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 and DOAJ, and was selected for China's Science and Technology Journal International Influence Enhancement Plan (D-class projects). IJO’s JCR IF in 2024 is 1.8 (Q3), Five-year Impact Factor is 1.8, CiteScore in 2024 is 2.8. 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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E Murali, T Prasad, J. Hari Krishna, Abdul Hussain Sharief, Peta Nandini
2026(4):637-645 ,DOI: 10.18240/ijo.2026.04.01
Abstract:
AIM: To develop an automated diagnostic system for early detection of diabetic retinopathy (DR) using fundus images by identifying exudates, hemorrhages, and microaneurysms with advanced image processing and machine learning techniques. METHODS: Fundus images from the IDRiD dataset and additional Kaggle datasets were used. A wavelet-based band-pass filter was applied for edge enhancement of retinal features. Gaussian mixture model (GMM) clustering was used to segment and extract texture features. These extracted features were classified using machine learning algorithms, including a random forest classifier and a multilayer perceptron neural network. Performance metrics such as sensitivity, specificity, and accuracy were computed to evaluate the proposed model’s diagnostic effectiveness. RESULTS: The random forest-based classification system achieved a sensitivity of 95.08%, specificity of 86.67%, and overall accuracy of 95.20% in detecting DR lesions. The combination of wavelet-based edge enhancement, GMM clustering, and neural network-based feature classification demonstrated high reliability in lesion identification. CONCLUSION: The proposed method effectively detects early signs of DR from fundus images, offering a high-accuracy, automated, and scalable solution for assisting ophthalmologists. Its application can support large-scale screening programs, particularly in regions with limited access to specialized eye care.
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Hao Hu, Da-Dong Jia, Li-Cheng Liang, Yi-Yao Wang, Ru-Wen Wang, Xiao-Yu Liu, Xue-Lian Guo, Liang Liang
2026(4):646-654 ,DOI: 10.18240/ijo.2026.04.02
Abstract:
AIM: To explore the mechanism of carnosic acid (CA) in treating primary open angle glaucoma (POAG)-induced optic nerve injury using network pharmacology and bioinformatics analyses. METHODS: CA targets were predicted using SwissTargetPrediction and TARGET PREDICTION databases, while glaucoma-related targets were identified via GeneCards, OMIM, DisGeNET, and CTD. Differentially expressed genes (DEGs) were identified by analyzing the Gene Expression Omnibus (GEO) dataset GSE45570, which includes optic nerve head samples from 6 POAG patients and 6 controls. Key targets were derived by intersecting DEGs with CA and glaucoma targets. The expression of the key target gene, FABP3, was further validated in two independent GEO datasets: GSE13534 (lamina cribrosa cells) and GSE2387 (lamina cribrosa region samples). The expression was also validated at mRNA and protein levels using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot (WB) in experimental models. Molecular docking was used to assess binding affinity, and co-immunoprecipitation (Co-IP) confirmed the interaction. Functional enrichment and immune-infiltration correlation analyses were also performed. RESULTS: A total of 306 DEGs, 84 CA targets, and 15 715 glaucoma targets were identified. FABP3 was identified as the key target, which was significantly upregulated in POAG samples in both validation datasets (GSE13534 and GSE2387) and confirmed by qRT-PCR and WB assays. Molecular docking revealed a strong binding affinity between FABP3 and CA (docking score: -9.79 kcal/mol), which was validated by Co-IP. Functional enrichment analysis showed FABP3 was associated with mitochondrial function and immune-related pathways. Correlation analysis indicated FABP3 had a significant negative correlation with activated dendritic cells (aDCs). CONCLUSION: Our study suggests that CA may treat POAG by targeting FABP3, potentially by mitigating oxidative stress and modulating immune responses. This provides a pharmacological foundation and identifies FABP3 as a potential therapeutic target for POAG treatment.
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Xiao-Qing Cai, Ping Zhang, Zhou-Fan Zhang, Jing Gu, Ting-Ting Chen, Ai-Na Chen
2026(4):655-664 ,DOI: 10.18240/ijo.2026.04.03
Abstract:
AIM: To investigate the therapeutic efficacy and underlying mechanisms of epigallocatechin gallate (EGCG), a major green tea catechin with potent antioxidant properties, in an N-methyl-N-nitrosourea (MNU)-induced mouse model of retinitis pigmentosa (RP). METHODS: C57BL/6 mice were randomly divided into control (PBS), MNU-induced RP, and MNU+EGCG pretreatment groups. EGCG (50 mg/kg, intraperitoneal) was administered daily for 3 consecutive days prior to a single MNU injection (50 mg/kg). Retinal function was evaluated by scotopic electroretinography (ERG). Retinal structure was assessed using optical coherence tomography (OCT) and hematoxylin-eosin staining, with outer nuclear layer (ONL) thickness measurement. Mechanisms were explored via RNA sequencing, reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) validation of oxidative stress- and inflammation-related genes, and immunohistochemistry for microglial activation, astrocytic gliosis, and apoptosis markers. RESULTS: Compared with the MNU group, EGCG pretreatment significantly preserved scotopic ERG a-wave and b-wave amplitudes (P<0.001). OCT and histological analysis showed that EGCG markedly attenuated MNU-induced thinning of total retina and ONL (P<0.005, P<0.001, respectively). RNA sequencing identified 1147 differentially expressed genes modulated by EGCG, with significant upregulation of antioxidant genes (Nrf2, Sod1, Gpx4, Cat1, Ho-1) and downregulation of pro-inflammatory genes. Immunohistochemistry confirmed that EGCG significantly reduced microglial activation, glial fibrillary acidic protein (GFAP) expression, and cleaved caspase-3-positive cells (P<0.01 to P<0.001). CONCLUSION: EGCG exerts robust neuroprotective effects in MNU-induced RP through enhancement of antioxidant defenses, suppression of neuroinflammation, and preservation of retinal structure and function. These findings suggest EGCG as a promising candidate for adjuvant antioxidant therapy in RP.
