Abstract:Aqueous humor provides the necessary nutrition for the lens and transports the metabolites in the eye. It was a liquid that can directly reflect the microenvironment in the eye, and it can be easily obtained during the operation. This review intended to analyze the components of aqueous humor in patients with different types of cataracts, so as to reflect the pathogenesis and development of the disease, evaluate the incidence of postoperative complications and provide reference value for the surgical design of sequential cataract surgery. The aqueous humor components of different types of cataracts showed different degrees of inflammation, oxidative stress and extracellular matrix remodeling. The biomarker of early neuropathy in diabetic cataract was neural cell adhesion molecule-1(NCAM1). Transforming growth factor-β(TGF-β)was the evaluation factor of disease development in patients with pseudoexfoliation syndrome. The relationships between postoperative complications of different types of cataracts and aqueous humor components were as follows: Macular edema after diabetic cataract surgery was associated with tumor necrosis factor-alpha; capsular contraction after high myopic cataract surgery was related to monocyte chemoattractant protein-1(MCP-1)and TGF-β2; Klotho and glutathione S-transferase P 1(GSTP1)were associated with high intraocular pressure after primary open-angle glaucoma complicated by cataract surgery; capsular contraction after retinitis pigmentosa complicated by cataract surgery was associated with matrix metalloproteinases; pro-inflammatory cytokines and fibroblast growth factor 4 in the aqueous humor of congenital cataracts were associated with posterior capsular opacification after surgery. Granulocyte colony stimulating factor 3 and MCP-1 were the main cytokines mediating the pain of the second eye in the binocular sequential cataract surgery short interval(1 wk), while MCP-1 mediated pain in the long interval(6 wk). The second eye after binocular sequential cataract surgery had a higher level of proinflammatory factors. The components of aqueous humor in patients with different types of cataracts were related to the pathogenesis and postoperative complications of the disease. Monitoring the components of the aqueous humor could help better understand the intraocular microenvironment of different types of cataracts and provide a reference for predicting the development of the disease and implementing relevant targeted therapy.

Abstract:AIM: To assess the protective effect of adipose tissue-derived mesenchymal stem cells(ADSCs)exosomes on injured retinal ganglion cells(RGCs)by establishing an in vitro rat RGC pressure injury model.

METHODS: ADSCs were cultured, and exosomes were extracted from the supernatant and identified. Rat RGCs were divided into a control group, pressure model groups(40, 80, 120 mmHg), and exosome-treated groups under different pressures. Cell proliferation activity was assessed using the CCK-8 assay. The mRNA expression levels of brain-derived neurotrophic factor(BDNF)and Caspase-3 in RGCs were detected by qPCR, and protein levels were measured by Western Blot.

RESULTS: The CCK-8 assay showed that cell proliferation activity in the control group increased significantly at 48 h compared to 24 h(P<0.05). At 48 h, cell viability in the exosome-treated groups increased significantly compared to the 40, 80, and 120 mmHg pressure model groups(all P<0.05). qPCR results indicated that BDNF mRNA expression decreased in the 40 mmHg pressure model group without statistical significance(P>0.05), and significantly decreased in the 80 and 120 mmHg pressure model groups(all P<0.05). BDNF mRNA expression significantly increased in the 40 and 80 mmHg pressure model groups after exosome treatment(both P<0.05), and increased in the 120 mmHg pressure model group without statistical significance(P>0.05). Caspase-3 mRNA expression increased in the 40 mmHg pressure model group without statistical significance(P>0.05), and significantly increased in the 80 and 120 mmHg pressure model groups(all P<0.05). Caspase-3 mRNA expression significantly decreased in the 40 and 80 mmHg pressure model groups after exosome treatment(P<0.05), and decreased in the 120 mmHg pressure model group without statistical significance(P>0.05). Western Blot analysis showed that BDNF protein expression decreased in the 40 mmHg pressure model group without statistical significance(P>0.05), and significantly decreased in the 80 and 120 mmHg pressure model groups(all P<0.001). After exosome treatment, BDNF protein expression significantly increased compared to the pressure model groups(all P<0.05). Caspase-3 protein expression increased significantly in all pressure model groups compared to the control group(all P<0.05), and significantly decreased in all exosome-treated groups compared to the model groups(all P<0.05).

CONCLUSION: ADSCs-derived exosomes enhance cell proliferation and viability in cultured rat RGCs in vitro under different pressure-induced injuries, enhance BDNF mRNA and protein expression levels, and reduce Caspase-3 mRNA and protein expression levels, suggesting that ADSCs-derived exosomes have a protective effect on pressure-injured in cultured rat RGCs in vitro.

Abstract:AIM: To analyze the mechanism of Usher syndrome(USH)caused by Adgrv1 gene variation through the Hedgehog(Hh)signaling pathway.

METHODS: Based on Adgrv1 gene variant mice(Adgrv1^-/-), taking wild type(WT)C57BL/6 mice as controls, the expression of Adgrv1 gene and the structure of retina and cell cilia were analyzed by qRT-PCR, HE, transmission electron microscopy, and immunofluorescence. Additionally, the changes of key factors in the Hh signaling pathway caused by Adgrv1 gene variation were observed.

RESULTS: The Adgrv1 gene was expressed in both the retina and primary cultured lung fibroblasts of Adgrv1^-/- mice, but the expression levels were significantly decreased. The Adgrv1 gene variation can cause dissolution of the outer disc membrane of the retinal photoreceptors and significantly shorten the cilia length in primary lung fibroblasts. In the Hh signaling pathway, the expression of Ptch1 and Gli genes of Adgrv1^-/- was significantly reduced, while the expression of PKA genes was increased.

