Abstract:Visual information-processing disorder(VIPD)is a disorder of visual information-processing process caused by various factors, which is manifested by different degrees of reduction or loss of visuospatial ability, visual analytical ability, and visual-motor integration ability, which interferes with the normal visual cognitive and behavioral performance of individuals and causes many dysfunctions in daily life, schooling, and occupational settings. As a complex disorder, VIPD involves impaired visuospatial, analytical, and motor integration abilities, which seriously affects patients' lives, studies, and work. The causes of VIPD are diverse, including developmental abnormalities, craniocerebral trauma, ocular diseases and surgery,etc., and span multiple disciplines such as ophthalmology, pediatrics, neurology, rehabilitation, etc., which has become an urgent challenge in clinical diagnosis, treatment and rehabilitation practice. Currently, despite the increasing international attention to this disorder, there are still many deficiencies in its diagnosis and treatment in China. Medical workers have limited knowledge of the disorder, diagnostic methods lack standardization, and rehabilitation methods vary. In view of this, this guideline is compiled on the basis of European and American experience, combined with local research and practice, and developed under the auspices of the Optometry Branch of China Association of Ethnic Medicine, International Association of Ophthalmology, Ophthalmology Committee of International Association of Intelligent Medicine, Ophthalmic Imaging and Intelligent Medicine Branch of China Medical Education Association, Optometry Association of Fujian Province, with the aim of providing clinicians with comprehensive, systematic, and operational guidance on the diagnosis and treatment of VIPD and its rehabilitation, upgrading the level of diagnosis and treatment, and promoting multidisciplinary collaboration, so as to improve the patients' visual function and quality of life.

Abstract:AIM:To investigate the characteristics of corneal endothelial cells(CEC)and nuclear density(ND)in cataract patients with type 2 diabetes and to assess the impact of blood glucose related indicators.

METHODS: A total of 187 cases(187 eyes)that underwent cataract surgery at our hospital from July 2023 to July 2024 were enrolled. CEC were measured using a non-contact specular microscope. ND was measured through IOLMaster 700. A total of 187 participants were further stratified based on glycosylated hemoglobin(HbA1c)and fasting blood glucose(FBG)levels. Correlation analyses and multiple linear regression analyses were used to elucidate the association between diabetic status and ocular parameters. We measured the concentrations of ascorbic acid(AA)in the aqueous humor of 52 participants.

RESULTS: Compared to the control group, the diabetic group exhibited larger maximum endothelial cell size, lower endothelial cell density(ECD), a reduced proportion of hexagonal cells, higher ND, and lower corneal vertex equivalent spherical power(Scv; P<0.05). Correlation analysis revealed those changes of CEC and ND were significantly associated with the level of FBG, HbA1c, and the duration of diabetes(P<0.05). Among 52 participants, diabetic patients had lower levels of AA in their aqueous humor, indicating a diminished antioxidant ability.

CONCLUSION:Diabetic state can significantly influence corneal maximum cell size, hexagonal cell ratio and ND in cataract patients, potentially linked to a decrease in total antioxidant capacity of the aqueous humor.

Abstract:AIM: To investigate how angles kappa and alpha affect postoperative visual quality in patients with multifocal intraocular lens(mIOLs)implantation.

METHODS: Retrospective cases series. A total of 46 patients(46 eyes)who underwent phacoemulsification were subsumed. The correlation between Preoperative angles kappa and alpha, wave-front aberrations and objective visual quality of cornea, internal, and total eye after surgery were analyzed using iTrace.

RESULTS: The magnitude of angle kappa was negatively correlated with internal and total modulation transfer function(MTF)at 3 mm; the magnitude of angle kappa was positively correlated with astigmatism, trefoil, higher-order aberrations(HOAs)of both internal and total eye at 3 mm. The magnitude of angle alpha was negatively correlated with total MTF and total Strehl ratio at 3 mm. The magnitude of angle alpha was positively correlated with corneal coma at 5 mm, internal astigmatism at both 3 mm and 5 mm, and total spherical aberration(SA)at 3 mm. Multivariate linear regression analysis showed that, among candidate independent variables(kappa, alpha, astigmatism, SA, coma, trefoil, and HOAs), astigmatism is the only independent factor for altering corneal MTF at 3 mm and 5 mm; astigmatism and HOAs emerged as independent factors for altering internal MTF at 3 mm and 5 mm, and total MTF at 3 mm; astigmatism, SA and HOAs emerged as independent factors for altering total MTF at 5 mm.

CONCLUSION: With greater preoperative angle kappa or angle alpha, patients who accept mIOL implantation tend to have larger internal astigmatism and HOAs, which resulting in poor visual quality, especially those with small pupil size.

Abstract:AIM:To investigate the mechanism by which Shuangdan Mingmu Capsules alleviate retinal inflammatory responses in mice with diabetic retinopathy(DR)through the inhibition of the cGAS-STING signaling pathway.

METHODS:SPF C57BL/6J male mice were first randomly divided into two groups: a DR model group(n=30)receiving daily intraperitoneal STZ injections(50 mg/kg)for 5 d, and a normal control group(n=10)receiving equivalent sodium citrate buffer. After successful diabetes induction, the mice were randomly divided into model group, Shuangdan Mingmu Capsules group, and positive drug group, with 10 mice in each group. The Shuangdan Mingmu Capsules group received gavage with Shuangdan Mingmu Capsules solution at a clinically equivalent dose(11.2 g/kg), while the positive drug group received gavage with Calcium Dobesilate solution at an equivalent dose of 11.6 mg/kg. The model group and the normal group received gavage with an equal volume of normal saline. Each group of mice received gavage once daily, and after 8 weeks of intervention treatment, Evans blue staining was used to detect the retinal leakage in each group of mice, HE staining was used to detect changes in the retinal tissue structure, TUNEL staining was used to observe the apoptosis of retinal cells, and immunofluorescence was used to detect the expression levels of retinal Rhodopsin, Opsin, Iba1 and GFAP. Furthermore, Western blot was used to detect the protein expression levels of cGAS, STING, TNF-α, IL-6 and IL-1β in the mouse retina.

