International Journal of Ophthalmology-IJO is a global ophthalmological scientific publication and a peer-reviewed open access periodical (ISSN 2222-3959 print, ISSN 2227-4898 online). This journal is sponsored by Chinese Medical Association Xi’an Branch and published by the IJO Press. It has been indexed in SCIE, PubMed, PMC, CA, IC, Scopus, EMBASE, DOAJ, and WJCI. It was selected for Project for Enhancing International Impact of China STM Journals and The Highest International Impact Academic Journal of China. IJO’s JCR IF in 2025 is 2.0 (Q3), Five-year Impact Factor is 1.9, Total Citations are 5166. CiteScore in 2025 is 3.5 (Q2). IJO was established in 2008, with editorial office in Xi’an, China. It is a monthly publication and accept contributions from all over the world, both basic and clinical research.
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Valenchia, Damara Andalia, Nyssa Alexandra Tedjonegoro, Viona
2026(8):1431-1439 ,DOI: 10.18240/ijo.2026.08.01
Abstract:
AIM: To evaluate the diagnostic performance of human and artificial intelligence (AI)-guided graders in a community eye screening program and assess follow-up adherence over six years in Jakarta, Indonesia. METHODS: This retrospective study analyzed patients screened through the EyeCheck™ program (2018–2024). Human graders (Eye Scan™, 2018–2019) evaluated multiple anterior and posterior segment images; AI systems (DR. NOON™ and Vuno™, 2020–2024) assessed single posterior segment images only—constituting a non-concurrent comparison. Diagnostic accuracy was calculated for patients (6.2% of those with abnormal findings) who attended follow-up, using ophthalmologists’ diagnoses as the reference standard. RESULTS: Of 18 628 patients screened, 9262 (49.7%) had abnormal findings, but only 574 (6.2%) sought follow-up care. Among the 574 patients who completed follow-up examination, 286 (49.8%) were male and 288 (50.2%) were female. The median age was 25y (range: 7–81y), with the majority (72.3%) aged 17–50y. Among these, human graders demonstrated higher sensitivity (93.8% vs 72.4%) but lower specificity (17.2% vs 70.1%) and accuracy (56.3% vs 70.8%) compared to AI graders. AI systems provided real-time results, whereas human grading required 3–7 business days. The most frequent diagnoses were refractive error (51.4%), cataract (13.1%), and dry eye syndrome (9.1%). CONCLUSION: In this non-concurrent comparison, AI-guided graders show higher specificity and accuracy while human graders achieved higher sensitivity. These findings should be interpreted cautiously given selection bias from low follow-up rates, temporal confounders, and differences in imaging protocols. The critically low follow-up rate underscores that effective screening requires robust linkage-to-care systems. Prospective studies with concurrent comparison are needed.
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Lu Sun, Yu-Ming Li, Yu-Wen Song, Yi-Chen Yang, Lian Duan, Yang Gao, Jian-Xin Li, Yan-Kun Yu, Kun-Peng Pang, Guang-Fu Dang, Can-Wei Zhang
2026(8):1440-1450 ,DOI: 10.18240/ijo.2026.08.02
Abstract:
AIM: To investigate the transcriptional profiling of ocular surface ectoderm (OSE) derived from human embryonic stem cells (hESC), and identified CACNG6 and AQP3 as the surface markers of OSE. METHODS: hESCs were differentiated into OSE, neuroectoderm (NE), surface ectoderm (SE), and other surface ectoderm (OE) cells in vitro. RNA-seq was performed to analyze transcriptomic profiling of hESC-derived OSE, NE, OE, and SE. The differential expressed genes (DEGs) were identified, and Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) databases, and protein-protein interaction (PPI) network analyses were performed to screen the signals and hub genes associated to OSE commitment. Also, the highly expressed transcription factors (TFs) and membrane proteins (MPs) in OSE cells were identified. RESULTS: Transcriptome analysis revealed that OSE development is dually regulated by signals associated with both SE and NE development. The signaling pathways such as Hippo, encoding extracellular matrix (ECM)-receptor interaction, and transforming growth factor-β (TGF-β) might delineate the surface ectodermal phenotype of OSE, with FN1, COL1A1, and TGFB1 identified as hub genes. Additionally, pathways such as axon guidance, might elucidate the influence of NE in OSE commitment, and with PAX6, LHX2, FOXG1, SOX2, MSI1, and DCLK1 recognized as the hub genes. Genes implicated in retinoic acid (RA) synthesis (ALDH1A1, ALDH1A3, and RDH10) exhibited high expression in OSE, indicating the significant role of the RA signaling pathway in OSE development. Furthermore, OSE-specific transcription factors and surface markers (CACNG6 and AQP3) were identified. CONCLUSION: This study reveals the transcriptome profiling of OSE, which could provide insights into the characteristics of OSE and the underlying molecular mechanisms involved in its derivation.
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Zhi-Kun Ouyang, Ling Ge, Shi-Tong Yu, Jing-Yi Luo
2026(8):1451-1460 ,DOI: 10.18240/ijo.2026.08.03
Abstract:
AIM: To investigate the mitochondrial dysfunction-related genes and their regulatory mechanisms involved in primary open angle glaucoma (POAG), which is characterized by retinal ganglion cell loss. METHODS: Multi-omic summary-data-based Mendelian randomization (SMR) integrating methylation quantitative trait loci (mQTL), expression quantitative trait loci (eQTL), and protein quantitative trait loci (pQTL) were performed for mitochondrial genes with genome-wide association studies (GWAS) of POAG and related traits [intraocular pressure (IOP), macular retinal nerve fiber layer thickness (mRNFL), and macular ganglion cell-inner plexiform layer thickness (mGCIPL)]. Bayesian colocalization was used to support shared causal variants and to define evidence tiers across omics. SPATA20 expression was assessed in a mouse glaucoma model by immunofluorescence and Western blot. RESULTS: SMR identified 64 mitochondrial genes associated with at least one outcome, including ALDH18A1 for POAG and MRPL55 for mRNFL. eQTL analysis revealed 212 associations, prioritizing MRPL20, SLC25A26, ALAS1, and GLYCTK for POAG, ACAD10 for IOP, ALDH6A1, GRPEL2, and YARS2 for mRNFL, and ALDH6A1, TIMM21, TIMM29, LARS2, and METAP1D for mGCIPL. The pQTL layer implicated 21 proteins, including BOLA1 for POAG. Cross-omic synthesis supported 18 genes by ≥2 omics layers. SPATA20 was supported by all three layers, showed a consistent negative association with mRNFL, and in mice was transiently upregulated in retina, with expression in the ganglion cell layer. CONCLUSION: Multi-omic SMR with colocalization highlights mitochondrial genes for POAG and related traits and nominates SPATA20 as a leading cross-omics signal for mRNFL.
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Ying Li, Meng Chen, Han-Guang Dong
2026(8):1461-1469 ,DOI: 10.18240/ijo.2026.08.04
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AIM: To examine whether SLC31A1 knockdown protects human retinal microvascular endothelial cells (HRMECs) exposed to high glucose and copper. METHODS: HRMECs were exposed to normal glucose (5 mmol/L) or high glucose (30 mmol/L), with or without 50 μmol/L CuSO4 during the final 6h, and transfected with control or SLC31A1 small interfering RNA. Cell viability (cell counting kit-8) and adenosine triphosphate (ATP) content were measured. Oxidative stress was assessed by glutathione/oxidized glutathione ratio, malondialdehyde, superoxide dismutase, catalase, and reactive oxygen species. Intracellular copper and mRNA levels of SLC31A1, ferredoxin 1, lipoic acid synthetase, dihydrolipoamide S-acetyltransferase (DLAT), and tight junction genes were quantified. SLC31A1 protein and lipoylated DLAT were detected by Western blotting. Endothelial barrier function was evaluated by fluorescein isothiocyanate-dextran permeability and transendothelial electrical resistance. RESULTS: High glucose alone caused modest loss of viability, ATP depletion, increased oxidative stress, downregulation of tight junction genes, and mild barrier impairment, with minimal additional effect of SLC31A1 knockdown. Copper supplementation under high glucose induced marked intracellular copper overload, enhanced DLAT lipoylation, severe ATP loss, oxidative injury, and pronounced barrier dysfunction. SLC31A1 knockdown significantly reduced copper accumulation, lipoylation of DLAT, and oxidative stress, preserved ATP and viability, and partially restored tight junction gene expression and barrier function, although none of these parameters returned to normal glucose levels. CONCLUSION: SLC31A1-dependent copper influx appears to contribute to cuproptosis-associated mitochondrial energy failure, oxidative stress, and barrier breakdown in high glucose-exposed retinal endothelial cells, indicating that SLC31A1 may represent a potential therapeutic target for diabetic retinal microvascular protection.
