Abstract:AIM: To investigate the association between dyslipidemia and macular hard exudates(HEs)in non-proliferative diabetic retinopathy(NPDR)secondary to type 2 diabetes mellitus(T2DM).

METHODS: NPDR patients attending the outpatient ophthalmology clinic from January 2021 to December 2023 were selected and divided into three groups according to the severity of macular HEs. Group A: None or minimal HEs; Group B: Definite HEs; Group C: Prominent HEs. Total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), lipoprotein(a)\〖Lp(a)\〗 levels and other lipid-related indicators were routinely measured. The correlation between these indicators and HEs was analyzed.

RESULTS:Group A(24 eyes)consisted of 9 males and 15 females with the mean age of 54.71±6.15 y, group B(52 eyes)consisted of 20 males and 32 females with the mean age of 55.08±6.27 y, group C(14 eyes)consisted of 9 males and 5 females with the mean age of 53.93±6.08 y. The concentration of TC, TG, LDL-C and Lp(a)was highest in group C, followed by group B and lowest in group A with statistically significant differences(P<0.001). There were no statistically significant differences between the three groups for fasting plasma glucose(FPG), glycated hemoglobin A1c(HbA1c), creatinine(Cr), and HDL-C(P>0.05). The results of multivariate Logistic regression analysis showed that elevated levels of TC, TG, LDL-C, and Lp(a)were associated with the presence of macular HEs. Receiver operating characteristiccurve analysis showed that the area under the curve(AUC)for TC, TG, LDL-C, Lp(a), and their combination in predicting macular HEs in NPDR were 0.785, 0.718, 0.784, 0.742, and 0.911, respectively, with the combined model demonstrating the highest predictive performance.

CONCLUSION: Dyslipidemia is closely associated with the development and progression of macular HEs in patients with NPDR and T2DM. The levels of TC, TG, LDL-C, and Lp(a)were correlated with the severity of macular HEs, suggesting that dyslipidemia may be involved in the pathological process of macular HEs formation.

Abstract:AIM:To investigate the therapeutic effects of bone marrow mesenchymal stem cell-derived exosomes(BMSC-Exos)on diabetic retinopathy(DR)in rats, with a focus on their ability to modulate oxidative stress and inflammatory responses through the TLR4/NF-κB signaling pathway.

METHODS:Streptozotocin(STZ)-induced diabetic Sprague-Dawley(SD)rats were randomly divided into four groups: Group 1 \〖normal+phosphate-buffered saline(PBS)\〗, Group 2(normal+Exos), Group 3(DR+PBS), and Group 4(DR+Exos). At the 8^th week after modeling, BMSC-Exos or PBS were injected intravitreally. Retinal tissues were collected at the 16^th week for histological analysis \〖hematoxylin and eosin(HE)staining\〗, apoptosis detection(TUNEL). Oxidative stress markers \〖8-OHdG, superoxide dismutase(SOD), and glutathione(GSH)\〗 were assessed, and inflammatory cytokines \〖enzyme-linked immunosorbent assay(ELISA)for interleukin(IL)-6 and tumor necrosis factor-alpha(TNF-α)\〗, and molecular profiling \〖quantitative polymerase chain reaction(qPCR)for TLR4, NF-κB, and VEGF\〗 were measured.

RESULTS:The BMSC-Exos treatment significantly suppressed the activation of the TLR4/NF-κB pathway in DR rats(P<0.01), which was accompanied by reduced retinal vascular leakage(Evans blue assay, P<0.001), decreased apoptosis(TUNEL, P<0.05), and attenuated oxidative stress(elevated SOD and GSH, reduced 8-OHdG, P<0.05). The levels of inflammatory cytokines(IL-6 and TNF-α)were markedly decreased(P<0.01).

CONCLUSION:BMSC-Exos alleviate DR by suppressing the TLR4/NF-κB axis, thus reducing oxidative damage, inflammation, and microvascular dysfunction. This research offers a novel therapeutic approach for early-stage DR.

Abstract:AIM:To assess the influence of preoperative lacrimal passage probing and dilation on the therapeutic effectiveness of nasolacrimal silicone intubation in cases of incomplete primary acquired nasolacrimal duct obstruction(PANDO).

METHODS: A retrospective case-control clinical study was conducted. The study included patients with incomplete PANDO who underwent nasolacrimal silicone intubation at the hospital between October 2022 and October 2024. Participants were categorized into two groups based on their receipt of nasolacrimal duct probing and dilation prior to intubation. Group A consisted of patients who had undergone one or more sessions of nasolacrimal duct probing and dilation before nasolacrimal silicone intubation, while Group B included patients who did not receive nasolacrimal duct probing and dilation before intubation. All patients had their nasolacrimal silicone tubes removed 3 mo postoperatively and were monitored for 6 mo following tube removal to evaluate surgical success rates.

RESULTS: A total of 136 patients(152 eyes)completed the six-month follow-up period. The overall surgical success rate for both groups was 72.4%(110/152 eyes).Group A included 22 males and 36 females, mean age 58.09±11.07 y, and achieved a success rate of 82.8%(53/64 eyes), while Group B included 27 males and 51 females, mean age 59.35±8.84 y and attained a success rate of 64.8%(57/88 eyes). The difference in surgical success rates between the two groups was statistically significant(P=0.014). Furthermore, Group A achieved a complete success rate of 67.2%(43/64 eyes), compared to 47.7%(42/88 eyes)in Group B, with this difference also reaching statistical significance(P=0.017). No serious postoperative complications were observed in either group.

CONCLUSION: Nasolacrimal silicone intubation is a safe and effective intervention for incomplete PANDO, with preoperative nasolacrimal duct probing and dilation potentially enhancing therapeutic outcomes.

Abstract:AIM:To explore the toxicological mechanisms of benzalkonium chloride(BAC)as a preservative in ophthalmic preparations leading to corneal injury in dry eye.

METHODS:Network toxicology was employed to obtain the chemical structure of BAC, its toxic targets, and targets associated with dry eye-related corneal injury from databases including PubChem, CTD, ChEMBL, and STITCH. The protein-protein interaction(PPI)networks were constructed using the STRING database to screen key toxicity targets. Gene ontology(GO)functional annotation and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses were performed to elucidate the potential biological processes and signaling pathways affected by BAC. Furthermore, molecular docking techniques were employed to validate the binding affinity of BAC to its key targets(IL-6, IL-1β, TNF, and EGF).

RESULTS:BAC had a toxicity grade of 4 and exhibited significant eye irritation. A total of 85 common targets of BAC and dry eye corneal damage were screened out, of which 49 were key toxic targets, including TNF, IL-6, TP53, IL-1β, BCL2, etc. KEGG enrichment analysis showed that BAC mainly acted on 7 corneal injury pathways closely associated with corneal injury, such as IL-17, TNF, NF-κB, JAK-STAT, PI3K-Akt, Rap1, and MAPK. The results of molecular docking showed that BAC had stable binding ability to IL-6, IL-1β, TNF, EGF, and other targets(binding energy <0).

CONCLUSION:BAC may induce corneal damage in dry eye through multi-target and multi-pathway mechanisms, involving processes such as inflammatory response, apoptosis, disruption of tear film stability, and delayed corneal repair, which suggests that long-term use of ophthalmic preparations containing BAC may aggravate ocular surface damage.

