Volume 18,Issue 1,2025 Table of Contents

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  • 1  Assessing the possibility of using large language models in ocular surface diseases
    Qian Ling Zi-Song Xu Yan-Mei Zeng Qi Hong Xian-Zhe Qian Jin-Yu Hu Chong-Gang Pei Hong Wei Jie Zou Cheng Chen Xiao-Yu Wang Xu Chen Zhen-Kai Wu Yi Shao
    2025, 18(1):1-8. DOI: 10.18240/ijo.2025.01.01
    [Abstract](9) [HTML](0) [PDF 2.07 M](20)
    Abstract:
    AIM: To assess the possibility of using different large language models (LLMs) in ocular surface diseases by selecting five different LLMS to test their accuracy in answering specialized questions related to ocular surface diseases: ChatGPT-4, ChatGPT-3.5, Claude 2, PaLM2, and SenseNova. METHODS: A group of experienced ophthalmology professors were asked to develop a 100-question single-choice question on ocular surface diseases designed to assess the performance of LLMs and human participants in answering ophthalmology specialty exam questions. The exam includes questions on the following topics: keratitis disease (20 questions), keratoconus, keratomalaciac, corneal dystrophy, corneal degeneration, erosive corneal ulcers, and corneal lesions associated with systemic diseases (20 questions), conjunctivitis disease (20 questions), trachoma, pterygoid and conjunctival tumor diseases (20 questions), and dry eye disease (20 questions). Then the total score of each LLMs and compared their mean score, mean correlation, variance, and confidence were calculated. RESULTS: GPT-4 exhibited the highest performance in terms of LLMs. Comparing the average scores of the LLMs group with the four human groups, chief physician, attending physician, regular trainee, and graduate student, it was found that except for ChatGPT-4, the total score of the rest of the LLMs is lower than that of the graduate student group, which had the lowest score in the human group. Both ChatGPT-4 and PaLM2 were more likely to give exact and correct answers, giving very little chance of an incorrect answer. ChatGPT-4 showed higher credibility when answering questions, with a success rate of 59%, but gave the wrong answer to the question 28% of the time. CONCLUSION: GPT-4 model exhibits excellent performance in both answer relevance and confidence. PaLM2 shows a positive correlation (up to 0.8) in terms of answer accuracy during the exam. In terms of answer confidence, PaLM2 is second only to GPT4 and surpasses Claude 2, SenseNova, and GPT-3.5. Despite the fact that ocular surface disease is a highly specialized discipline, GPT-4 still exhibits superior performance, suggesting that its potential and ability to be applied in this field is enormous, perhaps with the potential to be a valuable resource for medical students and clinicians in the future.
    2  A new tube chamber system for evaluation of anterior chamber pressure during phacoemulsification tested in porcine eyes
    Fumiaki Higashijima Makoto Hatano Manami Ohta Tadahiko Ogata Takuya Yoshimoto Atsushige Ashimori Makiko Wakuta Kazuhiro Kimura
    2025, 18(1):9-14. DOI: 10.18240/ijo.2025.01.02
    [Abstract](9) [HTML](0) [PDF 1.34 M](17)
    Abstract:
    AIM: To measure the optimal anterior chamber pressure (ACP) for safe phacoemulsification using a new tube chamber system with internal pressure measurement function in the porcine eye. METHODS: The 20-gauge and 21-gauge straight tips with yellow and orange sleeves, respectively, were covered by a test chamber combined with a pressure sensor for measuring ACP. This was measured for 20s from 10s after starting aspiration in the linear mode using vacuum levels of 200 and 150 mm Hg with a 20-gauge tip, and 300 and 250 mm Hg with a 21-gauge tip. Using a porcine eye, a pressure sensor fixed with a 0.9 mm corneal incision measured ACP. For the posterior capsule contact assay, porcine eyes were treated as described above, and the ultrasonic needle tip was held at the height of the iris and aspirated for 30s in linear mode at a vacuum of 200 and 150 mm Hg for the 20-gauge tip, and 300 and 250 mm Hg for the 21-gauge tip. The bottle height at which the posterior capsule accidentally contacted the ultrasonic tip was recorded, and the estimated ACP was calculated. RESULTS: The internal pressure of the new tube chamber system and ACP from the porcine eye closely matched proportional changes at vacuum levels of 200 and 150 mm Hg with 20-gauge tips. Similarly, proportional changes at vacuum levels of 300 and 250 mm Hg with the 21-gauge tip were nearly equal. The bottle height at which the posterior capsule contacted with the tip and estimated ACP were 57.5±12.6 cm (20.2±7.9 mm Hg) at 200 mm Hg with a 20-gauge tip, 35.0±10.0 cm (16.6±6.3 mm Hg) at 150 mm Hg with a 20-gauge tip, 47.5±12.6 cm (18.7±8.7 mm Hg) at 300 mm Hg with a 21-gauge tip, and 32.5±5.0 cm (15.7±3.5 mm Hg) at 250 mm Hg with a 21-gauge tip. CONCLUSION: A comprehensive understanding of this chamber system’s characteristics and usage can resolve anterior chamber instability caused by changing preoperative settings on the phaco machine.