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Cheng Li, Yuan-Rui Sun, Qiu-Mei Hu, Lin-Lin Luo, Xi Chen, Shu-Hong Zhou, Jie Xu, Xue Li, Wei Liu
2026(8):1470-1483 ,DOI: 10.18240/ijo.2026.08.05
Abstract:
AIM: To explore how vacuolar protein sorting 35 (VPS35) regulates astrocytic inflammation, impairs retinal endothelial function and drives early diabetic retinopathy (DR) neurovascular lesions in diabetic mouse model. METHODS: A streptozotocin (STZ)-induced C57BL/6J diabetic mouse model was established. Retinal tissues were collected from 0 to 12wk after successful induction of diabetes. Protein expression levels of VPS35, glial fibrillary acidic protein (GFAP), excitatory amino acid transporter 2 (EAAT2), leucine-rich repeat kinase 2 (LRRK2), and vascular endothelium-associated proteins were assessed by Western blotting (WB). The interaction between VPS35 and LRRK2 was verified by co-immunoprecipitation. Vascular leakage and astrocyte activation were evaluated by fundus fluorescein angiography and retinal flat-mount immunofluorescence staining. Primary astrocytes were cultured in vitro and subjected to high-glucose stimulation or VPS35 knockdown. Cell activation, expression of glutamate transport-associated proteins, and inflammatory cytokine expression were examined. Supernatant fluid from the primary astrocytes was applied to human umbilical vein endothelial cells (HUVECs) to assess cell migration, proliferation, and tube formation capacity. The expression of proteins related to the nuclear factor kappa-B (NF-κB) pathway was also evaluated. RESULTS: In diabetic mice, retinal VPS35 protein expression exhibited a progressive decline beginning at 4wk post-diabetes onset, whereas GFAP protein expression increased significantly. By 8wk, marked astrocyte activation was observed, accompanied by retinal microvascular leakage and a reduction in vascular area. In vivo and in vitro experiments further confirmed that under high-glucose conditions, retinal VPS35 and EAAT2 protein levels were markedly decreased, while GFAP and LRRK2 protein levels were significantly elevated. Co-immunoprecipitation verified the physical interaction between VPS35 and LRRK2 in astrocytes. Finally, in vitro experiments demonstrated that both high-glucose stimulation and VPS35 knockdown led to astrocyte activation, upregulation of inflammatory cytokine expression, downregulation of EAAT2 and AMPA receptor subunit GLUA2, and upregulation of LRRK2. Treatment of HUVECs with supernatant fluid from these astrocytes enhanced cell migration but significantly inhibited cell proliferation and tube formation. WB analysis revealed markedly increased levels of NF-κB and phosphorylated NF-κB in the treated HUVECs. CONCLUSION: During early DR in mice model, decreased retinal VPS35 protein expression induces astrocyte-mediated inflammatory responses and glutamate transport dysfunction. Through the interaction between VPS35 and LRRK2, paracrine inflammatory cytokines subsequently activate the NF-κB signaling pathway in vascular endothelial cells, leading to endothelial dysfunction and further driving DR-associated neurovascular injury. This study provides novel insights into the pathogenesis of DR and highlights the potential of VPS35 as a target for early intervention in DR.
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Yi Shao, Cong Zhang, Chun-Nan Zhang
2026(8):1484-1498 ,DOI: 10.18240/ijo.2026.08.06
Abstract:
Visual information processing (VIP) is essential for perception and cognition. It enables the brain to acquire and integrate visual stimuli into coherent representations. Visual information processing disorder (VIPD) is characterized by impairments in visuospatial ability, visual analysis, and visuomotor integration. These deficits significantly affect daily activities, learning, and occupational performance. The etiology of these disorders is multifaceted, including developmental anomalies, traumatic brain injuries, ocular diseases, and surgical interventions. This condition involves multiple disciplines (ophthalmology, pediatrics, neurology, and rehabilitation), posing significant challenges for clinical diagnosis, treatment, and rehabilitation. Despite the growing international focus on these disorders, there remain considerable deficiencies in their diagnosis and treatment within China. Clinicians often have limited awareness of VIPD. Standardized diagnostic criteria are lacking, and rehabilitation approaches remain inconsistent. Visual abnormalities are often overlooked in pediatrics and neurology. In contrast, ophthalmology is limited in addressing disorders related to neurological dysfunction. In response to these challenges, this guide has been developed, drawing on the experiences of Europe and America and integrating local research and practice. It provides practical and systematic guidance for the diagnosis and management of VIPD. The objective is to enhance diagnostic and therapeutic capabilities, foster interdisciplinary collaboration, and improve patients’ visual function and quality of life.
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Nor Fariza Ngah, Hanizasurana Hashim, Amelia Lim Lay Suan, Shelina Oli Mohamed, Rajasudha Sawri Rajan, Roslin Azni Abdul Aziz, Nor Azita Ahmad Tarmidzi, Tara Mary George, Maizan Yaakub, Kenneth Fong, Chui Ming Gemmy Cheung, Hon Seng Wong, Nur Hasnah Ma’amor, Fatin Norhasny Leman, Nor Asiah Muhamad
2026(8):1499-1509 ,DOI: 10.18240/ijo.2026.08.07
Abstract:
The aim for this study was to develop consensus terminology, diagnostic criteria of multimodal imaging and develop a guideline for management of polypoidal choroidal vasculopathy (PCV). A systematic consensus process was conducted to develop updated clinical recommendations for the management of PCV. In order to develop the guidelines, a panel of ten PCV experts nationwide reviewed current evidence, focusing on key randomized controlled trials (EVEREST-II and PLANET), and conducted a systematic literature search to inform the guidelines. Several draft recommendations were evaluated and improved to determine the strength and quality of evidence. Consensus was defined as ≥90% agreement achieved, with multiple voting rounds if needed. The finalized guidelines incorporate the most recent evidence available up to November 30, 2023. The panelists reached an agreement on several aspects of PCV management, including the need for diagnostic criteria, classification, various treatment options and the development of a treatment algorithm. Recommendations are made for the clinical management of PCV based on a professional assessment of current evidence.
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Parvin Esmaili-Badrabadi, Payam Nabovati, Morad Amir Ahmad, Abdollah Farzaneh, Asgar Doostdar, Abbasali Yekta, Mahdi Mahmoodi, Mohammad Saeid Hoseinzade, Mehdi Khabazkhoob
2026(8):1510-1517 ,DOI: 10.18240/ijo.2026.08.08
Abstract:
AIM: To investigate the long-term effects of mini-scleral lens wear on intraocular pressure (IOP) and anterior chamber angle (ACA) in patients with keratoconus (KCN). METHODS: A convenience sampling method was adopted to enroll KCN patients between November 2023 and April 2024. All participants had a definitive KCN diagnosis and were eligible for mini-scleral lens fitting. Baseline optometric examinations included visual acuity measurement, objective and subjective refraction, and slit-lamp biomicroscopy. Mini-scleral lenses were fitted with trial lenses. Participants returned for a 3-month follow-up, where all examinations were repeated. RESULTS: Seventeen KCN patients (12 males) were enrolled, aged 20–53y with a mean age of 38.09±12.86y. Mean IOP rose by 0.33±1.60 mm Hg after mini-scleral lens wear, without statistical significance (P=0.525). The nasal ACA increased by 0.73°±2.69° (P=0.390), whereas the temporal ACA decreased by −1.46°±3.10° (P=0.152). In severe KCN cases, mean IOP elevated from 7.60±0.96 to 8.60±1.14 mm Hg after lens fitting. By contrast, mild-to-moderate KCN patients showed a slight IOP decline from 11.58±2.50 mm Hg at baseline to 11.33±2.42 mm Hg post-fitting. Females presented a statistically significant reduction in temporal ACA after lens wear (P=0.020). Older baseline age was negatively correlated with temporal ACA width (β=−0.719, P=0.041). CONCLUSION: Patients with advanced KCN face higher risks of IOP elevation after mini-scleral lens fitting. ACA changes induced by mini-scleral lenses vary by sector, with temporal angle narrowing being more prominent. Clinicians should closely monitor potential temporal angle narrowing, especially in female and older KCN patients during mini-scleral lens fitting.
