Abstract:AIM: To develop a traditional Chinese medicine (TCM) knowledge graph (KG) for diabetic retinopathy (DR) diagnosis and treatment by integrating literature and medical records, thereby enhancing TCM knowledge accessibility and providing innovative approaches for TCM inheritance and DR management. METHODS: First, a KG framework was established with a schema-layer design. Second, high-quality literature and electronic medical records served as data sources. Named entity recognition was performed using the ALBERT-BiLSTM-CRF model, and semantic relationships were curated by domain experts. Third, knowledge fusion was mainly achieved through an alias library. Subsequently, the data layer was mapped to the schema layer to refine the KG, and knowledge was stored in Neo4j. Finally, exploratory work on intelligent question answering was conducted based on the constructed KG. RESULTS: In Neo4j, a KG for TCM diagnosis and treatment was constructed, incorporating 6 types of labels, 5 types of relationships, 5 types of attributes, 822 nodes, and 1,318 relationship instances. This systematic KG supports logical reasoning and intelligent question answering. The question answering model achieved a precision of 95%, a recall of 95%, and a weighted F1-score of 95%. CONCLUSION: This study proposes a semi-automatic knowledge-mapping scheme to balance integration efficiency and accuracy. Clinical data-driven entity and relationship construction enables digital dialectical reasoning. Exploratory applications show the KG’s potential in intelligent question answering, providing new insights for TCM health management.

Abstract:AIM: To investigate the effects of a Chinese medicine formula “Qingxuan Runmu Yin” (QRY) on ocular surface inflammation in a rat model of dry eye, and its mechanism via the toll-like receptor 4 (TLR4)/transforming growth factor kinase 1 (TAK1)/p38 mitogen-activated protein kinase (p38MAPK) signaling pathway. METHODS: Seventy-two Sprague-Dawley rats were randomly divided into six groups (n=12 each): the control group, model group, 3 groups of QRY (with low-, medium-, and high-doses), and SB203580 group. Dry eye was induced using benzalkonium chloride. Schirmer’s test (SIT) and corneal fluorescein staining (CFS) were performed every 14d throughout the experiment. Histopathological changes in corneal and conjunctival tissues were observed using hematoxylin and eosin (HE) and periodic acid-Schiff (PAS) staining. Protein expression levels of key inflammatory markers and signaling pathway targets were assessed via immunohistochemistry, ELISA, and Western blotting. RESULTS: Compared to the control group, the model group showed significant reductions in SIT and increases in CFS scores, alongside structural disorganization of corneal/conjunctival tissues, decreased conjunctival goblet cell (CGC) numbers, and elevated expression of inflammatory markers [interleukin (IL)-1β, IL-6, tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase-9 (MMP9)] and pathway proteins (TLR4, p-TAK1, p-p38MAPK; P<0.05). Treatment with QRY (low, medium, and high doses) and SB203580 significantly improved SIT scores, reduced CFS scores, restored corneoconjunctival structure, increased CGC numbers, and decreased expression levels of IL-1β, IL-6, TNF-α, MMP9, TLR4, p-TAK1, and p-p38MAPK proteins compared to the model group (P<0.05). CONCLUSION: QRY may alleviate ocular surface inflammation associated with dry eye by inhibiting the TLR4/TAK1/p38MAPK signaling pathway, highlighting its potential therapeutic efficacy for dry eye.

Abstract:AIM: To investigate whether pyroptosis contributes to retinal ganglion cell (RGC) degeneration in aged TgAPPswePS1 transgenic mice and to explore the relationship between amyloid-beta (Aβ) accumulation and activation of the pyroptotic pathway in the retina. METHODS: The twelve 18-month-old TgAPPswePS1 transgenic mice and twelve 18-month-old wild-type C57BL/6J mice were used to investigate amyloid precursor protein (APP) and Aβ expression, retinal structural changes, and activation of pyroptosis in RGCs. Immunohistochemical analyses were performed to detect APP, Aβ, and pyroptosis-related proteins [NOD-like receptor thermal protein domain associated protein 3 (NLRP3), caspase-1, gasdermin D (GSDMD), interleukin (IL)-1β, and IL-18]. Quantitative assessments of retinal nerve fiber layer (RNFL) thickness were conducted to evaluate retinal integrity. RESULTS: Compared to age-matched wild-type controls, TgAPPswePS1 transgenic mice exhibited significant upregulation of APP and Aβ within RGCs. Histological analysis revealed reduced RNFL thickness, indicating structural degeneration. Notably, RGCs in transgenic mice showed robust immunoreactivity for NLRP3, caspase-1, and GSDMD, alongside elevated levels of IL-1β and IL-18, supporting the activation of pyroptosis. CONCLUSION: Aβ accumulation in RGCs is associated with retinal degeneration and activation of the pyroptosis pathway in aged TgAPPswePS1 mice. This study provides new insights into the inflammatory mechanisms underlying Aβ-related retinal neurodegeneration and suggests that targeting pyroptosis may represent a promising therapeutic strategy for retinal disorders linked to amyloid pathology.