    3  IL-17A mediates inflammation-related retinal pigment epithelial cells injury via ERK signaling pathway
    Hui-Min Zhong Bing-Qiao Shen Yu-Hong Chen Xiao-Huan Zhao Xiao-Xu Huang Min-Wen Zhou Xiao-Dong Sun
    2025, 18(1):15-27. DOI: 10.18240/ijo.2025.01.03
    [Abstract](3) [HTML](0) [PDF 4.75 M](14)
    Abstract:
    AIM: To investigate whether interleukin-17A (IL-17A) gets involved in the mechanisms of inflammation-related retinal pigment epithelium (RPE) cells injury and its significance in age-related macular degeneration (AMD). RESULTS: In the scenario of NaIO3 stimulation, RPE cells obviously tended to degenerate. Simultaneously proliferation and activation of retinal microglia was confirmed in NaIO3-stimulated mice, whereas such effects induced by NaIO3 were significantly ameliorated with IL-17A NAb intervention or in IL-17A-/- mice. In addition, IL-17A promoted the proliferation and activation of microglia as well as oxidative damage and the secretion of inflammatory cytokines alongside NaIO3-induced damage in RPE cells in vivo and ex vivo. Meanwhile, the extracellular signal-regulated kinase (ERK) signaling pathway was shown to be participated in the regulation of NaIO3-induced RPE cells injury mediated by IL-17A in vivo and ex vivo, as IL-17A-induced inflammatory cytokines release in the NaIO3 model was alleviated after blocking the ERK pathway. CONCLUSION: IL-17A probably promotes the NaIO3-induced RPE cells injury through exacerbating inflammation in terms of retinal microglia activation and inflammatory cytokines release via ERK signaling pathway. Inhibition of IL-17A may be a new potential target for dry AMD treatment.
    4  Autophagy serves as a protective effect against inflammatory injury of oxidative stress in ARPE-19 cell
    Na-Na Meng Lei-Zhou Xia Yi-Qing Gong Pei-Rong Lu
    2025, 18(1):28-38. DOI: 10.18240/ijo.2025.01.04
    [Abstract](2) [HTML](0) [PDF 5.04 M](12)
    Abstract:
    AIM: To test the effect of autophagy on inflammatory damage resulting from oxidative stress in adult retinal pigment epithelial cell line (ARPE-19). METHODS: ARPE-19 cells were pretreated with 200 and 600 µmol/L hydrogen peroxide (H2O2) at various time intervals. The changes of cell morphology, cell viability, reactive oxygen species (ROS) level, autophagic activity, and the inflammatory cytokines (TNFα, IL-6, and TGFβ) were measured at baseline and after treatment with autophagy inducer rapamycin (Rapa) and suppressor wortmannin (Wort) or shATG5. RESULTS: The levels of ROS, cytokines (TNFα, IL-6, and TGFβ), and autophagic activity were significantly increased in ARPE-19 cells after pretreated with H2O2 (all P<0.05) and IL-10 was significantly decreased (P<0.05). By upregulating autophagy, Rapa significantly reduced oxidative stress-induced secretion of pro-inflammatory factors (TNFα and IL-6) and ROS (all P<0.05), yet elevated the production of TGFβ (P<0.05). In contrast, suppression of autophagy through Wort or ATG5 knockdown reduced cell viability, increased cell apoptotic rate, and exacerbated the generation of ROS and inflammatory cytokines (TNFα, IL-6, and TGFβ; all P<0.05). CONCLUSION: Autophagy demonstrates a protective effect on ARPE-19 cell through mitigating oxidative damage and oxidative stress-induced inflammatory response. Regulation of autophagy may be a potential way for age-related macular degeneration.
    5  HMGB2 knockdown ameliorates retinal ganglion cell injury by inhibiting NLRP3 inflammasome activation after retinal ischemia
    Lin-Ping Xue Hai-Song Feng
    2025, 18(1):39-50. DOI: 10.18240/ijo.2025.01.05
    [Abstract](4) [HTML](0) [PDF 3.43 M](12)
    Abstract:
    AIM: To explore the neuroprotective effects of high mobility group box 2 (HMGB2) knockdown on retinal ganglion cells (RGCs) in the retinal ischemia-reperfusion injury (RIRI). METHODS: Oxygen-glucose deprivation (OGD)-injured RGCs from postnatal three-day C57BL/6 mice pups and high intraocular pressure (IOP)-induced RIRI mice were used as cellular and animal models of RIRI. The expression of HMGB2 in the retina of RIRI mice and OGD-injured RGCs was detected through reverse transcription-polymerase chain reaction (RT-qPCR) and Western blotting. The effects of HMGB2 silencing on the morphological changes, RGCs survival, and cell apoptosis in mouse retinal tissues were observed through H&E staining, immunofluorescence staining with RNA-binding protein with multiple splicing (RBPMS) antibody, and TUNEL staining, respectively. RGC viability and apoptosis were examined by CCK-8 and flow cytometry assays. The levels of proteins associated with NOD-like receptor thermal protein domain associated protein 3 (NLRP3)-mediated pyroptosis [NLRP3, Caspase-1, GSDMD-N, interleukin (IL)-1β, IL-18] in vivo and in vitro were measured by Western blotting. RESULTS: HMGB2 protein and NLRP3 were upregulated in the retina of RIRI mice and OGD-injured RGCs (P<0.001). The retina was edematous, accompanied by disorganized cell arrangement and decreased thickness of all layers, and obvious vacuoles in ganglion cell layer. HMGB2 silencing alleviated the reduction in total retinal thickness and the severity of retinal tissue damage as well as suppressed RGC loss and retinal cell apoptosis in RIRI mice. OGD-induced RGC apoptosis was ameliorated after downregulation of HMGB2 in vitro. Intravitreal injection of the AAV-sh-HMGB2 and si-HMGB2 resulted in significantly decrease of NLRP3, Caspase-1, GSDMD-N, IL-1β, and IL-18 protein levels in the retinal tissues of RIRI mice and OGD-injured RGCs, respectively (all P<0.001). CONCLUSION: HMGB2 knockdown protects against RGC apoptosis and pyroptosis after RIRI through suppressing NLRP3 inflammasome activation.