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Fan Yang, Jie Xu, Pei-Min Lin, Ming-Yang Wang, Tian-Yu Zheng
2026(8):1518-1525 ,DOI: 10.18240/ijo.2026.08.09
Abstract:
AIM: To compare the changes of pupil parameters and visual quality after cataract surgery and explore their potential correlations. METHODS: This retrospective cohort study analyzed clinical data of Han Chinese patients who received cataract surgery from June 2016 to October 2016. Visual acuity, pupil size, pupil shift, wavefront aberrations, point spread function (PSF), and modulation transfer function (MTF) were detected preoperatively, 1d and 1mo postoperatively. Pupil parameters and visual outcomes were compared across the three time points. RESULTS: A total of 110 eyes from 110 patients (42 males and 68 females) were enrolled, with a mean age of 66.8±7.9y (range: 53–88y). Under both photopic and mesopic conditions, pupil diameter and pupil shift at 1d and 1mo after surgery were significantly lower than baseline levels. Corneal aberrations decreased postoperatively. Photopic and mesopic modulation transfer function derived from higher-order (HO) aberrations increased significantly from postoperative day 1 to postoperative month 1. Pupil size was positively correlated with wavefront aberrations, and negatively correlated with total PSF and HO-PSF. Significant correlations were identified between preoperative pupil diameter and 1-month postoperative visual quality indicators (including aberrations, PSF and modulation transfer function). A preoperative mesopic pupil diameter over 5.60 mm effectively predicted poor 1-month postoperative visual quality (HO aberrations >0.5 μm), with an area under the curve (AUC) of 0.71. CONCLUSION: Pupil parameters and visual quality alter significantly after cataract surgery, and moderate correlations exist between pupil diameter and visual quality at each time point. Preoperative pupil diameter is correlated with 1-month postoperative visual quality.
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An-Ran Xuan, Wei Liu, Ya-Ning Zhang, Chen Zhang, Rui-Bo Yang, Yue Huang, Hui Liu, Shao-Zhen Zhao
2026(8):1526-1532 ,DOI: 10.18240/ijo.2026.08.10
Abstract:
AIM: To compare the efficacy, safety, visual outcomes, satisfaction, and comfort of three-dimensional (3D) heads-up visualization system-assisted and conventional microscopic implantable Collamer lens (ICL) surgery. METHODS: Patients undergoing ICL or Toric ICL (TICL) implantation were enrolled and randomized into two groups: TM group (under a conventional microscope) and 3DM group (under NGENUITY 3D visualization system). Ocular parameters were assessed preoperatively and at 1wk, 1, 3, and 6mo postoperatively. The duration of key surgical steps and the incidence of complications were recorded. Patient-reported outcomes (dry eye, visual quality, comfort) and surgeon satisfaction were assessed using standardized questionnaires. RESULTS: The study included 98 eyes of 98 refractive error patients (17 males), 50 eyes in TM group (age 27.74±5.65y), and 48 eyes in 3DM group (age 29.20±4.89y). Efficacy, safety, quality of vision (QoV), dry eye symptoms, and patients’ satisfaction at 6mo were not significant across the time points of 1wk, 1, 3 and 6mo. No complication was observed in either group. The 3DM group was associated with a longer main step operation time (P=0.037) but better patient visual comfort (P<0.001). The difference in surgical fluency was not statistically significant (P=0.067). Notably, surgeons reported no delays or discomfort and rated the 3DM system significantly higher in image resolution, range of view, depth perception, color contrast, and postural comfort (all P<0.001). CONCLUSION: For ICL surgery, the use of the NGENUITY 3D visualization system achieves comparable surgical efficacy, safety, and patient satisfaction to procedures performed under a traditional microscope, while delivering superior intraoperative visual performance and postural comfort for the surgeon. These ergonomic and visual advantages make it a promising tool for enhancing clinical practice and surgical training.
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Susanna Friederike Koenig, Jens Ulrich Werner, Julie Charlotte Meyer, Efstathios Vounotrypidis, Benjamin Mayer, Armin Wolf
2026(8):1533-1538 ,DOI: 10.18240/ijo.2026.08.11
Abstract:
AIM: To investigate the intraocular pressure (IOP)-lowering efficacy of bleb-free ab interno trabeculectomy by means of the Kahook Dual Blade (KDB). METHODS: This retrospective cohort study enrolled patients with uncontrolled open angle glaucoma (OAG) who underwent standalone KDB ab interno trabeculectomy. Changes in IOP, the number of preoperative and postoperative IOP-lowering medications, as well as intraoperative and postoperative surgical profiles were analyzed. All participants completed a 6-month follow-up. Arithmetic mean, standard deviation (SD) and frequency were calculated, and the Wilcoxon test was used for statistical analysis. RESULTS: A total of 23 participants (15 males) were included, with a mean age of 69.3±9.6y. The baseline mean IOP was 21.7±5.6 mm Hg, with patients taking an average of 3.1±1.0 topical IOP-lowering medications, and 10 patients received adjuvant systemic acetazolamide preoperatively. At the 3-month follow-up, the mean IOP decreased to 12.7±4.3 mm Hg, with a mean medication score of 2.9±1.8. At the 6-month follow-up, mean IOP was reduced by 40.6% from the baseline level (P<0.01), with a mean medication requirement of 2.8±1.0; one-fifth of all participants discontinued glaucoma medications completely. Only mild postoperative hyphemata occurred in 10 cases, and no other surgery-related adverse complications were observed. CONCLUSION: Standalone ab interno trabeculectomy with KDB yields significant IOP reduction and favorable surgical safety in patients with uncontrolled OAG, meanwhile decreasing the requirement of topical IOP-lowering medications. Long-term therapeutic efficacy remains to be further validated. Distinct from previous published studies, this study focuses on a Caucasian population and confirms surgical efficacy of KDB as a single glaucoma procedure.
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Zi-Chen Wang, Yu-Xin Luo, Nan-Nan Gao, Xin-Liang Cheng, Ying Yu, Hai-Xia Ji
2026(8):1539-1549 ,DOI: 10.18240/ijo.2026.08.12
Abstract:
AIM: To compare the effects of different side-cut angles on postoperative ocular surface recovery after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: The prospective and randomized study enrolled 99 patients (198 eyes) with ametropia who underwent FS-LASIK in the Eye Institute at the Affiliated Hospital of Nantong University from September 2021 to December 2022. The patients were categorized into the 45°, 90°, and 135° side-cut angle groups. Preoperatively and at 10d, 1mo, and 6mo after surgery, patients in the three groups had their visual acuity, corneal flap edge scar, corneal region sensation, dry eye-related index changes, and nerve fiber repair at the corneal flap margin compared and analyzed. RESULTS: In the groups with 45°, 90°, and 135° side-cut angles, 56, 58, and 62 eyes, respectively, finished the 6-month follow-up. The incidence of flap edge healing scar was the lowest in the 90° side-cut angle group (74.1%). At 10d postoperatively, corneal sensation at all sites decreased significantly compared with preoperative corneal sensation in the three groups (P<0.05), while patients in the 90° side-cut angle group had the highest sensation among the three groups. After surgery, the Ocular Surface Disease Index (OSDI) scores of the three groups showed a substantial rise 10d later, a reduction 1mo later, and a continued increase beyond preoperative values 6mo later (P<0.05). The 90° side-cut angle group had the lowest OSDI score at each follow-up time. At each time point after surgery, the number of eyes repaired by corneal flap nerves in the scarless group was higher than that in the scarred group (P<0.05), and the corneal flap nerve growth was relatively fast in the scarless area. CONCLUSION: Different side-cut angles in FS-LASIK may have different effects on the postoperative ocular surface recovery. The 90° side-cut angle has a low incidence of corneal flap scar, the highest corneal sensation in the early postoperative period, and the lowest subjective dry eye symptom scores at each postoperative follow-up time. Therefore, the selection of a 90° side-cut angle for the FS-LASIK corneal flap may help patients to recover the ocular surface after surgery.
