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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Hao Wu, Na Lu, Zhong-Bao Qiao, Chi Cheng, Wen-Ting Luo, Ting Wan, Tong Qiao, Yue Di
2026(2):211-218 ,DOI: 10.18240/ijo.2026.02.01
Abstract:
AIM: To investigate the effects of different light intensities and various mydriatic and miotic drugs on pupil accommodation in guinea pigs. METHODS: Forty-two-week-old guinea pigs were randomly divided into four groups to assess pupillary responses under varying light intensities (100, 250, 500 lx) and pharmacological interventions (1% atropine, 1% cyclopentolate, 1% tropicamide, or 2% pilocarpine). Baseline pupil size and eccentricity were recorded using a non-contact Python-based imaging system integrating edge detection and pixel-to-distance conversion. Direct illumination effects were measured at sequential time points, followed by drug administration and longitudinal tracking of pupillary changes. The protocol was repeated at 12wk of age for developmental comparisons. Post-experiment, enucleated eyes were analyzed to evaluate in vitro vs in vivo differences. RESULTS: Significant age-dependent differences in pupil dynamics were observed. Both 2- and 12-week-old guinea pigs exhibited marked pupil constriction under direct illumination (P<0.001), with decreased eccentricity post-constriction (P<0.001). Indirect illumination caused inconsistent pupil size changes (2-week: P=0.68; 12-week: P=0.49). Pharmacologically, atropine, cyclopentolate, and tropicamide induced pupil dilation (P<0.001), whereas pilocarpine caused constriction (P<0.001). All drug groups showed reduced eccentricity (P<0.001). In vivo/in vitro comparisons revealed significant structural differences. CONCLUSION: This study investigates pupillary responses in developing guinea pigs, revealing a direct pupillary light reflex (PLR) with light intensity-dependent responses, while indirect PLR was undetectable. The differential effects of muscarinic modulators on pupillary responses underscore the critical role of cholinergic signaling in ocular accommodation, with age-related variations in sensitivity. Additionally, a novel non-contact measurement methodology achieved a precision of 0.01 mm for pupillary quantification, enhancing accuracy in ocular studies.
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Qing Wang, Qing-Yu Li, Jing Yang, Jun Ma, Ji-Hua Ping, Zheng Wang, Dai-Jie Wang, Xia Hua, Xiao-Yong Yuan
2026(2):219-229 ,DOI: 10.18240/ijo.2026.02.02
Abstract:
AIM: To determine whether paeonol (Pae), a naturally occurring phenolic compound, can serve as an effective pharmacological inhibitor of posterior capsular opacification (PCO). METHODS: A rat model of cataract surgery—induced PCO was established, and Pae was administered via anterior chamber injection to evaluate its preventive effect on capsular opacification and fibrotic remodeling. Histological and immunohistochemical analyses were performed to assess epithelial-mesenchymal transition (EMT)—related changes in lens epithelial cells (LECs). Ex vivo lens capsule cultures were employed to examine the expression of Vimentin and Zonula Occludens-1 (ZO-1) by immunofluorescence and immunohistochemistry. In the human LEC line SRA01/04, EMT marker expression at both mRNA and protein levels was analyzed following transforming growth factor beta 2 (TGF-β2) stimulation, with Pae treatment. Western blotting and immunofluorescence were used to investigate the effect of Pae on TGF-β/Smad signaling and AMP-activated protein kinase (AMPK) activation. Molecular docking was performed to predict Pae–AMPK binding, and rescue experiments with AMPK inhibition were conducted to validate the mechanistic pathway. RESULTS: Pae significantly reduced capsular opacification and fibrotic remodeling in the rat PCO model compared with controls. In LECs, Pae markedly suppressed TGF-β2–induced EMT, evidenced by decreased expression of mesenchymal markers, such as Vimentin, Fibronectin, Collagen 1A1, α-SMA and preserved epithelial junctional protein ZO-1. Mechanistically, Pae was predicted to directly interact with the catalytic pocket of AMPK, which was experimentally confirmed by enhanced AMPK phosphorylation and nuclear translocation (P<0.05). This activation disrupted canonical TGF-β/Smad signaling, leading to suppression of EMT. Rescue experiments using AMPK inhibition abrogated the anti-EMT effect of Pae, further validating the AMPK-dependent mechanism. CONCLUSION: Pae exerts a potent inhibitory effect on PCO formation by blocking EMT of LECs through direct activation of AMPK and subsequent disruption of TGF-β/Smad signaling.
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Shuo Yu, Jin-Yi Yu, Xin-Li Liu, Jing Wang, Shi-Lan Feng, Hong Lu
2026(2):230-238 ,DOI: 10.18240/ijo.2026.02.03
Abstract:
AIM: To identify key genes and inflammatory signaling pathways involved in the anti-inflammatory effects of Hedysarum polybotrys polysaccharide (HPS) in a rat model of endotoxin-induced uveitis (EIU). METHODS: EIU was induced in Wistar rats through subcutaneous injection of lipopolysaccharide (LPS, 200 μg) and the rats were then randomly assigned to EIU group (n=5) and the HPS intervention group (n=5). HPS (400 mg/kg, intraperitoneally) or its carrier was administered 24h and 1h prior to EIU induction. Eyes were examined and enucleated 24h post-induction, and total RNA was extracted from the iris-ciliary body. Gene expression microarrays were used to identify differentially expressed genes (DEGs), followed by bioinformatics analyses, including gene ontology (GO) and pathway analysis. Key findings were not experimentally validated at the mRNA or protein level. RESULTS: A total of 322 DEGs were identified, comprising 254 mRNA and 68 lncRNA genes. GO analysis revealed significant functional categories, including response to LPS. Pathway analysis identified key signaling pathways involved in uveitis, such as cytokine-cytokine receptor interactions. Notably, 16 mRNA and 7 lncRNA DEGs emerged as central nodes in the gene correlation network. CONCLUSION: HPS exerts its anti-inflammatory effects through coordinated signaling pathways, offering insights into potential therapeutic targets for managing uveitis.