RESULTS:Compared with the normal group, the model group mice exhibited increased levels of neuroretinal leakage, retinal thinning, and elevated retinal cells apoptosis, accompanied by upregulation of Iba1 and GFAP expression levels in the retina, and downregulation of Rhodopsin and Opsin expression. The protein expression levels of cGAS, STING, TNF-α, IL-6, and IL-1β in the retinal tissue were significantly increased. In contrast to the model group, the Shuangdan Mingmu Capsules group and positive drug group mice showed decreased levels of neuroretinal leakage and retinal cells apoptosis, along with downregulation of Iba1 and GFAP expression levels in the retina, and upregulation of Rhodopsin and Opsin expression. The protein expression levels of cGAS, STING, TNF-α, IL-6, and IL-1β in the retinal tissue were significantly decreased. However, there was no significant difference between the Shuangdan Mingmu Capsules group and the positive drug group.

CONCLUSION:Shuangdan Mingmu Capsules exert therapeutic effects on retinal inflammation and early damage in DR mouse models, with the underlying mechanism involving the inhibition of the cGAS-STING signaling pathway.

Abstract:AIM: To compare the visual quality in patients with low-to-moderate myopia after 0.05 D interval spherical lens optometry-guided small-incision lenticule extraction(SMILE)and conventional 0.25 D interval spherical lens optometry-guided SMILE.

METHODS: Retrospective study. A total of 400 cases(400 eyes)with low-to-moderate myopia that underwent SMILE in the ophthalmology department of 989th Hospital of Joint Logistic Support Force from August 2021 to August 2023 were enrolled and the data from the right eyes were collected for analysis. According to the method of optometry test modality, they were divided into 0.05 D group and 0.25 D group, with 200 eyes in each group. The differences were compared between the two groups of patients in intraoperative corneal ablation thickness, uncorrected distance visual acuity(UDVA), high-order corneal aberrations(HOA), spherical aberrations, vertical coma, horizontal coma and trefoil aberrations before and at 1, 3 and 6 mo after surgery. Additionally, the percentage of eyes with residual spherical equivalent(SE)≤±0.25 D, postoperative visual symptoms and scores on the quality of visual(Qov)were compared between the two groups at 6 mo after surgery.

RESULTS: The corneal ablation thickness in the 0.05 D group was 92.78±16.56 μm, which was slightly higher than that in the 0.25 D group(83.24±17.33 μm; P<0.001). The UDVA at each postoperative time point in the 0.05 D group was superior to that in the 0.25 D group(all P<0.001). The HOA, spherical aberration, horizontal coma and vertical coma in the two groups at 1, 3 and 6 mo after operation were higher than those before operation(all P<0.05). The spherical aberration in the 0.05 D group at each time point after surgery were higher than those in the 0.25 D group, and vertical coma were lower than those in the 0.25 D group(all P<0.05). At 6 mo postoperatively, the percentage of eyes with residual SE ≤±0.25 D in the 0.05 D group was 97.5%(195 eyes), which was higher than 87.5%(175 eyes)in the 0.25 D group(P<0.05). The most common adverse visual symptoms after SMILE in both groups were hazy vision and glare. The total Qov score in the 0.05 D group was 0.35(0.24, 0.55), which was lower than \〖0.62(0.32, 0.89)\〗 in the 0.25 D group(P<0.05).

CONCLUSION: Compared with conventional 0.25 D interval spherical lens optometry-guided SMILE, the 0.05 D interval spherical lens optometry-guided SMILE for the correction of low-to-moderate myopia has better predictability and can achieve better vision and visual quality.

Abstract:AIM: To quantitatively evaluate the clinical characteristics of haze after transepithelial photorefractive keratectomy(TPRK)for astigmatism using corneal densitometry.

METHODS:In this retrospective clinical study, a total of 74 patients(106 eyes)with astigmatism ≥1.25 D who underwent TPRK in our hospital from October 2022 to December 2024 were continuously collected. All of the study subjects were divided into transparent group(65 eyes)and haze group(41 eyes)based on whether haze occurred after surgery. Pentacam examination was performed before and after surgery, and corneal densitometry was recorded at the time points of preoperation, 1 mo postoperation in the transparent group and the most severe haze degree in the haze group. The collected corneal densitometry included the average densitometry of the entire corneal layer in the central 2 mm, 2-6 mm, and 6-10 mm areas, as well as the average densitometry of the entire layer of the corneal section in the center 6 mm of the astigmatism axis(astigmatism expressed in negative cylindrical form)and orthogonal axis(the axis perpendicular to the astigmatism axis), and the average densitometry of the entire layer of the corneal section in the nasal and temporal 2-6 mm areas of the astigmatism axis in the haze group of patients with regular astigmatism. The change in corneal densitometry after surgery compared with that before surgery was calculated.