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Yu-Jie Tang, Jiang-Ying Liu, Sheng-Xiang Zhang, Bo-Yu Liu, Liao Quan, Qi-Hua Xu
2026(4):665-672 ,DOI: 10.18240/ijo.2026.04.04
Abstract:
AIM: To identify differentially expressed genes (DEGs) in rabbits with traumatic proliferative vitreoretinopathy (PVR) using high-throughput sequencing (HTS). METHODS: Thirty-six rabbits were randomly allocated to the control group and the PVR group induced by scleral puncture. On the 28th day following modeling, fundus B-ultrasound and fundus photography were performed on all rabbits, and hematoxylin-eosin (HE) staining was conducted on retinal tissues. RNA sequencing (RNA-Seq) combined with bioinformatics analysis was used to screen PVR-associated DEGs. Gene Ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were carried out for the identified DEGs. S100A6, EDNRB and CEBPD were randomly selected for quantitative reverse transcription polymerase chain reaction (RT-qPCR) validation to verify the reliability of the RNA-Seq results. RESULTS: Fundus B-ultrasound, fundus photography and retinal HE staining confirmed the successful establishment of the traumatic PVR rabbit model. A total of 1587 DEGs were screened, of which 1094 were significantly up-regulated and 493 were significantly down-regulated. GO function enrichment analysis showed that these DEGs were mainly enriched in immune response, extracellular region and inflammatory response. KEGG pathway enrichment analysis showed that DEGs were mainly involved in the cytokine-cytokine receptor interaction and hematopoietic cell lineage pathway. RT-qPCR results showed that S100A6, CEBPD and EDNRB were significantly increased in PVR group. CONCLUSION: A large number of genes exhibit significant differential expression in rabbits with traumatic PVR, among which S100A6, CEBPD and EDNRB may play an important role in traumatic PVR.
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Ting-Ting Yang, Hong-Yu Duan, Yi-Fan Zhou, Bai-Kai Ma, Lu Zhao, Qian-Qian Lan, Jia-Wei Chen, Xiao-Yu Wang, Kyung Chul Yoon, Hong Qi
2026(4):673-680 ,DOI: 10.18240/ijo.2026.04.05
Abstract:
AIM: To evaluate 3% diquafosol ophthalmic solution on ocular surface parameters and the alterations of lipid and muco-aqueous layer in tear film of patients with visual display terminal (VDT)-associated dry eye disease (DED). METHODS: This study included patients with VDT-associated DED. It was a prospective single-arm interventional clinical trial. Patients were provided with 3% diquafosol ophthalmic solution for 3mo and were followed up in 1, 2 and 3mo after treatment. Tear breakup time (TBUT), ocular surface staining score, and ocular surface disease index (OSDI) score were ocular surface characteristics. Lipid layer thickness (LLT), tear meniscus height (TMH), and mucin mRNA expression levels (MUC1, MUC4, MUC5AC, MUC16, and MUC20) were used to measure changes in the tear film. The LipiView interferometer was used to measure the partial blink rate (PBR). RESULTS: Sixty-eight eyes of 68 participants (54 females; mean age 25.12±4.10y; mean spherical equivalent -4.35±2.69 D) were enrolled. Compared with the pre-treatment, OSDI scores and TBUT improved significantly at all follow-up time points (all P<0.01), and TMH increased significantly at 1 and 3mo (P<0.01, P<0.001, respectively). Conjunctival lissamine green staining improved only at 2mo (P<0.05), while corneal fluorescein staining showed no significant changes. Overall LLT remained unchanged, but the PBR<1 subgroup exhibited significant LLT elevation at 3mo (P<0.05), unlike the PBR=1 subgroup. Conjunctival mRNA expression of MUC1, MUC5AC, MUC16, and MUC20 was significantly upregulated at 1 and 3mo (all P<0.01), and MUC4 expression increased significantly only at 1mo (P<0.001). CONCLUSION: In patients with VDT-associated DED, 3% diquafosol ophthalmic solution dramatically reduced symptoms and enhanced tear film stability by promoting ocular surface muco-aqueous secretion. Patients with better blinking habits (PBR<1) demonstrate greater LLT improvement than those with poorer habits.
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Fang Ruan, Wen-Tao Peng, Lian-Yong Xie, Ying Han, Bin Xu, Wen-Jun Kong
2026(4):681-687 ,DOI: 10.18240/ijo.2026.04.06
Abstract:
AIM: To evaluate ocular surface characteristics and dry eye symptoms in primary biliary cholangitis (PBC) patients with seasonal allergic conjunctivitis (SAC). METHODS: This retrospective case-control study included 73 PBC patients: 38 with SAC (PBC+SAC group, 38 eyes) and 35 controls (35 eyes). All the participants underwent comprehensive ocular surface assessment and ocular surface disease index (OSDI) scoring. The severity of ocular allergy in PBC+SAC group was indicated by total ocular symptom score (TOSS), and correlation analysis was carried out between TOSS and ocular parameters. RESULTS: Age (59.60±10.69y vs 58.72±11.13y, P=0.629) and gender distribution (34 vs 32 females, P=0.713) did not differ significantly between groups. Compared to controls, the PBC+SAC group had higher dry eye prevalence (65.79% vs 28.57%, P=0.002), higher OSDI score [median: 34.3 (interquartile range, IQR: 26.05, 43.6) vs 21.2 (IQR: 15.15, 31.2), P<0.001], shorter non-invasive tear film breakup time [NIBUT, median: 4.16s (IQR: 2.52, 6.48) vs 6.88s (IQR: 4.81, 9.28), P<0.001], more severe upper meibomian gland loss (P<0.001), higher corneal fluorescein staining score [median: 1 (IQR: 0, 1) vs 0 (IQR: 0, 0.25), P<0.001], and higher rates of meibomian gland duct thinning (60.53% vs 31.43%, P=0.004) and distortion (73.68% vs 25.71%, P=0.001). TOSS was positively correlated with OSDI score (r=0.484, P<0.001) in PBC+SAC group but not with other ocular parameters (all P>0.05). CONCLUSION: PBC patients with SAC have higher dry eye prevalence and more severe dry eye symptoms, mainly evaporative dry eye with obvious upper meibomian gland morphological abnormalities. Allergic symptom severity is positively correlated with dry eye discomfort, suggesting allergic inflammation may exacerbate ocular surface burden in PBC patients.