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Hao-Yue Wu, Si-Wei Liu, Zhao Liu, Cheng Pei, Chang-Rui Wu, Shan Gao
2026(2):239-246 ,DOI: 10.18240/ijo.2026.02.04
Abstract:
AIM: To investigate the genetic basis of Weill-Marchesani syndrome (WMS) in a Chinese family and clarify the pathogenic mechanism of novel ADAMTS17 mutations. METHODS: Comprehensive clinical assessments and genetic analyses were performed on a Chinese family with two affected siblings. Whole-exome sequencing (WES) was conducted for the proband and other family members. Bioinformatics tools were used to evaluate the conservation, predicted pathogenicity, and structural effects of the identified ADAMTS17 variants. In addition, protein structure modeling was applied to assess the functional impacts of the mutations. RESULTS: The proband (a 32-year-old male) and his elder sister (42y) presented typical clinical features of WMS, including short stature, brachydactyly, high myopia, ectopia lentis, and secondary glaucoma. WES identified a novel compound heterozygous mutation in ADAMTS17: a splicing mutation (c.451-2A>G) inherited from the father and a missense mutation (c.1043G>A; p.C348Y) inherited from the mother. The splicing mutation disrupted normal mRNA splicing and processing, leading to premature translation termination. The missense mutation, which is located in the metalloprotease catalytic domain, was predicted to abolish a critical disulfide bond, thereby impairing protein stability. Both mutations exhibited high evolutionary conservation and were predicted to be pathogenic by multiple bioinformatics algorithms. CONCLUSION: A novel compound heterozygous mutation in ADAMTS17 is identified in this WMS-affected Chinese family, and its pathogenicity is verified via bioinformatics analysis and protein structural modeling. These findings are expected to facilitate the genetic diagnosis of WMS and deepen the understanding of its molecular pathogenesis.
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Alperen Bahar, Aysun Şanal Doğan
2026(2):247-251 ,DOI: 10.18240/ijo.2026.02.05
Abstract:
AIM: To investigate the effect of pentagonal conjunctival autograft on reducing graft retraction following pterygium surgery. METHODS: This retrospective comparative study included patients who underwent primary pterygium excision with either pentagonal (created by shaping the junction with the recipient conjunctiva into a wedge) or quadrangular conjunctival autograft transplantation. All patients completed a 6mo postoperative follow-up. The primary outcome measure was the incidence of graft retraction; secondary outcomes included graft displacement requiring re-suturing and pterygium recurrence rate. RESULTS: The study enrolled 58 participants, comprising 26 (15 males, 11 females) in the pentagonal graft group (mean age: 54.9±13.1y), and 32 (17 males, 15 females) in the quadrangular graft group (mean age: 57.6±10.4y). Graft retraction occurred in only 1 eye (3.8%) in the pentagonal autograft group, compared to 9 eyes (28.1%) in the quadrangular autograft group. No cases of graft displacement requiring re-suturing were reported in the pentagonal autograft group. Although graft displacement and recurrence requiring re-suturing were observed less frequently in surgeries with a pentagonal graft, the difference was not statistically significant (P>0.05). CONCLUSION: Designing the conjunctival autograft in a pentagonal shape—mimicking geodesic dome architecture and conforming to the eye’s spherical structure—enhances compatibility with the recipient conjunctiva and improves resistance to physical traction forces. This design effectively reduces the incidence of graft retraction and other related complications, providing a more favorable surgical option for pterygium treatment.
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Jia-Jun Chen, Ling Wang, Sha-Sha Xue, Zhi-Ying Yu, Yun-Xiao Wang, Feng-Lei Wang
2026(2):252-259 ,DOI: 10.18240/ijo.2026.02.06
Abstract:
AIM: To investigate age-related differences in the iris-lens angle (ILA) among patients with age-related cortical cataracts and elucidate the impact of age on lens stability. METHODS: A prospective observational study was conducted on patients with age-related cortical cataracts scheduled for phacoemulsification surgery. Preoperative ultrasound biomicroscopy (UBM) images were collected and analyzed. Initially, patients were stratified into two age groups: <60y and ≥60y, with no significant intergroup differences in sex or eye laterality. For further analysis, participants were subdivided into three age strata: <60y, 60-75y, and >75y. The ILA was measured in four quadrants (superior, inferior, nasal, and temporal). Intergroup differences in ILA were compared, and correlations between age and ILA parameters were analyzed using statistical methods. RESULTS: The sample data were categorized into three groups according to age, <60y (113 patients; 55.8% female), 60–75y (245 patients; 61.0% female), and >75y (70 patients; 50.2% female). The superior quadrant ILA increased progressively with age stratification (P=0.02), and the maximum ILA difference (ΔILA) was significantly higher in patients over 75y (P<0.01). Simple linear regression analysis demonstrated a positive correlation between age and ILA in the superior (Y=7.487+0.096X, R=0.191, P<0.001) and temporal (Y=10.254+0.052X, R=0.104, P=0.032) quadrants. Additionally, the mean ILA across all quadrants (ILAmean) and ΔILA were positively correlated with age (ILAmean: Y=9.721+0.055X, R=0.138, P=0.004; ΔILA: Y=3.267+0.044X, R=0.006, P<0.05). CONCLUSION: In patients with age-related cortical cataracts, ILA increases with age, particularly in the superior and temporal quadrants, suggesting that advanced age is associated with greater lens deviation and decreased lens stability. UBM imaging can effectively evaluate the status of the zonule and lens stability, providing crucial evidence for personalized surgical planning based on patients’ age.