Abstract:AIM: To investigate the effect and potential mechanism of liraglutide(LIR)combined with neural stem cells(NSCs)in alleviating diabetic retinopathy(DR)in rats.

METHODS:A DR rat model was established using a high-fat diet combined with a single intraperitoneal injection of streptozotocin(STZ). Rats in the control group were fed a normal diet and received an intraperitoneal injection of citric acid-sodium citrate buffer. After modeling, the rats were divided into the control group, DR group, DR+LIR group, DR+BMSCs group, DR+NSCs group, DR+BMSCs+LIR group, and DR+NSCs+LIR group. According to the grouping instructions, rats were given intraperitoneal injection of LIR at 200 μg/(kg·d)and intravitreal injection of bone marrow mesenchymal stem cells(BMSCs), or NSCs, or the combined therapy accordingly for 8 wk. Fasting blood glucose(FBG)and serum insulin levels, as well as retinal oxidative stress indexes and serum inflammatory indexes, were detected in each group. Retinopathy was evaluated by hematoxylin-eosin(HE)staining, retinal cell apoptosis was detected by TUNEL staining, SIRT1 expression in retinal tissues was detected by immunohistochemistry, and BDNF expression in retinal tissues was detected by immunofluorescence. The transcriptional levels of cZNF532, miR-29a-3p, SIRT1, TGF-β1, NRF2, Keap1, and BDNF in retinal tissues were detected by qRT-PCR, and the protein expression levels of SIRT1, TGF-β1, SMAD2/3, p-SMAD2/3, NRF2, Keap1, p65, and p-p65 in retinal tissues were detected by Western blot.

RESULTS:Compared with the other groups of rats, the retinal morphology of rats in the DR+NSCs+LIR group was significantly improved, the levels of FBG, TNF-α, IL-1β, IL-6 and MDA were decreased(all P<0.05), the serum insulin level and the levels of SOD, CAT, and GSH-Px were increased(all P<0.05), the TUNEL-positive rate of retinal cells was reduced(all P<0.05). The expression levels of cZNF532, SIRT1, NRF2, and BDNF in retinal tissue were up-regulated(all P<0.05), whereas the expression levels of miR-29a-3p, TGF-β1, p-SMAD2/3, Keap1, and p-p65 were down-regulated(all P<0.05).

CONCLUSION:LIR combined with NSCs alleviates DR by regulating the cZNF532-miR-29a-3p-SIRT1 network and its downstream TGF-β/SMAD, NF-κB, and Keap1/NRF2 signaling pathways.

Abstract:AIM:To observe the effect of cationic nanoemulsion eye drops on the tear film and ocular surface morphology of orthokeratology wearers, and to provide a basis for the clinical selection of eye drops during orthokeratology wear.

METHODS:A prospective study was conducted on patients with refractive errors who were fitted with orthokeratology lenses for the first time at Anhui Aier Eye Hospital,from February 2025 to October 2025. Patients were randomly assigned to the experimental group, which received a cationic nanoemulsion eye drops, or the control group, which received a 0.1% sodium hyaluronate eye drops. One drop of the assigned lubricant was instilled in each eye before lens insertion and before lens removal in both groups for 3 consecutive months. Uncorrected visual acuity, spherical equivalent, anterior corneal curvature, tear film break-up time, tear film lipid layer score, and corneal fluorescein staining score were compared between the two groups at baseline and at 1 wk, 1 and 3 mo after lens wear.

RESULTS: A total of 64 eyes(all right eyes)from 64 patients with refractive errors were enrolled. Ultimately, 60 patients completed the final follow-up, including 30 in the experimental group(n=30; male/female: 14/16; age: 9.57±1.07 y)and the control group(n=30; male/female: 12/18; age: 9.43±1.01 y). No significant intergroup differences were found in uncorrected visual acuity, spherical equivalent, anterior corneal curvature, or corneal fluorescein staining scores either before or after lens wear(all P>0.05).The tear film break-up time was significantly longer and tear film lipid layer score was significantly better in the experimental group than in the control group at post-wear time point(all P<0.05). Uncorrected visual acuity, spherical equivalent, and anterior corneal curvature improved significantly from baseline at 1 wk, 1 and 3 mo after lens wear in both groups(all P<0.05). Corneal fluorescein staining scores increased significantly from baseline at 1 wk and 1 mo in the control group(both P<0.05), whereas no significant change was observed in the experimental group. No cases of severe corneal injury(score of 3)were found in either group.

CONCLUSION: Cationic nanoemulsion eye drops have a similar effect to 0.1% sodium hyaluronate eye drops in improving the visual acuity and corneal morphology of orthokeratology wearers, but have more advantages in stabilizing the tear film and improving the state of the tear film lipid layer, and have good safety, so they can be used as an ideal choice of eye drops for orthokeratology wearers.

Abstract:AIM: To explore the effect of Kappa angle on changes in visual quality and stereoscopic acuity after regional refractive multifocal intraocular lens(MIOL)implantation in patients with high myopia complicated by cataract.

METHODS:A retrospective analysis was conducted on data from patients with normal Kappa angle and high myopia complicated by cataract treated at the hospital from January 2024 to January 2025. Patients were divided into two groups based on the median preoperative Kappa angle(0.182 mm): Group A(0RESULTS: A total of 100 patients(100 eyes)with normal Kappa angle and high myopia complicated by cataract were included. Patients were divided into Group A(52 patients, 52 eyes; 34 males, 18 females; mean age 52.35±3.16 y)and Group B(48 patients, 48 eyes; 31 males, 17 females; mean age 52.79±3.54 y). At 3 mo postoperatively, both groups showed increases in 9% contrast visual acuity(CVA), 20% CVA, 100% CVA, modulation transfer function cut off(MTF cut off), and strehl ratio(SR)compared with their respective preoperative values, while objective scatter index(OSI)decreased(all P<0.05). However, there were no differences between the two groups in BCDVA, BCIVA, BCNVA, 9%, 20%, and 100% CVA, OSI, MTF cut off, SR, total ocular higher-order aberrations, or total ocular spherical aberration at any postoperative time point(all P>0.05). The actual residual astigmatism in Group A was lower than that in Group B at 7 d, 1 and 3 mo postoperatively(all P<0.001). The proportion of eyes with near stereoscopic acuity <60″ was higher in Group A than in Group B, while the proportion of eyes with near stereoscopic acuity between 400″ and 3000″ was lower in Group A than in Group B(both P<0.05). Meanwhile, the incidence of visual disturbances in Group B was higher than that in Group A(P<0.05).

CONCLUSION: The Kappa angle has no significant effect on visual acuity or objective visual quality in patients with normal Kappa angle and high myopia complicated by cataract after regional refractive MIOL implantation. However, patients with a larger Kappa angle exhibit higher postoperative residual astigmatism, worse near stereoscopic acuity, and a higher incidence of vision-related adverse symptoms.

Abstract:Dry eye disease(DED)is a multifactorial ocular surface disorder characterized by the loss of tear film homeostasis among which evaporative DED associated with meibomian gland dysfunction(MGD)accounts for up to 86%, and traditional drugs fail to effectively target the core pathological mechanism. As a new type of anhydrous and preservative-free eye drops approved by the FDA, perfluorohexyloctane has a unique amphiphilic structure, which can form an artificial lipid monolayer at the air-liquid interface of the tear film. It exerts its therapeutic effects by inhibiting tear evaporation, stabilizing the tear film, unclogging meibomian gland orifices, and promoting corneal oxygen supply. This drug can not only serve as a first-line treatment option for evaporative DED but also be combined with other drugs for personalized treatment. This review summarizes the mechanism of action, pharmacological properties, clinical efficacy, and safety of perfluorohexyloctane eye drops, and further elaborate on its application value in complex types of DED and patients with other concurrent ocular surface diseases, aiming to provide more evidence support for the precise treatment of DED.