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Saeed Rahmani, Saeedeh Hoseinmenni, Cirous Dehghani, Ebrahim Jafarzadehpour, Haleh Kangari, Jeffery Cooper, Mohammad Reza Talebnejad, Ali Reza Akbarzadeh Baghban, Enayatollah Osroosh
2026(8):1550-1555 ,DOI: 10.18240/ijo.2026.08.13
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AIM: To evaluate the effectiveness of combining patching with active vision therapy, compared to patching with placebo training on contrast sensitivity (CS) in pediatric participants with bilateral refractive amblyopia. METHODS: In this double-blind, clinical trial, 43 participants aged 5–8 with bilateral refractive amblyopia, unresponsive to spectacles, were randomly assigned to either the experimental group (active vision therapy plus patching) or the control group (placebo treatment with patching) for four months. Active therapy included anti-suppression, accommodative, vergence, and visual memory exercises. CS was measured at baseline and after four months, serving as key outcome measures. RESULTS: Forty participants (20 in each group) completed the study. The mean age for the experimental group (5 males) was 6.10±0.84y, and 6.50±1.15y for the control group (11 males). CS in the experimental group improved by 0.10 log (right eye), 0.14 log (left eye), and 0.07 log binocularly (P≤0.03). The control group showed no statistically significant enhancements in monocular or binocular CS (P≥0.07). Compared to the control group, the experimental group demonstrated a rate of change in monocular CS of 0.05 during follow-up time. CONCLUSION: Active vision therapy leads to significant and accelerates improvements in CS among children with bilateral refractive amblyopia.
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Ashfaque Rahman Khan, Sadia Sultana, Riffat Rashid, Farzana Afzal, Syeed Mehbub Ul Kadir
2026(8):1556-1562 ,DOI: 10.18240/ijo.2026.08.14
Abstract:
AIM: To evaluate the efficacy and safety of a medium-dose intravenous methylprednisolone (IVMP) pulse regimen for moderate-to-severe active thyroid-associated orbitopathy (TAO), with change in clinical activity score (CAS) as the primary outcome. METHODS: This prospective interventional study was conducted at a tertiary eye care center in Bangladesh between February and November 2022. Patients with active moderate-to-severe TAO (CAS≥3) received IVMP totaling 4.0 g (500 mg daily for 3 consecutive days, followed by 500 mg every 3wk for 5 cycles). Clinical outcomes, including CAS, proptosis measured by Hertel exophthalmometry, best-corrected visual acuity (BCVA; logMAR), and intraocular pressure (IOP), were assessed at baseline and at 6mo. RESULTS: A total of 30 patients with active TAO were enrolled and completed the 6-month follow-up. The mean age of the participants was 38.63±12.11y, and 19 (63.3%) were male. The mean CAS decreased significantly from 3.66±1.03 to 0.87±0.63 (mean change −2.79±0.95; P<0.0001). The mean degree of proptosis decreased from 22.47±1.59 to 20.13±1.97 mm (−2.34±1.25 mm; P<0.0001). BCVA improved from 0.46±0.31 to 0.15±0.18 logMAR (−0.31±0.28; P=0.02). The mean IOP decreased from 16.80±3.56 to 14.93±1.73 mm Hg (−1.87±2.45 mm Hg; P<0.001). Eyelid swelling, conjunctival redness, chemosis, and retro-orbital pain resolved in more than 90% of patients. Adverse events, including transient increased IOP (26.66%), hyperglycemia (20.00%), and elevated SGPT (6.67%), were mild and reversible; no severe hepatic, cardiovascular, or psychiatric complications occurred. CONCLUSION: Medium-dose IVMP (4.0 g) significantly improve disease activity, proptosis, visual acuity, and IOP, with an acceptable safety profile. This regimen represents an effective and safer alternative to high-dose IVMP for active moderate-to-severe TAO, particularly in resource-limited settings. Larger, multicenter trials with longer follow-up periods are needed to confirm these findings.
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Ling-Li Jiang, Man-Rong Yu, Ying-Ying Wang, Jiang-Xiong Cai, Hao Hu, Min-Jie Chen
2026(8):1563-1572 ,DOI: 10.18240/ijo.2026.08.15
Abstract:
AIM: To assess the burden and temporal trends of blindness and vision loss attributable to type 2 diabetes mellitus (T2DM) in young adults aged 20–39y from 1990 to 2021. METHODS: Cross-sectional datasets were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Prevalence and years lived with disability (YLDs) metrics were applied to quantify temporal changes in blindness and vision loss across 1990–2021. Data were stratified by global, regional, and socio-demographic index (SDI) tiers, and further split by age and sex for comprehensive subgroup analysis. Joinpoint regression was adopted to detect inflection points of trend shifts. A Bayesian age-period-cohort model was utilized to forecast disease burden projections for 2045. RESULTS: Globally, the prevalence of T2DM-related blindness and vision loss in young adults (20-39y) rose from 4.7 per 100 000 population in 1990 to 6.4 per 100 000 population in 2021 [average annual percentage change (AAPC)=1.03; P<0.001]. The YLD rate likewise increased from 0.5 per 100 000 in 1990 to 0.7 per 100 000 in 2021 (AAPC=1.02; P<0.001). Southeast Asia and Grenada bore the highest prevalence, whereas Central Latin America and Cambodia exhibited the highest YLD rates. Both prevalence and YLD rates increased markedly within the high-SDI quintile. Singapore was the only setting presenting declining prevalence and YLD trends. Females experienced steeper rises than males in prevalence (AAPC: 1.16 vs 0.88) and YLDs (AAPC: 1.16 vs 0.82). CONCLUSION: The global disease burden of early-onset T2DM-induced visual impairment has increased substantially among 20–39-year-old individuals, particularly in high-SDI regions, with females facing a greater rising prevalence burden. Targeted intervention measures are warranted to guide integrated population-level prevention and clinical management frameworks.