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Xi-Xia Ding, Lin-Feng Xiang, Wen-Tao Tong, Dan-Dan Wang, Hong-Fang Zhang, Ping-Jun Chang, Fu-Man Yang, Yun-E Zhao
2026(2):260-265 ,DOI: 10.18240/ijo.2026.02.07
Abstract:
AIM: To evaluate and compare alterations in the effective lens position (ELP) and refractive outcomes among three distinct intraocular lens (IOL) types. METHODS: Patients with cataracts were enrolled and allocated to 3 groups: Group A (implanted with the SN6CWS), Group B (implanted with the MI60), and Group C (implanted with the Aspira-aA). ELP measurements were obtained with swept-source optical coherence tomography (SS-OCT) at 1d, 1wk, 1mo, and 3mo postoperatively. Subjective refraction assessments were conducted at 1wk, 1mo, and 3mo following surgery. RESULTS: The study included 189 eyes of 150 cataract patients (66 males). There were 77 eyes in Group A, 55 eyes in Group B, and 57 eyes in Group C. The root mean square of the ELP (ELPRMS) within the initial 3mo was significantly lower for Group A than for Groups B and C. Refractive changes within Group A were not significant across the time points of 1wk, 1mo, and 3mo. Conversely, both Group B and Group C demonstrated statistically significant shifts toward hyperopia from 1wk to 3mo postsurgery. CONCLUSION: Among the three IOLs examined, the SN6CWS IOL showes the greatest stability during the first 3mo postoperatively. Between 1wk and 3mo after surgery, notable hyperopic shifts are evident in eyes implanted with the MI60 and Aspira-aA IOLs, whereas refractive outcomes remain relatively constant in eyes implanted with SN6CWS IOLs.
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Jia-Yan Fang, Jing Jin, Yi-Ling Jiang, Fu-Man Yang, Ping-Jun Chang, Yin-Ying Zhao, Yun-E Zhao
2026(2):266-272 ,DOI: 10.18240/ijo.2026.02.08
Abstract:
AIM: To compare the visual outcomes between bilateral implantation of Tecnis ZXR00 extended depth-of-focus (EDOF) intraocular lenses (IOLs) and mixed implantation of Tecnis ZXR00 (EDOF) with Tecnis ZMB00 (bifocal) IOLs. METHODS: This postoperative cross-sectional study enrolled patients who underwent phacoemulsification combined with IOL implantation. Patients were divided into two groups: the bilateral ZXR00 group (ZXR00-only group) and the mixed IOL group (ZXR00+ZMB00 group). Primary outcome measures included uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and distance-corrected near visual acuity (UNVA, DCNVA), uncorrected and distance-corrected intermediate visual acuity (UIVA, DCIVA), and defocus curves. Secondary outcome measures were visual quality, spectacle independence, patient satisfaction, photic phenomena, and stereopsis. RESULTS: A total of 47 patients (94 eyes) were included, with 26 patients (11 males, 15 females) in the ZXR00-only group (mean age: 62.73±7.24y) and 21 patients (7 males, 14 females) in the mixed group (mean age: 65.71±9.16y). There was no statistically significant difference in age between the two groups (P=0.218). The mixed group showed significantly better binocular DCNVA compared to the ZXR00-only group (P=0.002). Defocus curve analysis revealed that the mixed group exhibited superior performance at −2.5 to −4.0 D but inferior performance at −0.5 and −1.5 D. Near stereoacuity was significantly poorer in the mixed group (Randot: 5.589±0.744 vs 6.240±0.394 ln arcsec; Contour: 4.966±0.973 vs 5.740±0.833 ln arcsec; both P<0.01). Both groups achieved high levels of spectacle independence and patient satisfaction, with no significant differences in photic phenomena or questionnaire scores. CONCLUSION: Mixed implantation of EDOF and bifocal IOLs improve near visual acuity but may compromise near stereopsis. This approach provides a viable option for patients prioritizing near vision; however, caution is recommended for individuals requiring fine stereoscopic vision for daily or professional tasks.