Abstract:AIM: To evaluate the effect of different monochromatic lights on the refractive status and the secretion levels of neurotransmitters in the progressive myopic model of guinea pigs. METHODS: Guinea pigs (n=90) underwent different monochromatic lights irradiation for two weeks were randomly divided into 6 groups: white light (control), ultraviolet (UV), blue, green, red, and simulative sunlight (simSUN). The refractive status and axial length (AL) were measured. Transmission electron microscopy, Masson’s trichrome staining and hematoxylin-eosin staining were performed to observe the structural changes of retina and sclera. High-performance liquid chromatography (HPLC), western blotting and immunofluorescence were used to measure neurotransmitters and their receptors. RESULTS: Myopia models were established successfully. When compared the degrees of change in myopic eyes of control group, the UV group showed a minor decrease in AL and refraction, along with a significant increase in scleral thickness. In contrast, the red and green groups revealed a net increase in AL and refraction, coupled with a net decrease in scleral thickness (all, P<0.01). The dopamine concentration increased in the UV group, while concentrations of serotonin and melatonin significantly decreased (all, P<0.01). The groups that were exposed to UV, blue and simSUN, the expression of dopamine receptor D2 (DRD2) increased, and the expression of hydroxytryptamine receptor 2A (HTR2A) and melatonin receptor type 2 (MT2) decreased significantly when compared to the control group (all P<0.01). CONCLUSION: Exposure to short-wavelength light could slow the development of myopia by promoting the production of dopamine and suppressing the serotonin and melatonin concentration. The neurotransmitter receptors MT2, DRD2, and HTR2A in the sclera appear to play different roles by different color lights in myopic guinea pigs.

Abstract:AIM: To identify the genetic factors underlying anophthalmia and microphthalmia (A/M), and to perform computational analysis to verify the pathophysiological mechanisms of the disease.​ METHODS: This study investigated a consanguineous Pakistani family with multiple affected individuals. Clinical evaluations were conducted using A-Scan and ophthalmic B-Scan ultrasonography (B-Scan). To identify the disease-causing variant, whole exome sequencing (WES) and Sanger sequencing were performed. In silico functional analyses were carried out using AlphaFold (for protein modeling) and ClusPro (for protein docking analysis) tools, and the hydrodynamic properties of the protein were determined via molecular dynamics simulations.​ RESULTS: Clinical analysis of the five patients revealed severe phenotypes of bilateral anophthalmia. Ocular B-Scan did not detect ocular tissue or intraocular fluid, thus confirming the diagnosis of anophthalmia in all patients. Due to these structural defects, all patients exhibited complete blindness and absence of light perception; additionally, two patients had mild to moderate intellectual disability. Genetic analysis identified a splice site variant [NM_000693.2: c.884-2_885dup; p.(Asp296SerfsTer35)] in the 9th exon of the ALDH1A3 gene.​ CONCLUSION: The present study expands the genetic spectrum of ALDH1A3 and contributes to establishing the genotype-phenotype correlation for this gene.​

Abstract:AIM: To evaluate parameters measured using the tear film imager (TFI) prototype, a new technology that enables to quantify the tear film thickness of lipid and mucoaqueous layers. METHODS: In this cross-sectional study, patients with dry eye, meibomian gland dysfunction (MGD), and non-dry eye/MGD from February 2020 to January 2021 were analyzed. Quantified TFI outputs included lipid layer thickness (LLT), mucoaqueous layer thickness (MALT), MALT rate of change (MALTR), and lipid breakup time. Two other interferometry devices, LipiView2 and DR-1α, were used for comparison. TFI outputs and other clinical parameters were analyzed using correlation coefficients. Each patient underwent one or several study visits. Baseline values of three device outputs, other clinical parameters, and their changes were examined. RESULTS: This study involved 28 patients (8 patients with dry eyes, 13 with MGD, and 7 with non-dry eye/MGD). Baseline TFI, LipiView2, and DR-1α values were associated with various clinical parameters. The LLT values estimated using TFI had a correlation with the plugging score in the upper eyelid (r=−0.42). Several TFI values have correlated better than LipiView2 and DR-1α, particularly with questionnaire scores. MALTR by TFI revealed a correlation between standardized patient evaluation on eye dryness (SPEED) and dry eye-related quality of life score (DEQS) scores (r=0.59, 0.43), respectively. CONCLUSION: TFI enabled to quantify the LLT and MALT separately over time and shows the moderate correlations between TFI measurements and clinical parameters, which yields the potential for TFI to serve as a complementary tool for assessing dry eye and MGD.