RESULTS:There was no statistically significant difference in baseline data such as gender, age, and spherical equivalent between the transparent group and the haze group(all P>0.05). The change in corneal densitometry in the 2-6 mm area of the haze group was greater than that in the transparent group(Z=-2.226, P=0.026), while there was no significant difference in the change of corneal densitometry in the central 2 mm and 6-10 mm areas between the two groups(both P>0.05). There was no significant difference in the change of corneal densitometry between the transparent group and haze group along the orthogonal axis(all P>0.05), while the change of corneal densitometry in the haze group along the astigmatism axis was greater than that in the transparent group(Z=-2.371, P=0.018). The temporal corneal densitometry of patients with regular astigmatism in the haze group after surgery was higher than that of the nasal side, and the change in corneal densitometry was also greater than that of the nasal side(Z=-4.288, P<0.001; Z=-4.043, P<0.001).

CONCLUSION:Unlike spherical correction for myopia and hyperopia, haze after TPRK for astigmatism was mainly manifested in the peripheral cutting area of the astigmatism axis, and patients with regular astigmatism had a higher probability or severity of haze on the temporal side of the astigmatism axis than on the nasal side.

Abstract:The mitochondrial unfolded protein response(UPRmt)represents a crucial intracellular stress response mechanism that plays a fundamental role in maintaining mitochondrial and cellular homeostasis. Growing evidence suggests that dysregulation of UPRmt contributes significantly to the pathogenesis of various systemic disorders, including neurodegenerative diseases such as Parkinson's and Alzheimer's diseases, as well as age-related pathologies. Emerging research has particularly highlighted the involvement of UPRmt in ocular diseases, including cataracts, glaucoma, and diabetic retinopathy. This comprehensive review examines the physiological functions of UPRmt and its regulatory mechanisms in age-related eye diseases. The roles of key UPRmt downstream effector molecules in ocular cell populations such as lens epithelial cells, retinal pigment epithelial cells, and retinal ganglion cells are systematically analyzed. Importantly, the dual regulatory nature of UPRmt in ocular pathophysiology is discussed, that is, its moderate activation promotes mitochondrial homeostasis, mitigates oxidative stress, and suppresses inflammatory responses, its chronic or excessive activation triggers apoptotic pathways, induces metabolic dysfunction, and ultimately accelerates disease progression. By elucidating these mechanisms, our review provides novel insights into ocular disease pathogenesis and proposes potential therapeutic strategies targeting UPRmt modulation for the prevention and treatment of age-related eye disorders.

Abstract:Amblyopia is a common visual development disorder and is the main cause of monocular vision impairment in children and adults. Photobiomodulation(PBM), a non-invasive treatment method, has gradually gained attention in the field of ophthalmology. This paper begins with the macroscopic manifestation of light on the animal model of amblyopia. Additionally, it discusses the pathological changes of the amblyopic retina and the human eye's central nervous system, as well as the influence and mechanism of PBM on the visual perception and processing system and its chemical effect on the visual system through dopamine and melatonin. It examines its mechanism of action, current clinical application status, and future development direction in order to provide new ideas and theoretical foundation for amblyopia treatment.

Abstract:Cataract is the world's leading cause of blindness, and surgery is the most effective treatment for cataract. With the development of femtosecond laser technology and ophthalmic surgical equipment, the application of femtosecond laser systems in cataract surgery is becoming increasingly widespread. It can be used in cataract surgery for corneal incisions, anterior capsulotomy, lens fragmentation, arcuate incisions and other key operations. Compared to traditional surgery, femtosecond laser assisted cataract surgery(FLACS)offers significant advantages in precision, safety and postoperative visual outcomes. Its clinical benefits have garnered growing recognition among ophthalmologists. However, the key technologies and high-precision equipment for FLACS remain predominantly controlled by Western countries. In China, the research in this field began later. This article reviews the technological advancements in FLACS, with a focus on femtosecond laser technology, optical coherence tomography(OCT), artificial intelligence, and clinical application progress. The objective is to provide theoretical foundations and practical insights for the development of ophthalmic medical technology in China.

Abstract:The anterior chamber(AC), a space bounded anteriorly by the cornea and posteriorly by the iris and the lens in the pupillary zone, is one of the most significant parameters in the anterior segment of the eye clinically. It is closely associated with the pathogenesis, progression, and treatment of various ocular diseases. Accurate preoperative assessment and utilization of anterior chamber depth(ACD)before surgery are crucial for achieving optimal postoperative visual outcomes. The term, effective lens position(ELP), has been introduced in recent years to better describe the postoperative position of the intraocular lens(IOL). To enhance the comprehension of ACD and ELP, this review elaborates on their definitions and interrelationship. It enumerates preoperative ACD measurement methodologies and compares the applicability of different devices. Furthermore, the review synthesizes its application on IOL power calculation and ELP prediction, recommending optimized formulas such as the Kane formula for scenarios with atypical ACD. The discussion extends to the impact of abnormal ACD on postoperative visual quality and relevant intraoperative interventions, aiming to provide evidence-based references for clinical practice.

Abstract:Normal tension glaucoma(NTG)is a chronic optic neuropathy characterized by progressive damage to the optic nerve and visual field defects, with its pathophysiology closely linked to genetic, immune-inflammatory and vascular factors. Optical coherence tomography angiography(OCTA)is a noninvasive imaging technique that provides real-time, quantitative assessment of retinal microvascular perfusion. In recent years, OCTA has been increasingly applied in NTG studies, demonstrating significant potential in early diagnosis, disease monitoring and management. This systematic review summarizes the latest advancements in the application of OCTA for NTG, with a focus on vascular parameters in the optic nerve head and macular regions. Its diagnostic value and monitoring management are further summarized. Moreover, the current limitations of OCTA technology and the challenges related to its clinical application are critically evaluated, while exploring its future developments. These insights aim to provide a theoretical foundation for further research on NTG-related microvascular pathology and the broader clinical application of OCTA.