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Kai Yan, Jing Yu, Yan-Mei Zeng, Cheng Chen, Lei Zhong, Jin-Yu Hu, Liang-Qi He, Xiao-Yu Wang, Qian Ling, Xu Chen, Yi Shao, Yao Yu
2026(2):273-280 ,DOI: 10.18240/ijo.2026.02.09
Abstract:
AIM: To compare spontaneous brain regional activities between diabetic vitreous hemorrhage patients (DVHs) and healthy controls (HCs). METHODS: Thirty-two DVHs and 32 HCs were enrolled in this study. Baseline demographic and vision data were compared between groups using an independent sample t-test. Resting-state functional magnetic resonance imaging (rs-fMRI) was used in all participants. fMRI data was obtained and analyzed using MRIcro and SPM8 software. Fractional amplitude of low-frequency fluctuation (fALFF) technology was used to measure regional spontaneous brain activity, and sensitivity was tested using receiver operating characteristic curves (ROCs). The fALFF values were analyzed using REST software and two-sample t-tests were used to compare values between groups. Hospital anxiety and depression scale (HADS) score was assessed in DVHs and Pearson’s correlation was used to test relationships between mean fALFF value and both HADS score and duration of DVH. RESULTS: Except for the best-corrected visual acuity (BCVA) in both eyes, which showed a statistically significant difference (P<0.05), there were no statistically significant differences in the other indicators (P>0.05) between the HCs and DVHs group. Compared with controls, fALFF value was higher in DVH in cerebellum posterior lobe (CPL) and lower in right anterior cingulate cortex (ACC) and right medial orbitofrontal cortex (OFC). In DVH patients, mean fALFF value of CPL was positively correlated with HADS score and duration of diabetes. However, no such correlation was found, for right ACC or right medial OFC. DVH may lead to abnormal activities in certain brain regions related to visual control and mood. CONCLUSION: Visual impairment caused by DVH may lead to adjustment in regional visual brain activities and may be related to depression or reward system processing in some brain regions.
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Yi-Ning Guo, Jing Ding, Hao-Ran Ai, Xin-Zuo Zhou, Xue-Min Li, Chun Zhang
2026(2):281-290 ,DOI: 10.18240/ijo.2026.02.10
Abstract:
AIM: To investigate the long-term outcomes in acute primary angle closure (APAC) patients treated with lens extraction (LE) surgery and to identify risk factors for glaucomatous optic neuropathy (GON). METHODS: In this longitudinal observational study, detailed medical histories of APAC patients and comprehensive ophthalmic examinations at final follow-up were collected. Logistic regression analysis was performed to identify predictors of blindness. Univariate and multivariate linear regression analyses were conducted to determine risk factors associated with visual outcomes. RESULTS: This study included 39 affected eyes of 31 subjects (26 females) with an average age of 74.1±8.0y. At 6.7±4.2y after APAC attack, 2 (5.7%) eyes had best-corrected visual acuity (VA) worse than 3/60. Advanced glaucomatous visual field loss was observed in 15 (39.5%) affected eyes and 5 (25.0%) fellow eyes. Nine affected eyes (23.7%) had GON, and 11 (28.9%) were blind. Six (15.4%) affected eyes and 2 (9.1%) fellow eyes had suspicious progression. A significantly higher blindness rate in factory workers compared to office workers. Logistic regression identified that worse VA at attack (OR 10.568, 95%CI 1.288-86.695; P=0.028) and worse early postoperative VA (OR 13.214, 95%CI 1.157-150.881; P=0.038) were risk factors for blindness. Multivariate regression showed that longer duration of elevated intraocular pressure (P=0.004) and worse early postoperative VA (P=0.009) were associated with worse visual outcomes. CONCLUSION: Despite LE surgery, some APAC patients experience continued visual function deterioration. Lifelong monitoring is necessary. Target pressure and progression rates should be re-evaluated during follow-up.
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Yi Huang, Hong-Dou Luo, Yong-Qiang Shu, Feng Ouyang, Yu-Ning Song, Yuan-Yuan Wang, Xue-Qing Yu, Chan Xiong, Lu Yang, Xu Zhang
2026(2):291-301 ,DOI: 10.18240/ijo.2026.02.11
Abstract:
AIM: To study the relationships between amplitude of low-frequency fluctuations (ALFF) changes and clinical ophthalmic parameters in patients with primary open angle glaucoma (POAG) and analyze the diagnostic value of ALFF. METHODS: Twenty-four POAG patients and 24 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (rs-fMRI). Nonparametric rank-sum tests were used to compare the ALFF values in the slow-4 and slow-5 bands, and Spearman or Pearson correlation analysis was used to assess the correlation between ALFF changes and clinical ophthalmic parameters in POAG patients. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of the ALFF. RESULTS: There were 16 males in POAG patients (median age 48y) and 12 males in HCs (median age 39y). Compared with HCs, POAG patients presented increased or decreased ALFF values in different brain regions, and similar changes were observed in mild POAG patients. The ALFF values were correlated with retinal nerve fiber layer (RNFL) thickness, inner limiting membrane-retinal pigment epithelium thickness changes and the degree of visual field defects. Analysis of the diagnostic value of the ALFF via ROC curves revealed that the right medial frontal gyrus [area under the curve (AUC)=0.9063] and superior frontal gyrus (AUC=0.9097) had better diagnostic value than did the optic disc area (AUC=0.8019), visual field index (VFI%, AUC=0.8988) and macular parameters. CONCLUSION: POAG patients present altered cortical function that is significantly correlated with the optic nerve and retinal thickness and had good diagnostic value, which may reflect the underlying neuropathological mechanism of POAG.