CONCLUSION:The Adgrv1 gene variation leads to shortened cell cilia and dissolution of the outer disc membrane of the retinal photoreceptors, resulting in retinitis pigmentosa, which is related to decreased expression of PTCH1 and GLI1 proteins in the Hh pathway.

Abstract:AIM: To prepare a nanodrug MMC-ATS-@PLGA using polylactic acid hydroxyacetic acid copolymer(PLGA)as a carrier and mitomycin C(MMC)loaded on PLGA, and to analyse the biological safety and treatment effect of this nanodrug on inhibiting the proliferation of filtering bleb scarring after glaucoma surgery in vivo.

METHODS: The thin-film dispersion hydration ultrasonic method was used to prepare the MMC-ATS-@PLGA, and its physical and chemical properties were detected. The effect of MMC-ATS@PLGA on rabbit corneas was analysed through corneal fluorescence staining and HE staining, and tear film rupture time(BUT), Schirmer test and intraocular pressure data were collected to analyse ocular surface biosafety. A slit lamp was used to observe and calculate the filtration bubble size, and the tissue morphological changes were analysed by conjunctival HE staining. In addition, immunohistochemistry and Elisa were used to compare the anti-inflammatory effects of Flumiolone Eye Drops(FML), MMC, and MMC-ATS-@PLGA nanoparticles on inhibiting the formation of filtering bleb scarring after glaucoma surgery from multiple perspectives via comparative proteomic analysis.

RESULTS: The average particle size and zeta potential of MMC-ATS-@PLGA were 128.78±2.54 nm and 36.49±4.25 mV, respectively, with an encapsulation efficiency and a drug loading rate of(78.49±2.75)% and(30.86±1.84)%, respectively. At 33°C(the ocular surface temperature), the cumulative release rate of the MMC-ATS-@PLGA nanoparticles reached(76.58±2.68)% after 600 min. Moreover, corneal fluorescence staining, HE, BUT, Schirmer, and intraocular pressure results showed that MMC-ATS-@PLGA had good biocompatibility with the ocular surface of rabbits. At 3 wk after surgery, the area of filtering blebs in the MMC-ATS-@PLGA group was significantly larger than that in the FML group and MMC group, and the filtering blebs in the control group had basically disappeared. Pathological tissue analysis of the conjunctiva in the filtering blebs area of the eyes of the rabbits revealed that compared with that in the normal group, the morphology of the collagen fibres in the MMC-ATS-@PLGA group was relatively regular, the fibres were arranged neatly, and the tissue morphology was similar to that of the normal group. Immunohistochemistry and Elisa confirmed that compared with those in the normal group, the expression levels of α-SMA, CTGF, and type Ⅲ collagen fibre antibodies were significantly increased in the control group. After FML, MMC, or MMC-ATS-@PLGA treatment for 3 wk, the expression of inflammatory factors gradually decreased. Among the groups, the MMC-ATS-@PLGA group showed the most significant decrease(P<0.05).

CONCLUSION: This study successfully synthesized a nanomedicine(MMC-ATS-@PLGA)that inhibits scar proliferation after glaucoma filtration surgery. The drug had stable physicochemical properties, good biocompatibility, and better anti-inflammatory effects by inhibiting the expression of α-SMA, CTGF, and type Ⅲ collagen fibres, which can prevent the formation of scarring in the filtering blebs area, thereby improving the success rate of glaucoma filtering surgery.

Abstract:AIM: To explore the effect of lncRNA SNHG6 on injury of human retinal microvascular endothelial cells(hRMECs)induced by high glucose and its possible mechanism.

METHODS: The D-glucose-induced hRMECs were used to establish normal glucose(NG)and high glucose(HG)cell injured model. In the HG group, the hRMECs were cultured in DMEM medium at a concentration of 25 mmol/L D-glucose for 24 h, while in the NC group, they were cultured in DMEM medium at a concentration of 5.5 mmol/L D-glucose; according to experimental design, si-NC, si-SNHG6, si-SNHG6 and anti-miR-NC and si-SNHG6 and anti-miR-186-5p were transfected into hRMECs, and then incubated at a concentration of 25 mmol/L D-glucose for 24 h, with HG+si-NC group, HG+si-SNHG6 group, HG+si-SNHG6+anti-miR-NC group and HG+si-SNHG6+anti-miR-186-5p group marked, respectively. The quantitative real-time polymerase chain reaction(qRT-PCR)was used to detect the expression of lncRNA SNHG6 and miR-186-5p; dual-luciferase reporter assay was used to detect the targeting relationship; MTT assay and flow cytometry were used to detect the cell proliferation and apoptosis, respectively; enzyme linked immunosorbent assay(ELISA)was used to detect the levels of IL-1β, TNF-α, IL-8, IL-10; testing kits were used to detect activity of SOD and level of MDA; the Western blot was used to detect the protein expression of cleaved-caspase3, Bax and Bcl-2.

RESULTS: The lncRNA SNHG6 expression increased in the HG group, while miR-186-5p expression decreased(both P<0.05). There was target binding of lncRNA SNHG6 with miR-186-5p. After the transfection of si-SNHG6, cell inhibition rate, apoptosis rate, cleaved-caspase3, Bax protein levels, IL-1β, TNF-α, IL-8 contents, and MDA activity were decreased(P<0.05), while Bcl-2 protein, IL-10 contents, and SOD activity were increased(P<0.05). Co-transfection of si-SNHG6 and anti-miR-186-5p increased cell proliferation inhibition rate, apoptosis rate, cleaved-caspase3, Bax, IL-1β, TNF-α, IL-8, and MDA(P<0.05), but decreased Bcl-2, IL-10 and SOD(P<0.05).