Abstract:Age-related macular degeneration(AMD)is a prevalent retinal degenerative disease closely linked to age and stands as a leading cause of central vision loss among the elderly. Under physiological condition, microglia in the retina plays crucial roles in tissue homeostasis, immune surveillance, and tissue repair. However, in pathological state, microglia can be abnormally activated and migrate to AMD lesion sites, which results in exacerbating damage to retinal pigment epithelial cells and photoreceptor cells, thus promoting the progression of AMD. This review focuses on the origins, distribution, and functional changes of microglia under physiological and pathological conditions. Recent advances in microglia-targeted therapies for AMD are also summarized, which provides a theoretical basis for the development of novel treatment strategies.

Abstract:Age-related macular degeneration(ARMD)is a leading cause of irreversible vision loss in the elderly, characterized by complex mechanisms such as oxidative stress, inflammation, and metabolic dysregulation. In vitro cellular models have become indispensable in ARMD research, enabling the study of ARMD pathogenesis, drug screening, and treatment evaluation through retinal microenvironment simulation. This review provides a systematic overview of recent advances in various in vitro models for ARMD research, encompassing retinal pigment epithelium(RPE)cell cultures, 3D bioprinted retinal constructs, and organoid technologies. We critically examine their development methodologies, experimental applications, as well as comparative strengths and weaknesses. The review also addresses ongoing debates and technical challenges in this research domain. In the future, continued progress in microfluidic platforms, gene-editing tools, and 3D bioprinting technologies promises to enhance the precision and patient-specific relevance of these models, ultimately facilitating earlier diagnosis and more tailored therapeutic interventions for ARMD.

Abstract:Fundus neovascular diseases(FNDs)are ocular diseases caused by pathological changes in retinal blood vessels, which are the leading cause of visual impairment globally. The overexpression of vascular endothelial growth factor(VEGF)plays an important role in the formation of new blood vessels, and the current first-line treatment for FNDs is anti-VEGF drugs. The eyes have a special blood-eye barrier, which makes it difficult for eye drops, oral or intravenous drugs to enter the eye and exert their effects. Intraocular injection can bypass this barrier and directly inject drugs into the eye, which is the main route of administration for the treatment of eye diseases. Compared with systemic administration, it is more conducive to enrich the drug at the target site and reduce systemic adverse reactions. Intraocular administrations include intravitreal injection(IVI), suprachoroidal space(SCS)injection, subretinal injection(SRI), drug delivery systems and other invasive intraocular treatments. Previous studies have shown that different intraocular administration methods can affect the pharmacokinetic(PK)properties of drugs. This article reviews the PK changes of anti-VEGF drugs under different intraocular administration methods.

Abstract:Retinal vascular diseases(RVD)are among the leading causes of blindness worldwide, with their prevalence showing an increasing trend year by year. Among them, age-related macular degeneration(ARMD), diabetic macular edema(DME), and retinal vein occlusion(RVO)are the most common types. Faricimab, developed by Roche's CrossMAB platform, is a novel bispecific monoclonal antibody that can simultaneously target and inhibit vascular endothelial growth factor-a(VEGF-A)and angiopoietin-2(Ang-2). The dual inhibition of these two key factors by Faricimab endows it with the potential to regulate angiogenesis and inflammatory responses more comprehensively and effectively, thus bringing new opportunities for the treatment of RVD.

Abstract:Recent years have witnessed significant advancements in myopia control research through the application of diffuse optical technology(DOT)spectacle lenses. Myopia has emerged as a global public health challenge, affecting nearly half of the world's population, with childhood and adolescent myopia rates continuing to rise. DOT lenses represent an innovative myopia control intervention based on retinal contrast signal theory. These lenses incorporate micro-light scattering dots distributed across the lens surface to reduce retinal imaging contrast and modulate the influence of visual input on axial elongation, thereby slowing myopia progression. The core mechanism operates through refractive index differences between the lens substrate(1.53)and scattering dots(1.50), which generate optical scattering effects. This design maintains clear vision through a central 5 mm optical zone while effectively reducing contrast signal intensity in the peripheral retina. Large-scale randomized controlled trials, including the CYPRESS study, have demonstrated significant myopia control efficacy in children aged 6-10 years: 12-month follow-up data revealed a 74% reduction in myopia progression and a 50% reduction in axial elongation, with sustained safety and visual quality maintained over 4-year long-term follow-up. However, several aspects of DOT technology remain contentious and require further clinical validation, including its applicability across different age groups, optimal scattering dot density configurations, combined application effects with other myopia control methods, and long-term visual adaptation during extended use. This review systematically examines the theoretical foundations, design characteristics, clinical application progress, and future development directions of DOT technology, providing scientific evidence for clinical myopia prevention and control strategy formulation.

Abstract:AIM: To investigate the causal effects of ceramides on retinal vein occlusion(RVO)and elucidate their potential mediating mechanisms using Mendelian randomization(MR)analysis.

METHODS: Genome-wide association study(GWAS)data for four ceramide species were utilized as exposures, and RVO GWAS data from the FinnGen database as the outcome. Additionally, GWAS data for 1 400 intermediate metabolites were analyzed to identify potential mediators in the ceramide-RVO pathway.