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Sanghun Jeong, Hwayeong Kim, Sangwoo Moon, EunAh Kim, Hojin Yang, Jiwoong Lee, Kouros Nouri-Mahdavi
2026(2):302-311 ,DOI: 10.18240/ijo.2026.02.12
Abstract:
AIM: To build a functional generalized estimating equation (GEE) model to detect glaucomatous visual field progression and compare the performance of the proposed method with that of commonly employed algorithms. METHODS: Totally 716 eyes of 716 patients with primary open angle glaucoma (POAG) with at least 5 reliable 24-2 test results and 2y of follow-up were selected. The functional GEE model was used to detect perimetric progression in the training dataset (501 eyes). In the testing dataset (215 eyes), progression was evaluated the functional GEE model, mean deviation (MD) and visual field index (VFI) rates of change, Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS) scores, and pointwise linear regression (PLR). RESULTS: The proposed method showed the highest proportion of eyes detected as progression (54.4%), followed by the VFI rate (34.4%), PLR (23.3%), and MD rate (21.4%). The CIGTS and AGIS scores had a lower proportion of eyes detected as progression (7.9% and 5.1%, respectively). The time to detection of progression was significantly shorter for the proposed method than that of other algorithms (adjusted P≤0.019). The VFI rate displayed moderate pairwise agreement with the proposed method (k=0.47). CONCLUSION: The functional GEE model shows the highest proportion of eyes detected as perimetric progression and the shortest time to detect perimetric progression in patients with POAG.
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Jue-Xue Wang, Nan Zhou, Li-Hong Yang, Wen-Bin Wei
2026(2):312-319 ,DOI: 10.18240/ijo.2026.02.13
Abstract:
AIM: To evaluate the clinical features, diagnosis, treatment, and outcome of peripheral exudative hemorrhagic chorioretinopathy (PEHCR), a variant of polypoidal choroidal vasculopathy (PCV), in a case series of Chinese patients. METHODS: This study was retrospectively conducted from September 2018 to March 2025. Clinical examinations included color fundus photography, B-scan ultrasonography, fluorescein angiography (FA), indocyanine green angiography (ICGA), swept-source optical coherence tomography (SS-OCT), and optical coherence tomography angiography (OCTA), and two active or inactive subgroups and misdiagnosed cases were analyzed. RESULTS: Totally 19 patients (21 eyes) with a mean age of 54.3±9.4 (range, 36–68)y were included, with a majority of women (n=13, 68.4%). The mean follow-up period was 13±1.4 (range: 1–57)mo. Decreased visual acuity was the most frequent initial manifestation (17 eyes, 84.2%), and lesions were mainly distributed in the inferotemporal or temporal quadrant (14 eyes, 66.7%), with choroidal polyps and branching neovascular networks revealed by OCTA and ICGA. Nine patients had been previously misdiagnosed with choroidal melanoma, and 6 of them had massive vitreous hemorrhage (VH). PEHCR manifested along a spectrum ranging from active or inactive subretinal hemorrhagic forms to chronic fibrotic or atrophic forms. One patient experienced natural regression. Ten eyes received a mean of 4.7±1.1 (range: 3–7) intravitreal anti-vascular endothelial growth factor (VEGF) injections, two eyes underwent vitrectomy, and six eyes were treated with vitrectomy combined with anti-VEGF therapy. Best-corrected visual acuity (logMAR) in treated eyes (18 eyes) improved to 0.31±0.25 from the baseline of 1.50 ± 0.75 (P<0.001). CONCLUSION: PEHCR is a variant of PCV. Chinese patients with PEHCR have a relatively younger age of onset. Anti-VEGF injections and/or vitrectomy are treatment options for lesion regression or dense VH to gain better visual outcomes.
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Jung Yeon Joo, Yong Hyun Jun, Seong Taeck Kim
2026(2):320-325 ,DOI: 10.18240/ijo.2026.02.14
Abstract:
AIM: To compare the intravitreal brolucizumab and bevacizumab injections for chronic central serous chorioretinopathy (cCSC). METHODS: Patients with cCSC were classified into bevacizumab and brolucizumab group. The proportion of complete resolution of subretinal fluid (SRF), best-corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were compared between the two groups. RESULTS: A total of 40 eyes from 40 patients with aged 34-59y were enrolled in the study. Twenty eyes in bevacizumab group (17 males) and 20 eyes (18 males) in brolucizumab group. Comparing the proportion of complete resolution of SRF, the brolucizumab group was statistically significantly higher than the bevacizumab group (P<0.05). In 1mo, CMT was significantly reduced in the brolucizumab group compared to the bevacizumab group (265±69 vs 319±70 μm; P=0.021). However, there was no significant difference in CMT between the two groups at 2 and 3mo (P>0.05). CONCLUSION: Brolucizumab is anatomically and functionally superior to bevacizumab in the treatment of patients with cCSC.
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Dilan Yildiz, Tahsin Uzundede, Akin Cakir, Gamze Karatas, Busra Coban
2026(2):326-332 ,DOI: 10.18240/ijo.2026.02.15
Abstract:
AIM: To investigate the effects of chronic alcohol consumption on retinal microcirculation by comparing different alcohol-consuming groups using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: This observational clinical study utilized a cross-sectional and prospective design, focusing on chronic alcohol consumers alongside a non-consuming control group. OCT/OCTA imaging parameters including central retinal subfield thickness (CST), subfoveal choroidal thickness (SCT), foveal avascular zone (FAZ) and vessel density (VD) in the superficial and deep capillary plexuses in both the macular and optic disc (OD) regions were recorded. Data were analyzed using SPSS 15.0; descriptive statistics were reported, group comparisons were performed with Chi-square, Kruskal–Wallis, and Bonferroni-corrected Mann–Whitney U tests, and relationships were assessed using Spearman correlation, with statistical significance set at P<0.05. RESULTS: A total of 160 eyes of 160 participants (110 females and 50 males with mean age 38.7±9.9y) who don’t smoke were divided into five groups: never, occasional, monthly, weekly and daily drinkers. The mean CST was 216.6±14.2 µm and the mean SCT was 358.9±84.5 µm. There was no statistically significantly difference in CST and SCT among the groups (P=0.890, 0.799). Foveal superficial capillary plexuses (SCPs) VD was higher in monthly drinkers compared to occasional drinkers (P=0.015). Foveal VD in deep capillary plexus was also higher in monthly drinkers than in never and occasional drinkers (P=0.004, 0.006). Nasal SCPs VD at the OD was higher in monthly drinkers compared to never drinkers (P=0.005). There was no significant difference FAZ area among the groups (P=0.071). CONCLUSION: Both superficial and deep microvascular structures in the inferior quadrants of macula are positively correlated with frequency of alcohol use. Also in our study results is that the monthly drinker group has uniquely higher VDs in both macula and OD. This leads us to consider moderate alcohol consumption may also have protective effects on retinal microcirculation.