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Roland Joseph D. Tan, Rachel R. Milante, Adriel Vincent R. Te, Esther Carmen Arvella G. Ereño, Redentor Caesar G. Gonzales, Jewel Faith Flores-Anotado, Christopher Sebastian J. Uy, Knedrick Kevin Macalma, Jennifer Joy Y. Santos-Rayos, Lorenz Jacob D. Mangahas, Karen R. Cabrera, Lyka R. Agcaoili, Clyde Joshua A. Ecija, Tamilyn Chelsea C. Laddaran, Kristine D. Corpus-Velasquez, Jose Melvin Jimenez IV, Kyla S. Ilagan, Ian J. Daguman, Xavier Daryl L. Martinez, Almira A. Manzano, Ron Joseph R. Moreno, Gabrielle S. Evangelista, Kanja Drisa Taclobao, Marie Christine T. Marcelo-Tan, Christian Q. Castillo, Manuel Benjamin B. Ibañez IV, Maijann D. Precia, Patricia S. Tacata, Robert Kelvin Carbonell, Dominico Carlo S. Dator, Jemeson M. Tiburan, Rachelle G. Anzures, Niño Enrico D. Marohom, Lois Agnes E. Lumontod, Margarita E. Quitos, Beltran Alexis A. Aclan, Angeline Therese Y. Uy, Claire Baldovino Barja, Van Alvin Gambalan, Jona May S. Ongkeko, Gabriel L. Villanoy
2026(8):1573-1582 ,DOI: 10.18240/ijo.2026.08.16
Abstract:
AIM: To determine the clinico-epidemiologic profile of premature infants diagnosed with retinopathy of prematurity (ROP), and treated for type 1, severe, and aggressive (TOSA) ROP in the different regions of the Philippines. METHODS: A multiregional ambispective cohort study of premature infants (<37wk gestational age) referred for ROP screening across 20 hospitals in 12 Philippine regions between January 2024 and September 2025 was conducted. Demographic, neonatal, and maternal risk factors were analyzed. Outcomes were compared between National Capital Region (NCR) and non-NCR cohorts. RESULTS: Of 2085 referred infants, 1900 premature infants were included. Mean gestational age was 32.34±2.31wk; mean birthweight was 1593±439 g. ROP developed in 483 infants (25%), of whom 177 (37%) progressed to TOSA ROP. Lower gestational age, lower birthweight, male gender, and packed red blood cell transfusion were significantly associated with ROP development, whereas sepsis and oxygen supplementation were not. Among TOSA ROP cases, 87% received treatment, most commonly anti-vasular endothelial growth factor (VEGF) injection (46%) or laser photocoagulation (24%). At the last follow-up, 34% of treated infants had not reached full regression or retinal maturity. ROP incidence was higher in NCR (32%) than in Region I and Cordillera Administrative Region (8%, P=0.001), Region III (13%, P=0.005), and Region XI (14%, P=0.001), but lower than Region VI (55%, P=0.001). CONCLUSION: Lower gestational age and birthweight, male, and packed red blood cell transfusion are risk factors of ROP development. This study also provides the first multiregional multicenter data on ROP in the Philippines, demonstrating substantial incidence and progression beyond NCR.
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Bei-Xi Yi, Lu-Run Yu, Qi Gong, Mei-Hong Ye, Yong Zhang, Gang Luo, Jin Gong, Yi-Qiao Xing, Lian-Hong Zhou
2026(8):1583-1589 ,DOI: 10.18240/ijo.2026.08.17
Abstract:
AIM: To establish percentile curves of refractive development for children and adolescents aged 5–18y in Hubei Province. METHODS: A cross-sectional study was conducted in 103 county-level administrative districts of Hubei Province via a multistage stratified cluster sampling strategy. Participants underwent non-cycloplegic autorefraction, and spherical equivalent refraction (SER) of the right eye was calculated. Generalized additive models for location, scale, and shape (GAMLSS) were applied to construct age-specific standard SER percentile curves stratified by gender and region. Moreover, age-related curves of annual refractive progression rate at each percentile were plotted. RESULTS: A total of 1 255 454 participants (673 341 boys and 582 113 girls) aged 5–18y (mean age: 11.13±3.59y) were enrolled. An overall myopic shift trend was observed with advancing age. The median SER was +0.25 diopters (D) at 5 years of age and decreased to -0.50 D at 9 years of age. From 5 to 18 years of age, the refractive progression was -6.63 D at the 3rd percentile, while the values were -3.25 D and -1.00 D at the 50th and 97th percentiles, respectively. Girls and rural children presented higher myopic degrees. The annual age-dependent refractive progression rate curve showed a U-shaped pattern, with greater annual refractive changes in lower percentiles and peak refractive progression occurring at younger ages. CONCLUSION: Children in lower SER percentiles suffer from more severe myopia and faster refractive progression. Therefore, earlier and targeted intensive myopia interventions are warranted for children with SER below the 50th percentile.
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Jun-Zhao Yang, Yan-Ting Liu, Xin-Sen Liu, Yu-Ting Wu, Dan-Lin Zhi, Xiao-Wen Zhu, Yong-Hong Zhang
2026(8):1590-1599 ,DOI: 10.18240/ijo.2026.08.18
Abstract:
AIM: To identify early molecular diagnostic biomarkers for optic atrophy (OPA) and explore potential mechanisms mediated by proteins. METHODS: Gene expression data was sourced from eQTLGen (31 684 samples; 19 960 genes). The OPA discovery cohort came from FinnGen (629 cases; 496 621 controls); the validation cohort came from the genome-wide association studies (GWAS) catalog (58 cases; 496 621 controls). Protein data for mediation analysis was obtained from the deCODE Genetics consortium (35 559 samples; 4907 proteins). Causal estimates were derived using two-sample Mendelian randomization (MR). Inverse-variance weighted (IVW) was the primary analysis method. Sensitivity analyses included MR-Egger intercept, Cochran’s Q test for heterogeneity, and leave-one-out analysis. Colocalization analysis validated identified genes. Additionally, interaction analysis identified potential biomarkers. Finally, mediation analysis assessed potential mediating mechanisms. RESULTS: Multi-cohort validation revealed that increased expression levels of the SEC61A2 and THNSL2 were causally associated with an elevated risk of OPA. Furthermore, we identified 386 genes potentially associated with OPA. Hormone secretion and immune-related pathways were found to play significant roles in OPA pathogenesis. Mediation analysis indicated that Upper zone of growth plate and cartilage matrix associated (UCMA) potentially mediates the effect of SEC61A2 in increasing OPA risk. CONCLUSION: SEC61A2 and THNSL2 may serve as early diagnostic biomarkers for OPA. Additionally, SEC61A2 likely increases OPA risk through UCMA.
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Yu-Hang Yang, Wen-Da Zhou, Han-Qing Zhao, Rui-Heng Zhang, Li Dong, Lei Shao, Wen-Bin Wei
2026(8):1600-1607 ,DOI: 10.18240/ijo.2026.08.19
Abstract:
AIM: To conduct a bibliometric analysis of retinoblastoma (RB) research to delineate global research trends, identify key research contributors, and highlight emerging research directions in this field. METHODS: Publications from 2015 to 2024 were collected from the Web of Science Core Collection. Data on publication volume, citations, H-indexes, and collaborative networks were analyzed using CiteSpace. RESULTS: In total, 1719 publications were included. Annual publication outputs on RB research exhibited an overall upward trend. The United States dominated global RB research with 500 publications (29.09%), 8978 citations and an H-index of 43, followed by China (468 articles, 27.23%) and India. Switzerland and Spain yielded the highest average citation per article, at 29.00 and 27.72, respectively. Institution-wise, Thomas Jefferson University (76 publications) and Memorial Sloan Kettering Cancer Center (70 publications) ranked top in publication quantity. Indian Journal of Ophthalmology was the most prolific journal with 52 relevant articles, while Shields CL was the leading author contributing 67 papers in this domain. Cited-reference analysis identified the article entitled “Global Retinoblastoma Presentation and Analysis by National Income Level” in JAMA Ophthalmology as the most frequently cited work with the strongest citation burst. Journals covering molecular biology and genetics constitute the fundamental academic basis for contemporary RB investigations. Keyword analysis demonstrated that “cancer”, “management”, “expression”, and “chemotherapy” were the most recurrent research hotspots. CONCLUSION: This study performed the first decade-long CiteSpace-based bibliometric analysis of RB. Substantial disparities in publication productivity and clinical practice exist across nations and institutions. Low- and middle-income countries (LMICs) remain burdened by diagnostic and therapeutic limitations for RB, highlighting the necessity of strengthened international collaboration. Future research priorities encompass overcoming chemotherapy resistance, optimizing intra-arterial chemotherapy (IAC) regimens, and translating molecular discoveries into accessible therapies via global partnerships.