RESULTS: Two ceramide species exhibited significant causal associations with RVO: ceramide(d40:1)\〖IVW OR(95% CI): 0.750(0.604-0.930), P<0.05\〗 and ceramide(d42:2)\〖IVW OR(95% CI): 0.771(0.632-0.941), P<0.05\〗, suggesting protective effects. Mediation analysis revealed that ceramide(d40:1)influenced RVO risk through metabolites including 3-methylxanthine, branched/straight-chain/cyclopropyl 10:1 fatty acids, glutamine, and hydroxypalmitoyl sphingomyelin. Similarly, ceramide(d42:2)acted via N-methylhydroxyproline, the same fatty acid group, N1-methyladenosine, and the leucine-to-N-palmitoyl-sarcosinate ratio.

CONCLUSION: Ceramides(d40:1)and(d42:2)confer protection against RVO, partially mediated by specific metabolic pathways.

Abstract:AIM: To explore the diagnostic value of combining the corneal stress-strain index(SSI)with corneal biomechanical parameters for early keratoconus.

METHODS:A retrospective study was conducted on 34 patients(53 eyes)with early keratoconus diagnosed and treated in our hospital from March 2022 to February 2024. Additionally, 112 normal volunteers(112 eyes)who underwent physical examinations in our hospital during the same period were selected as a healthy control group. The CorvisST equipment was utilized for measurement and recorded deformation with Scheimpflug camera to obtain 10 biomechanical parameters: first applanation time(A1T), first applanation length(A1L), velocity of initial applanation(Vin), second applanation time(A2T), second applanation length(A2L), velocity of outward applanation(Vout), highest concavity time(HCT), highest concavity depth of applanation(HCDA), highest concavity radius(HCR), and peak distance(PD), as well as stress-strain index(SSI), and the corneal biomechanical parameters of the two groups were compared. Furthermore, Logistic regression analysis was used to identify the risk factors for keratoconus, and ROC curves were plotted to analyze the biomechanical parameters of the cornea for early diagnosis of keratoconus.

RESULTS:The SSI(0.77±0.17)in patients with keratoconus was lower than that in healthy controls(1.01±0.24; P<0.001). Patients with keratoconus had lower A1T, A1L, A2L, and HCR, and higher Vout, HCDA, and PD compared to healthy controls(all P<0.001). Logistic regression analysis showed that decreased SSI, A1T, A1L, A2L, and HCR, as well as increased Vout, HCDA, and PD, were risk factors for the development of keratoconus(P<0.001). ROC curve analysis showed that the AUC value for combined diagnosis of early keratoconus was 0.997, with a Youden's index of 0.954, sensitivity and specificity of 98.1% and 97.3%, respectively, and a 95% CI of 0.994-1.000.

CONCLUSION:The combination of SSI and corneal biomechanical parameters holds diagnostic significance for early keratoconus, and the joint diagnostic value is even higher. It can be considered as a diagnostic or screening indicator for early keratoconus.

Abstract:AIM: To investigate the expression of serum growth differentiation factor 11(GDF11)and thrombospondin 1(TSP1)in patients with diabetic retinopathy(DR), and discuss their relationship with microvascular injury.

METHODS: Totally 102 DR patients were served as DR group and assigned into non proliferative DR group(NPDR group)and proliferative DR group(PDR group)based on the severity of DR lesions. Meantime, 100 patients with simple diabetes were served as control group. Serum indicators of microvascular injury including vascular endothelial growth factor(VEGF), endothelial cells(ECs), endothelial progenitor cells(EPCs), and levels of GDF11 and TSP1 were measured in each group. Pearson method was used to discuss the correlation between GDF11, TSP1 and microvascular injury indicators. Logistic regression was used to discuss the factors that affected the occurrence of DR. Receiver operating characteristic(ROC)curve was applied to analyze the evaluation value of serum GDF11 and TSP1 for the DR conditions.

RESULTS: For the control group, DR group had lower EPCs and GDF11, and higher VEGF, ECs, and TSP1 levels(all P<0.05). The PDR group had lower GDF11 and higher TSP1 than the NPDR group(all P<0.05). Serum GDF11 was negatively related to VEGF and ECs(r=-0.486, -0.511, all P<0.001), and positively related to EPCs(r=0.475, P<0.001). TSP1 was positively related to VEGF and ECs(r=0.579, 0.594, all P<0.001), and negatively related to EPCs(r=-0.505, P<0.001). Moreover, GDF11 and TSP1 were negatively correlated(r=-0.443, P<0.001). The course of T2DM, VEGF, and TSP1 were risk factors for DR, while GDF11 was a protective factor(all P<0.05). The AUC of GDF11, TSP1, and combined diagnosis for PDR conditions was 0.819, 0.822, and 0.915, respectively. The combined diagnosis was better than single diagnosis(Z_{combination-GDF11}=2.070, P=0.039, Z_{combination-TSP1}=2.274, P=0.023).

CONCLUSION: GDF11 and TSP1 are closely associated with microvascular injury in DR patients and are related to the progression of DR disease, and the combined detection of their serum levels is of clinical value in the assessment of DR disease.

Abstract:AIM: To investigate the risk factors associated with the recurrence of macular edema secondary to branch retinal vein occlusion(BRVO-ME)after anti-vascular endothelial growth factor(anti-VEGF)therapy.