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Shao-Hua Zhang, Ning Lyu, Ying-Ying Hong, Yi Lu, Ying-Hong Ji
2026(2):333-338 ,DOI: 10.18240/ijo.2026.02.16
Abstract:
AIM: To characterize the distribution of persistent fetal vasculature (PFV) subtypes and to evaluate corneal astigmatism (CA) in children with unilateral PFV. METHODS: The medical records of patients diagnosed with PFV between January 2014 and August 2021 were retrospectively reviewed. Corneal keratometry parameters were measured using IOLMaster or a handheld keratometer. Differences in CA between the affected and fellow eyes were analyzed in 52 unilateral PFV patients with available examination data. RESULTS: Totally 133 patients diagnosed with PFV were retrospectively reviewed. The male-to-female ratio was 73/60. Median age at surgery was 38.03mo (interquartile range 58.27mo). Among the PFV patients, 32 (24.06%) had anterior PFV, 2 (1.50%) had posterior PFV, and 99 (74.44%) had combined anterior-posterior PFV. Mild combined PFV was the most common subtype. In unilateral PFV cases, the mean CA in the affected eye was 2.29±1.11 D, and 59.62% (31 eyes) had CA≥2.0 D. The mean CA in the affected eyes was significantly higher than in the fellow eyes (1.37±0.77 D; P<0.001). Among PFV-affected eyes with CA≥2.0 D, the steepest corneal meridian was vertically oriented in 30 cases (96.77%), while only 1 case (3.23%) had the steepest meridian oriented horizontally. CONCLUSION: In children with unilateral PFV, CA is significantly higher in the affected eyes than in the fellow eyes, and the steepest corneal meridian was predominantly oriented vertically.
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Ying-Yan Qin, Zhao-Tian Zhang, Shu-Wen Xing, Shi-Ya Lin, Bai-Zhou Chen, Liang-Ping Liu, Yao Ni
2026(2):339-345 ,DOI: 10.18240/ijo.2026.02.17
Abstract:
AIM: To evaluate the agreement of axial length (AL), anterior chamber parameters, and total cornea power obtained by swept-source optical coherence tomography (SS-OCT)-based and Scheimpflug-based optical biometers in myopic children. METHODS: AL, steep keratometry (K), flat K, posterior corneal keratometry (PK), total keratometry (TK), anterior chamber depth (ACD), horizontal corneal diameter (CD), and central corneal thickness (CCT) were obtained using IOL Master 700 and Pentacam AXL. The agreement between the devices was evaluated using intraclass correlation coefficients (ICC), Bland-Altman plots, and astigmatism vector analysis. RESULTS: Totally 175 myopic children (48.5% male) with a mean age of 10.29±2.14y were enrolled. The ICC and Bland-Altman plots indicated a satisfactory agreement for AL, ACD, and CCT. The mean difference in CD of -0.31±0.30 mm was considered clinically significant (>0.2 mm). Additionally, measurements of K and TK obtained from the IOL Master 700 showed good agreement. Nevertheless, there were clinically significant differences observed in PK, simulated keratometry (simK), total cornea power, and astigmatism (at least 10% of the cases with a difference of >10 degrees in meridian) between the two devices. CONCLUSION: The study findings demonstrate a significant difference in K, PK, astigmatism, and CD, indicating that the two optical biometers cannot be considered interchangeable. Therefore, it is recommended to utilize one kind device for follow-up examinations in myopic children.
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Phan Thi Thu Huong, Tham Truong Khanh Van, Bui Thi Van Anh, Hoang Thi Hai Van, Pham Ngoc Dong
2026(2):346-353 ,DOI: 10.18240/ijo.2026.02.18
Abstract:
AIM: To evaluate the clinical characteristics and risk factors associated with visual prognosis in patients with open globe injuries (OGIs) treated at Vietnam National Eye Hospital. METHODS: A prospective observational study included patients with OGIs treated between June 2023 and June 2024. Data on demographics, injury features, and clinical findings were extracted from medical records. Poor visual outcome was defined as final best-corrected visual acuity (BCVA) worse than 20/400 or no light perception. Multivariable logistic regression was performed to identify independent risk factors. RESULTS: Among 509 patients (636 eyes), the mean age was 35.13y (range 20–51y), and 67.6% were male. After treatment, the proportion of eyes achieving ≥20/40 increased from 12.6% to 42.1%, while no light perception decreased from 29.1% to 9.4%. Independent predictors of poor visual outcomes included delayed admission [>4h, odds ratio (OR)=3.33, 95% confidence intervals (CI): 1.76–6.33, P<0.001], Zone III injury (OR=5.90, 95%CI: 2.85–12.24, P<0.001), wound length >10 mm (OR=2.59, 95%CI: 1.60–4.18, P<0.001), relative afferent pupillary defect (RAPD, OR=1.65, 95%CI: 1.03–2.64, P=0.039), endophthalmitis (OR=1.75, 95%CI: 1.01–3.03, P=0.047), retinal detachment (OR=3.32, 95%CI: 2.02–5.45, P<0.001), and eyelid lacerations (OR=1.94, 95%CI: 1.13–3.33, P=0.016) associated with OGIs. Vitreous hemorrhage (OR=0.44, 95%CI: 0.22–0.89, P=0.023) was associated with better outcomes, and female gender appeared protective. CONCLUSION: Poor visual outcomes remain common after OGIs, despite improve visual acuity in many cases. Several clinical and injury-related factors are strongly associated with prognosis. Early recognition of these predictors can support risk stratification and improve trauma care in similar settings.