CONCLUSION: Interfering with lncRNA SNHG6 could inhibit cell apoptosis, inflammation and oxidative stress of high-glucose- induced hRMECs by elevating the expression of miR-186-5p.

Abstract:AIM: To investigate the structural changes in anterior segment of cataract patients after phacoemulsification combined with intraocular lens(Phaco+IOL)implantation, and to analyze theirs correlation.

METHODS: Retrospective case study. A total of 44 cases(88 eyes)of cataract patients who underwent Phaco+IOL surgery at ophthalmology department of the Peking University Third Hospital from January 2018 to December 2022 and consented to pre- and postoperative ultrasound biomicroscopy(UBM)were included. Patients' sex, age, axial length, corneal curvature, and IOL parameters were collected. UBM was utilized to measure various anterior segment parameters pre- and post-surgery, including anterior chamber depth(ACD), scleral ciliary process angle(SCPA), iris-lens contact distance(ILCD), maximum ciliary body thickness(CBTmax), and ciliary body thickness at 0 mm from the scleral spur(CBT0). The posterior chamber area(PCA)was calculated using Image J software.

RESULTS: Significant increases in ACD 3.50(2.89, 3.68)mm, CBTmax 1.199±0.233 mm, CBT0 1.11(0.964, 1.23)mm, and PCA 1.21(0.926, 1.57)mm² were identified postoperatively compared with preoperative values(all P<0.001). The postoperative ILCD was significantly reduced to 0.00(0.00, 0.794)mm(P<0.001). There was no significant change in the postoperative SCPA 37.9°(33.4°, 46.6°; P=0.908). The increase in PCA varied significantly between genders(P=0.045), with males showing a greater mean postoperative increase(0.679 mm²)than females(0.304 mm²). Age significantly correlated with postoperative SCPA, CBTmax, and CBT0(P=0.002, 0.004, 0.009, respectively).

CONCLUSION: Phaco+IOL surgery resulted in an enlargement of the PCA, significant increases in ACD, CBTmax, and CBT0, and a reduction in ILCD. The post-surgery increase of PCA was influenced by multiple factors, with age, preoperative ACD and SCPA being positively correlated, and preoperative CBT0 being negatively correlated. No significant differences were observed in the impact of different IOL brands on the structural changes of the anterior segment.

Abstract:AIM: To investigate the correlation between serum levels of secreted frizzled-related protein-4(SFRP-4), chitinase 3-like protein 1(CHI3L1)and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus.

METHODS: Prospective study. A total of 103 DR patients who admitted to our hospital from October 2018 to October 2023 were selected as DR group, including 39 cases of early DR, 42 cases of mid DR, and 22 cases of late DR; 98 patients with simple type 2 diabetes were selected as DM group, 101 healthy individuals were selected as the control group, and baseline data and clinical indicators were collected. Enzyme linked immunosorbent assay(ELISA)was applied to detect serum levels of SFRP-4 and CHI3L1.

RESULTS: The levels of serum SFRP-4, CHI3L1, triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), glycated hemoglobin(HbA1C), fasting plasma glucose(FPG), homeostasis model assessment of insulin resistance(HOMA-IR)in the DR group were higher than those in the DM group and the control group(all P<0.05); the serum levels of SFRP-4, CHI3L1, TG, LDL-C, HbA1C, FPG, HOMA-IR in the DM group were higher than those of the control group(all P<0.05). The course of disease, TG, LDL-C, HbA1C, FPG, HOMA-IR, SFRP-4, and CHI3L1 of late stage of DR were higher than those in the middle and early stages of DR(all P<0.05). The serum levels of SFRP-4 and CHI3L1 in DR patients were positively correlated with disease course, TG, LDL-C, HbA1C, FPG, HOMA-IR and DR staging(all P<0.05). The area under the curve(AUC)of serum SFRP-4, CHI3L1, and combined diagnostic DR was 0.809, 0.801, and 0.898, respectively. SFRP-4 and CHI3L1 were independent risk factors of DR(P<0.05).

CONCLUSION: The levels of serum SFRP-4 and CHI3L1 are closely related to DR in patients with type 2 diabetes. The higher levels of SFRP-4 and CHI3L1 suggested that patients have a higher risk of DR.

Abstract:Aging is a necessary process for organisms.The antioxidant capacity in the body decreases, which induces the activation of inflammasomes, autophagy dysregulation, protein misfolding in the lens, resulting in lens opacification. With the increase of age, the secretion of melatonin and glutathione(GSH)gradually decreased, and the pro-oxidant/pro-inflammatory factors increased, which created ideal conditions for the formation of age-related cataract(ARC). A series of changes such as oxidative stress, inflammation and autophagy dysregulation accompany the occurrence of aging, which is also the basis of various diseases. Melatonin has antioxidant, anti-inflammatory, regulation of autophagy and circadian rhythm effects, and has shown benefits in age-related macular degeneration(ARMD), diabetic retinopathy(DR), and glaucoma. Although phacoemulsification and lens implantation have developed maturely, they consume a lot of medical resources. This article reviews the research of melatonin in ARC, which may prevent/delay the formation of ARC, thereby reducing the economic burden of patients and reducing the loss of medical resources.