Abstract:AIM: To evaluate the influence of ocular biometric parameters on the performance of actual near-add power in the spectacle plane of multifocal intraocular lenses (MIOLs). METHODS: This retrospective study defined prediction error (PE) as the difference between actual postoperative near-add power and manufacturer-predicted values. Linear regression assessed PE correlations with axial length (AL), mean keratometry (K), pupil size, anterior chamber depth (ACD), lens thickness (LT), ACD+0.5×LT, and back-calculated IOL power. Differences in PE across MIOLs types, AL, K, pupil size, ACD, LT, ACD+0.5×LT, and back-calculated IOL power groups were compared. RESULTS: Totally 250 eyes of 250 patients (116 males and 134 females, mean age 56.22±12.31y) who underwent phacoemulsification with MIOL implantation were reviewed. PE showed no significant correlation with most parameters but had a weak positive correlation with LT. The mean predicted error (MPE) in the AL≤22, 26–27, and 27–28 mm groups were 0.83 (0.51, 1.01) D, 0.78 (0.51, 1.07) D, and 0.72 (0.57, 0.94) D respectively (P<0.001). The MPE in the K between the 45–46 D groups was 0.78 (0.37, 1.07) D (P=0.0004). The MPE in the LT between the 4.5–5.0 mm groups and ≥5 mm was 0.72 (0.50, 1.01) D and 0.72 (0.51, 1.01) D respectively (P<0.001). The MPE in the back-calculated IOL power ≥25 D was 0.86 (0.60, 1.01) D (P<0.001). CONCLUSION: Although there is no significant linear relationship between near-add power and most ocular biometry parameters, and specific segments of AL, K, LT, and IOL power have a significant impact on the near-add power of MIOLs. These factors should be taken into account in preoperative evaluations.

Abstract:AIM: To evaluate the efficacy of the Tecnis® Symfony® ZXR00 lens in achieving optimal visual outcomes for cataract surgery patients with axial length (AL) shorter than 24 mm. METHODS: A total of 21 subjects (37 eyes) were submitted to cataract surgery and implantation of Tecnis® Symfony® ZXR00 lens (Johnson & Johnson Vision) was assessed. Patients were examined at 5 m, 80 cm, and 40 cm for uncorrected distance visual acuity (UCDVA) and corrected distance visual acuity (CDVA), uncorrected intermediate (UCIVA), and uncorrected near visual acuity (UCNVA). Further, based on the optimal distance correction, the monocular defocusing curve in the range of +0.5 to -3.5 D was investigated. A simple patient-reported spectacle independence questionnaire (PRSIQ) was used to evaluate subjects’ subjective feelings about their dependence on glasses at various distances. Multiple linear regression was employed to examine the association amony intraocular lenses (IOLs) diopter, AL, corneal curvature, anterior chamber depth, mean manifest refractive spherical equivalent, pupil, pupil/scan, target refraction, and near vision (logMAR). RESULTS: The study demonstrated enhanced UCNVA alongside comparable distant vision and UCIVA outcomes in eyes with AL shorter than 24 mm. Mean post-operative UCDVA significantly improved from preoperative levels 0.530±0.406 (P=0.000). Notably, 83.3% of eyes achieved 0.01 logMAR in UCNVA. Five unilateral cases with blended IOL implantation also showed satisfactory visual acuity and satisfaction. The 90.5% (19/21) achieved spectacle independence. The average score for self-reported spectacle-independence on the PRSIQ was 3.52 with a standard deviation of 0.98. The results of the regression analysis revealed that one predictor, the pupil/scan accounted for 27.6% of the variation in near vision [logMAR; F(1,35)=13.33, P<0.01]. CONCLUSION: The results affirm the effectiveness of the Tecnis® Symfony® ZXR00 lens in enhancing visual outcomes for cataract surgery patients with AL shorter than 24 mm. Additionally, the pupil/scan emerges as a critical factor influencing postoperative near vision.

Abstract:AIM: To evaluate the short-term efficacy and safety of ultrasound cycloplasty (UCP) procedure in Chinese patients with angle-closure glaucoma (ACG), and the mechanisms of its intraocular pressure (IOP) lowering effects. METHODS: Fifty-six patients (56 eyes) diagnosed with primary and/or secondary ACG were enrolled in this prospective study. Visual acuity, IOP, slit-lamp examinations, structural parameters of anterior segments including anterior chamber depth (ACD), pupillary diameter (PD), anterior chamber area (ACAr), anterior chamber angle (ACAn), and side effects were evaluated. Seven rhesus macaques (Macaca Mulatta) were used for the analyses of IOP lowering effects, including inflammatory reactions, pathohistological evaluation, scanning electron microscopy (SEM), and aqueous outflow pathway via 1% basic fuchsin perfusion. RESULTS: Fifty six eyes of 24 male and 32 female patients with an average age of 58.93±15.97 years old were recruited in primary and secondary ACG affected 31 and 25 eyes, respectively. Clinically, the mean IOP was 17.89±7.93 mm Hg (n=53, 53.63% reduction, P<0.001) at 1wk and 22.47±12.00 mm Hg at 12mo (n=16, 18.67% reduction, P<0.01) after UCP, compared to the baseline of 39.08±14.75 mm Hg (n=56). Postoperative tolerance was favorable in 94.64% of cases, with visual acuity unchanged or improved in 96.43% of patients. Mild and transient inflammatory reactions were observed post UCP. UBM analysis revealed statistically significant changes in anterior chamber parameters: increased ACD (n=22, P<0.05), enlarged PD (n=22, P<0.05), expanded ACAr (n=16, P<0.01), and widened ACAn (n=19, P<0.05) compared to preoperative measurements. As in normal monkey eyes, IOP was also reduced upon UCP. Mild inflammatory reactions were seen 1-7d post treatment. Hematoxylin and Eosin (H&E) staining showed enlarged spaces among ciliary muscle bundles. Ciliary process stromal edema was evident, but significant loss of two layers of ciliary epitheliums was not seen. SEM confirmed ciliary muscle fibers concentrated. Fuchsin anterior chamber perfusion showed the whole ciliary body staining in UCP group, but only surface staining in controls. CONCLUSION: UCP is efficient and safe to lower the IOP of patients with ACG. Changed anterior chamber structure and increased aqueous humour outflow via uveoscleral pathway may significantly attribute to IOP lowering effects of UCP.