    6  Guidelines for standard operation of imaging modalities in orbital diseases (2024)
    Yi Shao Jian-Min Ma Xiao-Ming Huang Expert Workgroup of Guidelines for the use of imaging equipment in orbital diseases () Ophthalmic Imaging Intelligent Medicine Branch Chinese Medicine Education Association Ocular Oncology Committee of the Ophthalmology Branch of the Chinese Medical Doctor Association Ophthalmology Committee of International Association of Translational Medicine Chinese Ophthalmic Imaging Study Groups
    2025, 18(1):51-66. DOI: 10.18240/ijo.2025.01.06
    [Abstract](6) [HTML](0) [PDF 2.05 M](14)
    Abstract:
    Orbital disorders include conditions originating from the orbital bones, surrounding tissues, and post-orbital septum. They also include systemic ailments affecting the orbit. Different clinical symptoms make up the complex range of orbital disorders. Because these disorders mostly impact the orbital area instead of the intraocular compartment, there is little diagnostic usefulness for typical ophthalmic visual tests. As such, the vital instruments for diagnosing and evaluating orbital illnesses have become ophthalmic imaging modalities, including ocular ultrasonography (B-scan), computed tomography (CT), and magnetic resonance imaging (MRI). One way to improve the precision and promptness of diagnosing orbital diseases is to standardize the functioning of widely used imaging equipment and define the radiological features of orbital abnormalities. Such programs are crucial for the care of patients with orbital disorders since they considerably reduce the number of misdiagnoses and missed diagnoses in these individuals. The underlying concepts, operational techniques, and normal and pathological imaging findings associated with common diagnostic tools for orbital illnesses are all thoroughly reviewed in this guideline. The objective is to improve primary healthcare settings’ diagnostic competence in the field of orbital pathology and to standardize procedures for diagnosing orbital disorders.
    7  Topographic factors associated with anterior chamber angle narrowing in patients with keratoconus
    Hamed Soltan-Dehghan Abdollah Farzaneh Hassan Hashemi Payam Nabovati Mehdi Khabazkhoob
    2025, 18(1):67-73. DOI: 10.18240/ijo.2025.01.07
    [Abstract](4) [HTML](0) [PDF 556.92 K](14)
    Abstract:
    AIM: To identify topographic determinants of the anterior chamber angle (ACA) in patients with keratoconus (KCN). METHODS: Four hundred and ten eyes of 294 patients with KCN were recruited for this study. First, complete ocular examinations were performed for all patients, including visual acuity measurement, refraction, and slit-lamp biomicroscopy. Then, all participants underwent corneal imaging by the Oculus Pentacam HR. RESULTS: The mean age of the participants was 32.40± 8.52y (15-60y) and 69.5% of them were male. The mean ACA was 38.47°±5.75° (range: 14.40° to 56.50°) in the whole sample, 38.24°±6.00° in males, and 38.98°±5.11° in females (P=0.447). The mean ACA was significantly different among different groups of cone morphology, as patients with nipple cones showed the lowest mean ACA. Moreover, there were statistically significant differences in the mean ACA among different groups of cone locations, with patients having central cones exhibiting the lowest mean ACA (P<0.001). Anterior and posterior Q values were significantly, directly correlated with ACA (anterior Q: r=0.122, P=0.014, posterior Q: r=0.192, P<0.001). CONCLUSION: This study provides critical insights into the risk factors for ACA narrowing in KCN patients, which is essential for planning intraocular surgeries. Patients with nipple and central cones exhibited the most significant ACA narrowing. Additionally, more negative Q-values are associated with increased ACA narrowing, highlighting the need for targeted diagnostic and therapeutic strategies.