Abstract:The cornea is a transparent tissue essential for maintaining ocular refractive function and visual quality. Corneal injury and disease remain major causes of visual impairment and blindness. However, conventional pharmacological therapies and corneal transplantation are still limited by immune rejection, donor tissue shortage, and suboptimal long-term outcomes. Exosomes, a subtype of extracellular vesicles(EVs)secreted by various cell types, are enriched in bioactive molecules such as proteins, lipids, mRNA, and miRNA. Owing to their low immunogenicity, favorable biocompatibility, capacity to stably deliver key signaling molecules involved in inflammation regulation and tissue repair, and suitability for local corneal administration, exosomes partially overcome the limitations of traditional corneal therapies in terms of precise immunomodulation and repair efficiency, thereby demonstrating considerable research value. This review systematically summarizes the biological characteristics of exosomes and recent advances in the application of exosomes derived from different sources in corneal injury repair, inflammation and immune regulation, and related corneal diseases, with a particular focus on their underlying mechanisms and therapeutic potential, aiming to provide a reference for standardized research and clinical translation of exosome-based therapies in corneal diseases.

Abstract:Extracellular vesicles(EVs)are nanoscale membrane vesicles released by cells that carry bioactive molecules such as proteins and nucleic acids. They play a key role in intercellular communication. In recent years, they have shown significant potential in the diagnosis and treatment of corneal and ocular surface diseases. As diagnostic biomarkers, EVs derived from tears or other sources can reflect disease-specific characteristics, providing a basis for the early disease detection. In terms of therapy, mesenchymal stem cells(MSCs)-derived EVs deliver miRNAs to modulate inflammatory pathways, promote corneal epithelial repair, and inhibit fibrosis. Furthermore, as natural drug vehicles, EVs enable precise delivery of therapeutic agents and promote corneal wound healing. This review systematically summarizes the recent research advances in the application of EVs in the field.

Abstract:The core pathological process of optic neuropathy caused by glaucoma is the progressive loss of retinal ganglion cells(RGCs). As the primary glial cells in the retina, Müller glial cells play a crucial and complex dual regulatory role in the pathological microenvironment of glaucoma. On one hand, Müller cells can exert endogenous protective effects by secreting neurotrophic factors, enhancing RGC viability through co-culture, and regulating glutamate metabolism. On the other hand, under sustained stress such as elevated intraocular pressure, Müller cells are activated by mechanosensitive channels(e.g., TRPV4), transforming into a reactive gliosis phenotype. This leads to the release of inflammatory cytokines that exacerbate RGC apoptosis, while their metabolic reprogramming and epigenetic alterations also contribute to the process of neuronal injury. This article systematically reviews the research progress on the dual roles of Müller cells in protecting and damaging the optic nerve in glaucoma, exploring new therapeutic strategies for neuroprotection by regulating their cellular states. It outlines the main controversies and unresolved issues in this field and, based on the latest research advances, analyzes the implications of targeting Müller cells for current clinical treatments and future development trends.

Abstract:High-altitude retinopathy(HAR)is a retinal vascular disorder induced by exposure to high-altitude environments. With the increasing popularity of high-altitude travel, mountaineering, and special occupational activities, worldwide, the incidence of HAR has risen, particularly among individuals with rapid or short-term exposure to elevated altitudes. Most cases of HAR are self-limiting and gradually resolve with descent to lower altitudes. However, severe cases may result in permanent visual function impairment if not recognized and managed promptly. This review systematically summarizes the epidemiology, diagnostic progress, pathogenesis, and prevention and treatment strategies of HAR, with particular emphasis on hypoxia-associated molecular pathways involved in retinal damage, and evaluates current evidence for clinical interventions. Deepened understanding of its pathological mechanisms and clinical management strategies facilitates early identification, targeted intervention, and ocular health protection for populations exposed to high altitudes.

Abstract:Retinal degenerative diseases(RDDs)are one of the leading causes of vision impairment and blindness worldwide, whose core pathological mechanism is closely related to mitochondrial dysfunction. Mitochondria, as the energy metabolism center of cells, their dysfunction can lead to excessive accumulation of intracellular reactive oxygen species, imbalance in energy metabolism, and subsequently trigger apoptosis and degeneration of retinal pigment epithelial cells, photoreceptors, and retinal ganglion cells. In recent years, intercellular mitochondrial transfer has emerged as a novel therapeutic strategy, demonstrating significant potential in repairing impaired cellular energy metabolism, alleviating oxidative stress, and delaying disease progression by supplementing healthy mitochondria. This article systematically reviews the specific mechanisms of mitochondrial dysfunction in various RDDs(such as age-related macular degeneration, inherited retinal diseases, glaucoma, and diabetic retinopathy), explores therapeutic strategies related to mitochondrial transplantation for RDDs, existing research, limitations, and future directions, aiming to promote the eventual clinical application of this cutting-edge therapy.

Abstract:The choroidal vascularity index(CVI)is a quantitative structural parameter derived from optical coherence tomography(OCT)images. It is defined as the ratio of the luminal area to the total choroidal area, which characterizes alterations in the structural proportion between choroidal vascular lumens and stroma, and indirectly indicates changes in choroidal status to a certain extent. With the development of enhanced depth imaging optical coherence tomography(EDI-OCT), CVI has been increasingly applied in ophthalmic research and clinical practice.Measurements of CVI exhibit excellent repeatability and reliability. Combined with the noninvasive nature of EDI-OCT, CVI is an extremely valuable assessment tool for clinical ophthalmic research and routine clinical practice. CVI can quantify proportional changes between the choroidal luminal area and total choroidal area, and better reflects relative variations in choroidal vascular and stromal components compared with choroidal thickness alone. In recent years, CVI has been widely applied to multiple ocular diseases including age-related macular degeneration(ARMD), central serous chorioretinopathy(CSC), diabetic retinopathy(DR), and high myopia. In addition to the diseases themselves, various ocular surgeries and procedures can also affect CVI. Current evidence suggests that changes in CVI may be associated with factors such as postoperative inflammatory response, choroidal hemodynamic alterations, vascular permeability changes, and intraocular pressure fluctuations. However, discrepancies remain among studies regarding the direction and duration of these changes and their relationship with visual outcomes. This review summarizes the effects of ocular surgeries and procedures on CVI and further discusses its clinical interpretation, existing controversies, and future research directions, aiming to provide a reference for perioperative assessment of choroidal structural changes and prognostic evaluation.

Abstract:Ocular neuroinflammation has moved beyond being regarded as a mere accompanying phenomenon and has emerged as a central paradigm for understanding the onset, progression, and outcome of a variety of blinding eye diseases. It serves as a common pathological thread that traverses etiologically diverse conditions, closely linking acute injury with chronic degeneration, autoimmunity with psychological stress, and vascular events with metabolic dysregulation. This review aims to construct a broader framework that not only deepens mechanistic understanding of neuroinflammation in classic ocular disorders, but also extends the perspective to a wider disease spectrum. Furthermore, cutting-edge advances from basic research to clinical translation were systematically summarized, thereby providing a panoramic view of the current landscape and future directions of ocular neuroinflammation research.