Abstract:AIM: To explore the mechanical indices used for differential diagnosis and to investigate the relationship between ocular biomechanics and glaucoma severity within each group. METHODS: This cross-sectional study included 185 eyes from 185 subjects: 62 normal controls, 91 high-tension glaucoma (HTG), and 32 normal-tension glaucoma (NTG) patients. All participants underwent a comprehensive ophthalmic examination that involved ocular biomechanical measurements. Glaucoma severity was assessed using visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD) and retinal nerve fiber layer (RNFL) thickness. Multivariable models were used to compare fifteen biomechanical parameters among the three groups adjusting for age, gender, intraocular pressure (IOP), central corneal thickness (CCT), and axial length (AL). The generalized linear model was utilized for multifactor comparison. RESULTS: Significant differences in first applanation time (AT1), highest concavity time (HC time), stress strain index (SSI), and HC deflection were found among the three groups (P<0.05). AT1 was significantly higher in the HTG group compared to controls (P<0.05), and SSI was higher in HTG than NTG (P<0.05). HC deflection in the HTG group was significantly smaller than in NTG (P<0.05). Furthermore, AT1 levels were observed to be significantly higher in primary open angle glaucoma (POAG) patients compared to controls (P<0.05). Receiver operating charactristic (ROC) analysis showed HC deflection had an area under the curve (AUC) of 0.802 between HTG and NTG. A negatively significant correlation was observed between SSI and VFI in POAG patients. CONCLUSION: Biomechanical analysis reveals that corneas in POAG patients are stiffer than normal controls, with increased corneal stiffness correlating with more severe glaucomatous damage. Interestingly, stiffer corneas in NTG patients appeares protective. In addition, HC deflection may be useful for differentiating HTG and NTG.

Abstract:AIM: To investigate the ultrasonographic features of ciliary body mesectodermal leiomyomas (CBL).​ METHODS: Ultrasonographic data of 18 eyes from 18 patients with histopathologically confirmed CBL were analyzed, covering the period from March 2018 to February 2024. The study included 5 male and 13 female patients, aged 14-64y, with a mean age of 40.11±13.54y. The following ultrasonographic features were evaluated: tumor base diameter, thickness, maximum base diameter-to-thickness ratio, shape, internal echogenicity, margin echogenicity, internal echo homogeneity, secondary changes, color Doppler flow imaging (CDFI) findings, and contrast-enhanced ultrasound (CEUS) characteristics.​ RESULTS: Conventional ultrasound findings of the 18 CBL cases were as follows: 1) Tumor size: base diameter of (13.48±4.74)×(11.57±4.00) mm2, thickness of 7.70±2.60 mm, and maximum base diameter-to-thickness ratio of 1.77±0.36. 2) Shape: 14 cases (77.8%) were hemispherical, and 4 cases (22.2%) were irregular. 3) Internal echogenicity: the solid component of the tumor was hypoechoic in 16 cases (88.9%) and low-to-medium echogenic in 2 cases (11.1%). 4) Margin echogenicity: relatively hyperechoic with a “ring-shaped” margin in 15 cases (83.3%) and isoechoic in 3 cases (16.7%; compared with internal echogenicity). 5) Internal echo homogeneity: homogeneous in 11 cases (61.1%) and heterogeneous in 7 cases (38.9%), with 6 cases (33.3%) among the 7 heterogeneous cases exhibiting cystic anechoic areas. 6) Secondary retinal detachment was observed in 4 cases (22.2%). CDFI revealed heterogeneous vascularity within the tumors, with blood flow signals ranging from minimal to marked. CEUS was performed in 14 patients: complete contrast agent perfusion was observed in 10 cases (71.4%), and partial perfusion was noted in 4 cases (28.6%). Additionally, 8 cases (57.1%) showed a rapid wash-in and slow wash-out pattern, while 6 cases (42.9%) demonstrated a rapid wash-in and rapid wash-out pattern. CONCLUSION: CBL exhibit relatively typical ultrasonographic features, which can provide valuable evidence for the clinical diagnosis and differential diagnosis of intraocular tumors.​