    8  Risk factors for biometry prediction error by Barrett Universal II intraocular lens formula in Chinese patients
    Xu-Hao Chen Ying Hong Xiang-Han Ke Si-Jia Song Yu-Jie Cen Chun Zhang
    2025, 18(1):74-78. DOI: 10.18240/ijo.2025.01.08
    [Abstract](1) [HTML](0) [PDF 552.68 K](11)
    Abstract:
    AIM: To investigate the influence of postoperative intraocular lens (IOL) positions on the accuracy of cataract surgery and examine the predictive factors of postoperative biometry prediction errors using the Barrett Universal II (BUII) IOL formula for calculation. METHODS: The prospective study included patients who had undergone cataract surgery performed by a single surgeon from June 2020 to April 2022. The collected data included the best-corrected visual acuity (BCVA), corneal curvature, preoperative and postoperative central anterior chamber depths (ACD), axial length (AXL), IOL power, and refractive error. BUII formula was used to calculate the IOL power. The mean absolute error (MAE) was calculated, and all the participants were divided into two groups accordingly. Independent t-tests were applied to compare the variables between groups. Logistic regression analysis was used to analyze the influence of age, AXL, corneal curvature, and preoperative and postoperative ACD on MAE. RESULTS: A total of 261 patients were enrolled. The 243 (93.1%) and 18 (6.9%) had postoperative MAE<1 and >1 D, respectively. The number of females was higher in patients with MAE>1 D (χ2 = 3.833, P=0.039). The postoperative BCVA (logMAR) of patients with MAE >1 D was significantly worse (t=-2.448; P=0.025). After adjusting for gender in the logistic model, the risk of postoperative refractive errors was higher in patients with a shallow postoperative anterior chamber [odds ratio=0.346; 95% confidence interval (CI): 0.164, 0.730, P=0.005]. CONCLUSION: Risk factors for biometry prediction error after cataract surgery include the patient’s sex and postoperative ACD. Patients with a shallow postoperative anterior chamber are prone to have refractive errors.
    9  Outcomes of a non-diffractive extended depth of focus intraocular lens in patients with well-controlled glaucoma and ocular hypertension
    Jia-Ru Liu Andrei-Alexandru Szigiato Paul Harasymowycz
    2025, 18(1):79-85. DOI: 10.18240/ijo.2025.01.09
    [Abstract](2) [HTML](0) [PDF 861.30 K](12)
    Abstract:
    AIM: To assess visual outcomes and satisfaction of a non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) in individuals with ocular hypertension (OHT) and well-controlled mild glaucoma undergoing cataract surgery. METHODS: An investigator-initiated, single-center, prospective, interventional, noncomparative study conducted in Montreal, Canada. The study enrolled 31 patients (55 eyes) with OHT or mild glaucoma who received a non-diffractive EDOF IOL (Acrysof IQ Vivity). Participants underwent sequential cataract surgery with the Vivity IOL. Follow-up evaluations occurred at 1d, 1, and 3mo postoperatively, assessing uncorrected distance, intermediate, and near visual acuity. Questionnaires (QUVID: Questionnaire for visual disturbances and IOLSAT: Intraocular lens satisfaction) were administered pre and post-operatively to measure visual disturbances and spectacle independence in various lighting. Safety parameters included intraocular pressure (IOP), glaucoma medications, spherical equivalence, mean deviation and pattern standard deviation or square root of lost variance on Octopus visual field. RESULTS: At 1 and 3mo postoperatively, significant improvements were observed in uncorrected distance and intermediate visual acuity. Spectacle independence was enhanced for distance and intermediate vision, especially in bright light settings. Spectacle-free intermediate vision was improved even in dim lighting. Visual disturbances, particularly glare symptoms, were reduced, and there was a notable decrease in IOP and glaucoma medication burden at 3mo. There was more hazy vision postoperatively with no impact on visual acuity and visual satisfaction. CONCLUSION: The non-diffractive EDOF lens improves distance and intermediate spectacle-free visual function in patients with OHT and well-controlled glaucoma. The findings highlight significant improvements in visual acuity, reduced glare, enhanced spectacle independence, and improved visual performance in different lighting conditions.
    10  Assessing XEN microstent’s one-year efficacy: independent of site variability
    Caroline Bormann Catharina Busch Matus Rehak Christian Thomas Scharenberg Focke Ziemssen Jan Darius Unterlauft
    2025, 18(1):86-93. DOI: 10.18240/ijo.2025.01.10
    [Abstract](2) [HTML](0) [PDF 575.91 K](12)
    Abstract:
    AIM: To evaluate the short-term efficacy of XEN45 Gel Stent (XEN) implantation for primary open angle glaucoma (POAG) and pseudoexfoliation (PEX) glaucoma across two university eye clinics, aiming to assess the impact of varying center-specific protocols during the first postoperative year. METHODS: We retrospectively examined 282 patients (183 in center 1, 99 in center 2), who underwent XEN microstent implantation for uncontrolled POAG or PEX glaucoma. Parameters including intraocular pressure (IOP), IOP-lowering medication count, best corrected visual acuity (BCVA), and postoperative complications were evaluated over 12mo. RESULTS: Post-implantation, center 1 reported a mean IOP reduction from 25.3±7.4 to 14.1±4.7 mm Hg (P<0.01) and a decrease in IOP-lowering medications from 3.2±1.2 to 1.0±1.3 (P<0.01). Center 2 observed a similar reduction from 24.4±6.5 to 15.1±5.5 mm Hg (P<0.01) and medication decrease from 3.0±1.1 to 1.2±1.0 (P<0.01). BCVA remained stable in both cohorts. The most common complications were hypotony (center 1: 32; center 2: 20) and choroidal detachment (center 1: 22, center 2: 15), with nearly identical needling rates (40% in center 1, 41% in center 2). CONCLUSION: XEN implantation yields consistent reductions in IOP and medication use across different centers using comparable surgical and postoperative treatment regime. These findings underscore XEN’s short-term effectiveness and suggest standardizable outcomes regardless of exact surgical procedure or treatment differences.