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Gökhan Gürelik, Betül Seher Uysal, Merve Nur Şahin, Hüseyin Baran Özdemir, Kamil Bilgihan
2026(4):688-695 ,DOI: 10.18240/ijo.2026.04.07
Abstract:
AIM: To evaluate the corneal biomechanical properties in patients with angioid streaks (AS), and to compare these parameters with those of healthy subjects. METHODS: A retrospective study was conducted, enrolling AS patients and healthy participants as controls. The collected corneal tomographic parameters included flat keratometry, steep keratometry, mean keratometry, maximum keratometry, topographic cylinder value, central corneal thickness, and the total deviation value of the Belin-Ambrósio enhanced ectasia display measured with Pentacam tomography. Corvis ST was used to measure corneal biomechanical parameters, non-contact tonometry intraocular pressure (IOPnct), and biomechanically corrected intraocular pressure (bIOP). RESULTS: The study comprised 18 eyes from 10 male and 8 female AS patients with a mean age of 48.83±10.66y, and the controls included 31 eyes from 12 male and 19 female healthy participants with a mean age of 47.87±10.69y. All corneal tomographic parameters were comparable between the two groups (all P>0.05), and no corneal ectasia was observed in any AS patient. Compared with the controls, AS patients exhibited statistically significant increases in applanation 1 (A1) time and stiffness parameter A1 (SP-A1), along with significant decreases in applanation 2 (A2) velocity, deformation amplitude (DA), DA ratio (2 mm), and Corvis biomechanical index (CBI; all P<0.05), which indicated higher corneal stiffness in AS. The IOPnct value in AS was significantly elevated, while no significant difference was found in the bIOP value compared to controls (P=0.031 and P=0.095, respectively). CONCLUSION: Eyes with AS exhibit normal corneal tomographic characteristics and increased corneal stiffness.
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Kyu Sang Eah, Hayoung Lee, Yoo Young Jeon, Ho Seok Chung, Hun Lee, Jae Yong Kim
2026(4):696-700 ,DOI: 10.18240/ijo.2026.04.08
Abstract:
AIM: To introduce a novel technique for stabilizing the capsular bag in cataract surgery. METHODS: This retrospective observational case series included eyes with unstable capsular bag that underwent cataract surgery. A standard capsular tension ring (CTR) with 10-0 Prolene sutures was inserted into the capsular bag and fixated to the sulcus to stabilize the bag, enabling in-the-bag intraocular lens (IOL) implantation. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and slit-lamp examination were performed preoperatively and at 1 and 6mo postoperatively. RESULTS: Of the 17 eyes from 15 patients (mean age 51.20±19.60y, male/female=11/6), 8 had subluxation due to Marfan syndrome, 3 due to trauma, 5 due to zonular weakness, and 1 due to acute angle closure glaucoma. The preoperative mean CDVA (logMAR) was 0.56±0.67 (mean spherical equivalent: −6.39±4.78 D). At 1mo postoperatively, the mean CDVA improved to 0.21±0.37 (mean spherical equivalent: −0.35±1.07 D). At 6mo, the mean CDVA was 0.32±0.39, and the mean spherical equivalent was −0.34±0.99 D. All patients showed significant visual improvement at both postoperative visits (P<0.05), with stable IOLs in all cases. CONCLUSION: This technique offers a viable surgical option in complex cataract cases with zonulysis.
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Pilar Casas-Llera, Raquel García-Gil, Yaiza del Valle-Najarro, Gorka Lauzirika, Roberto Fernández-Buenaga
2026(4):701-708 ,DOI: 10.18240/ijo.2026.04.09
Abstract:
AIM: To assess the effectiveness and safety of VISULAS® green laser selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with pseudoexfoliative syndrome glaucoma (PEXG) and pseudoexfoliative syndrome ocular hypertension (PEXS-OHT). METHODS: This prospective, single-center, interventional study included 20 eyes from 20 patients diagnosed with PEXG or PEXS-OHT. Patients underwent 180° SLT using the VISULAS® green laser, a diode-pumped, frequency-doubled Nd:YVO4 laser with a 532 nm wavelength. IOP was measured at baseline and post-treatment at 1, 3, and 6mo. Medications regimen was stable through the study. Primary outcomes included mean IOP reduction, while secondary outcomes assessed visual and structural parameters, and safety. RESULTS: The mean age of participants was 72.2±6.6y, with 65% of the eyes being left eyes and 35% right eyes. At baseline, the mean IOP was 22.9±2.9 mm Hg. A significant reduction in IOP was observed at all follow-up intervals: 18.5±3.1 mm Hg at 1mo (18.8% reduction, P=0.001), 19.0±4.2 mm Hg at 3mo (16.7% reduction, P=0.002), and 18.2±4.5 mm Hg at 6mo (19.8% reduction, P=0.001). Subgroup analysis showed greater IOP reduction in patients with Shaffer grade 4 angles, phakic eyes, and those with PEXS-OHT compared to PEXG. No significant changes were detected in visual acuity, visual field index, mean deviation, or retinal nerve fiber layer thickness. At 1h post-procedure, 20% of eyes showed an IOP spike >5 mm Hg that resolved without intervention except for one patient. CONCLUSION: SLT with the VISULAS® green laser is an effective and safe treatment for PEXG and PEXS-OHT, achieving significant IOP reduction without increasing medication burden or causing severe complications. These findings suggest its potential as an alternative or adjunct therapy in managing pseudoexfoliative glaucoma.