Abstract:AIM: To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy (PPV) in patients with primary rhegmatogenous retinal detachment (RRD). METHODS: Clinical data of patients with primary RRD treated at the Shenzhen Eye Hospital were retrospectively collected. Twenty-four potential influencing factors, including patient characteristics and surgical factors, were selected for analysis. Independent risk factors for secondary cataract were identified through univariate comparisons and multivariate logistic regression analysis. A risk prediction model was constructed and evaluated using receiver operating characteristic (ROC) curves, area under the ROC curve (AUC), calibration plots, and decision curve analysis (DCA) curves. RESULTS: The 386 cases (389 eyes) of patients who underwent PPV and had complete surgical records were ultimately included. Within a 2-year longitudinal observation, 41.39% of patients developed cataract secondary to PPV. Logistic regression results identified a history of hypertension [odds ratio (OR)=1.78, 95%CI: 1.002–3.163, P=0.049], silicone oil tamponade (OR=3.667, 95%CI: 2.373–5.667, P=0.000), and lens thickness (OR=1.978, 95%CI: 1.129–3.464, P=0.017) as independent risk factors for cataract secondary to PPV. The constructed nomogram achieved AUC=0.6974. Calibration plots indicated good agreement between predicted and observed outcomes, while DCA curves demonstrated the model’s clinical utility. CONCLUSION: By incorporating a history of hypertension, vitreous substitute type, and lens thickness, this study constructs a prediction model with moderate discriminative ability. This model offers a valuable tool for clinicians to identify high-risk patients early, potentially allowing for more timely interventions and improved patient outcomes.

Abstract:AIM: To examine effects of switching intravitreal aflibercept to bevacizumab in neovascular age-related macular degeneration (nAMD). METHODS: Data from patients treated for nAMD with anti-vascular endothelial growth factor (VEGF) injections at Örebro University Hospital between January 2014 and June 2020, were extracted from the Swedish macular register (SMR). A total of 230 eyes were included in the study: 116 in the study/bevacizumab switch group and 114 in the control/aflibercept group. Central retinal thickness (CRT) was measured at baseline and after 2y. Primary outcome was mean change in best corrected visual acuity (BCVA) between baseline and 2y. Secondary outcome variables included proportion of patients with a clinically significant change in BCVA [increase or decrease of ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters], mean change in CRT, number of anti-VEGF injections, number of visits assessing disease activity and number of visits with active disease. RESULTS: The mean difference in BCVA between baseline and 2y was 1.13±14.47 ETDRS letters in the bevacizumab switch group and 1.81±13.01 ETDRS letters in the aflibercept group. The lower bound of the 95% confidence interval of the difference in BCVA was -4.25, indicating non-inferiority within a 5 ETDRS letter limit. No significant differences in mean change of CRT between baseline and 2y were detected (study -185.9±167.0 versus control -149.4±193.1 µm, P=0.127). The distribution of clinically significant improvement (P=0.598) or worsening (P=0.508) of BCVA during follow-up did not show statistically significant differences between groups. The number of anti-VEGF injections administered (study 12.76±2.20 versus control 13.10±4.20, P=0.442), the number of visits assessing disease activity (P=0.301), and the number of visits with active disease (P=0.065) did not show differences between subjects receiving bevacizumab and aflibercept treatment. No significant differences were detected in baseline characteristics between the study and control groups, including age, BCVA, CRT, neovascular membrane type or location, duration of symptoms or prior cataract surgery. CONCLUSION: Switching to off-label bevacizumab in patients responding to initial aflibercept treatment is non-inferior to continued aflibercept treatment with respect to change in visual acuity at 2y. Switching anti-VEGF from aflibercept to bevacizumab may be a viable option in clinical settings with limited resources.

Abstract:AIM: To evaluate the efficacy and safety of conbercept combined with 577 nm subthreshold micropulse laser (STML) for treatment of diabetic macular edema (DME). METHODS: A retrospective study was conducted. From October 2022 to March 2024, 72 patients diagnosed with DME at the outpatient clinic were enrolled. The patients were divided into two groups: the simple group (treated with conbercept alone) and the combination group (treated with 577 nm STML combined with conbercept). The following itmes were compared between the two groups: best corrected visual acuity (BCVA), central macular thickness (CMT), foveal avascular zone (FAZ), vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), retinal mean sensitivity (RMS), injection numbers, and the number of cases with adverse effects. RESULTS: The mean age of patients was 57.13±8.76 (range 34-77)y with DR history of 0.89±0.55y. With the progression of treatment, both groups showed significant improvements in BCVA, CMT, DCP vessel density, and RMS compared to baselines (all, P<0.05). At 3 and 6mo after treatment, the combination group exhibited significantly better outcomes in BCVA, CMT, DCP vessel density, and RMS than the simple group (P<0.05). During the treatment period, neither group showed significant improvements in FAZ and SCP vessel density (P>0.05), and no significant differences in FAZ and SCP vessel density were observed between the two groups (P>0.05). The average number of injections required in the combination group was lower than that in the simple group (3.33±0.68 vs 4.06±0.96, P<0.05). No other serious ophthalmic adverse events were observed in either group. CONCLUSION: Conbercept combined with STML has better outcomes for treatment of DME and less intravitreal injections compared to conbercept monotherapy.

