwent comprehensive ophthalmic examinations, genetic testing, and surgical repair. Genetic variants were interpreted via the ACMG/AMP criteria. RESULTS: The cohort consisted of 21 males and 7 females, with a mean age of 15.1±6.71y (ranged: 4–29). The predominant etiologies were Stickler syndrome (10/28, 35.7%), familial exudative vitreoretinopathy (FEVR; 6/28, 21.4%), and Marfan syndrome (4/28, 14.3%). A total of 30 disease-associated variants were identified, among which 60.0% (18/30) were classified as pathogenic/likely pathogenic (P/LP) and 40.0% (12/30) as VUS per ACMG/AMP criteria. The primary factors contributing to VUS classification included high population allele frequency (33.3%), variant novelty (33.3%), and discrepant in silico predictions (25.0%). Patients with P/LP variants exhibited a significantly higher prevalence of high myopia (<-6 D; 93.8% vs 50.0%, P=0.027) and tessellated fundus (87.5% vs 50.0%, P=0.044) compared to those with VUS/not available (NA) variants. CONCLUSION: Stickler syndrome, FEVR, and Marfan syndrome are the leading causes of gene-related RD in the Chinese Han cohort. A high VUS rate (40.0%) poses diagnostic challenges, primarily due to population-specific frequency differences, novel variants, and insufficient functional evidence. By integrating clinical history, phenotypic manifestations, and family history, a clear diagnosis can be established in 66.7% of VUS cases. Ethnically tailored genomic databases and expanded multicenter cohorts are needed to improve VUS resolution and enhance the clinical utility of genetic testing in young RD individuals.

Abstract:AIM: To identify independent risk factors for postoperative proliferative vitreoretinopathy (PVR) in patients with primary rhegmatogenous retinal detachment (RRD) treated with scleral buckling surgery and to develop a nomogram for predicting postoperative PVR. METHODS: Patients who underwent scleral buckling surgery for primary RRD were retrospectively enrolled. Patients were randomly assigned to a training cohort (n=515) and a validation cohort (n=55). Candidate variables included demographic characteristics, systemic comorbidities, preoperative ocular status, and retinal break features. Independent predictors of postoperative PVR were identified using univariate and multivariate logistic regression analyses. A nomogram was constructed to predict the risk of PVR at 1, 3, and 6mo after surgery. Model performance was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). RESULTS: A total of 570 eyes were included, with mean age of 52.65±15.70y, and 51.4% of patients were male. Postoperative PVR occurred in 28.8% of eyes overall, including 28.5% in the training cohort and 30.9% in the validation cohort. Postoperative PVR developed in a subset of patients during follow-up. Preoperative PVR, a history of diabetes mellitus, and more than four retinal breaks were identified as independent risk factors for postoperative PVR. In the training cohort, the C-indices of the nomogram at 1, 3, and 6mo were 0.888, 0.931, and 0.948, respectively, and 0.885, 0.885, and 0.909 in the validation cohort. ROC and calibration analyses demonstrated good discrimination and agreement, while DCA showed favorable net clinical benefit across a wide range of threshold probabilities. CONCLUSION: Preoperative PVR, diabetes mellitus, and more than four retinal breaks are independent predictors of postoperative PVR after scleral buckling for RRD. The proposed nomogram provides accurate individualized risk prediction at 1, 3, and 6mo postoperatively, and may assist clinicians in postoperative surveillance and decision-making.

Abstract:AIM: To characterize the multimodal fundus imaging features of optic disc melanocytoma (ODM) in a Chinese population. METHODS: This retrospective observational case series included patients diagnosed with ODM at Beijing Tongren Hospital between January 2015 and December 2025. Demographic data and multimodal fundus imaging findings were reviewed and analyzed. RESULTS: Sixty-nine patients (69 eyes) were included. The mean age at presentation was 47.8±12.1y (range, 17–70y), with a female predominance (71.0%). All cases were unilateral. Clinically, lesions appeared as elevated gray-to-black masses involving the optic disc. The mean basal diameter was 3.84 mm, and the mean tumor thickness was 1.68 mm. Associated findings included optic disc edema (69.6%), retinal nerve fiber layer thinning (56.5%), perivascular sheathing (33.3%), retinal edema or exudation (5.8%), epiretinal membrane (7.2%), vitreous seeding (13.0%), and peripapillary hyperreflective ovoid mass-like structures (PHOMS, 19.0%). On optical coherence tomography (OCT), the tumor-retina interface was classified into three patterns: smooth hyperreflective (27 eyes), nodular hyperreflective (34 eyes), and honeycomb-like hyperreflective (9 eyes). CONCLUSION: Chinese patients with ODM demonstrate clinical and multimodal imaging characteristics comparable to those reported in other ethnic populations. However, tumors in this cohort are slightly larger, and are associated with two relatively uncommon complications: PHOMS and epiretinal membrane. Three distinct OCT tumor-retina interface patterns were identified, which may reflect variations in tumor-retinal interaction.