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Yan Gao, Xiao-Wei Yu, Lin Deng, Feng Mei, Miao Zhang, Hong-Yu Zhong, Tian-Rui Zhang, Yan Shi, Zhi-Gang Fan
2026(4):709-719 ,DOI: 10.18240/ijo.2026.04.10
Abstract:
AIM: To explore and summarize outcomes of a modular surgical approach for the personalized management of angle-closure glaucoma (ACG) secondary to nanophthalmos. METHODS: This was a retrospective interventional case series involving consecutive patients with nanophthalmos and ACG. All patients were treated with a modular surgical approach tailored to their specific disease characteristics, which included the following surgical combinations: Procedure I [phacoemulsification (phaco)+goniosynechialysis (GSL)], Procedure II [Procedure I +irido-zonulo-hyaloid-vitrectomy (IZHV)], Procedure III [phaco +IZHV+Ahmed glaucoma valve (AGV) implantation], and Procedure IV (Procedure III+scleral window creation). RESULTS: A total of 92 eyes from 62 patients were enrolled, with a median age of 52 (range: 23-72)y and a median axial length of 19.89 (range: 14.84-20.99) mm. According to the patients’ distinct clinical characteristics, 14, 26, 22, and 30 eyes underwent Procedures I, II, III, and IV, respectively. The median follow-up duration was 13 (range: 12-36)mo. At the final follow-up visit, all patients achieved a sustained intraocular pressure (IOP) below 21 mm Hg without the administration of anti-glaucoma medications. Postoperative complications included malignant glaucoma (MG, 9 eyes), uveal effusion (UE, 5 eyes), suprachoroidal hemorrhage (1 eye), fibrin membrane formation (4 eyes), uveitis (1 eye), macular edema (1 eye), and impaired corrected distance visual acuity (CDVA, 6 eyes). Univariate analysis revealed that younger age was associated with a higher risk of MG (OR: 1.06, P=0.04), UE (OR: 1.07, P=0.046), and impaired CDVA (OR: 1.11, P=0.02). CONCLUSION: The modular surgical approach yields favorable and consistent clinical prognoses, while reducing the incidence of complications, in the challenging clinical scenario of ACG secondary to nanophthalmos.
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Ke-Ke Zhang, Meng Li, Yan-Hong Liao, Zhi-Hai Yu, Can Tu, Ying-Chao Shi, Wei-Hua Yang, Yan Gong
2026(4):720-732 ,DOI: 10.18240/ijo.2026.04.11
Abstract:
AIM: To evaluate the effectiveness and safety of superselective ophthalmic artery thrombolysis (SOAT) for central retinal artery occlusion (CRAO) beyond 24h after onset. METHODS: This was a retrospective cohort study of CRAO patients treated from January 2019 to July 2025. Patients were divided into four groups by treatment (SOAT/conservative) and onset-to-treatment time (<24h/>24h). Main outcome measures were best-corrected visual acuity (BCVA, logMAR) and central macular thickness (CMT) assessed via spectral-domain optical coherence tomography (SD-OCT), recorded at baseline, 3d and 1mo after treatment. Ocular/systemic adverse events were documented. RESULTS: A total of 109 CRAO participants were enrolled, including 74 males (67.89%) and 35 females (32.11%), with a mean age of 52.30±11.76y. Underlying diseases were hypertension (78 cases, 71.56%), diabetes (40 cases, 36.70%), arterial atherosclerosis with plaque formation (81 cases, 74.31%), hyperlipidemia (14 cases, 12.84%), and hypercholesterolemia (16 cases, 14.68%). Four groups included 25, 28, 26, and 30 cases in Groups 1 (SOAT<24h), 2 (SOAT>24h), 3 (conservative <24h), and 4 (conservative >24h), respectively. In <24h cohort, BCVA improved significantly in both Group 1 (2.36±0.53 to 1.71±0.81 logMAR, P<0.05) and Group 3 (2.42±0.40 to 1.92±0.76 logMAR, P<0.05). In >24h cohort, thrombolysis improved BCVA (1.84±0.88 to 1.31±0.53 logMAR, P<0.05), while conservative treatment showed no significant change (2.04±0.74 to 1.92±0.73 logMAR, P=0.808). Clinically significant improvement (≥0.3 logMAR) was more frequent with SOAT in both time windows (P<0.05). SOAT significantly reduced CMT in both <24h (256±25.65 to 209±21.22 μm, P<0.001) and >24h groups (242±23.33 to 204±27.22 μm, P<0.001), while conservative treatment had no significant effect on CMT (all P>0.05). Adverse events included orbital swelling (11.3%), new cerebral infarction (7.55%), dizziness/headache (7.55%), and nausea/vomiting (5.66%). No intracranial hemorrhage occurred. CONCLUSION: SOAT provides meaningful visual and anatomical benefit even beyond 24h after symptom onset. However, potential ocular and systemic adverse events necessitate careful patient selection and individualized risk assessment.