Abstract:AIM: To evaluate retinal hemoglobin oxygen saturation in myopic eyes by scanning laser ophthalmoscope (SLO) and to assess its correlations with different severity of myopia. METHODS: Sixty-one eyes from 61 patients were included and subdivided into three groups according to their refractive errors: high myopia group [20 eyes, spherical equivalent (SE)≤-6 D]; low and moderate myopia (22 eyes, -6.00.05). CONCLUSION: SO2A and SO2V increased in more myopic eye based on SLO measurements. Further studies are warranted to investigate the changes of retinal hemoglobin oxygen saturation in myopia with different methods.

Abstract:AIM: To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction (SMILE) surgery for myopia and myopic astigmatism in patients with thin corneas. METHODS: A prospective study included patients with thin corneas (preoperative thinnest corneal thickness ranging from 480 to 520 μm) who underwent SMILE for myopia or myopic astigmatism. Corneal topography and posterior corneal elevation were assessed using Pentacam HR at three time points: preoperatively, 1mo, and 6mo postoperatively. The measured parameters included thinnest point elevation (PTE), posterior maximal elevation (PME), posterior central elevation (PCE), and 24 additional reference points. RESULTS: A total of 106 eyes from 106 patients (age range: 18-34) were included in the study. Uncorrected distance visual acuity (UDVA) improved significantly, with a mean logMAR value of -0.07±0.06 at the final follow-up visit. Measurements of posterior corneal elevation showed no significant changes in most points, hemispheres, and meridians at 6mo postoperatively. Notably, only two points, ∆E2mm-45° and ∆E2mm-90°, exhibited statistically significant elevation changes: the elevation of ∆E2mm-45° increased from -2.3±4.99 to -1.0±5.9 μm (P=0.0037), and that of ∆E2mm-90° increased from -16±7.53 to -15±7.4 μm (P=0.016). However, these changes were within the measurement error range of the Pentacam HR (±5 μm in a 5 mm area). CONCLUSION: SMILE surgery is a safe and stable procedure for correcting myopia or myopic astigmatism in patients with thin corneas, as evidenced by the stability of posterior corneal elevation.

Abstract:AIM: To analyze the two-year visual and refractive outcomes as well as the safety, and efficacy of photorefractive keratectomy (PRK) surgery for myopia. METHODS: In this prospective cohort study, 63 eligible patients were recruited, including 45 women (71.4%) and 18 men (28.6%). Demographic characteristics along with pre- and post-operative clinical data including visual acuity, refraction, maximum ablation, spherical and cylindrical error, and residual stromal bed (RSB) were evaluated. RESULTS: The mean age of the patients was 35.42±8.16y (range 22 to 55y). The mean spherical and cylindrical error before surgery were -2.23±1.58 D (range -5 to +0.25) and -1.24±0.94 D, respectively (range -3.75 to 0.00). The mean efficacy and safety of PRK surgery at 2y follow-up were 0.98±0.06 and 1.01±0.04 respectively. The lower age was significantly correlated with a higher amount of efficacy index (P<0.001, r=-0.42). Also, the lower amount of preoperative myopia and spherical equivalent (SE) were correlated with a higher safety index (P<0.001, r=-0.44; P<0.001, r=-0.46). CONCLUSION: The two-year efficacy and safety of PRK for the treatment of low myopia is excellent. Younger age and lower amount of refractive error are correlated with higher efficacy and safety indices of the surgery.