Abstract:Pathologic myopia(PM)is characterized by progressive axial elongation, posterior staphyloma, and fundus degenerative changes, representing a leading cause of blindness in Asian countries.Posterior scleral reinforcement(PSR)is currently the only surgical intervention to slow axial elongation. Its mechanisms involve mechanical reinforcement, improved blood circulation, and biological stimulation of scleral remodeling. This article reviews recent advances in PSR: surgical techniques have evolved from complex, classic procedures to standardized single-strip methods, incorporating 3D MRI to quantify posterior staphyloma morphology for personalized graft design and facilitating minimally invasive, precision surgery. Among implant materials, biomaterials such as allogeneic dura mater are being continuously optimized, while biomimetic piezoelectric smart materials actively promote scleral collagen synthesis through electrical signals, achieving a paradigm shift from “passive support”to “active reinforcement”. Clinical outcomes indicate advantages in regulating axial length, enhancing visual function and blood circulation, and facilitating early intervention in children. Combined procedures with ICL implantation, cataract surgery or vitrectomy provide comprehensive treatment regimens for individual patients with varied conditions. This article also analyzes long-term issues and core controversies including ectopic posterior staphyloma and reoperation, and prospects future research directions such as artificial intelligence assistance, translation of smart materials and full-cycle prevention and treatment systems, so as to provide references for clinical practice and scientific research.

Abstract:Orthokeratology is an effective intervention for myopia control in adolescents,and the precision of lens fitting and the efficacy of follow-up monitoring directly influence treatment outcomes.The conventional fitting process depends largely on physicians' subjective experience,which leads to bottlenecks such as poor consistency in lens fitting and insufficient quantitative evaluation of therapeutic effects.In recent years,artificial intelligence has achieved groundbreaking progress in the field of medical image analysis,offering new options for the fitting of orthokeratology lenses.This article reviews the application and research advances of machine learning in orthokeratology lens fitting as reported in recent publications indexed in PubMed and Web of Science,aiming to provide a reference for future research.

Abstract:The therapeutic concept of amblyopia has gradually shifted from improving the visual acuity of the amblyopic eye to restoring binocular visual function.Conventional occlusion therapy and routine visual training have issues such as long treatment cycles, insufficient entertainment value and poor patient compliance, which limits the stability of therapeutic effects. Virtual reality(VR)technology, characterized by immersion, interactivity, and adjustable stimulus parameters, has been increasingly applied to visual training for amblyopia.Current evidence suggests that VR-based training can improve visual acuity and binocular visual function in amblyopia patients to a certain extent.Moreover, its gamified interactions and feedback-driven design may also enhance patient motivation and treatment adherence. This review begins with the mechanisms and theoretical basis of VR training for amblyopia, proceeds to summarizeits advantages over conventional methods, current systems, training modes, clinical efficacy, commonly used outcome measures, as well as safety and acceptability, aiming to provide a reference for its standardization, clinical translation, and widespread adoption.

Abstract:AIM: To compare objective visual quality and vision-related quality of life after implantation of different presbyopia-correcting intraocular lenses(PC-IOLs).

METHODS:A prospective, non-randomized controlled study. Cataract patients who underwent phacoemulsification combined with PC-IOL implantation at Jinan Mingshui Eye Hospital from September 2023 and December 2025 were included. These patients were divided into three groups according to the type of IOL: the Trifocal IOL group,the Vivity group, and the Synergy group. Follow-ups were conducted at 1 wk,1 and 3 mo postoperatively. Uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), and uncorrected near visual acuity(UNVA), objective scatter index(OSI), modulation transfer function cut off(MTF-cut off), and Strehl ratio(SR), as well as contrast visual acuity(CVA)at 100%, 20%, and 9% contrast were assessed. Postoperative defocus curves were plotted. Vision-related quality of life and spectacle independence were evaluated using questionnaires.

RESULTS: This study included 101 cataract patients(101 eyes),aged 30-70(53.8±9.7)y,with 59 males and 42 females.The Trifocal group consisted of 33 patients(33 eyes), aged 30-71(51.7±11.3)y, with 21 males and 12 females; the Vivity group consisted of 37 patients(37 eyes), aged 36-71(54.2±9.0)y, with 18 males and 19 females; and the Synergy group consisted of 31 patients(31 eyes), aged 30-73(55.9±8.5)y, with 20 males and 11 females.No significant differences were observed among the three groups in UDVA or UIVA(all P>0.05). Significant differences were found in UNVA among groups(P<0.05). UDVA differed significantly across different time points(P<0.05), while there were no significant differences in UIVA and UNVA(all P>0.05). At 3 mo postoperatively, significant differences were found among the three groups in OSI, MTF -cut off, SR, and CVA at all contrast levels(all P<0.05). The defocus curve at postoperative 1 mo showed that the Trifocal group had a smooth and continuous profile from +1.0 D to -3.0 D, providing good distance, intermediate, and near vision. All groups demonstrated smooth transitions in the intermediate range(-1.0 D to -1.5 D), with LogMAR visual acuity better than 0.2. In the near range(-2.5 D to -3.5 D), the Trifocal and Synergy groups performed significantly better than the Vivity group. No significant differences were observed in VF-14 questionnaire scores among groups(P>0.05). For night driving(motorized or non-motorized), the Vivity group performed better than the Trifocal and Synergy groups. Spectacle independence rates were 92.3% in the Trifocal group, 54.1% in the Vivity group, and 80.0% in the Synergy group(P<0.05).

CONCLUSION: All types of PC-IOLs can effectively improve postoperative full-range visual acuity in cataract patients. There are discrepancies in the objective visual quality between Trifocal IOLs and extended depth of focus(EDOF)IOLs. Some patients suffer from postoperative optical disturbances, which result in certain difficulties with night driving, although patients generally report favorable subjective visual perceptions.

Abstract:AIM: To analyze the relationship between obesity-related indicators, blood lipid levels and primary open angle glaucoma(POAG)and explore its risk factors.

METHODS:Patients with POAG treated in the hospital from March 2022 to March 2024 were selected as the POAG group, and healthy people in the same period were selected as the non-POAG group. The obesity related indicators \〖body mass index(BMI), waist circumference, waist-to-hip ratio\〗, blood lipid levels \〖serum total cholesterol(TC), triglyceride(TG), high-density lipoprotein(HDL-C), low-density lipoprotein(LDL-C)\〗 and general clinical data of the two groups were compared. The binary Logistic regression analysis was used to analyze the risk factors affecting the occurrence of POAG, and the ROC curve was established to analyze the efficiency of various variables in predicting the occurrence of POAG.

RESULTS:A total of 54 POAG patients and 54 non-POAG subjects were included. The POAG group had a mean age of 50.30±5.73 y(29 males, 25 females), and the non-POAG group had a mean age of 50.28±5.72 y(28 males, 26 females).The BMI, intraocular pressure, waist circumference, waist-to-hip ratio, and TG levels in the POAG group were higher than those in the non-POAG group, while the HDL-C level was lower than that in the non-POAG group(all P<0.001). High BMI, high waist circumference, high waist-to-hip ratio, and high TG were identified as risk factors for POAG(all P<0.05), whereas high HDL-C was a protective factor(P<0.05).The AUCs for BMI, waist circumference, waist-to-hip ratio, TG, HDL-C, and the combined prediction were 0.885, 0.873, 0.707, 0.777, 0.664, and 0.974, respectively; the sensitivities were 0.815, 0.833, 0.730, 0.637, 0.663, and 0.944, respectively; and the specificities were 0.852, 0.759, 0.711, 0.789, 0.752, and 0.889, respectively. These results indicate that the combined multi-index prediction had the best performance, with good sensitivity and specificity.