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Yan Jiang, Tian Niu, Guo-Hui Lan, Yu-Peng Xu, Kun Liu
2026(4):733-741 ,DOI: 10.18240/ijo.2026.04.12
Abstract:
AIM: To investigate the potential impact of lipidaemic and clinical factors on the development of proliferative vitreoretinopathy (PVR) following uncomplicated primary rhegmatogenous retinal detachment (RRD) surgery in nondiabetic individuals. METHODS: This was a retrospective, single-center, case-control study of consecutive patients who underwent primary RRD surgery. The study group comprised 145 patients who developed PVR within 3y of follow-up, while the control group comprised 161 patients with RRD who did not develop PVR. Cox regression analysis was utilized to identify independent associations between various risk markers and the occurrence of PVR. RESULTS: The mean age of patients was 52.31y (SD=13.29), and 54.25% (n=166) were male. The median time to PVR formation after surgery was 150d. Multivariate Cox regression indicated that cigarette smoking status [hazard ratio (HR): 0.43, 95% confidence interval (CI): 0.31-0.60, P<0.001], retinal detachment (RD) not involving the macula (HR: 0.52, 95%CI: 0.37-0.73, P<0.001), apolipoprotein A1 (ApoA1; HR: 1.01, 95%CI: 1.01-1.02, P<0.001) and apolipoprotein E (ApoE; HR: 3.81, 95%CI: 1.64-8.85, P=0.002) were independent predictors of PVR. CONCLUSION: Apart from macular involvement and smoking, the lipidaemic factors ApoA1 and ApoE are risk factors of PVR after primary RRD surgery.
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Li-Na Cheng, Song Wang, Hong-Bing Zhang, Hong-Song Li, Pei Chen, Yan-Yan Xue
2026(4):742-749 ,DOI: 10.18240/ijo.2026.04.13
Abstract:
AIM: To establish and validate a multidimensional predictive model of postoperative visual recovery after idiopathic macular hole (IMH) surgery. METHODS: Retrospective cohort study. Examinations within a three-month period, both pre- and postoperative, included assessments of best corrected visual acuity (BCVA), intraocular pressure (IOP), and morphological parameters of IMH with optical coherence tomography (OCT). Then, a series of indices were derived, including the IMH index (MHI), diameter hole index (DHI), macular hole closure index (MHCI), hole form factor (HFF), and tractional hole index (THI). Subfoveal anatomical damage (macular hole inferior volume, Vi) was calculated based on the basal diameter (BD), minimum diameter (MD), and height at the narrowest point (HMD) of IMH. Pearson correlation analysis was utilized to discern significant correlations between postoperative BCVA and the multiple indices examined. A subsequent linear correlation analysis was performed. RESULTS: The study involved 51 eyes from 51 patients (mean age 66.90±6.07y) diagnosed with IMH. Preoperative BCVA was 1.22±0.76 logMAR and improved to 0.88±0.38 logMAR after surgery (P<0.001). The correlation analysis results showed significant correlations between postoperative BCVA and preoperative BCVA (P<0.001), BD (P=0.042), MD (P=0.001), MHI (P=0.047), THI (P=0.004), and Vi (P=0.007). The multidimensional model integrating THI, Vi, and preoperative BCVA significantly outperformed traditional predictors (MD, BD, and height) in terms of postoperative visual recovery prediction. THI, reflecting posterior vitreous traction mechanics, independently predicted anatomical reset potential (β=-0.06, P=0.022), while Vi, quantifying subfoveal photoreceptor disruption, was correlated with structural-functional recovery (β=0.01, P=0.046). Preoperative visual acuity served as a critical surrogate for retinal functional reserve (β=0.15, P=0.020). Redundant morphometric parameters (MHI, DHI, MHCI, HFF) were excluded, as their predictive contributions were subsumed by THI/Vi or mediated by preoperative vision. CONCLUSION: The combination of biomechanical traction (THI), subfoveal anatomical damage (Vi), and preoperative BCVA represents a clinically applicable framework for predicting postoperative visual recovery after IMH surgery. This model can be used as a practical tool to guide surgical planning, facilitating the identification of high-risk patients who may benefit from additional techniques (such as an internal limiting membrane flap) while optimizing resource allocation for standard cases.
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Xia Jin, Ying Wang, Meng-Fang Gui, Xiao-Hong Guo, Yan Gong, Xiao-Jin Zhang, Lu Zhang
2026(4):750-756 ,DOI: 10.18240/ijo.2026.04.14
Abstract:
AIM: To investigate efficacy and ocular surface safety of 3 kinds of different correction methods for correction of high myopia in adolescents. METHODS: A prospective, randomized, controlled clinical trial was conducted. From January 2022 to December 2022, 62 adolescents with high myopia (124 eyes) were recruited, with spherical refractive errors ranging from -6.00 to -7.50 diopters (D) and refractive astigmatism ≤1.50 D. All participants were randomly assigned to three groups: the orthokeratology combined with single-vision spectacle lenses (OK+SVLs) group (20 cases, 40 eyes), the peripheral defocus rigid gas permeable contact lenses (Defocus RGPCL) group (22 cases, 44 eyes), and the single-vision spectacle lenses (SVLs) group (20 cases, 40 eyes). All of them were followed up for 1.5y. The observation indicators included refractive error, axial length (AL), tear break-up time (BUT), percentage of hexagonal corneal endothelial cells (CEC), CEC density, and ocular surface adverse reactions. RESULTS: The three groups had mean age of 14.84±1.87y, 14.57±1.91y, and 14.80±1.52y, respectively. No statistically significant differences were found in age, gender, corneal curvature, AL, and spherical equivalent among the groups (all P>0.05). At the 6mo, 1, and 1.5y follow-ups after spectacle lens wear, the improvements in refractive error in the OK+SVLs and Defocus RGPCL groups were significantly superior to those in the SVLs group (F=4.221, P=0.017; F=7.226, P=0.001; F=16.140, P<0.001), while no significant difference was observed between the OK+SVLs and Defocus RGPCL groups (all P>0.05). Intergroup comparisons of AL changes revealed statistically significant differences at all follow-up time points (F=3.493, P=0.034; F=9.930, P<0.001; F=20.570, P<0.001), with no notable difference between the OK+SVLs and Defocus RGPCL groups (all P>0.05). After 1.5y of lens wear, the intergroup comparison of BUT showed a statistically significant difference (F=5.783, P=0.004), whereas no significant differences were found in the percentage of hexagonal CEC and CEC density among the three groups (all P>0.05). No severe complications were observed in the two contact lens groups; only 5 eyes presented with grade 1 or 2 bulbar conjunctival hyperemia and corneal epithelial staining. All adverse reactions were well controlled by temporary lens discontinuation or medication, and resumed lens wear subsequently, with no statistically significant difference in the incidence of adverse reactions between the two contact lens groups (P>0.05). CONCLUSION: Orthokeratology lenses and peripheral defocus RGPCL yield better visual acuity correction and superior image quality, which can minimize retinal image aberrations induced by high refractive errors. Both interventions achieve satisfactory corrective vision and effective myopia control effects in adolescents with high myopia, with no significant adverse reactions observed during the follow-up period, indicating a high level of wearing safety for clinical application.