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Rafael Vidal Merola, Sebastião Cronemberger
2026(8):1608-1617 ,DOI: 10.18240/ijo.2026.08.20
Abstract:
Accurate measurement of intraocular pressure (IOP) is essential for the diagnosis and treatment of glaucoma. Keratoconus (KC) is an ectatic corneal disease, which evolves with progressive non-inflammatory thinning and is characterized by irregular astigmatism, and alteration of corneal biomechanics. There are many doubts regarding the best method to measure IOP in patients with KC, and, as far as we know, there are no manometric studies in patients with KC. It seems that IOP measurements made by Goldmann applanation tonometry (GAT) probably underestimate the real values in patients with KC. With the aim of obtaining more accurate measurements of IOP in KC, new devices were developed such as dynamic contour tonometry (DCT), ocular response analyzer (ORA) and corneal visualization scheimpflug technology (Corvis-ST). Possibly, DCT, corneal-compensated IOP (IOPcc)-ORA, and biomechanical corrected IOP (bIOP)-Corvis-ST can reduce some inaccuracies in IOP measurements related to thinning central corneal thickness and other biomechanical changes present in these patients. The different IOP measurement methods in KC are not interchangeable. Therefore, in KC we must always monitor IOP using the same device during follow-up. Furthermore, it is necessary to carefully study possible structural and functional changes that may occur in suspected cases of glaucoma.
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Chu-Ning Wang, Yi-Hao Xia, Hui Huang, Yun-Xi Xu, Ding-Meng Zhao, Jia-Ling Dong, He-Jiang Ye
2026(8):1618-1628 ,DOI: 10.18240/ijo.2026.08.21
Abstract:
Diabetic retinopathy (DR) is conventionally recognized as a microvascular complication of diabetes mellitus. Nevertheless, accumulating evidence confirms that early retinal neurodegeneration develops in the course of diabetes and drives early visual impairment. Multiple studies have verified that abnormal retinal neural responses frequently emerge before identifiable microvascular lesions. This review therefore systematically summarizes existing evidence confirming retinal neurodegeneration as a core, early pathological event in diabetic retinal disease (DRD), elaborates the cellular and metabolic mechanisms of neurodegeneration inside the retinal neurovascular unit (NVU), and assesses novel neuroprotective therapeutic modalities. Retinal neurodegeneration manifests prior to clinically apparent microvascular complications. NVU dysfunction, triggered by neuroinflammation, oxidative stress, advanced glycation end products (AGEs), excitotoxicity and mitochondrial dysfunction, serves as the pivotal pathway mediating neuronal injury. Notably, current vasculotropic therapies fail to effectively block early neuronal dysfunction. By comparison, neuroprotective interventions targeting oxidative stress, inflammatory cascades, glial dysfunction, deficient neurotrophic supply and mitochondrial damage exhibit promising effects on maintaining retinal neuronal architecture and function. In conclusion, retinal neurodegeneration constitutes a core pathological cascade of DR. Incorporating neuroprotective regimens into established treatment systems facilitates earlier intervention, optimizes visual function prognosis, and ultimately transforms the clinical management paradigm of DRD toward retinal neural protection.
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Xiao-Han Jin, Xin-Xin Yu, Mei-Qi Fan, Yi-Zhuo Zhao, Jun-Jie Ma, Yuan-Feng Zhang, Lu-Sheng Ma
2026(8):1629-1642 ,DOI: 10.18240/ijo.2026.08.22
Abstract:
Ocular graft-versus-host disease (oGVHD) is an immune disease that occurs in the eye after allogeneic hematopoietic stem cell transplantation and seriously affects the vision and quality of life of patients. Current treatment modalities are inadequate, and new treatment options and targets are required to improve the therapeutic efficacy of oGVHD. In recent years, a large number of studies have shown that exosomes, as important mediators of cell-to-cell communication, have important research value in the pathogenesis, diagnosis, and treatment of oGVHD. This article reviews the research progress on exosomes from different sources of oGVHD.
Volume ,2026 Issue 8
Intelligent Ophthalmology
Basic Research
Clinical Research
Investigation
Mendelian Randomization
Bibliometric Research
Review Article
Letter to the Editor
Comment and Response
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Algorithm of automatic identification of diabetic retinopathy foci based on ultra-widefield scanning laser ophthalmoscopy
Jie Wang, Su-Zhen Wang, Xiao-Lin Qin, Meng Chen, Heng-Ming Zhang, Xin Liu, Meng-Jun Xiang, Jian-Bin Hu, Hai-Yu Huang, Chang-Jun Lan
Abstract:
● AIM: To propose an algorithm for automatic detection of diabetic retinopathy (DR) lesions based on ultra-widefield scanning laser ophthalmoscopy (SLO). ● METHODS: The algorithm utilized the FasterRCNN (Faster Regions with CNN features)+ResNet50 (Residua Network 50)+FPN (Feature Pyramid Networks) method for detecting hemorrhagic spots, cotton wool spots, exudates, and microaneurysms in DR ultra-widefield SLO. Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate. Feature fusion was carried out by the feature pyramid network FPN, which significantly improved lesion detection rates in SLO fundus images. ● RESULTS: By analyzing 1076 ultra-widefield SLO images provided by our hospital, with a resolution of 2600×2048 dpi, the accuracy rates for hemorrhagic spots, cotton wool spots, exudates, and microaneurysms were found to be 87.23%, 83.57%, 86.75%, and 54.94%, respectively. ● CONCLUSION: The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO, providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.
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Abstract:
AIM: To explore the correlation between several blood cell-associated inflammatory indices including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and the presence and severity of diabetic retinopathy (DR). METHODS: We searched for eligible studies from PubMed, EMBASE, Web of Science and CNKI up to December 13, 2017. Standardized mean difference (SMD) calculated with confidence interval (CI) of 95% was used to estimate the values of those indices. RESULTS: A total of 31 studies were included in the present Meta-analysis. As compared with type 2 diabetes mellitus (T2DM) patients without DR, the values of MPV, PDW, NLR, and PLR were higher in patients with DR (SMD=0.67; 95%CI: 0.36 to 0.98; SMD=0.51; 95%CI: 0.27 to 0.75; SMD=0.77; 95%CI: 0.49 to 1.05 and SMD=1.18; 95%CI: 0.07 to 2.28). Additionally, it was also observed that MPV was closely correlated with the severity of DR. CONCLUSION: MPV, PDW, NLR, and PLR could be recommended as diagnostic biomarkers for DR, and MPV could be applied to assess the severity of DR.
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Arshad Ali Lodhi, Sameen Afzal Junejo, Mahtab Alam Khanzada, Imran Akram Sahaf, Zahid Kamal Siddique
Abstract:
AIM: To evaluate the surgical outcome of congenital upper eyelid coloboma repair. · METHODS: All patients underwent complete ophthalmic and general examination before going to surgery, and then examination under anesthesia was performed to assess the site and size of eyelid defect, conjunctival involvement. The status of cornea and ocular motility with forced duction test was also being noted. The surgical procedure was performed according to the size of defect. · RESULTS: Out of 21 cases of congenital upper eyelid coloboma, 18 occurred in isolation with upper eyelid medial defect, 13 were bilateral and 5 were unilateral. Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects. All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age. Cosmetically surgical results were acceptable, except one that was already presented with opaque corneal. · CONCLUSION: In this study, overall surgical results were satisfactory except one that was presented late with compromised cornea.
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Veronica E. Giordano, Sergio E. Hern, ez-Da Mota, Tania N. Adabache-Guel, Arm, o Castillejos-Chevez, Sonia Corredor-Casas, Samantha M. Salinas-Longoria, Rafael Romero-Vera, Juan M. Jimenez-Sierra, Jose L. Guerrero-Naranjo, Virgilio Morales-Canton
Abstract:
AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.
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Anteneh Amsalu, Kindie Desta, Demiss Nigussie, Demoze Delelegne
Abstract:
AIM: To assess the pattern of ocular manifestation and associated factors among human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART) at Hawassa University Referral Hospital, Southern Ethiopia. METHODS: A cross sectional study was conducted from January 2014 to April 2015. After obtaining informed written consent, 240 adult HIV/AIDS patients on HAART were randomly selected regardless of their ophthalmic symptoms, WHO status or CD4 count. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 20.0 software. RESULTS: The mean duration of HAART was 62.5mo. The prevalence of HIV related ocular manifestation was 14.2%. Seborrheic blepharitis (5%) was the most common ocular manifestation, followed by squamoid conjunctival growth (3.8%). The rate of ocular manifestation was significantly higher among study participants who had CD4+ count <200 cells/μL (AOR=3.83; 95%CI: 1.315-11.153), low duration of HAART (AOR=3.0; 95%CI: 1.305-6.891) and who had primary school education [odds ratio (OR) =2.8; 95%CI: 1.105-7.099]. Prevalence of visual impairment and blindness was 10.9% and 5.8%, respectively. CONCLUSION: HAART may be the reason for the decline in the prevalence of ocular manifestation in HIV/AIDS patients in the study area. Ophthalmologic screening of HIV/AIDS patients, especially those with CD4 counts of <200/μL cells and in the first five years of HAART follow-up is recommended to reduce visual impairment and/or blindness.