CONCLUSION:Obesity-related indicators such as high BMI, high waist circumference, high waist-to-hip ratio, and dyslipidemia(high TG, low HDL-C)are associated risk factors for POAG. The combined multi-index prediction model including BMI, waist circumference, waist-to-hip ratio, TG, and HDL-C demonstrates the best performance in POAG risk assessment, with both high sensitivity and specificity, providing a scientific basis for early clinical screening and intervention.

Abstract:AIM: To investigate the expression levels of follistatin-like protein 1(FSTL1)and a disintegrin and metalloproteinase with thrombospondin type 1 motif 13(ADAMTS13)in the serum of patients with proliferative diabetic retinopathy(PDR), and to analyze their predictive value for visual disability.

METHODS:A prospective study. From January 2022 to September 2024, patients with diabetes retinopathy(DR)were selected from Fengfeng General Hospital of North China Medical and Health Group. They were divided into non-proliferative diabetes retinopathy(NPDR)group and PDR group. In the same period, simple type 2 diabetes(T2DM)patients were selected as T2DM group, and healthy people were selected as control group. Enzyme linked immunosorbent assay was used to detect serum levels of FSTL1 and ADAMTS13. Patients in the PDR group were followed up for 12 mo to observe the occurrence of visual disability, and were accordingly divided into a non-visual disability group and a visual disability group. Risk factors for visual disability in PDR patients were analyzed by Logistic regression, and the predictive value was assessed via receiver operating characteristic(ROC)curves and decision curve analysis(DCA).

RESULTS: This study included 220 DR patients, including 119 cases in the NPDR group and 101 cases in the PDR group. There were 120 cases in the T2DM group and 120 cases in the control group. The control group had an age of 56.92±8.15 y, with 66 males and 54 females. The T2DM group had an age of 57.21±8.30 y, with 63 males and 57 females. The NPDR group had an age of 57.36±8.25 y, with 60 males and 59 females. The PDR group had an age of 57.45±8.22 y, with 53 males and 48 females. There were 68 patients without visual disability and 33 patients with visual disability in the PDR group. The non-visual disability group had a mean age of 57.26±8.14 y, including 35 males and 33 females. The visual disability group had a mean age of 57.85±8.37 y, including 18 males and 15 females. Diabetes duration was progressively longer in the T2DM, NPDR, and PDR groups. Levels of fasting plasma glucose(FPG), glycated hemoglobin(HbA1c), and FSTL1 progressively increased, while ADAMTS13 levels progressively decreased across the control, T2DM, NPDR, and PDR groups(all P<0.001). Within the PDR group, serum FSTL1 levels increased sequentially while ADAMTS13 levels decreased sequentially in patients with grade Ⅳ, Ⅴ and Ⅵ lesions(all P<0.001). The visual disability group had significantly longer diabetes duration and higher levels of FPG, HbA1c, and FSTL1, as well as lower ADAMTS13 levels, compared to the non-visual disability group(all P<0.001). The diabetes duration, FSTL1, ADAMTS13 were the influencing factors of visual disability in PDR patients(all P<0.001). ROC curve and DCA curve analysis showed that the predictive value of combined detection of serum FSTL1 and ADAMTS13 levels is higher than that of individual measurement(all P<0.05).

CONCLUSION:PDR patients have higher serum FSTL1 levels and lower ADAMTS13 levels. Both are related to the severity of PDR. The combined measurement has a high predictive value for visual disability in PDR patients.

Abstract:AIM:To evaluate the accuracy of a portable non-contact tonometer(PNCT)compared with a traditional non-contact tonometer(NCT)in measuring intraocular pressure(IOP)at different levels.

METHODS:Patients who presented to Ningbo Eye Hospital between January 2025 and January 2026 were retrospectively included. All patients underwent measurements using PNCT, NCT, and Goldmann applanation tonometry(GAT). Based on the GAT measurements, the patients were categorized into a low IOP group(IOP≤16 mmHg), a moderate IOP group(16 mmHgRESULTS: A total of 94 patients(184 eyes)were included in this study, comprising 52 males and 42 females with a mean age of 48.6±16.4 y. The median IOP values measured by GAT, PNCT, and NCT were 19.3(15.5, 24.0), 19.3(16.0, 24.1), and 19.0(15.0, 26.0)mmHg, respectively(χ²=3.77, P>0.05). Spearman correlation analysis revealed that the IOP values measured by both PNCT and NCT were positively correlated with those measured by GAT(r_s=0.86 and 0.84, respectively, P<0.05). Intraclass correlation coefficient(ICC)analysis demonstrated an ICC of 0.89 between PNCT and GAT(P<0.05), and 0.88 between NCT and GAT(P<0.05), with an overall ICC of 0.88 among the three instruments(P<0.05). Bland-Altman analysis indicated a mean bias of 0.1 mmHg \〖95% limits of agreement(LoA): -7.3 to 7.6 mmHg\〗 between PNCT and GAT, and a mean bias of 0.1 mmHg(95%LoA: -8.4 to 8.6 mmHg)between NCT and GAT. Based on the GAT measurements, the eyes were categorized into a low IOP group(60 eyes, 32.6%, IOP≤16 mmHg), a moderate IOP group(63 eyes, 34.2%, 16 mmHgLoA: -4.4 to 7.4 mmHg)for PNCT and 0.5 mmHg(95%LoA: -5.6 to 6.6 mmHg)for NCT. In the moderate IOP group, the mean bias was -0.2 mmHg(95%LoA: -5.4 to 5.1 mmHg)for PNCT and -0.1 mmHg(95%LoA: -8.6 to 8.4 mmHg)for NCT. In the high IOP group, the mean bias was -0.8 mmHg(95%LoA: -10.6 to 8.9 mmHg)for PNCT and -0.1 mmHg(95%LoA: -10.5 to 10.4 mmHg)for NCT. Furthermore, 175 eyes underwent central corneal thickness(CCT)measurements, with a mean CCT of 553.3±35.9(450-660)μm. The IOP measurements from GAT(r_s=0.31), PNCT(r_s=0.39), and NCT(r_s=0.40)all exhibited positive correlations with CCT(P<0.05). Notably, the measurement difference between PNCT and GAT was not correlated with CCT(r_s=0.08, P>0.05), whereas the difference between NCT and GAT showed a positive correlation with CCT(r_s=0.23, P<0.05).

CONCLUSION:The IOP measurements obtained by PNCT, NCT, and GAT demonstrated strong correlation and good agreement, with PNCT being less influenced by CCT. However, as IOP levels increased, the measurement errors of both PNCT and NCT also increased. Therefore, PNCT and NCT readings should only serve as references and cannot replace GAT.

Abstract:AIM:To investigate the effect of peripheral defocus design rigid gas permeable contact lenses(defocus RGPCL)in controlling myopia progression in children aged 6-12 y with high myopia, and to compare the outcomes with traditional single-vision RGPCL and single-vision spectacles.