Abstract:Acute idiopathic maculopathy(AIM)is an inflammatory lesion of unknown cause that primarily affects the macula. It follows a unique natural course, distinct from other maculopathy, often manifesting as a sudden loss of visual acuity followed by flu-like symptoms that gradually resolve as the disease subsides. A comprehensive understanding of the unique history, multimodal imaging, and a thorough systematic examination are crucial in determining the final diagnosis of AIM. The treatment and prognosis of AIM remain controversial. Meanwhile, it presents similar clinical manifestations and pathological changes to various chorioretinopathy, posing challenges for clinical differentiation. This article provides a review of its pathogenesis, clinical symptoms, multimodal imaging features, diagnosis and differential diagnosis, treatment and prognosis, in order to reduce misdiagnosis and mistreatment while enhancing comprehension of AIM.

Abstract:The corneal epithelium, an essential refractive interface, plays an integral role in the corneal healing after corneal refractive surgery. All existing corneal refractive surgeries entail a degree of corneal epithelial remodeling; however, excessive epithelial remodeling precipitates adverse outcomes on the refractive correction efficacy of such surgeries. This review summarizes the application of corneal epithelial remodeling in the corneal refractive surgery, and more comprehensively investigates the influencing factors of perioperative epithelial remodeling after corneal refractive surgery, with a view to augmenting the safety, efficacy, predictability, and stability of corneal refractive surgical outcomes.

Abstract:Glial-mesenchymal transition(GMT)is a biological process of transdifferentiation where endothelial cells gradually adopt the phenotypic characteristics of mesenchymal cells under the influence of various factors. GMT is closely associated with retinal fibrosis diseases. Müller cells, the predominant retinal macroglia, undergo activation and transdifferentiation in response to diverse stimuli and pathological conditions. Researches indicate that GMT plays a significant role in the pathogenesis of diseases such as diabetic retinopathy(DR), idiopathic epiretinal membrane(iERM), age-related macular degeneration(ARMD), and proliferative vitreoretinopathy(PVR). Although the exact mechanism of GMT is not well understood, it has showed great promise as potential target. Clarifying the research progress of GMT provides new ideas in the early diagnosis and treatments of retinal diseases, which is clinically and scientifically important for revealing interactive effects of cell transdifferentiation families in retinal diseases.

Abstract:With the intensification of global aging,presbyopia has gradually become a global problem, and presbyopia correction surgery has emerged in recent years. The application of laser technology has brought great convenience to refractive surgery, and it also plays an increasingly important role in the correction of presbyopia. The emergence of excimer laser and femtosecond laser technology has opened a new world of surgical treatment for presbyopia, and brought new hope for surgical correction of presbyopia. In this paper, the application and new progress of excimer laser and femtosecond laser in presbyopia surgery are described.

Abstract:With the popularization of small incision lenticule extraction(SMILE), a large number of one-piece corneal stromal lenticules are removed during surgery. As an additional product of surgery, the experimental research and clinical reuse of extracted corneal stromal lenticules from SMILE have become a research hotspot in recent years. Corneal stromal lenticules are thin and transparent, rich in sources, low in cost, and have the advantages of low immunogenicity and good tissue compatibility, so they can be used as important source of cells and corneal stroma research, and also can be used as good biomaterials for corneal reinforcement, patch graft, refractive correction, and lacrimal duct embolization in clinical study. This article reviews the clinical application of SMILE-derived lenticule in the treatment of corneal-related diseases, correction of hyperopia and presbyopia, coverage of glaucoma drainage valve to prevent their exposure, and its use in lacrimal duct plug, aiming to fully recognize the reuse of lenticules in clinical practice, expand its surgical indication, and providing new directions for the treatment of other eye diseases and its application in tissues and organs.

Abstract:Hippo signaling pathway plays an important role in cell growth, proliferation, apoptosis, and stem cell regeneration. Dysregulation of this pathway has been linked to various diseases, such as cancer, heart disease, lung disease, kidney disease, liver disease, and immune dysfunction, as well as ocular diseases. Consequently, regulating the balance of Hippo signaling pathway may be an effective treatment for ocular diseases. This article reviews the mechanism of action and therapeutic potential of Hippo signaling pathway in ocular diseases, and discusses the potential therapeutic targets of the Hippo signaling pathway, to identify new targets and provide new research ideas for treating ocular diseases.

Abstract:Nuclear factor kappa-B(NF-κB), an intricate nuclear transcription factor, is ubiquitously present within the myriad tissues and cells of the human corpus, engaging in a multiplicity of biological processes such as the development of the immune system, immune responses, inflammatory reactions, angiogenesis, and tumorigenesis. Its cardinal role in the pathogenesis of ocular diseases is increasingly illuminated by its prevalence. Owing to the unique architecture of the ocular globe, burgeoning studies have identified the excessive activation or dysregulation of the NF-κB signaling pathway as intimately associated with the progression of a multitude of ocular conditions, including, but not limited to, cataracts, dry eye syndrome, and glaucoma. The modulation of NF-κB activation, by targeting it, offers a potent mechanism for regulating ocular inflammation and mitigating disease progression, holding promise as a potential therapeutic strategy for ophthalmic disorders. An in-depth examination of the NF-κB signaling pathway's role in ocular diseases not only enriches our comprehension of the underlying mechanisms of these ailments, but also lays a crucial foundation for the innovation of new treatment modalities. Therefore, this article endeavors to provide a compendious review of the regulatory effects exerted by the NF-κB signaling pathway in ophthalmic conditions throughout recent years.