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Yao-Ling Li, Ning Hua, Xiao-Yu Zeng, An-Qi Wang, Hui-Yu Wang, Xue-Han Qian
2026(4):757-763 ,DOI: 10.18240/ijo.2026.04.15
Abstract:
AIM: To evaluate the three-dimensional choroidal vascularity index (3D-CVI) in amblyopic eyes of preschool children compared with age-matched healthy controls using swept-source optical coherence tomography angiography (SS-OCTA). METHODS: A cross-sectional case-control study was conducted. Children aged between 4y and less than 7y diagnosed with hyperopic amblyopia were consecutively recruited between January 1, 2021 and May 30, 2024. Age-matched controls were selected from healthy children without ocular or systemic diseases. All participants underwent SS-OCTA scanning, and choroidal parameters—including 3D-CVI, choroidal vessel volume (CVV), and choroidal thickness (CT)—were analyzed in both foveal and parafoveal regions. Comparative and correlational analyses were conducted to examine differences between groups and to explore the relationship between best-corrected visual acuity (BCVA) and 3D-CVI. RESULTS: A total of 80 eyes (40 amblyopic and 40 age-matched controls) were included. 3D-CVI was significantly lower in the amblyopic group compared to controls in both the foveal [0.318 (0.2885-0.3525) vs 0.381 (0.3460-0.4212), P<0.05] and parafoveal [0.331 (0.2982-0.3589) vs 0.386 (0.3538-0.4293), P<0.05] regions. Similarly, CT was significantly higher in the amblyopic group than in the control group in both the foveal (438±67.3 vs 369±74.1 µm, P<0.001) and parafoveal regions (419±59.0 vs 353±67.5 µm, P<0.001), whereas CVV did not differ significantly between the two groups in either region (P>0.05). Furthermore, multivariate regression analysis showed that BCVA was positively associated with foveal 3D-CVI (P=0.024), whereas no such association was found in the parafoveal region. CONCLUSION: Hyperopic amblyopic eyes in preschool children show significantly lower foveal and parafoveal 3D-CVI compared to normal controls, suggesting a potential reduction in 3D-CVI during early refractive development. Lower foveal 3D-CVI is also associated with poorer BCVA, suggesting that 3D-CVI may serve as a valuable parameter for monitoring structural changes in hyperopic amblyopia.
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2026(4):764-774 ,DOI: 10.18240/ijo.2026.04.16
Abstract:
AIM: To evaluate nanosilver eye patches versus Atrauman nanosilver dressings for ocular surface trauma. METHODS: This randomized non-inferiority trial (November 2024–April 2025) enrolled 60 patients assessed pre-treatment and on days 1, 7, and 14 post-treatment. The patients were then randomized into treatment (nanosilver eye patches) and control groups (Atrauman nanosilver dressings). Outcomes included wound healing, comfort (Ocular Comfort Index, OCI), and safety. Statistical analyses used t-tests, non-inferiority tests, and Chi-square tests. RESULTS: Patient baseline characteristics were comparable between groups, with a mean age of 60.633±10.934 in the treatment group versus 64.933±9.606 in controls, and similar gender distribution (20/10 vs 17/13 male/female). Both groups showed comparable baseline OCI scores (treatment group: 6.100±2.187 vs control group: 6.267±2.303, P=0.775). Following treatment, scores increased significantly at day 1 (treatment group: 9.367±2.251; control group: 9.067±2.212, both P<0.001 vs baseline). Marked improvement was observed by day 7 (treatment group: 4.067±1.929; control group: 3.900±1.918, P<0.001 vs baseline), with complete resolution at day 14 (0.467±0.860 vs 0.467±1.008, P<0.001). The non-inferiority criterion was met. The treatment group showed greater improvement in Grade A wound healing rates (76.67% to 93.33%) compared to controls (80.00% to 86.67%) between 1 and 7d post-treatment. By 14d post-treatment, all patients achieved Grade A healing in both groups, with no Grade C cases observed throughout the study period. No adverse events were reported. CONCLUSION: Nanosilver eye patches are non-inferior to Atrauman dressings, offering effective, safe emergency care for ocular trauma.