METHODS:A total of 32 patients(32 eyes)with BRVO-ME who were treated at the ophthalmology department of the Affiliated Hospital of Shandong Second Medical University from February 2021 to June 2022 were selected. They were treated with a 3+pro re nata (PRN)anti-VEGF regimen and followed up for 6 mo. Following 3 consecutive anti-VEGF injections, patients were categorized into a non-recurrence group and a recurrence group based on central macular thickness(CMT)measured by optical coherence tomography(OCT)at 6 mo post-treatment. Aqueous humor levels of various cytokines levels were quantified using suspension assay method. Demographic characteristics, CMT, and cytokine levels were compared between the two groups, and their correlations with the recurrence of BRVO-ME after anti-VEGF treatment were analyzed.

RESULTS:At 6 months post-treatment, ME resolved in 19 eyes(no recurrence group), while 13 eyes showed persistent or recurrent ME(recurrence group). Compared to baseline, the CMT significantly improved in both groups at 1 d, 1, and 6 mo post-treatment(all P<0.05). However, the recurrence group exhibited significantly higher baseline, 1 d and 6 mo post-treatment CMT values than the non-recurrence group(all P<0.05). The aqueous humor levels of VEGF and monocyte chemoattractant protein-1(MCP-1)at baseline were significantly higher in the recurrence group than the non-recurrence group(all P<0.05). Spearman correlation analysis revealed positive associations between baseline CMT and interlukin IL-1β, IL-5, IL-12, MCP-1 and IP-10 levels(all P<0.05). Multivariable Logistic regression analysis identified baseline CMT and MCP-1 levels as independent risk factors for BRVO-ME recurrence(OR>1, P<0.05).

CONCLUSION: Elevated baseline CMT and aqueous humor MCP-1 levels were identified as independent risk factors for BRVO-ME recurrence after anti-VEGF therapy. Patients exhibiting higher baseline CMT and MCP-1 levels demonstrated significantly increased susceptibility to recurrence.

Abstract:AIM: To assess the consistency of the new anterior segment analyzer, MS-39, the Sirius and Pentacam in measuring corneal white-to-white(WTW)and central anterior chamber depth(ACD), and to compare their differences in guiding implantable collamer lens(ICL)size selection.

METHODS: Retrospective case study. A total of 210 consecutive patients(420 eyes)who treated at the Ophthalmology Refractive Surgery Center of the First Affiliated Hospital of Xi'an Jiaotong University between September 2019 and September 2020 were enrolled. Three anterior segment analysis systems, MS-39, Sirius, and Pentacam, were utilized to assess the WTW and ACD, with comparative analysis of the results. The sizing of the ICL V4c was simulated using the method recommended by the STAAR company. Data correlation and consistency were evaluated.

RESULTS: The WTW measurement results obtained from MS-39, Sirius, and Pentacam were 11.39±0.35, 11.42±0.36, and 11.46±0.35 mm, respectively. Notably, the WTW measurement value from MS-39 was significantly lower than that from Pentacam(P=0.002), while no statistically significant differences were observed between MS-39 and Sirius, or between Sirius and Pentacam(all P>0.05). The WTW measurements from the three devices exhibited a strong positive correlation, with correlation coefficients(r)of 0.942 between MS-39 and Sirius, 0.925 between MS-39 and Pentacam, and 0.882 between Sirius and Pentacam(all P<0.0001). The ACD measurements values from the MS-39, Sirius and Pentacam were 3.28±0.22, 3.28±0.24, and 3.21±0.23 mm, respectively. While, no statistically significant difference was found between MS-39 and Sirius(P>0.05), both measurements were significantly higher than that of Pentacam(both P<0.0001). The ACD measurements also demonstrated a strong positive correlation, with r values of 0.959 between MS-39 and Sirius, 0.947 between MS-39 and Pentacam, and 0.932 between Sirius and Pentacam(all P<0.0001). In terms of ICL size selection based on the measurements from the three devices, the 12.6 mm size was the most frequently selected, while the 13.7 mm size was the least common, the distribution of size selections across the devices was similar.

CONCLUSION: MS-39 demonstrated strong positive correlation with both Sirius and Pentacam for WTW and ACD measurements, indicating that the results can be considered clinically interchangeable. Furthermore, the outcomes derived from MS-39 for ICL size selection were closely aligned with those from Sirius and Pentacam, suggesting its clinical feasibility.

Abstract:AIM:To analyze the clinical phenotypes and genotypes of children with incontinentia pigmenti(IP)and enhance clinicians' understanding of the condition.

METHODS: A family with IP diagnosed in February 2020 at the ophthalmology department of People's Hospital of Ningxia Hui Autonomous Region was enrolled. The proband and family members underwent comprehensive systemic and ocular examinations. Peripheral venous blood was collected for DNA extraction, followed by whole-exome sequencing and MLPA assay to identify pathogenic variants. Corresponding treatments were administered based on the severity of fundus lesions, and ocular clinical features and therapeutic outcomes were monitored during follow-up.

RESULTS: The child in this study was a female, aged 8 years, with typical skin changes and scarring alopecia and dental abnormalities at the time of initial consultation. The results of genetic testing suggested that the child carried a heterozygous deletion of exons 4-10 of the IKBKG gene chrX:153440010-153446570del. The child had asymmetric lesions in both eyes, with severe lesions in the left eye, atrophy of the eyeballs, and ocular B-ultrasound suggesting structural disturbances in the eye, and neovascularization was seen in the peripheral retina of the right eye, and the patient was given laser photocoagulation treatment for the right eye, and no progression of retinopathy was detected during follow-up.

CONCLUSION:Children with IP have different ocular clinical phenotypes, and retinal vasculopathy is the main change. Early screening and timely and standardized treatment are crucial for children diagnosed with IP.