    11  Assessing microcatheter-assisted 360-degree trabeculotomy combined with trabeculectomy for refractory glaucoma: 1-year results
    Jia-Yin Qin Yan Liu Tao Wang
    2025, 18(1):94-102. DOI: 10.18240/ijo.2025.01.11
    [Abstract](1) [HTML](0) [PDF 759.29 K](13)
    Abstract:
    AIM: To evaluate the efficacy and safety of microcatheter-assisted 360-degree trabeculotomy combined with trabeculectomy (MATT-Trab) for treating refractory glaucoma. METHODS: Patients with refractory glaucoma who underwent MATT-Trab were retrospectively examined. Efficacy indicators for research statistics included the intraocular pressure (IOP) level, degree of decrease, changes in medication dosage, and success rate. Safety indicators included the best-corrected visual acuity and incidence of complications. RESULTS: This study comprised 31 patients, including 11 males and 20 females, with ages ranging from 8mo to 67y (mean age: 29.40±22.10y). The average postoperative IOP at 1d, 1wk, 1mo, 3mo, 6mo, 1y, and the last follow-up was significantly lower than the average preoperative IOP (31.33±9.24 mm Hg, P<0.05). The average number of postoperative medications at 1y was 0.48±1.51, which was significantly reduced compared to that used preoperatively (3.77±0.99, P=0.00). The absolute and qualified success rates were 45.16% and 83.87%, respectively. Visual acuity exhibited no statistically significant difference between the postoperative and preoperative follow-up time points, except for the first day after surgery. The most common postoperative complications were anterior chamber hemorrhage (25 cases, 86.21%) and high IOP (10 cases, 34.48%). CONCLUSION: Our results indicate that MATT-Trab is effective and safe for treating refractory glaucoma.
    12  Neurodegeneration and choroidal vascular features on OCT in the progression to advanced age-related macular degeneration
    Inês Costa Ana Carvalho Helton Andrade Bruno Pereira Pedro Camacho
    2025, 18(1):103-110. DOI: 10.18240/ijo.2025.01.12
    [Abstract](3) [HTML](0) [PDF 971.67 K](13)
    Abstract:
    AIM: To quantify and compare longitudinal thickness changes of the ganglion cell complex (GCC) and the choroid in patients with different patterns of age-related macular degeneration (AMD) progression. METHODS: Retrospective cohort analysis of anonymized data from participants aged 50y or more and diagnosed with early/intermediate AMD in at least one eye (with no evidence of advanced AMD). A total of 64 participants were included from the Instituto de Retina de Lisboa (IRL) study (IPL/2022/MetAllAMD_ESTeSL) and divided into 4 groups according to the Rotterdam classification for AMD. Spectral domain optical coherence tomography (SD-OCT) was used to assess and quantify GCC and choroid thickness at two time points (first visit vs last visit) with a minimum interval of 3y. RESULTS: In the GCC inner ring, a thinner thickness (P=0.001) was observed in the atrophic AMD group (51.3±21.4 µm) compared to the early AMD (84.3±11.5 µm), intermediate AMD (77.6±16.1 µm) and neovascular AMD (88.9±16.3 µm) groups. Choroidal thickness quantification showed a generalized reduction in the central circle (P=0.002) and inner ring (P=0.001). Slight reductions in retinal thickness were more accentuated in the inner ring in the atrophic AMD (-13%; P<0.01). CONCLUSION: The variation of the analyzed structures could be an indicator of risk of progression with neurodegenerative (GCC) or vascular (choroid) pattern in the intermediate and atrophic AMD. The quantification of both structures can provide important information about the risk of disease progression in the early and intermediate stages but also for the evolution pattern into late stages (atrophic or neovascular).
    13  Retinal capillary density among healthy Egyptian and South Asian students: an optical coherence tomography angiography study
    Abdussalam M Abdullatif Alimulhaq Mohammad Moamnlhaq Tamer A. Macky Noha Ahmed Edris
    2025, 18(1):111-116. DOI: 10.18240/ijo.2025.01.13
    [Abstract](2) [HTML](0) [PDF 542.05 K](12)
    Abstract:
    AIM: To compare the macular and optic nerve perfusion and vascular architecture using optical coherence tomography angiography (OCTA) in normal eyes of Egyptian (Caucasians) and South Asian (Asians) volunteers. METHODS: Cross-sectional analytical OCTA study performed on 90 eyes of South Asian (n=45) and Egyptians (n=45) were analyzed. All participants underwent best-corrected visual acuity test, slit lamp, and fundus examination. OCTA images; macular 6×6 mm2 grid and optic nerve 4.5×4.5 mm2 grid were used to examine the parafoveal and peripapillary regions, respectively. RESULTS: The mean capillary vessel density (CVD) in macular sectors among South Asians and Egyptians participants were (50.31%±2.53%, 51.2%±5.93%) and (49.71%±3.6%, 51.94%±4.79%) in superficial (SCP) and deep capillary plexuses (DCP), respectively (P>0.05). Mean CVD in both groups was higher in DCP compared to SCP in all sectors but was not significant (P>0.05). Mean foveal CVD increases with an increase in central retinal thickness in both SCP and DCP (P<0.001), among both groups. Mean area of the foveal avascular zone (FAZ) was 0.28±0.09 and 0.27±0.08 mm2 in South Asian and Egyptians, respectively. FAZ area decreases with an increase in the thickness and foveal CVD (P<0.001). Mean CVD in the peripapillary area was 48.23%±5.78% in South Asian and 49.52%±2.38% in Egyptian volunteers. The mean retinal nerve fiber layer thickness was found to be higher in the nasal quadrant among South Asian females than the Egyptian females (P<0.05). CONCLUSION: No significant racial disparity is found in this study. The findings are helpful for assessing and improving the normative data on the differences in South Asian and Egyptian populations.