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Zhi-Chun Zhao, Ying Zhou, Gang Tan, Juan Li
Abstract:
In recent years, people have become increasingly attentive to light pollution influences on their eyes. In the visible spectrum, short-wave blue light with wavelength between 415 nm and 455 nm is closely related to eye light damage. This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality. Therefore, the effect of Blu-rays on ocular is becoming an important concern for the future. We describe blue light’s effects on eye tissues, summarize the research on eye injury and its physical prevention and medical treatment.
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Ji Jin, Lei Chen, Gao-Qin Liu, Pei-Rong Lu
Abstract:
AIM: To analyze the retinal proteomes with and without conbercept treatments in mice with oxygen-induced retinopathy (OIR) and identify proteins involved in the molecular mechanisms mediated by conbercept. METHODS: OIR was induced in fifty-six C57BL/6J mouse pups and randomly divided into four groups. Group 1: Normal17 (n=7), mice without OIR and treated with normal air. Group 2: OIR12/EXP1 (n=14), mice received 75% oxygen from postnatal day (P) 7 to 12. Group 3: OIR17/Control (n=14), mice received 75% oxygen from P7 to P12 and then normal air to P17. Group 4: Lang17/EXP2 (n=21), mice received 75% oxygen from P7 to P12 with intravitreal injection of 1 μL conbercept at the concentration of 10 mg/mL at P12, and then normal air from P12 to P17. Liquid Chromatography-Mass Spectrometry (LC-MS)/MS data were reviewed to find proteins that were up-regulated after the conbercept treatment. Gene ontology (GO) analysis was performed of conbercept-mediated changes in proteins involved in single-organism processes, biological regulation, cellular processes, immune responses, metabolic processes, locomotion and multiple-organism processes. RESULTS: Conbercept induced a reversal of hypoxia-inducible factor 1 signaling pathway as revealed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and also induced down-regulation of proteins involved in blood coagulation and fibrin clot formation as demonstrated by the Database for Annotation, Visualization and Integrated Discovery (DAVID) and the stimulation of interferon genes studies. These appear to be risk factors of retinal fibrosis. Additional conbercept-specific fibrosis risk factors were also identified and may serve as therapeutic targets for fibrosis. CONCLUSION: Our studies reveal that many novel proteins are differentially regulated by conbercept. The new insights may warrant a valuable resource for conbercept treatment.
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Xi-Teng Chen, Hui Huang, Yan-Hua Chen, Li-Jie Dong, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM:To identify the genetic defects in a Chinese family with achromatopsia.METHODS:A 2.5-year-old boy, who displayed nystagmus, photophobia, and hyperopia since early infancy, was clinically evaluated. To further confirm and localize the causative mutations in this family, targeted region capture and next-generation sequencing of candidate genes, such as CNGA3, CNGB3, GNAT2, PDE6C, and PDE6H were performed using a custom-made capture array.RESULTS:Slit-lamp examination showed no specific findings in the anterior segments. The optic discs and maculae were normal on fundoscopy. The unaffected family members reported no ocular complaints. Clinical signs and symptoms were consistent with a clinical impression of autosomal recessive achromatopsia. The results of sequence analysis revealed two novel missense mutations in CNGA3, c.633T>A (p.D211E) and c.1006G>T (p.V336F), with an autosomal recessive mode of inheritance.CONCLUSION: Genetic analysis of a Chinese family confirmed the clinical diagnosis of achromatopsia. Two novel mutations were identified in CNGA3, which extended the mutation spectrum of this disorder.
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Abstract:
Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today’s world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician’s responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of optical coherence tomography, frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.
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Ping-Ting Zhao, Ling-Jun Zhang, Hui Shao, Ling-Ling Bai, Bo Yu, Chang Su, Li-Jie Dong, Xun Liu, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM: To test the therapeutic effects of delayed treatment of mesenchymal stem cells (MSCs) in recurrent experimental autoimmune uveitis (rEAU). METHODS: The efficacy of different regimens of MSC administration in rEAU were tested by evaluation of clinical and pathological intraocular inflammation, as well as retinal structural and functional integrity using optical coherence tomography (OCT) and electroretinogram (ERG). The retinal sections were also immunostained with antibodies to glial fibrillary acidic protein (GFAP) and rhodopsin (RHO). RESULTS: Delayed treatment of MSCs effectively alleviated the severity of intraocular inflammation with relative intact of outer retinal structure and function. Moreover, double therapies with longer interval led to an even better clinical evaluation, as well as a trend of decrease in relapse and amelioration of retinal function. MSC therapies also effectively reduced GFAP expression and increased RHO expression in the retina. CONCLUSION: MSC administration can effectively treat developed diseases of rEAU, and multiple therapies can provide additional therapeutic benefits.
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Li-Fei Yuan, Guang-Da Li, Xin-Jun Ren, Hong Nian, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM:To determine the effects of rapamycin on experimental autoimmune uveoretinitis (EAU) and investigate of role of rapamycin on T cell subsets in the disease. METHODS:EAU was induced in rats using peptides 1169 to 1191 of the interphotoreceptor binding protein (IRBP). Rapamycin (0.2 mg/kg/d) was administrated by intraperitoneal injection for a consecutive 7d after immunization. Th1/Th2/Th17 cytokines, TGF-β1, and IL-6 produced by lymphocyteswere measured by ELISA, while Th17 cells and CD4+CD25+ regulatory T cells (Tregs) from rat spleen were detected by flow cytometry. RESULTS: Intraperitoneal treatment immediately after immunization dramatically ameliorated the clinical course of EAU. Clinical responses were associated with reduced retinal inflammatory cell infiltration and tissue destruction. Rapamycin induced suppression of Th1/Th2/Th17 cytokines, including IFN-γ, IL-2, IL-17, IL-4, and IL-10 release from T lymphocytes of EAU rats, in vitro. Rapamycin also significantly increased TGF-β1 production but had no effect on IL-6 productionof T lymphocytes from EAU rats in vitro. Furthermore, rapamycin decreased the ratio of Th17 cells/CD4+T cells and upregulated Tregs in EAU, as detected by flow cytometry. CONCLUSION: Rapamycin effectively interferes with T cell mediated autoimmune uveitis by inhibiting antigen-specific T cell functions and enhancing Tregs in EAU. Rapamycin is a promising new alternative as an adjunct corticosteroid-sparing agent for treating uveitis.
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Abstract:
AIM: To report various ocular lesions caused by accidental instillation of superglue.METHODS: Three cases of ocular injuries are described in children aged 6 years, 3 years and 8 months, following accidental instillation of superglue in the eye.RESULTS: In the first case there was sticking of eyelashes in the medial 1/3 of eyelids in both eyes. In the second case sticking of eye lashes was present in the lateral 1/3 of eyelids in the left eye. In the third case, superglue was present on the right cheek, above the right ear and sticking of eyelids in medial 1/3 in right eye. The eyelids were separated by pulling the lid margins with fingers in the first case and later on superglue was removed by trimming the eyelashes; and by direct trimming the eyelashes in second and third cases. There was no injury to other structures of anterior segment in the first two cases. However, removal of the superglue on the cornea resulted in corneal abrasion in the third case which healed with medical treatment and patching of the right eye.CONCLUSION: Accidental instillation of superglue is possible because of the appearance of the tube like eye ointment tube. Immediate medical aid will prevent ocular morbidity.