METHODS:This prospective cohort study enrolled children aged 6-12 y with high myopia who visited the Ophthalmology and Optometry Center of Xi'an No.1 Hospital between January 2022 and January 2023. Based on parental preference, participants were divided into three groups: defocused RGPCL group, single-vision RGPCL group, and single-vision spectacles group. The axial length(AL)and cycloplegic spherical equivalent(SE)refraction were compared at baseline, 0.5, 1, 1.5, and 2 y after lens wear. Additionally, AL and SE delay rates were calculated for each group.

RESULTS: This study enrolled a total of 90 children with high myopia(180 eyes), with no participants lost to follow-up. Participants were allocated into three groups based on parental preference. Thirty children(60 eyes)were assigned to the peripheral defocus RGPCL group, consisting of 12 boys and 18 girls with a mean age of 9.96±1.56 y; 30 children(60 eyes)to the single-vision RGPCL group, including 15 boys and 15 girls with a mean age of 9.40±1.52 y; and 30 children(60 eyes)to the single-vision spectacles group, with 14 boys and 16 girls and a mean age of 9.80±1.37 y. At 0.5, 1, 1.5, and 2 y lens fitting, AL and SE increased significantly in all three groups(all P<0.05), with the growth rates in the defocused RGPCL group being significantly lower than those in the single-vision RGPCL and single-vision spectacles groups(all P<0.05). At 2 y lens fitting, the AL elongation was 0.22±0.24 mm and the mean SE progression was 0.70±0.70 D in the peripheral defocus RGPCL group; 0.49±0.38 mm and 1.34±0.60 D in the single-vision RGPCL group; and 0.50±0.21 mm and 1.72±0.47 D in the single-vision spectacles group. Using the single-vision spectacles group as the control, the AL delay rate and SE delay rate at 2 y lens fitting were 56.0% and 59.3%, respectively, in the defocused RGPCL group.

CONCLUSION:For children with high myopia aged 6-12 y, defocus RGPCLs can effectively and significantly delay AL elongation and SE progression, demonstrating markedly superior control efficacy compared to single-vision RGPCL or single-vision spectacles. Defocused RGPCL can serve as an effective optical intervention for high myopia children.

Abstract:AIM:To investigate the current status of astigmatism and its associated factors among children and adolescents from kindergarten through senior high school in Yangpu District, Shanghai, and to provide scientific evidence for the prevention and control of refractive errors.

METHODS:A cluster sampling method was employed. From September to November 2024, students from 14 randomly selected schools in Yangpu District, Shanghai, were enrolled as study subjects. Autorefraction and ocular biometry were performed under non-cycloplegic conditions, and questionnaire surveys were administered. Comparisons of astigmatism degree, detection rate, and axis were made across age groups, educational stages, and sexes. Multiple linear and logistic regression analyses were conducted to identify factors associated with astigmatism.

RESULTS:A total of 7 233 students aged 4-18 y were enrolled including 3 731 males, 3 502 females, with the mean age 10.13±4.18 y, astigmatism -0.76±0.82 D, and the detection rate(≤-1.00 D)was 29.23%. Both the degree and detection rate of astigmatism were correlated with age and educational stage, peaking in senior high school, with the most pronounced changes observed during primary school. Besides age, astigmatic refractive power was influenced by spherical equivalent(β=0.105, P<0.001), mean keratometry(β=-0.118, P<0.001), sex(with boys as the reference, girls: β=0.054, P<0.001), frequent sustained near work for 30-40 min(with “almost never” as the reference, β=-0.030, P=0.038), preterm birth(β=-0.023, P=0.044), maternal myopia(β=-0.028, P=0.020), and homework completion time on rest days(β=-0.035, P=0.041). The detection rate of astigmatism was associated with maternal myopia(OR=1.130, P=0.039), male sex(OR=0.773, P<0.001), shorter sleep duration on school days(OR=0.909, P=0.028), shorter sleep duration on rest days(OR=0.937, P=0.046), preterm birth(OR=1.382, P=0.012), frequent excessive head lowering(OR=1.216, P=0.045), homework completion time on rest days(OR=1.043, P=0.046), higher spherical equivalent(OR=0.891, P<0.001), and higher mean keratometry(OR=1.188, P<0.001).

CONCLUSION:The degree and detection rate of astigmatism among children and adolescents from kindergarten to senior high school in Yangpu District, Shanghai are correlated with educational stage, and primary school may represent a critical period for astigmatism prevention and control. Male sex, maternal myopia, preterm birth, high-intensity near work, and insufficient sleep and other factors may be associated with the onset and progression of astigmatism. It is recommended that education and health departments strengthen visual health screening during primary school, while promoting behavioral interventions such as scientific eye-use habits and adequate sleep across different educational stages to delay the onset and progression of astigmatism.

Abstract:AIM: To investigate the current incidence of retinopathy of prematurity(ROP)in Sichuan Province and analyze its risk factors, providing a scientific basis for establishing and improving the regional ROP screening and prevention system.

METHODS: A retrospective study was conducted on premature infants who underwent fundus screening at the Departments of Ophthalmology and Neonatology of Sichuan Provincial Maternity and Child Health Care Hospital from January 20, 2017 to February 10, 2025. The incidence of ROP was calculated. The patients were divided into ROP group and non-ROP group according to whether ROP occurred, and the clinical characteristics of the two groups were compared. Multivariate Logistic regression was used to analyze risk factors for ROP.

RESULTS:This study included a total of 861 premature infants, with 445 males(51.7%)and 416 females(48.3%).ROP occurred in 166 cases, with an incidence rate of 19.3%, and the non-ROP group consisted of 695 cases. The mean gestational age of the ROP and non-ROP groups was 30.24±2.20 and 33.06±1.90 wk(P<0.01), while the mean birth weight was 1438.94±389.66 and 1977.32±438.68 g(P<0.01). By comparing the clinical data of the two groups of preterm infants, the following factors were found to be associated with the occurrence of ROP: younger gestational age, low birth weight, history of oxygen therapy, respiratory distress syndrome, intracranial hemorrhage, neonatal anemia, bronchopulmonary dysplasia, patent ductus arteriosus, and sepsis(all P<0.01). Multivariate Logistic regression analysis revealed that gestational age(OR=0.685,95%CI:0.592-0.792,P<0.01), birth weight(OR=0.999,95%CI:0.998-0.999,P<0.01), and respiratory distress syndrome(OR=2.312,95%CI:1.313-4.070,P<0.01)were risk factors for ROP. Gestational age had the greatest impact.The younger the gestational age at birth, the higher the risk of ROP.

CONCLUSION:The incidence of ROP in Sichuan Province is relatively high compared to multicenter results from China. Significant risk factors include younger gestational age, low birth weight, and respiratory distress syndrome. Screening criteria should be formulated based on the local incidence of ROP, and a screening, prevention, and treatment system for ROP should be established and improved.

Abstract:AIM:To investigate the application value of contrast-enhanced ultrasound(CEUS)time parameters in the classification diagnosis of choroidal space-occupying lesions.

METHODS: Patients with choroidal space-occupying lesions who underwent CEUS at Xi'an People's Hospital(Xi'an Fourth Hospital)between June 2020 and January 2024 were enrolled. According to the final clinical diagnosis and pathological findings, the patients were divided into a benign group(choroidal hemangioma), a malignant group(choroidal melanoma), and a hemorrhage group(subchoroidal hemorrhage). CEUS characteristics and contrast parameters, including rise time(RT), time to peak(TP), and washout time(WT), as well as the incidence of adverse reactions, were analyzed to evaluate the diagnostic value of CEUS.