    14  Low-concentration atropine (0.01%) on quantitative contrast sensitivity function in Chinese children with myopia
    Yu-Hao Ye Yi-Yong Xian Fang Liu Zhong-Lin Lyu Xing-Tao Zhou Jing Zhao
    2025, 18(1):117-124. DOI: 10.18240/ijo.2025.01.14
    [Abstract](1) [HTML](0) [PDF 2.33 M](12)
    Abstract:
    AIM: To investigate the effect of 0.01% low-concentration atropine (LA) on quantitative contrast sensitivity function (qCSF) in children with myopia. METHODS: This paired case-control study included 90 eyes of 58 children who were sex-, age-, and refraction-matched and equally divided into two groups: the 0.01% LA group had undergone 6mo use of daily 0.01% atropine and control group was naïve to LA. Routine ophthalmic examinations and qCSF test without refractive correction were performed. Two groups were compared in monocular and binocular qCSF parameters, including the area under logCSF, CSF acuity, and contrast sensitivity (CS) at 1.0-18.0 cycle per degree (cpd). RESULTS: In the monocular comparison, the CSF acuity of the LA group was significantly higher than that of the control group (7.58±5.51 vs 6.37±4.22 cpd, P<0.05). The subgroup analysis showed that in the 6-9y group, CSF acuity was significantly higher in the LA group than the control group (8.76±6.19 vs 6.54±4.25 cpd, P<0.05), and in the Female group, low refraction sphere group, and high refraction cylinder group, the CS at high spatial frequencies (12.0 and 18.0 cpd) were significantly higher in the LA group than in the control group (all P<0.05). In the binocular test, CSF acuity and CS at 12.0 cpd were significantly higher in the LA group than in the control group (10.95±7.00 vs 8.65±5.12 cpd; 0.17±0.33 vs 0.06±0.16, respectively; both P<0.05). CONCLUSION: Use of LA may result in improved CS in children with early onset myopia.
    15  Femtosecond laser small incision lenticule extraction on binocularity for myopia with glasses-free 3D technique
    Bing-Jie Chen Yu-Chen Fan Yong-Chuan Liao
    2025, 18(1):125-131. DOI: 10.18240/ijo.2025.01.15
    [Abstract](1) [HTML](0) [PDF 887.31 K](11)
    Abstract:
    AIM: To evaluate the effect of femtosecond laser small incision lenticule extraction (SMILE) on the binocular visual function in myopic patients with glasses-free three-dimensional (3D) technique. METHODS: Totally 50 myopic patients (39 females and 11 males) with SMILE were enrolled in this prospective study. The glasses-free 3D technique was used to evaluate the binocular visual function in these subjects including static stereopsis, dynamic stereopsis, foveal suppression, and binocular balance point of signal to noise ratio (s/n ratio). All subjects received measurements in 1d before operation, and 1d, 1wk, and 1mo postoperatively. RESULTS: Both static and dynamic stereopsis showed no significant difference after SMILE. The foveal suppression improved significantly 1wk and 1mo after SMILE (P=0.005 and P=0.007 respectively). The binocular balance point of signal to noise ratio showed a significant improvement 1d, 1wk and 1mo after SMILE for both eyes (P<0.001 for each eye respectively). CONCLUSION: Glasses-free 3D technique can be used to evaluate the effect of SMILE on the binocular visual function in myopic patients perceptively, and SMILE can improve both foveal suppression and binocular imbalance in these patients.