Abstract:A model eye is used to study the anatomical structure and optical properties of the eye, and to analyze visual quality under different conditions using optical analysis software. By adjusting biological parameters such as axial length and corneal curvature radius and modifying its refractive state, the model eye can be used for ophthalmic surgical planning and treatment program development, leading to more accurate and objective assessments of visual quality. While previously used mainly for theoretical studies in optics and ophthalmology, model eyes and optical analysis software are now being applied to various ocular diseases, with their accuracy confirmed through comparison with clinical trials. This article aims to summarize the widely used model eyes and optical analysis software, as well as their applications, to offer new perspectives for diagnosing and treating ocular diseases and evaluating visual quality.

Abstract:In recent years, with the rapid development of radiological medical imaging technology, gamma knife surgery has been improved. With more accurate focusing and more precise radiation dose design, gamma knife surgery significantly reduced the complication rate, and it can treat a wider range of diseases. Currently, the application of gamma knife stereotactic radiosurgery in ophthalmology has increased, and better outcomes have been obtained in the treatment of ocular diseases. For eye diseases that are difficult to operate on, the gamma knife surgery controls tumor growth while avoiding surgery damage. It has advantages in terms of improved appearance, treatment cost and psychological trauma, and can be used as a preferred method for treating ophthalmic diseases or as an adjunctive treatment after surgery. This article provides an overview on the application history, therapeutic principles, treatment in ophthalmic diseases and complications of gamma knife, in order to contribute to the further application of the gamma knife in ophthalmology.

Abstract:AIM: To systematically evaluate the efficacy and safety of low-concentrations atropine eye drops in controlling adolescent myopia.

METHODS:A computer search was conducted on Wanfang Data, CNKI, VIP, PubMed, Cochrane Library, and Embase databases from January 2010 to March 2024 on clinical studies on low-concentration atropine eye drops for controlling adolescent myopia. Two researchers independently screened trials, extracted data, evaluated risk of bias and quality, and used Review Manager5.4 software to perform Meta-analysis.

RESULTS:A total of 17 articles, involving 3 764 cases and 3 952 eyes, were included. The Meta-analysis showed that compared with the control group, low concentrations of atropine could effectively slow down the growth of axial length \〖MD=-0.15, 95% CI(-0.20, -0.10), P<0.00001\〗, significantly controlled the changes in spherical equivalent \〖MD=0.39, 95% CI(0.29, 0.48), P<0.00001\〗, and had a significant effect on pupil diameter \〖MD=0.80, 95% CI(0.33,1.28), P=0.0010\〗 and amplitude of accommodation \〖MD=-2.54, 95%CI(-4.49, -0.60), P=0.01\〗.

CONCLUSION:Low-concentrations atropine are effective in controlling spherical equivalent and axial length of myopia in adolescents, significantly affecting pupil diameter and amplitude of accommodation, and effectively delaying the progression of myopia.

Abstract:AIM: To investigate the diagnostic value of the axial length/corneal radius of curvature(AL/CR)for myopia in children and adolescents.

METHODS: PubMed, Embase, The Cochrane Library, CNKI, CBM, WanFang Data and VIP databases were searched to collect clinical research on the value of AL/CR in diagnosing myopia in children and adolescents, and the retrieval time was from establishment to September 30, 2023. The QUADAS-2 tool was used to evaluate the quality of the extracted literature. A random-effects model was used to pool diagnostic test data, Meta-regression and subgroup analysis were performed to explore sources of heterogeneity.

RESULTS: A total of 10 articles involving 19 872 study participants were included, and Meta-analysis showed that the pooled sensitivity of the AL/CR for the diagnosis of myopia in children and adolescents was 0.91\〖95%CI(0.90-0.91)\〗, the pooled specificity was 0.84 \〖95%CI(0.84-0.85)\〗, and area under the SROC curve of 0.95 \〖95%CI(0.93-0.96)\〗.

CONCLUSION: The AL/CR is a good indicator of myopia in children and adolescents.

Abstract:AIM: To explore the predictive value of the combination of triglyceride-glucose(TyG)index, nesfatin-1, and retinol-binding protein 4(RBP4)for diabetic retinopathy, and provide evidence for early prediction of DR.

METHODS: The clinical data of 164 patients with type 2 diabetes mellitus(T2DM)who admitted to the hospital between February 2022 and December 2023 were retrospectively collected. Based on the fundus examination results, these patients were divided into two groups: the DR group(n=43), including proliferative DR(PDR, n=19)and non-proliferative DR(NPDR, n=24), and the T2DM without DR group(n=121). The TyG index and the level of nesfatin-1 and RBP4 were measured after admission.