Abstract:AIM: To investigate the outcome of combined anterior corneal elastic sublaminectomy, conjunctival flap, and prosthetic eyepiece for ocular atrophy following foldable capsular vitreous body (FCVB) implantation in severe trauma. METHODS: This study conducted a retrospective analysis of 38 patients who underwent conjunctival flap coverage followed by prosthetic eyepiece fitting after developing ocular atrophy secondary to FCVB surgery. Anterior corneal elastic sublaminectomy combined with conjunctival coverage was performed on the FCVB-implanted atrophic eyes. Prosthetic lenses were fitted after complete healing of the stroma and conjunctiva and suture removal. Corneal irritation, eyeball protrusion, axial length, lid height, cosmetic satisfaction, and pain numerical rating scale scores were observed before the conjunctival flap covering and after the prosthetic eyepiece surgery. RESULTS: The ocular protrusion was 11 mm preoperatively and 14 mm postoperatively, with the difference being statistically significant (Z=-5.459, P<0.001). The ocular axis length was 20.82±0.94 mm in the experimental group and 23.57±0.33 mm in the control group, showing a statistically significant difference (t=-20.207, P<0.05). The lid height was 6 mm in the experimental group and 9 mm in the control group, a difference that was statistically significant (Z=-5.326, P<0.001). The appearance satisfaction score was 1 in the experimental group and 4 in the control group, with this difference being statistically significant (Z=-5.447, P=0.001). Regarding the pain numerical rating scale score, the ranges were 0-2 in the experimental group and 0 in the control group. No discomfort was reported after wearing the prosthetic eyepiece, and the difference was not statistically significant (Z=-1.100, P>0.05). There was no statistically significant difference between pre- and post-treatment satisfaction. CONCLUSION: A conjunctival flap covering and a prosthetic eyepiece after FCVB postoperative atrophy can reduce the number of surgeries, alleviate patients’ economic burdens, satisfy patients’ psychological eyeball retention requirements, and provide better cosmetic efficacies for patients desiring eyeball retention or silicone-oil dependence.

Abstract:AIM: To analyze the environmental impact of patient travel for cataract surgery at a German ophthalmology center. METHODS: All cataract surgeries performed between October 23 and October 27, 2023, were analyzed, and all patient records were reviewed for follow-up visits. All travel distances were calculated, and the associated emissions were quantified. Additionally, patients’ utilization of geographically closer branch practices for follow-up care was evaluated, along with the corresponding effects on travel-related emissions. RESULTS: A total of 69 patients underwent unilateral cataract surgery. The average one-way travel distance was 40.1 km (24.9 mi; SD = 23.6 km). Corresponding emissions were 1284.8 kg of greenhouse gas (GHG), 2.477 kg of nitrogen oxides, and 0.101 kg of particulates. All patients attended at least two follow-up visits. Conducting follow-up visits at branch practices reduced travel distance by 49.1%. The associated GHG emissions from all travel were 1984.3 kg. Emissions from follow-up visits were 54.4% higher than those from the surgery itself. Total GHG emissions amounted to 3269.1 kg, with an average of 47.4 kg of GHG per patient for all travel associated with cataract surgery.​ CONCLUSION: A dense network of branch practices contributes to reducing the carbon footprint of cataract surgery-related patient travel; however, the development of digital health approaches for follow-up care is necessary to further optimize the environmental sustainability of cataract surgery.​

Abstract:AIM: To identify factors associated with adherence to annual eye examinations among adults with diabetes mellitus (DM) in Malaysia. METHODS: Data from community-dwelling adults aged ≥18y with known DM, defined as those who had previously been informed by a doctor or assistant medical officer of their diagnosis were analyzed using the National Health and Morbidity Survey 2023, a population-based cross-sectional survey conducted using a two-stage stratified random sampling design. Locally validated questionnaire on diabetic eye screening was administered through face-to-face interviews from July until September 2023. Adults with known DM were asked three key questions about eye examinations: whether their eyes had been examined using clinical tools (illustrated with images of a direct ophthalmoscope, slit lamp or fundus camera), the timing of their last eye examination (if applicable), and whether they had been referred to an ophthalmology clinic for DM-related complications, serving as a proxy for diabetic retinopathy (DR) referrals. Complex sample analysis, incorporating sample weights and the study’s design, were used to describe respondents’ baseline characteristics by urban or rural localities. Multivariable binary logistic regression with adjusted odds ratio (aOR) and 95% confidence interval (CI) was performed. RESULTS: Among 1554 adults with known DM in Malaysia, 58.8% had never undergone an eye examination and only 29.5% complied with the recommended annual eye check-ups. Additionally, 25.8% of DM patients were referred to an ophthalmology clinic for DR. Referral to ophthalmology clinic for DR (aOR=4.63, 95%CI: 3.27, 6.55), insulin use (aOR=1.93, 95%CI: 1.37, 2.72), secondary education (aOR=1.71, 95%CI: 1.03, 2.85) and DM duration ≥10y (aOR=1.48, 95%CI: 1.02, 2.16) were associated with higher odds of annual eye examinations. Chinese (aOR=0.50, 95%CI: 0.29, 0.87) and Indian (aOR=0.47, 95%CI: 0.29, 0.78) ethnicities had lower odds of undergoing annual eye examinations compared to Malay ethnicity. Similarly, those with a monthly household income of ≥RM10 000 (aOR=0.45, 95%CI: 0.21, 0.95) were less likely to get their eyes examined yearly. CONCLUSION: Fewer than one-third of adults with DM in Malaysia adhere to the recommended annual eye examinations, with lower compliance observed among Chinese or Indian ethnicities and those with higher household incomes. Targeted educational campaigns for Chinese, Indian, and higher-income adults with DM may encourage regular eye exams and reduce preventable vision loss from DR in Malaysia.