    16  Clinical profile and outcomes of ocular surface squamous neoplasia at the Philippine General Hospital: a retrospective study
    Mary Ellaine S. Diaz Ruben Lim Bon Siong Justin Alan Yao Gary John V. Mercado
    2025, 18(1):132-138. DOI: 10.18240/ijo.2025.01.16
    [Abstract](1) [HTML](0) [PDF 698.64 K](11)
    Abstract:
    AIM: To evaluate the demographics, clinical characteristics, treatments, and outcomes of patients with ocular surface squamous neoplasia (OSSN) at the Philippine General Hospital. METHODS: This was a single-center, 11-year retrospective, cross sectional case series on 18 cases of OSSN seen between January 2012 to June 2023. The patient’s demographics, presenting symptoms, tumor characteristics, histopathologic diagnosis, treatment, outcomes, and duration of follow-up were reviewed. RESULTS: Out of 33 identified cases of OSSN, only 18 were eligible for inclusion in the study. Mean age was 60.78y (range 31 to 80), with male predominance (66.67%). The left eye was most commonly affected (61.11%) with most presenting with fleshy mass (83.33%). Most tumors were located nasally (66.67%) and were predominantly papilliform (44.44%) in morphology with associated hyperpigmentation (38.89%). Squamous cell carcinoma (SCCA) was the most common histopathologic diagnosis (72.22%). The main primary treatment was surgical excision (94.44%) with or without adjunctive therapy, with only 1 patient undergoing first-line topical chemotherapy. Only 3 recurrences (16.67%) were noted with a median follow-up of 7.5mo. A statistically significant recurrence-free odds leaning towards the utilization of cryotherapy was noted. CONCLUSION: OSSN seen at the Philippine General Hospital is presented as a limbal papilliform mass, most commonly affecting elderly males. Surgical excision with adjuvant cryotherapy and/or chemotherapy is the preferred mode of treatment.
    17  A cross-sectional study of the association between dietary inflammatory index and glaucoma prevalence in a US population
    Wen-Li Chen Li-Xia Zhang
    2025, 18(1):139-145. DOI: 10.18240/ijo.2025.01.17
    [Abstract](3) [HTML](0) [PDF 883.99 K](15)
    Abstract:
    AIM: To assess the relationship between dietary inflammatory index (DII) and prevalence of glaucoma among individuals aged 40y and above in the United States. METHODS: Participants were drawn from 2 cycles of the National Health and Nutrition Examination Survey (NHANES, 2005-2008) for a cross-sectional study. DII was calculated from 24-hour dietary recall questionnaire conducted by experienced researchers and data analyzed in R according to the NHANES user guide, “Stratified Multi-stage Probability Sampling”. The relationship between DII and glaucoma was evaluated by multi-factor logistic regression analysis and the existence of a non-linear association examined by restricted cubic spline (RCS) analysis. RESULTS: A total of 5359 subjects were included and the cross-sectional analysis weighted to represent the US population of 109 million. DII was elevated in glaucoma patients (P<0.001) and smoking and alcohol use contributed to significant differences (P<0.001). DII correlated negatively with Healthy Eating Index (HEI)-2015 (Spearman rank correlation coefficient, r=-0.49). RCS analysis showed a linear relationship between DII and glaucoma risk (P of non-linear relationship =0.575). CONCLUSION: An increased DII is strongly associated with high risk of glaucoma and diet-induced inflammation should be controlled to delay glaucoma progression.
    18  Influencing factors of early post-traumatic stress disorder in young and middle-aged individuals with open globe injuries in west China: a cross-sectional study
    Yi-Man Li Xin Zhang Ji-Hong Zeng Hong-Mei Luo
    2025, 18(1):146-153. DOI: 10.18240/ijo.2025.01.18
    [Abstract](1) [HTML](0) [PDF 579.05 K](11)
    Abstract:
    AIM: To evaluate the prevalence of early post-traumatic stress disorder (PTSD) among young and middle-aged patients who have suffered open globe injuries, and to identify the psychosocial factors influencing PTSD in these patients. METHODS: A total of 280 patients who underwent ocular trauma surgery between January 2023 and January 2024 were selected through convenience sampling. Data were collected using a custom-designed demographic questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Cognitive Emotion Regulation Questionnaire (C-ERRI), and the PTSD Checklist-Civilian Version (PCL-C). Univariate analysis and stepwise multiple linear regression analysis were performed to determine the factors affecting PTSD in these patients. RESULTS: The average PTSD score for the patients was 33.22±13.48. The scores for individual PTSD dimensions, ranked from highest to lowest, were recurrent traumatic experiences, heightened arousal, avoidance reactions, and social dysfunction. Positive PTSD symptoms were observed in 85 patients (30.36%). Univariate analysis indicated that gender, postoperative vision, marital status, psychological resilience, and rumination were significant factors affecting PTSD symptoms (χ²/t=6.53, 17.88, 8.83, 2.17, and 14.1, respectively; all P<0.05). Pearson correlation analysis showed a positive correlation between rumination and PTSD symptoms (r=0.73, P<0.01) and a negative correlation between psychological resilience and PTSD symptoms (r= -0.14, P<0.05). Stepwise multiple linear regression analysis identified postoperative vision (notably eye removal), rumination levels, and psychological resilience (optimism) as major factors influencing PTSD in these patients (R²=0.57, P<0.001). CONCLUSION: Young and middle-aged patients with open globe injuries have a high incidence of PTSD. Significant risk factors for early PTSD include primary enucleation, high levels of rumination, and low psychological resilience (optimism). Conversely, patients with good postoperative vision recovery, low rumination levels, and high levels of optimism are less likely to develop PTSD. Healthcare providers should pay special attention to patients who undergo primary enucleation, strive to reduce their rumination levels, and enhance their psychological resilience, thereby promoting a positive and optimistic attitude towards their condition and reducing the incidence of PTSD.