RESULTS:T2DM patients with DR had a longer disease duration compared with T2DM patients without DR, and the DR group had higher fasting blood glucose, glycosylated hemoglobin, triglyceride, total cholesterol, low-density lipoprotein, TyG index, and RBP4 levels, while lower high-density lipoprotein and nesfatin-1 levels(all P<0.001). Multivariate Logistic regression analysis indicated that the duration of T2DM(OR=1.338, 95%CI: 1.059-1.690), glycosylated hemoglobin(OR=5.065, 95%CI: 1.659-15.470), low density lipoprotein(OR=12.715, 95%CI: 2.385-67.790), TyG index(OR=23.057, 95%CI: 2.936-181.073)and RBP4(OR=1.319, 95%CI: 1.028-1.692)were the independent risk factors for DR, while nesfatin-1(OR=0.007, 95%CI: 0.003-0.016)was an independent protective factor for DR. The ROC curves were drawn, and the results indicated that the TyG index, nesfatin-1, and RBP4 had certain predictive values for DR patients with T2DM, with areas under curve(AUC)of 0.804, 0.878 and 0.738, respectively. The combined AUC of the TyG index, nesfatin-1, and RBP4 was 0.946, sensitivity was 83.72%, and specificity was 92.56%. Patients with PDR had a higher TyG index, higher RBP4 level, and lower nesfatin-1 level than patients with NPDR(all P<0.05). Spearman's correlations indicated a positive association between the TyG index, RBP4 and DR degree, and a negative association between nesfatin-1 and DR degree(r_s=0.557, 0.392, -0.359, repectively, all P<0.05). Pearson correlation analysis indicated a negative correlation between the TyG index and the levels of nesfatin-1, a positive correlation between the TyG index and the levels of RBP4, and a negative correlation between the levels of nesfatin-1 and RBP4 in DR patients with T2DM(r=-0.486, 0.538, -0.592, all P<0.05).

CONCLUSION: The serum of TyG index and the levels of nesfatin-1 and RBP4 were early predictive markers for DR and were associated with the risk of the occurrence and severity of the disease. Besides, the combined prediction performance of TyG index, nesfatin-1, and RBP4 was better for DR.

Abstract:AIM: To investigate the effect of intense pulsed light(IPL)combined with meibomian gland massage in patients with meibomian gland dysfunction(MGD)related dry eye.

METHODS: Retrospectively selected 300 cases(300 right eyes)that diagnosed as MGD-related dry eye and treated in our hospital from October 2021 to October 2023, and they were divided into two groups according to the treatment modalities: 150 cases(150 eyes)in the control group were treated with meibomian gland massage, and 150 cases(150 eyes)in the observation group were treated with combined IPL. The efficacy of the two groups was compared, as well as the changes in tear film stability indexes \〖tear film break-up time(BUT), Schirmer I test(SIT)\〗, ocular surface disease index(OSDI)scores, tear film lipid layer thickness(LLT), mean objective scattering index(OSI), and the levels of inflammatory factors in the tear fluid \〖interleukin-10(IL-10)and IL-6\〗.

RESULTS: There was a difference in efficacy between the two groups of patients after treatment(88% vs 74%, P=0.002). At 8 wk after treatment, OSDI score, OSI, and tear IL-6 levels decreased, while BUT, SIt, LLT, and tear IL-10 levels increased in the two groups, and the observation group was better than the control group(all P<0.05).

CONCLUSION: IPL combined with meibomian gland massage for the treatment of dry eye patients with MGD is therapeutically effective, improving corneal stability and LLT, and reducing levels of OSI and inflammatory factors.

Abstract:AIM: To compare the effect of small-incision lenticule extraction(SMILE)with different corneal cap thicknesses on postoperative astigmatism and short-term visual quality of patients with myopic astigmatism.

METHODS: A total of 54 patients(108 eyes)with myopic astigmatism who underwent SMILE from June 2020 to June 2022 in our hospital were selected for the prospective controlled study, and patients were randomly assigned into two groups, with 27 cases(54 eyes)each. The corneal cap thickness design was 110 μm for the group A and 120 μm for the group B, while other operation parameters were consistent. Additionally, the uncorrected visual acuity(UCVA), spherical equivalent(SE), stiffness parameter A1(SP-A1), visual quality and vector parameters at baseline, 1 d,1 wk and 1 mo after surgery were compared between two groups.

RESULTS: There was a statistically significant difference in UCVA, SE, and SP-A1 between the two groups at various time points before and after surgery(all P<0.05), and UCVA in the group A was better than that in the group B at 1 d after surgery(P<0.05). There was no statistically significant difference in the results of astigmatism vector analysis between the two groups of patients(both P>0.05). The objective scattering index(OSI)of the group A was lower than that of the group B, while Strehl ratio(SR)of the group A was higher than that of the group B at 1 d after surgery(both P<0.05). There was no significant difference in modulation transfer function cutoff frequency(MTF cut off), contrast vision, visual symptoms and overall satisfaction, postoperative complications between the two groups(all P>0.05).

CONCLUSION: SMILE procedures with both 110 μm and 120 μm corneal cap thicknesses are safe and effective in correcting myopic astigmatism without affecting postoperative SE, astigmatism, SP-A1 or contrast visual acuity. Whereas 110 μm corneal cap thickness results in faster early postoperative visual recovery and better early visual quality than 120 μm.

Abstract:AIM: To investigate the early visual quality after 0.05 D interval spherical lens optometry-guided small incision lenticule extraction(SMILE)for the correction of different degrees of myopia.

METHODS: Retrospective study. A total of 200 cases(200 eyes)that underwent SMILE at the 989th Hospital of Joint Logistic Support Force from May to September 2023 were selected. The 0.05 D optometry was used to measure diopter. According to the preoperative spherical equivalent(SE), they were divided into low-to-moderate myopic group(>-6.0 D)and high myopic group(≤-6.0 D), with 100 eyes in each group. The total high-order corneal aberration(HOA), spherical aberration, coma and trefoil aberration were compared between the two groups preoperatively and at 6 mo postoperatively, and the quality of vision questionnaire was completed.