Abstract:AIM: To evaluate the safety and efficacy of allogeneic intrastromal lenticule implantation combined with corneal collagen cross-linking(CXL)in patients with moderate to advanced keratoconus.

METHODS: A retrospective case series analysis was conducted. A total of 19 patients(20 eyes)with moderate to advanced keratoconus who underwent combined allogeneic intrastromal lenticule implantation and CXL at the Jinan Mingshui Eye Hospital from June 2021 to December 2023 were included. The uncorrected distance visual acuity(UCVA), thinnest corneal thickness, central corneal epithelial thickness, anterior corneal flat keratometry(Kf), steep keratometry(Ks), and mean keratometry(Km), as well as the first applanation time(A1T), the first applanation length(A1L), the velocity during the first applanation moment(VIN), the second applanation time(A2T), the second applanation length(A2L), the velocity during the second applanation moment(VOUT), highest concavity time(HCT), highest concavity radius(HCR), peak distance(PD), deformation amplitude(DA), stiffness parameter at first applanation(SP-A1), integrated radius(IR), central corneal thickness(CCT), intraocular pressure(IOP), corneal thickness-corrected IOP, biomechanically intraocular pressure IOP(bIOP), and corneal thickness variation rate(ARTH)were compared between the two groups before surgery and at 1 wk, 1, 3 and 6 mo after surgery.

RESULTS: All patients successfully completed the surgery without any intraoperative complications. No significant differences were observed between pre-operative and post-operative measurements for UCVA or the corneal biomechanical parameters, including A1L, A2L, PD, A1T, A2T, VIN, VOUT, DA, IOP, and bIOP(all P>0.05). Significant differences were found between pre-operative and post-operative values for corneal thinnest point thickness, central corneal epithelial thickness, Kf, Ks, Km, and the corneal biomechanical parameters, including HCT, HCR, SP-A1, ARTH, IR, and CCT(all P<0.05). The anterior corneal curvature demonstrated an initial increase followed by a decrease post-operatively. Furthermore, significant differences were observed between pre-operative and post-operative values for HCT, HCR, SP-A1, ARTH, IR, and CCT(all P<0.005).

CONCLUSION: Allogenic intrastromal lenticule implantation combined with corneal collagen cross-linking demonstrates favorable safety and stability in treating moderate-to-advanced keratoconus. This combined procedure effectively increases corneal thickness and rigidity, resulting in corneas that are more resistant to deformation postoperatively.

Abstract:AIM: To investigate the effect of coaxial micro-incision phacoemulsification combined with intraocular lens(IOL)implantation on visual acuity recovery and safety in patients with age-related cataract.

METHODS:A total of 98 patients(98 eyes)with age-related cataract in our hospital from December 2022 to December 2023 were selected. According to the different surgical methods, they were divided into control group and observation group, with 49 cases(49 eyes)in each group. The control group was treated with 3.0 mm standard incision phacoemulsification combined with IOL implantation, and the observation group was treated with 2.2 mm coaxial micro-incision phacoemulsification combined with IOL implantation. The best corrected visual acuity(BCVA), corneal astigmatism and corneal endothelial cell indexes were compared between the two groups before and after surgery. The occurrence of postoperative complications was counted to evaluate the safety of the treatment.

RESULTS: The BCVA(LogMAR)of the two groups decreased at 1 d, 1 wk, 1 and 3 mo after surgery(P<0.05), and the BVCA of the observation group was better than that of the control group at 1 d, 1 wk, 1, and 3 mo after surgery(P<0.05). Compared with pre-operation, the corneal astigmatism of the two groups increased at 1 d, 1 wk and 1 mo after operation(P<0.05), and there was no significant difference between the two groups in corneal astigmatism at 3 mo after surgery(P>0.05). There was no significant difference between the two groups in corneal astigmatism at 3 mo after operation(P>0.05). Compared with the preoperative values, the corneal endothelial cell density and hexagonal cell proportion were significantly decreased, and the coefficient of variation of corneal endothelial cells was increased in the two groups at 3 mo after surgery(P<0.05), but there was no significant difference between the two groups in the above indexes after surgery(P>0.05). The incidence of postoperative complications in the two groups was 8%(4/49)and 4%(2/49), respectively, and the difference was not statistically significant(P>0.05).

CONCLUSION: Coaxial micro-incision phacoemulsification combined with IOL implantation can improve the BCVA of age-related cataract patients, and reduce the influence of corneal astigmatism, which is relatively safe.

Abstract:AIM: To investigate the efficacy of Yangyin Yiqi Decoction combined with polyethylene glycol eye drops on dry eye disease after cataract surgery and its effect on inflammatory factors in tears.

METHODS:Prospective study. A total of 104 patients(104 eyes)with dry eye disease after cataract surgery admitted to our hospital from April 2022 to March 2024 were selected and randomly divided into two groups: 52 cases(52 eyes)in the control group were treated with polyethylene glycol eye drops; 52 cases(52 eyes)in the combined group were treated with Yangyin Yiqi Decoction combined with polyethylene glycol eye drops. The dry eye symptom score, tear film stability index, tear inflammatory factor level, ocular surface disease index score(OSDI)and clinical efficacy of the two groups were compared before and after treatment.