    19  Comparison of biomechanical indices measured by ocular response analyzer between children and elderly: a systematic review
    Hassan Hashemi Fereshteh Shokrollahzadeh Hadi Ostadimoghaddam Abbasali Yekta Mehdi Khabazkhoob
    2025, 18(1):154-159. DOI: 10.18240/ijo.2025.01.19
    [Abstract](4) [HTML](0) [PDF 552.54 K](12)
    Abstract:
    Biomechanical study of the visual system by ocular response analyzer investigates the inter-structural biological relationships, mechanics, and function of the visual system. This review aimed to investigate the changes in corneal biomechanical parameters with age and sex. The articles published in PubMed between 2000 and 2021 were investigated and critiqued, and valid scientific evidence was collected, reviewed and concluded according to the inclusion and exclusion criteria. Most studies showed that corneal biomechanical changes occur infrequently in children up to the age of 20y, and with increasing age and wider age range, there was a significant decrease in corneal biomechanical indices, especially corneal hysteresis. In children and adults, most studies have shown that these biomechanical indicators, especially corneal resistance factor, were higher in females. Although hormonal changes may contribute to this finding, the role of axial length and other biometric indicators should not be ignored. The axial length, the intraocular pressure, and the corneal thickness are other factors associated with biomechanical parameters that should be taken into account in clinical diagnosis and management especially for patients undergoing refractive surgery as well as keratoconus patients.
    20  Glaucomatous retinal ganglion cells: death and protection
    Na Cui Jun Jia Yuan He
    2025, 18(1):160-167. DOI: 10.18240/ijo.2025.01.20
    [Abstract](0) [HTML](0) [PDF 1.20 M](11)
    Abstract:
    Glaucoma is a group of diseases characterized by progressive optic nerve degeneration, with the characteristic pathological change being death of retinal ganglion cells (RGCs), which ultimately causes visual field loss and irreversible blindness. Elevated intraocular pressure (IOP) remains the most important risk factor for glaucoma, but the exact mechanism responsible for the death of RGCs is currently unknown. Neurotrophic factor deficiency, impaired mitochondrial structure and function, disrupted axonal transport, disturbed Ca2+ homeostasis, and activation of apoptotic and autophagic pathways play important roles in RGC death in glaucoma. This review was conducted using Web of Science, PubMed, Project, and other databases to summarize the relevant mechanisms of death of RGCs in glaucoma, in addition to outlining protective treatments to improve the degradation of RGCs.
    21  Metamorphopsia after surgery for rhegmatogenous retinal detachment
    Han-Tao Zhou Zhong Lin
    2025, 18(1):168-177. DOI: 10.18240/ijo.2025.01.21
    [Abstract](0) [HTML](0) [PDF 398.41 K](11)
    Abstract:
    Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment (RRD). However, anatomical reattachment of the retina does not ensure complete recovery of visual function. The incidence of metamorphopsia remains the most common postoperative complaint, from 24% to 88.6%. Currently, the risk factors of metamorphopsia are categorized into macular involvement, retinal shift, outer retinal folds, subretinal fluid, secondary epiretinal membrane, outer retinal layer damage, and surgical approach. The associations of metamorphopsia with postoperative best-corrected visual acuity and postoperative vision-related quality of life were still controversial. The most popular methods for assessment of metamorphopsia remain the Amsler grid and M-Charts. Most treatments cannot progress beyond the management of negative visual sensations, through methods such as occlusion therapy and aniseikonia-correcting spectacles. The main treatment approach involves RRD prevention and the management of risk factors that can lead to postoperative metamorphopsia after RRD repair. Additional research concerning metamorphopsia treatment, further upgrades of auxiliary inspection methods, and more accurate microstructural assessments are needed to address this common complication.
    22  Recurrent corneal erosion after buried-suture double-eyelid blepharoplasty using barbed thread
    Tian-Ze Huang Jiu-Zuo Huang Di Chen
    2025, 18(1):178-180. DOI: 10.18240/ijo.2025.01.22
    [Abstract](2) [HTML](0) [PDF 764.80 K](13)
    Abstract:
    23  Corneal lipid degeneration following herpes zoster ophthalmicus keratitis
    Asako Kodama Fumitaka Kobayashi
    2025, 18(1):181-183. DOI: 10.18240/ijo.2025.01.23
    [Abstract](3) [HTML](0) [PDF 468.63 K](13)
    Abstract:
    24  Vitreous amyloidosis caused by Lys55Asn mutation in TTR with peripheral neuropathy onset: a case report of FAP-related complications
    Yi-Wen Xue Yi-Qin Xiao
    2025, 18(1):184-186. DOI: 10.18240/ijo.2025.01.24
    [Abstract](2) [HTML](0) [PDF 875.20 K](11)
    Abstract:
    25  Purtscher-like retinopathy associated with COVID-19: a case report
    Wen-Bo Liu Yi Cai Miao Zhou Hashimoto Kinji Ming-Wei Zhao Xuan Shi
    2025, 18(1):187-189. DOI: 10.18240/ijo.2025.01.25
    [Abstract](2) [HTML](0) [PDF 1.70 M](12)
    Abstract:

    Editors-in-Chief: Yan-Nian Hui and Peter Wiedemann

    Established in April, 2008

    ISSN 2222-3959 print

    ISSN 2227-4898 online

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