RESULTS: The HOA, spherical aberration and vertical coma aberration in the two groups at 6 mo after operation were significantly higher than those before operation(all P<0.05). At 6 mo postoperatively, the HOA, spherical aberration and vertical coma aberration in the low-to-moderate myopic group were lower than those in the high myopic group(all P<0.05). The scores of the quality of vision questionnaire, near vision, night vision, night glare and visual fatigue in the low-to-moderate myopic group were all higher than those in the high myopic group(all P<0.05).

CONCLUSION: Both low-to-moderate myopia and high myopia after the 0.05 D interval spherical lens optometry-guided SMILE had some visual symptoms, but great visual quality can be obtained after surgery.

Abstract:AIM: To evaluate the refractive status through computer refractometer and OPD-Scan III auto refractometer in cataract patients after extended depth of focus(EDOF)intraocular lens implantation.

METHODS: Retrospective observational study. A total of 61 cases(76 eyes)that received phacomulsification and implanted with TECNIS^® Symfony ZXR00 intraocular lens in Shanghai Eye Diseases Prevention & Treatment Center from May 2022 to May 2023 were collected. Measurements from the computer refractometer, OPD-Scan III auto refractometer, and subjective refraction, were taken from all patients on the same day postoperatively.

RESULTS: There were statistical significant difference in sphere(S)and spherical equivalent(SE)readings from the computer refractometer and subjective refraction(all P<0.01), with mean differences of -0.67±0.37 D and -0.75±0.35 D, respectively, and the S and SE obtained from computer refractometer more incline to myopia than those from subjective refraction; there were statistical significant difference in computer refractometer and subjective refraction(P<0.01), with a relative small absolute difference(0.21±0.24 D). The S, cylinder(C)and SE of computer refractometer(S, C, SE)were positively correlated with subjective refraction(r=0.7994, 0.7929, and 0.8118, respectively, all P<0.01). Additionally, there were statistical significant differences in S, C and SE of OPD-Scan Ⅲ and subjective refraction(P<0.01), and the absolute differences of S(0.63±0.36 D), C(0.35±0.26 D)and SE(0.53±0.36 D)were small. Furthermore, the S, C and SE of OPD-Scan Ⅲ were positively correlated with subjective refraction(r=0.4410, 0.4982, 0.5224, all P<0.01).

CONCLUSION: In patients who received implantation of EDOF lenses, the consistency of computer refractometer, OPD-Scan III auto refractometer and subjective refraction was good. The average difference of the S and SE obtained via computer refractometer was large, but both exhibited a myopic shift relative to those derived from subjective refraction, and the C values demonstrated minimal discrepancy. Furthermore, the differences between OPD-Scan III auto refractometer and subjective refraction were small, but the direction of the difference is unstable, sometimes it is myopic deviation, while sometimes it is hyperopic deviation.

Abstract:AIM: To investigate the influencing factors of corneal edema after phacoemulsification combined with intraocular lens(IOL)implantation in middle-aged and elderly patients with diabetic cataract, reducing postoperative complications of cataract in such patients.

METHODS: A total of 198 middle-aged and elderly patients(226 eyes)with diabetic cataract who underwent phacoemulsification combined with IOL implantation in Zhongxian People's Hospital of Chongqing from August 2021 to June 2023 were retrospectively analyzed, and they were divided into corneal edema group(n=53)and non-corneal edema group(n=173)according to their postoperative corneal edema. Baseline data were collected and compared between the two groups, and the operation-related indexes such as preoperative corneal thickness, endothelial cell density, operation time and effective phaco time were recorded and compared between the two groups. The influencing factors of corneal edema were analyzed by multivariate Logistic model, and the risk nomogram was drawn.

RESULTS: The age distribution of patients ≥60 years old in the corneal edema group was significantly higher than that in the non-corneal edema group, the duration of diabetes mellitus in the corneal edema group was significantly longer than that in the non-corneal edema group, and the lens nuclear hardness grade was significantly higher than that in the non-corneal edema group(all P<0.05). The changes in endothelial cell density in the corneal edema group were significantly higher than those in the non-corneal edema group(P<0.05); compared with the non-corneal edema group, the patients in the corneal edema group had a longer operation time and a longer effective phaco time(all P<0.05). Age, duration of diabetes mellitus, lens nuclear stiffness grade, operation time and effective phaco time were the risk factors for corneal edema after surgery(all P<0.05). When the total score of the patient risk nomogram is 150 points, the risk of corneal edema after surgery is about 65%.

CONCLUSION: The factors influencing the occurrence of corneal edema after phacoemulsification combined with IOL implantation include age, duration of diabetes, lens nuclear stiffness, operation duration and effective phaco time.

Abstract:AIM: To investigate the factors influencing non-response to intravitreal injection of anti-vascular endothelial growth factor(VEGF)therapy in fundus vascular diseases in a real-world setting.

METHODS: A retrospective analysis was conducted on 160 patients(160 eyes)with fundus vascular diseases, including 64 eyes(40.0%)of wet age-related macular degeneration(wARMD), 17 eyes(10.6%)of polypoidal choroidal vasculopathy(PCV), 45 eyes(28.1%)of diabetic macular edema(DME), 26 eyes(16.3%)of retinal vein occlusion-macular edema(RVO-ME), and 8 eyes(5.0%)of choroidal neovascularization(PM-CNV). All patients received 3+PRN anti-VEGF therapy. Factors influencing anti-VEGF treatment on the fundus vascular diseases were analyzed.