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Yusuf Cem Yilmaz, Serife Ciloglu Hayat, Merve Kelebek, Esra Hatipoglu
2026(4):775-781 ,DOI: 10.18240/ijo.2026.04.17
Abstract:
AIM: To investigate the potential of optical coherence tomography angiography (OCTA) for detecting subclinical microvascular damage, possibly before ocular complications develop, in treatment-naive Cushing’s disease (CD) patients. METHODS: This retrospective cross-sectional study included 48 newly diagnosed, treatment-naive CD patients and 48 healthy controls. Ophthalmological examinations, including best-corrected visual acuity, intraocular pressure, optical coherence tomography (OCT), and OCTA were conducted. Retinal and choroidal vessel density (VD) parameters were assessed in the macular and peripapillary regions. Correlations between VD and systemic hormone levels were analyzed. RESULTS: Age (47.3±13.3y vs 43.4±15.8y; P=0.053) and gender distribution (CD: 35 females, 13 males; controls: 34 females, 14 males; P=1.000) did not significantly differ. Patient group exhibited significant reductions in radial peripapillary capillary (RPC; P<0.05) and choriocapillaris (CC) VD across all quadrants (P<0.05) compared to controls. Nasal deep capillary plexus (DCP) VD was also significantly decreased (P=0.035). Subfoveal choroidal thickness (SFCT; P=0.459) did not differ significantly, but nasal choroidal thickness (CT) at 1500 µm (P<0.040) and 3000 µm (P<0.031) was markedly increased. Notably, hormonal correlations revealed associations between ACTH and temporal CC VD (r=0.367, P=0.009), plasma cortisol and superior RPC VD (r=0.303, P=0.034), and urinary free cortisol with superior, and nasal RPC (r=-0.404, P=0.004, r=-0.317, P=0.027) and nasal DCP VD (r=-0.287, P=0.045). CONCLUSION: High endogenous cortisol levels in CD patients primarily affect the peripapillary region and the nasal part of the macula. VD changes occur before pachyvessel formation, choroidal thickening, and the development of pachychoroid spectrum disorder.
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He Xie, Ruo-Bing Xia, Rui-Fen Wei, Ke-Xin Tang, Chen-Xi Wang, Hai Liu, Qi Zhang, Yan Cheng, Jie Wu, Ji-Zhong Yang, Jin-Song Xue, Bai-Hua Chen, Tao Sun, Feng Wen, Hui-Ping Li, Shao-Zhen Zhao, He Dong, Zhi-Rong Liu, Li-Min Chen, Peng-Cheng Wu, Yan-Ning Yang, Yu-Ping Han, Ying-Nan Xu, Qi Xie, Wei Qiang, Hui Liu, Man Yu, Lin-Ying Huang, Gang Chen, Wei Chen
2026(4):782-792 ,DOI: 10.18240/ijo.2026.04.18
Abstract:
AIM: To analyze the etiologies, disease course, clinical characteristics, and surgical management patterns of non-traumatic corneal perforation in China. METHODS: This multicenter, retrospective study reviewed medical records from patients with non-traumatic corneal perforation treated at 16 tertiary hospitals in China from 2019 to 2021. Data collected included demographics, etiology, disease duration, perforation location, visual acuity on admission, and surgical procedures. RESULTS: A total of 796 eyes from 791 patients were included, comprising 271 women (34.2%) and 520 men (65.7%), with a mean age of 58.4±15.6y (range, 0.38–92y). Infectious keratitis was the leading cause (62.6%), followed by postoperative complications (12.8%) and autoimmune diseases (8.7%). Fungal infections were more prevalent in rural areas, while autoimmune-related perforations were more common in females. Autoimmune cases more frequently presented with a chronic disease course and better visual acuity at admission compared to infectious causes (P<0.001). Among infectious causes, viral keratitis exhibited the highest proportion of chronic cases (65.7%). Perforation location varied significantly by etiology, with infectious cases predominantly central and autoimmune cases more often peripheral or limbal (P<0.001). Overall, 88.3% of eyes presented with poor visual acuity on admission. Most eyes (90.0%) required surgical intervention. Penetrating keratoplasty was the most common procedure, especially for central perforations, while lamellar keratoplasty was preferred for peripheral and autoimmune-related cases. CONCLUSION: This nationwide, multicenter study provides a comprehensive epidemiologic characterization of non-traumatic corneal perforation. Infectious keratitis was identified as the predominant etiology. Distinct patterns in disease progression, perforation location, and surgical intervention were observed across etiologic subgroups. These findings underscore the relevance of etiology-stratified assessment and support the need for tailored clinical management strategies.
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Yan-Ming Huang, Duo-Jie BianBa, Wei-Feng Duan, Yu-Xin Wang, Nan Wu
2026(4):793-798 ,DOI: 10.18240/ijo.2026.04.19
Abstract:
Vernal keratoconjunctivitis (VKC) is a chronic bilateral ocular allergic disease affecting mainly children and adolescents. Perilimbal pigmentation (PLP) has been noted as a new sign of VKC in pigmented race of Asian and African origin. To analyze the etiology, clinical significance, and pathophysiology of PLP, and to explore the possible association between ultraviolet (UV) exposure and the presence of PLP in VKC. A PubMed search of articles between January 1983 and January 2024 on VKC with PLP was performed. PLP takes the appearance of spotty pigmentation in the interpalpebral conjunctiva. Activation and proliferation of the melanocytes in the limbus in the status of inflammation had been proposed as possible pathogenesis of PLP. However, the clinical significance of PLP in the process of VKC were still controversial. VKC with PLP were mostly seen in pigmented races in equatorial region with hot, dry climates and strong UV. The regionality of VKC patients with PLP and the interpalpebral distribution of pigmentation suggest possible association of PLP with UV. Elucidating this issue will help to prevent and treat this regional and racial specific VKC.
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Identification and management of Descemet’s membrane detachment during glaucoma and cataract surgery
Ahmed Al Habash, Enas Alkhoutani, Halah Bin Helayel
2026(4):799-807 ,DOI: 10.18240/ijo.2026.04.20
Abstract:
Descemet’s membrane detachment (DMD) is defined as the detachment of Descemet’s membrane that occurs spontaneously or secondary to intraocular surgery. This review focuses on the characteristics and incidence of DMD following phacoemulsification and glaucoma surgery, and aims to compare DMD cases after phacoemulsification (PCE) and different types of glaucoma surgery in terms of incidence, risk factors, clinical manifestations, diagnosis and management strategies. The reported incidence of DMD after PCE ranges from 0 to 5%, and the complication is less frequently observed following glaucoma surgery. Patients with DMD may be asymptomatic or present with severe visual impairment caused by corneal edema, which is associated with the size and location of the detachment. The management of DMD varies according to the primary surgical procedure (PCE or glaucoma surgery), as well as case-specific factors including visual acuity, corneal clarity, and the size and location of the detachment. Longitudinal observational studies are warranted to investigate the underlying cellular mechanisms of DMD. Retrospective studies can be conducted to clarify the incidence and identify all potential risk factors for DMD following glaucoma surgery. In addition, it is crucial to explore all possible risk factors to reduce and prevent this complication.