RESULTS:A total of 120 patients(120 eyes)with choroidal space-occupying lesions were included, with 40 patients(40 eyes)in each group. The patients in the benign group were aged 45-70(mean age 57.5±12.4 )y, including 19 males and 21 females; those in the malignant group were aged 43-72(mean age 56.9±13.1 )y, including 23 males and 17 females; and those in the hemorrhage group were aged 40-61(mean age 54.4±9.7 )y, including 22 males and 18 females. The benign group predominantly exhibited homogeneous hyperenhancement with a “fast-in, slow-out”perfusion pattern, whereas the malignant group mainly showed heterogeneous hyperenhancement with a “fast-in, fast-out”perfusion pattern. No obvious enhancement was observed in the hemorrhage group, exhibiting a “no-in, no-out” perfusion pattern. Significant differences were found among the three groups in CEUS characteristics and quantitative parameters, whereas no significant difference was observed in the incidence of adverse reactions.

CONCLUSION: CEUS can significantly improve the diagnostic accuracy of choroidal space-occupying lesions and may serve as a useful reference for clinical decision-making, with a favorable safety profile.

Abstract:AIM: To investigate the relationship between microvascular density in macular area and anti-vascular endothelial growth factor(VEGF)response in patients with diabetic macular edema(DME).

METHODS: Retrospective case-control study. Clinical data of DME patients who received anti-VEGF treatment in the hospital from January 2021 to August 2025 were collected. All patients received intravitreal anti-VEGF treatment once a month for a total of 3 times. The patients were divided into the good response group and the poor response group based on the anti-VEGF treatment response. The vascular density of superficial capillary plexus(SCP)and deep capillary plexus(DCP)were compared between the two groups before treatment. Multivariate logistic regression models were used to analyze the factors affecting the anti-VEGF treatment response in DME patients. The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of SCP and DCP vascular density for anti-VEGF treatment response in DME patients.

RESULTS: The study included a total of 315 DME patients 315 eyes, including 172 males and 143 females with the mean age of 62.06±7.38 y. After completing three treatments, there were 211 cases 211 eyes in the good response group, including 114 males and 97 females with the mean age of 61.92±7.52 y. There were 104 cases in the poor response group, including 58 males and 46 females with the mean age of 62.35±7.10 y. The course of diabetes in the poor response group was longer than that in the good response group, the central retinal thickness before treatment was greater than that in the good response group, the level of glycosylated hemoglobin(HbA1c)before treatment was higher than that in the good response group, and the proportion of patients with serous retinal detachment was higher than that in the good response group. Before treatment, the vascular density of SCP and DCP in the poor response group was lower than that in the good response group(all P<0.01). Multivariate Logistic regression analysis showed that SCP and DCP vascular density were both influencing factors of anti-VEGF treatment response in DME patients(both P<0.05). ROC curves showed that the area under the curve(AUC)of the pre-treatment SCP vascular density, pre-treatment DCP vascular density alone, and their combined model for predicting poor response to anti-VEGF therapy in DME patients were 0.812, 0.797 and 0.901, respectively, indicating high predictive value.

CONCLUSION: The microvascular density in the macular area is closely related to the anti-VEGF treatment response in DME patients. The vascular density of SCP and DCP before treatment can be used as important indicators to predict treatment response, and targeted preventive and therapeutic interventions can be adopted in clinical practice.

Abstract:AIM: To evaluate clinical efficacy of recombinant human epidermal growth factor(rhEGF)combined with adjuvant amniotic membrane transplantation in corneal alkaline burns.

METHODS:In the prospective, randomized controlled study, patients with corneal alkaline burns treated in the hospital were enrolled between November 2022 and November 2024. After emergency treatment, patients were divided into combined treatment group and routine treatment group by random number table method. The routine treatment group was given basic treatment(rhEGF), while combined treatment group additionally underwent adjuvant amniotic membrane transplantation. The clinical efficacy, healing time of corneal epithelium, best corrected visual acuity, VAS scores, corneal neovascularization area, break-up time, score of corneal opacity, and levels of inflammatory factors(IL-6, hs-CRP, TNF-α)in the two groups were observed and compared.

RESULTS:There were 110 patients(110 eyes)in this study, including 55 cases(55 eyes)in each group. The combination group had a mean age of 46.82±10.38 y, including 26 males and 29 females. The routine treatment group had a mean age of 45.13±11.57 y, with 31 males and 24 females. The total response rate of combined treatment group \〖94.5%(52/55)\〗 was significantly higher than that of routine treatment group \〖81.8%(45/55), P<0.05\〗. The healing time of corneal epithelium in combined treatment group was significantly shorter than that in routine treatment group(P<0.001), and VAS score for pain severity after treatment was significantly lower than that in routine treatment group(P<0.001). The corneal neovascularization area in combined treatment group was significantly smaller than that in routine treatment group(P<0.001), break-up time was significantly longer than that in routine treatment group(P<0.001),and score of corneal opacity was significantly lower than that in routine treatment group(P<0.001). After treatment, levels of inflammatory factors in combined treatment group were significantly lower than those in routine treatment group(all P<0.05).

CONCLUSION:Adjuvant amniotic membrane transplantation combined with rhEGF presents prominent clinical advantages in the treatment of alkaline corneal burns. It can enhance therapeutic efficacy, accelerate wound healing, relieve pain, reduce corneal neovascularization, prolong tear film break-up time, alleviate corneal opacification, and reduce the levels of inflammatory factors.

Abstract:AIM:To evaluate the immediate effect of vocal training on tear film stability in patients with dry eye disease.

METHODS:A prospective crossover controlled study. From April 1 to April 20, 2026, volunteers with mild-to-moderate dry eye \〖Ocular Surface Disease Index-6(OSDI-6)score: 4-8\〗 were enrolled. Participants were randomly allocated into two groups to receive two interventions in different sequences. Group A underwent a 50-min standardized vocal training session during the first intervention, while Group B served as a blank control; The two groups crossed over to the alternative intervention for the second session, with a 1-week washout period between the two interventions. The immediate post-intervention changes in Dry Eye Symptoms Questionnaire(CDES-Q)score, pre-and post-intervention non-invasive tear film breakup time(NIBUT), including first NIBUT and average NIBUT, as well as tear meniscus height(TMH), were recorded for each session.

RESULTS:A total of 32 eligible participants(64 eyes)were enrolled and completed the study per protocol. The participants were randomly assigned to two groups with different intervention sequences. Group A(16 participants, 32 eyes)comprised 3 males and 13 females, with a mean age of 61.69±4.56 y and a mean OSDI-6 score of 5.750±1.183. Group B(16 participants, 32 eyes)comprised 3 males and 13 females, with a mean age of 63.19±1.56 y and a mean OSDI-6 score of 5.250±1.438.There were no significant differences in baseline characteristics between the two groups(P>0.05). After vocal training intervention, the net effect size for first NIBUT was 1.883 s(P=0.042), and for average NIBUT was 2.076 s(P=0.019). No significant change was observed in TMH(P=0.652). The CDES-Q score difference was -47.188(P<0.001). Further individual data analysis revealed that 59% of participants exhibited prolonged first NIBUT and 50% exhibited prolonged average NIBUT after vocal training.