Abstract:AIM: To determine the differences in temporal macular thinning among children with Alport syndrome (AS), thin basement membrane nephropathy (TBMN), and age-matched healthy controls and to clarify its diagnostic and differential diagnostic significance. METHODS: This was a case-control study. Children with AS and TBMN diagnosed at our hospital between January 2021 and December 2024 were enrolled. All participants underwent comprehensive ophthalmic assessments, including visual acuity, refraction, slit-lamp biomicroscopy with dilated pupils, color fundus photography, biometry, and optical coherence tomography (OCT). Refractive error, lens thickness, axial length, macular retinal thickness in all sectors, and temporal thinning index (TTI) values were compared using one-way analysis of variance (ANOVA) or an independent samples t-test. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of the TTI for AS in males. RESULTS: The cohort consisted of 40 patients with genetically confirmed AS [33 with X-linked Alport syndrome (XLAS): 16 males, 17 females; 7 with autosomal recessive Alport syndrome (ARAS): 4 males, 3 females], 40 patients with TBMN (male:female=1:1, 40 eyes), and 40 age-matched healthy controls (male:female=1:1, 40 eyes). The standard deviations of the mean TTI values were 12.08±3.18 in the AS group, 6.60±1.88 in the TBMN group, and 6.42±1.14 in the control group. The TTI was significantly greater in the AS group than in both the TBMN and control groups (P<0.001). A statistically significant difference in TTI was observed between sexes in the XLAS subgroup but not in the ARAS subgroup. ROC analysis for males with XLAS revealed an area under the curve of 0.897 (95% confidence interval: 0.844–0.949, P<0.001) for the TTI in the diagnosis of AS. The optimal cutoff value was 9.67, yielding a sensitivity of 0.875 and specificity of 0.826. CONCLUSION: Children with AS exhibit greater temporal macular retinal thinning than do those with TBMN and healthy controls. The TTI shows potential as an auxiliary diagnostic marker for AS in male patients.

Abstract:AIM: To compare the efficacy of posterior scleral reinforcement (PSR) surgery versus repeated low-level red light therapy (RLRL) treatment in controlling high and super high myopia (HM and SHM) of Chinese children. METHODS: This retrospective case analysis enrolled Chinese children with HM (-6.00 to -10.00 D; 76 children, 120 eyes) or SHM (<-10.00 D; 82 children, 114 eyes) according to spherical equivalent (SE). Each group was further subdivided into PSR subgroup [single-vision spectacle lenses (SVS) combined with PSR surgery], RLRL subgroup (SVS combined with RLRL therapy), and control subgroup (SVS alone). All participants were followed up at baseline, 3mo, 1, and 2y after treatment. The best corrected visual acuity (BCVA), axial length (AL), SE, and adverse reactions were evaluated. RESULTS: A total of 158 children (234 eyes) aged 6–16y were enrolled consecutively. Baseline BCVA, AL and SE were comparable among subgroups in both HM and SHM groups (all P>0.05). In the PSR group, BCVA improved significantly at 1 and 2y in both myopia groups (all P<0.05); AL and SE were markedly lower than those in the control group (all P<0.05), with no differences of BCVA, AL and SE improvements in HM and SHM groups (all P>0.05). In the RLRL group, BCVA was significantly improved at 1 and 2y, while AL shortened and SE decreased obviously from 3mo to 2y after treatment (all P<0.05); The SHM group showed greater BCVA improvement and AL reduction than the HM group at 1 and 2y, whereas SE improvement was similar between the two groups. In the control group, BCVA declined significantly, accompanied by continuous increases in AL and SE at the 2-year follow-up (all P<0.05). CONCLUSION: PSR and RLRL effectively improve BCVA in children with HM and SHM. PSR slows AL and SE progression, whereas RLRL reduces AL and SE, with better BCVA and AL outcomes in SHM at 1 and 2y. Both interventions are safe without severe adverse events within 2y. As a non-surgical approach, RLRL has promising clinical value.