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Visual prognosis and survival outcomes in patients with ocular adnexal diffuse large B-cell lymphoma
Sirawit Wainipitapong, Orapan Aryasit, Panarat Noiperm, Mansing Ratanasukon
2026(2):354-361 ,DOI: 10.18240/ijo.2026.02.19
Abstract:
AIM: To investigate the clinical characteristics and treatment outcomes, including visual function and overall survival (OS) of patients with ocular adnexal diffuse large B-cell lymphoma (OA-DLBCL). METHODS: This retrospective cohort study enrolled 29 patients diagnosed with OA-DLBCL based on histopathological biopsy between 2006 and 2023. Patients were stratified into two subgroups: primary OA-DLBCL (no prior history of lymphoma) and secondary OA-DLBCL (history of DLBCL at non-ocular adnexal sites). OS was defined as the time interval from OA-DLBCL diagnosis to death from any cause. Survival analysis was performed using the Kaplan–Meier method, and prognostic factors affecting OS were identified using multivariate Cox proportional hazards regression with a stepwise selection approach. RESULTS: The cohort included 24 patients with primary OA-DLBCL (13 males, 11 females; mean age: 61.36±18.29y) and 5 patients with secondary OA-DLBCL (2 males, 3 females; mean age: 50.94±18.17y). Among the primary OA-DLBCL subgroup, 12 patients (50%) presented with advanced disease (Ann Arbor stage IIIE–IV), and 16 patients (66%) were classified as T4 disease according to the tumor-node-metastasis (TNM) staging system. The mean final visual acuity was 1.72±1.10 in the primary group and 0.90±1.18 in the secondary group. The 5-year OS rate for the entire cohort was 27.7%. Multivariate analysis identified five factors significantly associated with poor survival outcomes: epiphora [adjusted hazard ratio (aHR), 36.95], atherosclerotic cardiovascular disease (aHR, 10.08), human immunodeficiency virus (HIV) infection (aHR, 12.47), M1 stage (aHR, 6.99), and secondary OA-DLBCL (aHR, 6.03; all P<0.05). The median OS was 1.68y for primary OA-DLBCL and 1.12y for secondary OA-DLBCL. CONCLUSION: A substantial proportion of patients with primary OA-DLBCL present with advanced-stage disease at diagnosis. Epiphora, atherosclerotic cardiovascular disease, HIV infection, M1 stage, and secondary OA-DLBCL are independent prognostic factors for poor survival outcomes. These findings emphasize the urgent need for optimized therapeutic strategies and early screening protocols to improve the management of OA-DLBCL, particularly in developing countries.
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2026(2):362-369 ,DOI: 10.18240/ijo.2026.02.20
Abstract:
AIM: To assess risk factors for epiretinal membranes (ERM) and examine their interactions in a nationally representative U.S. dataset. METHODS: Data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES) were analyzed, a nationally representative U.S. dataset. ERM was identified via retinal imaging based on the presence of cellophane changes. Key predictors included age group, eye surgery history, and refractive error, with additional demographic and health-related covariates. Weighted univariate and multiple logistic regression models were used to assess associations and interaction effects between eye surgery and refractive error. RESULTS: Totally 3925 participants were analyzed. Older age, eye surgery, and refractive errors were significantly associated with ERM. Compared to those under 65y, the odds ratio (OR) for ERM was 3.08 for ages 65–75y (P=0.0014) and 4.76 for ages 75+ years (P=0.0069). Eye surgery increased ERM risk (OR=3.48, P=0.0018). Moderate to high hyperopia and myopia were also associated with ERM (OR=2.65 and 1.80, respectively). A significant interaction between refractive error and eye surgery was observed (P<0.0001). Moderate to high myopia was associated with ERM only in those without eye surgery (OR=1.92, P=0.0443). Eye surgery was most strongly associated with ERM in the emmetropic group (OR=3.60, P=0.0027), followed by the moderate to high myopia group (OR=3.01, P=0.0031). CONCLUSION: ERM is significantly associated with aging, eye surgery, and refractive errors. The interaction between eye surgery and refractive error modifies ERM risk and highlights the importance of considering combined effects in clinical risk assessments. These findings may help guide individualized ERM risk assessment that may inform personalized approaches to ERM prevention and management.