CONCLUSION: Vocal training can immediately improve tear film stability. This therapeutic approach shows promise for dry eye management and provides a reference for future large scale and long-term investigations.

Abstract:AIM: To investigate differences in ocular biological parameters and refractive status among children with unilateral congenital ptosis.

METHODS:This was a retrospective cohort study enrolling patients with unilateral congenital ptosis in the Department of Ophthalmology, Xi'an Children's Hospital between August 2018 and March 2025, with the contralateral healthy eyes serving as the control group. All patients underwent a detailed ophthalmic examination to assess the degree of ptosis and evaluate refractive errors. Biometric measurements were performed using the IOL Master 700 biometer, including axial length(AL), central corneal thickness(CCT), anterior chamber depth(ACD), lens thickness(LT), and astigmatism(AST).

RESULTS:A total of 100 eyes from 100 children(affected eye group)with unilateral congenital ptosis were enrolled, and their 100 contralateral normal eyes without ptosis were set as the control group(healthy eyes group). Among the subjects, there were 67 males(67%)and 33 females(33%), with a mean age of 6.43±2.47 y; 45 affected eyes were the right eye and 55 were the left eye. Among the 100 patients, mild, moderate, and severe ptosis accounted for 7%, 21%, and 72%, respectively. The incidence of amblyopia in patients with unilateral congenital ptosis was 32%, all of which occurred in the affected eye. Compared with the healthy eye group, K2(total)and K2(severe ptosis)in eyes with severe ptosis were significantly lower(P<0.05), indicating that the cornea in the ptotic eye was flatter. In patients with moderate ptosis, the affected eye had a significantly greater corneal thickness(CCT)compared to the healthy eye(P<0.05), indicating that the corneas of eyes with moderate ptosis were thicker. The incidence of against-the-rule and oblique astigmatism in the affected eye group(39%)was significantly higher than that in the healthy eye group(14%); there was a significant difference in the corneal astigmatism axis between the affected and healthy eye groups(P<0.01). There were no differences in refractive status or biological parameters such as AL, K1, AST, ACD, and LT between the affected and healthy eyes.

CONCLUSION:Congenital ptosis can affect refractive errors, lead to oblique and against-the-rule astigmatism, increase the prevalence of amblyopia, and also result in corneal thickening and flattening. However, it has minimal effects on AL, LT, and ACD.

Abstract:AIM: To investigate the value of maximum standardized uptake value(SUV_max), extraocular muscle(EOM)diameter, and thyroid stimulating hormone receptor antibody(TRAb)in evaluating inflammatory activity in thyroid-associated ophthalmopathy(TAO).

METHODS: TAO patients underwent orbital ^99mTc-DTPA SPECT/CT imaging at the Affiliated Hospital of Panzhihua University between January 2023 and December 2024 were retrospectively enrolled. According to the clinical activity score(CAS), patients were classified into an active group and an inactive group. SUV_max and EOM were independently measured by three nuclear medicine physicians, and the mean values were used for analysis. Serum TRAb levels from TAO patients were measured using a fully automated electrochemiluminescence immunoassay analyzer. Nonparametric tests were used to compare differences between the two groups. Spearman correlation analysis was performed to assess the correlations of CAS with SUV_max, EOM, and TRAb. Using CAS as the reference standard, receiver operating characteristic(ROC)curves were plotted to evaluate the diagnostic performance of SUV_max, EOM, and TRAb, as well as their combination. Intraclass correlation coefficient(ICC)was used for reliability analysis to evaluate the consistency of SUV_max and EOM among the 3 measurers.

RESULTS: A total of 99 patients(198 eyes)with TAO were enrolled in this study, including 38 males and 61 females, aged 16-74(46.92±11.84)y. The active group comprised 46 patients(92 eyes), aged 16-71(48.40±12.02)y, with 25 males and 21 females. The inactive group included 53 patients(106 eyes), aged 17-74(45.46±11.59)y, consisting of 13 males and 40 females. There were no statistically significant differences between the two groups in terms of gender and age(P>0.05). Statistically significant differences were observed in SUV_max, EOM, and TRAb. Compared with the inactive group, the active group showed higher SUV_max, EOM, and TRAb levels(all P<0.01). Correlation analysis showed that CAS was positively correlated with SUV_max, EOM, and TRAb(r=0.734, 0.622, and 0.404, respectively, all P<0.01). ROC curves were plotted using CAS as the reference standard, and the AUCs for SUV_max, EOM, TRAb, and their combined diagnosis were 0.874, 0.797, 0.715, and 0.892, respectively. The ICC of SUV_max and EOM were 0.925(95%CI: 0.901-0.948, P<0.001)and 0.943(95%CI: 0.907-0.964, P<0.001)respectively.

CONCLUSION: Beyond CAS, there is a need to identify objective imaging and serological biomarkers. Measurements of SUV_max and EOM provide visualized and quantifiable tools for assessing TAO activity, and their combination with TRAb can further improve the accuracy of activity assessment.

Abstract:AIM: To explore the application value of machine learning models in predicting the myopia control efficacy of orthokeratology(OK)in pediatric population, and analyze the key factors affecting axial length(AL)elongation.

METHODS: This retrospective study included myopic subjects aged 8-17 y who were fitted with OK lenses and completed a 6 mo follow-up between January 1, 2021 and December 1, 2023. Baseline demographic and ocular biometric parameters were collected, including age, eye laterality, cycloplegic refraction, corneal curvature(K1 and K2)and AL. AL change(ΔAL)at 6 mo after lens wearing was defined as the primary outcome. Four machine learning models—decision tree, random forest, extreme gradient boosting(XGBoost), and neural network—were developed to predict treatment efficacy, and their predictive performance was compared. Multiple linear regression analysis was performed to identify relevant factors associated with ΔAL.

RESULTS: A total of 102 myopic patients(159 eyes)aged 8-17 y were included in this study, including 57 bilateral eyes and 45 unilateral cases. Among them, 56 were boys(54.9%)and 46 were girls(45.1%). The mean age was 11.98±1.93 y. At baseline, the mean spherical error was -2.28±1.37 D, the mean cylindrical power was -0.65±0.36 D, and AL was 24.60±0.82 mm, the mean flat keratometry(K1)was 42.55±1.39 D, and the mean steep keratometry(K2)was 43.58±1.44 D.After 6 mo of lens wear, the AL increased to 24.68±0.59 mm, The mean spherical power was -2.45±1.46 D, the cylindrical power was -0.68±0.38 D, the K1 value was 42.52±1.33 D, and the K2 value was 43.61±1.51 D. The mean ΔAL was 0.08±0.17 mm.The performance comparison of four machine learning models in predicting the efficacy of OK on AL control showed that the decision tree model achieved the best predictive performance(MAE=0.11, MSE=0.02, R²=0.44). Feature importance analysis indicated that age, baseline AL and K1 were the top three predictors. Multiple linear regression showed that age was negatively associated with ΔAL(β=-0.03, P<0.001), while other variables were not significantly associated(all P>0.05).

CONCLUSION: Machine learning models can effectively predict the efficacy of OK in controlling axial elongation in children. The decision tree model shows the best performance. Age is a key factor affecting the therapeutic effect of OK, while baseline AL and corneal curvature also contribute to prediction.This study provides new data support for individualized myopia prevention and control strategies in the pediatric population.