Abstract:AIM: To investigate macular changes characteristics among adults with high myopia in Egypt, and to evaluate the relationship between the degree of myopia and the extent of macular alterations. METHODS: A series of highly myopic eyes with axial length (AL)≥26.0 mm and/or spherical equivalent (SE)≤−6.0 D were included. All subjects underwent automated refraction, correction of refractive error, AL measurement, and optical coherence tomography (OCT) for macular scanning. Myopic maculopathy (MM) for each eye was recorded, and their association with age, refractive error, and AL was determined. RESULTS: Among the 427 eyes (mean SE: -11.11±4.34 D, mean AL: 27.84±1.66 mm) of 250 subjects (77 males, mean age 56.84±12.19y), all had tigroid fundus (A1, ATN classification of MM), associated macular lesions were chorioretinal atrophy [C-R atrophy; 8.47% diffuse C-R atrophy (A2), 11.0% patchy C-R atrophy (A3)]. Neovascular MM was: lacquer cracks in (N1) 1.64%, myopic choroidal neovascularization [mCNV; 6.09% active CNV (N2a), 19.20% choroidal neovascular membrane (N2b)], myopic traction maculopathy (MTM) in 11.48%, macular hole (MH; 3.98% lamellar MH, 2.34% full thickness MH). Older age was associated with MTM, MH, and lacquer cracks (P=0.004, P=0.025, P=0.013). More myopic SE was associated with increased odds of atrophic MM, neovascular MM, and MTM (P<0.001, P<0.001, P=0.002). Increased AL was associated with increased odds of atrophic MM, neovascular MM, and dome shape macula (P=0.049, P=0.037, P=0.001). In the multivariable linear mixed model with adjustment of age, gender and SE: the presence of atrophic MM (P<0.001), neovascular MM (P<0.001) were significantly associated with poorer best corrected visual acuity (BCVA). CONCLUSION: Among adult Egyptian patients with high myopia: age, more myopic SE and longer AL are associated with increased odds of MM. Atrophic or neovascular MM is associated with poorer visual acuity.

Abstract:AIM: To characterize regional variations in orbital morphology between populations from Southern China and Kashi through three-dimensional computed tomography (3D-CT) measurements, providing anatomical references for clinical practice. METHODS: In this observational cross-sectional study, patients from Zhongshan Ophthalmic Center (Southern China group) and the First People's Hospital of Kashi (Kashi group) were analyzed using Mimics Research software. And 24 orbital parameters were measured, including orbital volume, retroorbital fat, extraocular muscle volume, and various orbital dimensions. RESULTS: A total of 160 eyes from 80 participants were included, with each center enrolling 40 participants, comprising 20 males and 20 females. The mean age was 42.75±10.83y (range, 25–58) in the Southern China male group, 48.35±13.04y (range, 21–76) in the Southern China female group, 42.40±17.05y (range, 21–76) in the Kashi male group, and 43.05±13.52y (range, 19–74) in the Kashi female group. No significant differences were observed in orbital volume or medial orbital depth (P>0.05). The Southern China group had greater orbital height (35.98±1.66 vs 34.83±1.88 mm; P=0.005), higher orbital index (95.55±6.59 vs 91.91±4.72; P=0.006), and larger exophthalmos (16.60±2.15 vs 15.49±1.81 mm; P=0.014), while the Kashi group had smaller sphenoid trigone length (11.25±3.14 vs 12.64±3.19 mm; P=0.033) and width [7.43 (3.02) mm vs 8.83 (3.26) mm; P=0.016]. These differences were mainly observed in males. All 3D-CT measurements showed excellent interobserver reliability (ICC=0.95–0.99). CONCLUSION: This study reveals distinct regional variations in orbital anatomy between the Southern China and Kashi populations. Participants from Southern China exhibit greater orbital height, orbital index, and exophthalmos, whereas those from Kashi show smaller sphenoid trigone dimensions. These findings provide valuable anatomical references for orbital decompression, fracture reconstruction, and radiological diagnosis.