Abstract:AIM: To employ proteome-wide Mendelian randomization (MR) to explore novel protein and drug targets for retinal neurodegenerative diseases (RND) in individuals of European ancestry. METHODS: This study used summary data-based MR to analyze the correlation between plasma protein levels and three RND, with protein data derived from two independent large-scale proteomics datasets. Potential drug targets were identified using Bayesian colocalization, followed by MR analysis, sensitivity testing, and external validation. Drug prediction and molecular docking were conducted to evaluate the druggability of the target proteins. RESULTS: The study identified six promising protein targets, each successfully replicated at least twice. The results included three proteins related to diabetic retinopathy (ICAM1, GCKR, WARS), two proteins related to age-related macular degeneration (WARS, BRD2), and two proteins related to glaucoma (SVEP1, NPTXR). Additionally, drug prediction and molecular docking indicated that five drugs (fenofibrate, trofinetide, ticagrelor, lifitegrast, acetaminophen) effectively bound to the target proteins. CONCLUSION: This study identified six potential protein targets for RND and five existing drugs with therapeutic potential. By integrating plasma proteomics with genetic data, it provides a cost-effective framework for drug discovery.

Abstract:This study aimed to differentiate between the therapeutic and purely cosmetic aspects of keratopigmentation by examining the results of previous studies. Corneal opacity, corneal leukoma, and iris abnormalities represent the primary reasons for keratopigmentation in therapeutic settings. In therapeutic contexts, the most commonly reported adverse effects included inflammation, foreign body sensation, light sensitivity, reduced intraocular pressure, and neovascularization. The side effects most frequently noted in purely cosmetic applications were photophobia and ectasia. In therapeutic scenarios, patients who experience pre-operative vision impairment often report not only the absence of visual loss post-procedure but also an enhancement in visual acuity, accompanied by alleviation of symptoms such as glare. In purely cosmetic procedures, visual acuity tends to remain stable. Research indicates that dissatisfaction with keratopigmentation results is more prevalent in studies aimed at therapeutic interventions compared to cosmetic enhancements. Furthermore, instances of discoloration and fading are more frequently observed in therapeutic cases than in cosmetic ones, including the need for retouching. The use of keratopigmentation in both therapeutic and cosmetic settings produces positive and acceptable results, especially in cosmetic applications. Nevertheless, complications are more commonly observed in therapeutic situations, which underscores the importance of candidate selection for keratopigmentation procedures.

Abstract:The global prevalence of myopia is becoming increasingly severe, with epidemiological models predicting that by 2050, approximately 50% of the world’s population will be affected by myopia, and about 10% will suffer from high myopia. The incidence of high myopia is projected to increase fivefold, making it the leading cause of irreversible vision impairment. Myopia often leads to various complications and has been associated with other ocular diseases, including early-onset cataracts, age-related macular degeneration, and primary open angle glaucoma. As a result, the control and management of myopia have become ongoing and long-term research priorities. The pathogenesis of myopia involves complex multisystem interactions. Current mainstream theories focus primarily on choroidal hypoxia-induced scleral remodeling, with neurotransmitters such as acetylcholine and dopamine playing regulatory roles. However, recent studies have increasingly suggested that changes in nutritional intake, including proteins, fats, and cholesterol, may also be related to myopia development. The role of lipid metabolism in the onset and progression of myopia has gradually attracted growing attention. Therefore, this review aims to systematically elucidate the molecular mechanisms of lipid metabolism regulatory networks in axial myopia, integrating multidimensional factors to provide a theoretical foundation for precision intervention strategies.

Abstract:AIM: To propose a novel classification system for late postoperative capsular block syndrome (CBS) based on the turbidity of intracapsular fluid, and to investigate the imaging and refractive changes before and after Nd:YAG laser posterior capsulotomy for each subtype. METHODS: A retrospective analysis was performed on 5 eyes from 5 patients with late postoperative CBS. Patients were categorized into turbid (3 eyes) or clear (2 eyes) types based on the turbidity of intracapsular fluid. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive status, slit-lamp images, Pentacam Scheimpflug data, and ultrasound biomicroscopy (UBM) images were evaluated before and 1mo after successful Nd:YAG laser posterior capsulotomy. RESULTS: Nd:YAG laser posterior capsulotomy significantly improved UCVA and BCVA in all 5 late CBS eyes. Pentacam imaging: turbid intracapsular fluid showed hyperreflection between posterior capsule and intraocular lens (IOL); clear fluid showed hyporeflection. UBM: posterior capsule was clear in turbid type but poorly defined in clear type. Capsulotomy increased aqueous depth only in clear type. Refractive changes: turbid fluid induced myopic shift. Clear type myopic shift was due to anterior IOL displacement and clear fluid-induced concave lens effect. CONCLUSION: Nd:YAG laser posterior capsulotomy is effective for late CBS. Turbid and clear late CBS types differ in imaging (Pentacam/UBM) and refractive mechanisms, supporting the proposed classification’s clinical value.

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