RESULTS:There were 6 cases(6 eyes)lost to follow-up, and 3 cases(3 eyes)were lost to follow-up in each group, with a loss to follow-up rate of 5.8%. The total effective rate of treatment in the combination group was significantly higher than that in the control group(94% vs 80%, P=0.037), and the Schirmer I test(SIt)and tear film break-up time(BUT)were higher than those in the control group(all P<0.05), and the dry eye symptom score, corneal fluorescein staining(FL)score, IL-1β, TNF-α, hs-CRP levels in tears and OSDI score were lower than those in the control group(all P<0.05).

CONCLUSION:The combination of Yangyin Yiqi Decoction and polyethylene glycol eye drops provides an effective treatment plan for patients with dry eye disease after cataract surgery. It can effectively alleviate dry eye symptoms, reduce eye discomfort, improve tear film stability and ocular surface status, and reduce inflammatory factors in tears.

Abstract:AIM: To explore the therapeutic effect of oral Xuefu Zhuyu Pill combined with intravitreal injection of aflibercept in the treatment of retinal vein occlusion(RVO).

METHODS: A total of 80 patients(80 eyes)with RVO admitted to our hospital from January 2021 to March 2024 were prospectively selected. According to the treatment method, they were divided into a control group of 40 patients treated with intravitreal injection of aflibercept, and an observation group of 40 patients treated with oral Xuefu Zhuyu Pill combined with intravitreal injection of aflibercept. The efficacy, TCM syndrome score, retinal microcirculation parameters, macular edema(ME), and adverse reactions were compared between the two groups of patients in the treatment of RVO.

RESULTS: All patients have completed follow-up. The clinical effective rate of the observation group after treatment was 95%, obviously higher than that of the control group(80%; χ²=4.114, P=0.043). After treatment for 3 mo, the traditional Chinese medicine syndrome scores, foveal avascular area(FAZ)area, FAZ circumference, macular central retinal thickness, and neovascularization leakage area of both groups decreased, the overall blood flow density of the superficial capillary plexus(SCP)and deep capillary plexuses(DCP)increased, and the observation group showed better results than the control group(all P<0.05). There was no statistically significant difference in the occurrence of adverse reactions between the two groups during the treatment period(P>0.05).

CONCLUSION: Oral administration of Xuefu Zhuyu Pill combined with intravitreal injection of aflibercept in the treatment of RVO can improve retinal microcirculation, enhance vision, restore ocular blood circulation, improve bleeding, promote ME absorption, and improve clinical efficacy.

Abstract:AIM:To compare the differences and correlation of Spot vision screener and autorefractor in measuring preschool children refractive status under natural pupil conditions.

METHODS: A cross-sectional study was conducted from October to November 2021. A total of 311 children from a senior kindergarten in Jiangyin city were randomly selected and underwent refraction test using both Spot vision screener and autorefractor without cycloplegia. The astigmatism was decomposed into J₀ and J₄₅ by the Thibos vector analysis. The differences in spherical equivalence(SE), sphere, cylinder, J₀ and J₄₅ measured by these two devices were compared using Wilcoxon signed rank test. Spearman analysis was employed to analyze the correlation.

RESULTS:One child was excluded from the initial 311 children due to sphere power <-7.50 D, exceeding the detection range of the Spot vision screener(-7.50 to +7.50 D). A total of 310 children were ultimately included in this study, and the data of right eye of each child were selected. There was no statistically significant difference between the SE measured by the Spot vision screener and the autorefractor(P=0.598), while the difference in sphere, cylinder, J₀, and J₄₅ was statistically significant(all P<0.001). Measurements from these two devices had a positive correlation \〖SE(r_s=0.350, P<0.001), sphere(r_s=0.403, P<0.001), cylinder(r_s=0.545, P<0.001), J₀ (r_s=0.672, P<0.001), J₄₅ (r_s=0.439, P<0.001)\〗.

CONCLUSION:The results of Spot vision screener and autorefractor cannot be replaced by each other, and different referral indicators should be set for these two devices in vision screening.

Abstract:AIM: To compare the agreement between the ARK Biometer Combo and OA 2000 in patients wearing orthokeratology lenses.

METHODS: A prospective study. A total of 148 patients(148 eyes)who were wearing orthokeratology lenses and returned for follow-up at the Shanghai Eye Disease Prevention and Treatment Center from August to September 2024 were included. Biometric measurements were performed using both the ARK Biometer Combo and OA 2000. Parameters including axial length(AL), corneal central thickness(CCT), anterior chamber depth(ACD), lens thickness(LT), corneal curvature(Kf and Ks), astigmatism(AST), white-to-white corneal diameter(WTW)and pupil diameter(PD)were obtained. Differences in measurement parameters between the two biometers were compared, and agreement was assessed.

RESULTS: There were no statistically significant differences in the measurements of Kf, Ks and AST between the two biometers(P>0.05). Statistically significant differences were found in the measurements of AL, CCT, ACD, LT, WTW and PD(t=2.559, P=0.012; t=16.771, P<0.0001; t=4.749, P<0.0001; t=-15.212, P<0.0001; t=-14.915, P<0.0001; t=-2.402, P=0.018). ICC ranged from 0.615 to 0.999. Bland-Altman analysis showed that the maximum absolute values of the 95% limits of agreement(LoA)of AL, CCT, ACD, LT, Kf, Ks, AST, WTW and PD were 0.07 mm, 35.07 μm, 0.07 mm, 0.12 mm, 0.66 D, 1.14 D, 1.00 D, 0.76 mm, and 0.98 mm, respectively.

CONCLUSION: In orthokeratology patients, the ARK Biometer Combo and OA 2000 showed good agreement in measuring AL, CCT, ACD, Kf and LT, and can be used interchangeably.