Abstract:Age-related macular degeneration (AMD) is a leading ocular disorder that causes irreversible visual impairment and blindness in the elderly population. Accumulating evidence demonstrates that AMD is the end-stage outcome of various retinal degenerative lesions and vascular anomalies. Its core pathogenic mechanisms mainly involve dysfunction and atrophy of retinal pigment epithelium (RPE) cells, choroidal capillary degeneration, pathological choroidal neovascularization (CNV), chronic inflammation, oxidative stress injury, deposition of extracellular substances such as drusen, and genetic predisposition. Given its multifactorial origin and complicated pathophysiological processes, the full molecular regulatory network of AMD has not been fully clarified, which restricts the development of more efficient intervention regimens. This review systematically summarizes the latest research progress concerning the molecular mechanisms of AMD, and comprehensively discusses mainstream and emerging therapeutic strategies, including anti-vascular endothelial growth factor (VEGF) drugs, antioxidant and mineral supplements, photodynamic therapy, and laser therapy, as well as innovative modalities such as gene therapy, stem cell therapy, and targeted regulation of complement and inflammatory pathways. It is intended to provide theoretical basis and research references for in-depth mechanistic exploration, early prevention and precise clinical management of AMD.

Abstract:AIM: To summarize the influencing factors of color vision and their clinical implications, with an emphasis on the roles of genetic, environmental, demographic factors as well as ocular and systemic disorders. METHODS: Relevant literatures published from 2014 to 2024 were systematically retrieved from six databases including PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar. Search terms mainly covered color blindness, color vision deficiency (CVD), prevalence, incidence, protan, deutan, tritan, determinants, and risk factors. Eligible original English studies were screened according to predefined inclusion and exclusion criteria. Data extraction and quality evaluation were independently completed by two researchers. Qualitative systematic review was finally performed due to obvious inter-study heterogeneity. RESULTS: A total of 50 eligible studies were enrolled. The prevalence of CVD was markedly higher in males than in females. Age, gender, ethnicity, and occupation were closely correlated with CVD. Males and individuals aged over 60y were more vulnerable to red-green CVD. Occupational ultraviolet radiation exposure, systemic diseases including diabetes mellitus and hypertension, as well as optic nerve lesions were confirmed as vital risk factors for abnormal color vision. CONCLUSION: Apart from genetic and congenital factors, environmental exposure, aging, occupational characteristics, and various ocular and systemic diseases that impair retinal and optic nerve function can also affect color vision function. Clarifying these influencing factors helps ophthalmologists formulate targeted prevention schemes and individualized clinical interventions. Further well-designed longitudinal studies covering more diverse populations are still required in this field.

Abstract:Oculomics, the study of the relationship between ophthalmic biomarkers (changes or abnormalities in the eye) and systemic health or disease states, posits that the eye can serve as a window into the overall health of the body. This concept aligns closely with the ideas of traditional Chinese medicine (TCM) ocular diagnosis, which similarly emphasizes the eye as a reflective indicator of systemic conditions. As a burgeoning field, oculomics extends beyond traditional imaging-based approaches to encompass a broader spectrum of ocular biomarkers, including biochemical and electrophysiological data. While retinal imaging has been a cornerstone in identifying structural biomarkers from eyes, the integration of biochemical omics (e.g., metabolomics, proteomics, transcriptomics) and electrophysiological assessments offers a more comprehensive and multidimensional approach to understanding the association of systemic health between disease states. By integrating TCM ocular diagnosis with artificial intelligence, oculomics may offer a more cost-effective diagnostic option due to its non-invasive and economically efficient characteristics. In this review, we proposed a research framework for integrating ocular multimodal biomarkers from the perspectives of ocular imaging, biochemical testing, and electrophysiological assessment, further clarifying the new concept of oculomics. This multimodal approach exhibits significant potential for advancing precision medicine, ultimately improving patient outcomes through early detection and personalized treatment strategies.

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