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2026(2):370-378 ,DOI: 10.18240/ijo.2026.02.21
Abstract:
AIM: To conduct a systematic review and Meta-analysis to determine the differential effects of combined lutein and zeaxanthin supplementation on myopia prevention in teenagers. It also investigates the effects of supplements dosage, intervention duration, and geographical variation on intervention results. METHODS: A systematic search and screening of randomized controlled trials (RCTs) completed between 2014 and 2023 was undertaken using the PubMed, EMBASE, Cochrane Library, and Web of Science databases, in accordance with the PRISMA recommendations. The Cochrane risk of bias method was used to assess the quality of the studies. A Meta-analysis was performed using Stata 17.0 to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Subgroup analyses were performed to look at the effects of different doses, intervention periods, and geographic areas. Additionally, publication bias was assessed using Egger’s test. RESULTS: Ten studies including 1035 participants with myopia were analyzed. Supplementation with lutein and zeaxanthin resulted in a significant reduction in axial length elongation among adolescents in the intervention group (SMD=-0.40, P=0.001), an increase in macular pigment optical density (SMD=0.50, P=0.010), and an enhancement in visual sensitivity (SMD=0.53, P=0.008). Subgroup analyses revealed that participants receiving high doses and those undergoing intervention for more than 12mo exhibited significantly improved outcomes compared to those in the low-dose and short-term groups (high-dose vs low-dose: SMD=-0.41 vs -0.22, P=0.003; >12mo vs 6-12mo: SMD=-0.43 vs -0.23, P=0.004, respectively). Furthermore, Egger’s test indicated no significant publication bias (P=0.094). CONCLUSION: Combined lutein and zeaxanthin supplementation has a significant effect on myopia prevention in adolescents, with more pronounced benefits observed in high-dose and long-term interventions. The findings provide scientific evidence for its use as an adjunctive approach in myopia control.
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Wen-Hui Liu, Chang Shu, Bei-Di Jia, Xiao-Rong Li
2026(2):379-392 ,DOI: 10.18240/ijo.2026.02.22
Abstract:
AIM: To present an overview of the research on global glaucoma treatment in the last decade in terms of publication year, journals, countries/regions, organizations, references, and keywords, to investigate the current research international trends and hot topics in this area. METHODS: Bibliometric analysis was conducted on 9128 articles in the Web of Science Core Collection (WoSCC; Clarivate) database. Quantitative and qualitative analysis was employed using VOSviewer (v1.6.18), Pajek (v1.0.0.0), and CiteSpace (v6.1.R2) software. RESULTS: The 9128 papers relating to glaucoma treatment were published from April 2013 to April 2023, of which 7482 articles (82%) were original research articles and 1464 (18%) were review articles. The United States (2867) and Johns Hopkins University (166) were the most productive country and institution, respectively, but the University College London had the highest h-index (54). The Journal of Glaucoma was the most productive and Ophthalmology had the highest h-index compared with other journals. The Keywords of interest included treatment surgery, cyclophotocoagulation, minimally invasive glaucoma surgery (MIGS), trabeculectomy, baerveldt, epidemiology, medication adherence, nanoparticle, optical coherence tomography (OCT), gene therapy, and artificial intelligence (AI). Glaucoma surgery appeared as a current research hotspot through the analysis of keywords. CONCLUSION: This study provides insights into the research trends and potential research hotspots in the treatment of glaucoma. This will help researchers to evaluate research policies and to promote international cooperation.
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Jia-Wen Wei, Qing Zhang, Xiao-Yan Wang, Ming-Xue Huang, Jin-Hua Gan, Wei-Hua Yang, Wei Chi
2026(2):393-404 ,DOI: 10.18240/ijo.2026.02.23
Abstract:
Conventional surgical teaching techniques face several challenges, highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice. The recent rapid advancement of computer technology has enabled the integration of virtual reality (VR) into medical training, thereby revolutionizing ophthalmic surgical education through VR-based educational methods. VR technology offers a safe, risk-free environment for trainees to practice repeatedly, enhancing surgical skills and accelerating the learning curve without compromising patient safety. This research outlines the application of VR technology in ophthalmic surgical skills training, particularly in cataract and vitreoretinal surgery. Including assessing the effectiveness of intraocular surgery training systems, evaluating skills transfer to the operating room, comparing it with wet lab cataract surgery training, and enhancing non-dominant hand training for cataract surgery, among other aspects. Additionally, this paper will identify the limitations of VR technology in ocular surgical skills training, offer improvement strategies, and detail the advantages and prospects, with the objective of guiding subsequent researchers.
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Lun He, Jiang Zheng, Xiao-Kun Han, Tian-Yu Tao, Jing Zeng, Wei Luo, Xin Chen, Jun-Ming Wang, Xiang-Yin Sha
2026(2):405-413 ,DOI: 10.18240/ijo.2026.02.24
Abstract:
Micro/nanoplastics (M/NPs) have become pervasive environmental pollutants, posing significant risks to human health through various exposure routes, including ingestion, inhalation, and direct contact. This review systematically examined the potential impacts of M/NPs on ocular health, focusing on exposure pathways, toxicological mechanisms, and resultant damage to the eye. Ocular exposure to M/NPs can occur via direct contact and oral ingestion, with the latter potentially leading to the penetration of particles through ocular biological barriers into ocular tissues. The review highlighted that M/NPs can induce adverse effects on the ocular surface, elevate intraocular pressure, and cause abnormalities in the vitreous and retina. Mechanistically, oxidative stress and inflammation are central to M/NP-induced ocular damage, with smaller particles often exhibiting greater toxicity. Overall, this review underscored the potential risks of M/NPs to ocular health and emphasized the need for further research to elucidate exposure mechanisms, toxicological pathways, and mitigation strategies.
Volume ,2026 Issue 2
Basic Research
Clinical Research
Investigation
Meta-Analysis
Bibliometric Research
Review Article
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. Hernandez-Da Mota, Tania N. Adabache-Guel, Armando 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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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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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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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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