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Yang-Qing Huang, He Huang, Rong-Zhi Huang
Abstract:
AIM:To introduce a new near-vision chart for children aged 3-5 years old and its clinical applications.METHODS:The new near-vision chart which combined the Bailey-Lovie layout with a newly devised set of symmetry symbols was designed based on Weber-Fechner law. It consists of 15 rows of symmetry symbols, corresponding to a visual acuity range from 1.3 to 0.1 logMAR. The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle, square, triangle，and cross, which matched the preschool children''s cognitive level. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 15 lines. The progression rate of the optotype size between two lines was 1.2589 and two smaller groups of optotypes ranging from 0.7 to -0.1 logMAR were included for repetitive testing. A near visual acuity was recorded in logMAR or decimal, and the testing distance was 25 cm.RESULTS:This new near-vision chart with pediatric acuity test optotypes which consists of 4 different symbols (triangle, square, cross, and circle) met the national and international eye chart design guidelines. When performing the near visual acuity assessment in preschoolers (3-5 years old). It overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling ''E'' or Landolt ''C'', which the subjects were prone to lose interest in. Near vision may be recorded in different notations:decimal acuity and logMAR. These two notations can be easily converted each other in the new near-vision chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the Chinese national standard logarithmic near-vision chart (r=0.932, P<0.01), but also indicated good test-retest reliability (89% of retest scores were within 0.1 logMAR units of the initial test score) and a high response rate.CONCLUSION:The results of this study support the validity and reliability of near visual acuity measurements using the new near-vision chart in children aged 3-5y over a wide range of visual acuities, and the new eye chart was especially suitable for the detection of amblyopia risk factors and low vision examination in children (3-5y of age). It can be applied in routine clinical practice.
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Ali Ihsan Incesu, Güng?r Sobac?
Abstract:
Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today's world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician's responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of OCT (optical coherence tomography), frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.
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Blake F. Webb, Jadon R. Webb, Mary C. Schroeder, Carol S. North
Abstract:
AIM: To estimate the prevalence and risk factors for vitreous floaters in the general population.METHODS: An electronic survey was administered through a smartphone app asking various demographic and health questions, including whether users experience floaters in their field of vision. Multivariate logistic regression analysis was used to determine risk factors.RESULTS:A total of 603 individuals completed the survey, with 76% reporting that they see floaters, and 33% reporting that floaters caused noticeable impairment in vision. Myopes were 3.5 times more likely (P=0.0004), and hyperopes 4.4 times more likely (P=0.0069) to report moderate to severe floaters compared to those with normal vision. Floater prevalence was not significantly affected by respondent age, race, gender, and eye color.CONCLUSION:Vitreous floaters were found to be a very common phenomenon in this non-clinical general population sample, and more likely to be impairing in myopes and hyperopes.
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Abstract:
Photobiomodulation (PBM), also known as low level laser therapy, has recently risen to the attention of the ophthalmology community as a promising new approach to treat a variety of retinal conditions including age-related macular degeneration, retinopathy of prematurity, diabetic retinopathy, Leber’s hereditary optic neuropathy, amblyopia, methanol-induced retinal damage, and possibly others. This review evaluates the existing research pertaining to PBM applications in the retina, with a focus on the mechanisms of action and clinical outcomes. All available literature until April 2015 was reviewed using PubMed and the following keywords: “photobiomodulation AND retina”, “low level light therapy AND retina”, “low level laser therapy AND retina”, and “FR/NIR therapy AND retina”. In addition, the relevant references listed within the papers identified through PubMed were incorporated. The literature supports the conclusion that the low-cost and non-invasive nature of PBM, coupled with the first promising clinical reports and the numerous preclinical-studies in animal models, make PBM well-poised to become an important player in the treatment of a wide range of retinal disorders. Nevertheless, large-scale clinical trials will be necessary to establish the PBM therapeutic ranges for the various retinal diseases, as well as to gain a deeper understanding of its mechanisms of action.
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Bora Yüksel, Sultan Kaya ünsal, Sevgi Onat
Abstract:
AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft. METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months. RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.
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Wen-Bin Huang, Qian Fan, Xiu-Lan Zhang
Abstract:
Glaucoma is one of the leading causes of visual impairment and blindness. Improved knowledge of the pathogenesis of this disease has allowed the exploration of new therapeutic methods. In general, elevated intraocular pressure (IOP), oxidative stress, and vascular insufficiency are accepted as the major risk factors for the progression of glaucoma. Many natural compounds have been found beneficial for glaucoma. Nutritional therapies are now emerging as potentially effective in glaucomatous therapy. One nutritional supplement with potential therapeutic value is cod liver oil, a dietary supplement that contains vitamin A and omega-3 polyunsaturated fatty acids (PUFAs). Vitamin A is important for preserving normal vision and it is a well-known antioxidant that prevents the oxidative damage that contributes to the etiology and progression of glaucoma. Vitamin A is also a crucial factor for maintaining the integrity of conjunctival and corneal ocular surfaces, and preventing the impairment of ocular epithelium caused by topical antiglaucomatous drugs. Omega-3 fatty acids are beneficial for glaucoma patients as they decrease IOP, increase ocular blood flow, and improve optic neuroprotective function. In this article, we propose that cod liver oil, as a combination of vitamin A and omega-3 fatty acids, should be beneficial for the treatment of glaucoma. However, further studies are needed to explore the relationship between cod liver oil and glaucoma.
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Jun Yi, Jun Yun, Zhi-Kui Li, Chang-Tai Xu, Bo-Rong Pan
Abstract:
· Congenital cataract is a crystallin severe blinding disease and genetic factors in disease development are important. Crystallin growth is under a combination of genes and their products in time and space to complete the coordination role of the guidance. Congenital cataract-related genes, included crystallin protein gene (CRYAA, CRYAB, CRYBA1/A3, CRYBA4, CRYBB1, CRYBB2, CRYBB3, CRYGC, CRYGD, CRYGS), gap junction channel protein gene (GJA1, GJA3, GJA8), membrane protein gene (GJA3, GJA8, MIP, LIM2), cytoskeletal protein gene (BF-SP2), transcription factor genes (HSF4, MAF, PITX3, PAX6), ferritin light chain gene (FTL), fibroblast growth factor (FGF) and so on. Currently, there are about 39 genetic loci isolated to which primary cataracts have been mapped, although the number is constantly increasing and depends to some extent on definition. We summarized the recent advances on epidemiology and genetic locations of congenital cataract in this review.
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Juan-Juan Li, Yun-Peng Li, Zhu-Lin Hu
Abstract:
We describe the successful treatment in a patient with bilateral congenital aniridia and cataract by insertion of capsular tension rings and IOL.
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Abstract:
AIM: To compare the efficacy for preventing exposure keratopathy of three forms of eye care (artificial tear, moist chamber and polyethylene covers) for intensive care patients. METHODS: Eighty-four patients in Intensive Care Unit (ICU) were randomized to three treatment groups, including artificial tears group, moist chambers group and polyethylene film group. Patients of artificial tear group received two drops of carboxymethylcellulose drops to each eye every 2 hours. The moist chambers and the polyethylene were changed every 12 hours or as needed if they became unclean or torn. The corneal fluorescein stains were performed daily. RESULTS: No of 28 patients (0%) in the polyethylene group and one of the 27 patients (3.70%) in the moist chamber group had exposure keratopathy, compared to 8 of the 29 patients (27.59%) in the artificial tear group. There were statistical significance between the artificial tear group and the moist chamber group (P=0.02), and the artificial tear group and the polyethylene group (P =0.003). The time on eye care every day of the artificial tear group, the moist chamber group and the polyethylene group was 26.69±2.39 minutes, 35.33±2.63 minutes and 7.48±0.87 minutes, respectively. The eye care of the polyethylene group were statistically more time-save than that of the artificial tear group (P<0.001) and the moist chamber group (P<0.001). CONCLUSION: Polyethylene covers are more effective and more time-saving in reducing the incidence of corneal damage in intensive care patients
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