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Jing Xu, Mei Sun, Chen Wang, Pin Ju, Xiao-Duo Guan, Li-Ke Xie, Xiao-Feng Hao
2026(4):808-814 ,DOI: 10.18240/ijo.2026.04.21
Abstract:
With the acceleration of global aging, the incidence of retinal vein occlusion (RVO) has risen markedly. Its pathogenic mechanisms are closely linked to iron dyshomeostasis and microglial polarization and age-related degenerative changes in retinal microvessels. We systematically summarize the regulatory mechanisms of ferroptosis—an iron-dependent, lipid peroxidation-driven form of cell death, and elucidate the central pathway by which iron overload exacerbates retinal injury through the synergy of hypoxia-reoxygenation (H/R). Specifically, iron metabolic imbalance catalyzes the production of reactive oxygen species (ROS) via the Fenton reaction, which drives the polarization of microglia toward the proinflammatory M1 phenotype and activates the acyl-CoA synthetase long-chain family member 4 (ACSL4)-mediated lipid peroxidation cascade. This review proposes novel insights for combinatorial therapeutic strategies targeting key ferroptotic pathways (e.g., the SLC7A11/GPX4 axis) and modulating microglial polarization, while also addressing the translational challenges associated with iron chelators (deferoxamine), lipid peroxidation inhibitors (liproxstatin-1), and targeted delivery systems for RVO.
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Han Jiang, Wen-Ting Zhu, Ping-Fan Zhu, Gong-Qiang Yuan, Jing-Jing Zhang
2026(4):815-818 ,DOI: 10.18240/ijo.2026.04.22
Abstract:
AIM: To report on the clinical outcomes of rescuing dislocated Akreos intraocular lenses (IOLs) with a closed continuous-loop suture technique (CCS). METHODS: A retrospective review of patients who underwent CCS for rescuing dislocated IOL between June 2017 and March 2023. The clinical primary outcomes were best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL positioning, and complications, assessed both preoperatively and for at least 3mo postoperatively. RESULTS: Nine patients (9 eyes) were reviewed with an average age of 48.67y (range, 18-67y), and a follow-up period averaging 11.67mo (ranging from 3 to 36mo). Post-surgery, the IOLs were well-centered and stable. The preoperative BCVA was 1.03±0.79 logMAR, improving to 0.5±0.48 logMAR at the last follow-up (P<0.05). Preoperative IOP of 20±6.84 mm Hg and postoperative IOP 16.11±5.65 mm Hg (P=0.182). The mean corneal endothelial cell density decreased from 2177±587 to 2080±581 cells/mm² in five patients (P=0.71) and the endothelial cell loss rate is 4.56%. CONCLUSION: CCS is an effective, safe, and minimally invasive method for rescuing and stabilizing dislocated Akreos IOLs.
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Ze-Chen Liu, Jie Zhang, Jin-Dong Han
2026(4):819-826 ,DOI: 10.18240/ijo.2026.04.23
Abstract:
AIM: To analyze the clinical and multimodal imaging characteristics of acute central serous chorioretinopathy (CSC) with or without fibrinous exudation. METHODS: Retrospective case-control study. Patients diagnosed with acute CSC with fibrinous exudation (FE group) and without fibrinous exudation (non-FE group) were consecutively included. The clinical data and multimodal images including color fundus photography, fundus autofluorescence, spectral-domain optical coherence tomography (OCT), fundus fluorescein angiography, and indocyanine green angiography at presentation were recorded. Treatment method, follow-up outcomes including best-corrected visual acuity (BCVA) and OCT characteristics were also documented. RESULTS: The FE group (n=8, 8 eyes, 6 males) had a mean age of 47.50±7.27y, and the median symptom duration was 26.50d. The non-FE group (n=20, 20 eyes, 16 males) had a mean age of 40.40±4.36y, and the median symptom duration was 7.00d. Compared to the non-FE group, the FE group exhibited significantly older age (P=0.004), longer self-reported symptom duration (P=0.02), and poorer baseline and follow-up BCVA (P=0.011, P=0.003). After more than one month follow-up, visual improvement was statistically significant in the non-FE group (P=0.017), but not in the FE group (P=0.157). Multimodal imaging results found higher prevalence of pigment epithelial detachment (PED; P=0.029) and larger subfoveal choroidal thickness (P<0.001) in the FE group, while there was no significant difference in central macular thickness between the groups. The leakage start time was earlier in the FE group (14.50±2.33s) than in the non-FE group (22.67±1.24s, P<0.001). The expanding dot sign was the most common leakage pattern of fibrinous CSC. Late leakage area usually expanded to more than 1/2 disc diameter (DD) in the FE group, while it was less than 1/2 DD in the non-FE group. CONCLUSION: Fibrinous exudation in acute CSC is a multimodal imaging biomarker indicative of severe choroidal vasculopathy and retinal pigment epithelium barrier failure. Recognizing this entity and understanding its potential mechanisms are crucial for managing patient prognosis and may guide future targeted interventions.
Volume ,2026 Issue 4
Intelligent Ophthalmology
Basic Research
Clinical Research
Investigation
Review Article
Brief Report
Letter to the Editor
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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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