RESULTS: There were statistical significant difference in age, preoperative best corrected visual acuity(BCVA), hyper reflective dots(HRD), PCV, subretinal hyperreflective material(SHRM), and PM-CNV(all P<0.05). Logistics regression analysis noted that poor preoperative BCVA, age, intraretinal HRD, SHRM, PCV and PM-CNV were influencing factors of non-response to intravitreal injection of anti-VEGF in the treatment of fundus vascular diseases.

CONCLUSION: Non-response to anti-VEGF therapy in patients with fundus vascular diseases is associated with various factors, including age, baseline visual acuity, and disease pathology. Individualized treatment strategies should be explored to optimize outcomes for non-responding patients.

Abstract:AIM: To investigate the efficacy of lacrimal duct laser dacryoplasty combined with intubation and postoperative meibomian gland treatment in patients with chronic dacryocystitis complicated by meibomian gland dysfunction.

METHODS: Data were collected from 128 patients with chronic dacryocystitis complicated by meibomian gland dysfunction treated at Xi'an No.1 Hospital from March 2021 to December 2022. All patients underwent lacrimal duct laser dacryoplasty combined with intubation. Postoperatively, those patients were randomly divided into two groups: group A(64 cases, without meibomian gland treatment)and group B(64 cases, with meibomian gland treatment). The lacrimal intubation was removed at 3 mo after surgery to evaluate the patency rate of lacrimal irrigation. Additionally, changes in the ocular surface disease index(OSDI)score, non-invasive tear film break-up time, tear meniscus height, conjunctival hyperemia analysis, meibomian gland analysis, tear lipid layer thickness, tear ferning test, and conjunctival impression cytology were compared between the two groups.

RESULTS: The lacrimal irrigation patency rates in the group A and group B were 78.1% and 81.2% respectively, with no statistically significant difference between the two groups(P>0.05); compared with the group A, group B showed a significant extension in non-invasive tear breakup time at 3 mo after surgery, and the OSDI score, conjunctival hyperemia analysis, tear ferning test and conjunctival impression cytology grading were all significantly decreased(all P<0.05), while there was no significant difference in tear meniscus height, tear lipid layer thickness and meibomian gland loss score between the two groups(all P>0.05).

CONCLUSION: Comprehensive treatment for patients with chronic dacryocystitis combined with meibomian gland dysfunction have improved patients' comfort, tear film stability, and reduces local inflammatory response. It is important to simultaneously address ocular surface microenvironment abnormalities during surgical treatment to achieve satisfactory efficacy.

Abstract:AIM: To explore the clinicopathological and immunohistochemistry(IHC)characteristics of meibomian gland carcinoma(MGC).

METHODS: Patients who were pathologically diagnosed as MGC from January 1, 2015 to December 31, 2020 in our hospital were enrolled, and their clinicopathological information was retrospectively analyzed. Cancer tissues from all the cases were IHC stained. En Vision two-step method, DAB staining, as well as hematoxylin re-staining were applied in the IHC assay.

RESULTS: A total of 50 patients with 21 males and 29 females(1:1.38)were enrolled in the study, ranging from 26 to 80 years old, with a median age of 60 years. The upper eyelid, which was the predilection site, accounting for 66%(33/50). Histopathologically, moderately or poorly differentiated was in the majority(35/50, 70%). The expression rates of IHC parameters of MGC patients were as follows: GATA-3(49/50, 98%), EMA(49/50, 98%), CAM5.2(42/50, 84%), AR(41/50, 82%), MSH2(50/50, 100%), MSH6(50/50, 100%), MLH1(50/50, 100%), PMS2(50/50, 100%), Ki67(positive, 50%-90%). All the patients were followed up for 12 to 72 mo, with 5 cases of recurrence and 0 deaths.

CONCLUSION: Pathological diagnosis of MGC should focus on observing cancer cells' cytoplasm to find relevant clues for cortical gland differentiation. Comprehensive analysis of multiple indicators is required when using IHC to assist diagnosis. For most MGC cancer cells, positive expressions of GATA-3, EMA, AR, CAM5.2 and a high Ki67 proliferation index could be always found. In addition, screening for Muir-Torre syndrome related IHC indicators could be also performed in diagnosing MGC simultaneously.

Abstract:AIM:To summarize the clinical features and prognostic factors of patients with open ocular trauma in northwest China, and to explore the application of ocular trauma score(OTS)in open ocular trauma.

METHODS:The clinical data of 91 patients(91 eyes)with open ocular trauma admitted to Xijing Hospital from June 2021 to June 2023 were retrospectively analyzed. The correlation analysis of visual acuity prognosis was carried out by age, treatment time, initial visual acuity, trauma zone and other factors, and the relationship between different OTS and prognostic visual acuity was discussed.

RESULTS:Univariate analysis showed that age(0-20 years), treatment time(<24 h), initial visual acuity, trauma zone, trauma type(penetrating injury), anterior chamber hematoma, vitreous hematoma were correlated with prognostic visual acuity(all P<0.1); multivariate Logistic regression analysis showed that initial visual acuity and treatment time(<24 h)were risk factors(both P<0.05). There was a significant correlation between different OTS and prognostic visual acuity(r_s=0.639,P<0.001).

CONCLUSION:Patients with open ocular trauma should be diagnosed and treated as early as possible. The main factors influencing the visual prognosis are age, treatment time, initial visual acuity, trauma zone, trauma type, anterior chamber hematoma and vitreous hematoma. OTS has good application value in visual acuity evaluation of open ocular trauma prognosis.