Abstract:AIM: To evaluate the potential of artificial intelligence (AI) for automating corneal topography interpretation in orthokeratology patients, aiming to enhance diagnostic precision, efficiency, and clinical decision-making in myopia management. METHODS: The 1469 corneal topography images from 582 eyes of 326 myopic children treated with orthokeratology lenses over 47mo were collected. Each sample was categorized by decentration, treatment zone size, shape variation, and eye laterality. A multi-task AI model was developed to predict these parameters, with performance measured using area under curve (AUC), accuracy, and F1 scores. We compared AI-only, human-only, and combined Human+AI approaches on a subset of 100 images. External validation with images from additional hospitals tested model generalizability. RESULTS: The model achieved high accuracy in eye-side prediction (AUC 0.95) and AUC values of 0.52-0.74 for decentration, treatment zone, and shape variation tasks. The combined Human+AI method outperformed AI-only and human-only approaches, achieving the highest accuracy (up to 87%) and fastest processing time (80ms). External validation confirmed robust performance in simple tasks, though accuracy was lower for complex classifications due to imaging variations. CONCLUSION: AI provides efficient routine corneal topography assessments, while complex cases benefit most from a Human+AI approach, particularly in scenarios requiring nuanced clinical interpretation. The model currently functions as an assistive tool.

Abstract:AIM: To find the effective contrast enhancement method on retinal images for effective segmentation of retinal features. METHODS: A novel image preprocessing method that used neighbourhood-based improved contrast limited adaptive histogram equalization (NICLAHE) to improve retinal image contrast was suggested to aid in the accurate identification of retinal disorders and improve the visibility of fine retinal structures. Additionally, a minimal-order filter was applied to effectively denoise the images without compromising important retinal structures. The novel NICLAHE algorithm was inspired by the classical CLAHE algorithm, but enhanced it by selecting the clip limits and tile sized in a dynamical manner relative to the pixel values in an image as opposed to using fixed values. It was evaluated on the Drive and high-resolution fundus (HRF) datasets on conventional quality measures. RESULTS: The new proposed preprocessing technique was applied to two retinal image databases, Drive and HRF, with four quality metrics being, root mean square error (RMSE), peak signal to noise ratio (PSNR), root mean square contrast (RMSC), and overall contrast. The technique performed superiorly on both the data sets as compared to the traditional enhancement methods. In order to assess the compatibility of the method with automated diagnosis, a deep learning framework named ResNet was applied in the segmentation of retinal blood vessels. Sensitivity, specificity, precision and accuracy were used to analyse the performance. NICLAHE–enhanced images outperformed the traditional techniques on both the datasets with improved accuracy. CONCLUSION: NICLAHE provides better results than traditional methods with less error and improved contrast-related values. These enhanced images are subsequently measured by sensitivity, specificity, precision, and accuracy, which yield a better result in both datasets.

Abstract:AIM: To investigate the postnatal development of parvalbumin (PV)-positive gamma-aminobutyric acid (GABA) interneurons and the co-expression of perineuronal nets (PNNs) and PV in the visual cortex of rats, as well as the regulatory effects of fluoxetine (FLX) treatment and binocular form deprivation (BFD) on these indices. METHODS: Wistar rats were assigned to three experimental cohorts: 1) Age-related groups: postnatal week (PW) 1, PW3, PW5, PW7, and PW9; 2) FLX treatment duration groups: FLX 0W, FLX 2W, FLX 4W, FLX 6W, and FLX 8W; 3) Intervention groups: control (Cont), FLX, BFD, and BFD+FLX. The levels of PNNs, PV, and PNNs/PV co-expression in the visual cortex were detected and analyzed. RESULTS: The density of PV-positive cells and the co-expression of PNNs and PV increased gradually with the maturation of the visual cortex (b=0.960, P<0.01). The ratio of PV-positive cells surrounded by PNNs to total PV-positive cells (PNNs+/PV+/total PV+) was significantly decreased in the FLX 4W group (χ²=9.03, P=0.003). There was no significant difference in the PNNs+/PV+/total PV+ ratio between the FLX and BFD groups (χ²=1.08, P=0.161), but a significant difference was observed between the BFD+FLX group and the BFD group (χ²=5.82, P<0.01). CONCLUSION: The number of PV-positive neurons and PNNs-surrounded PV neurons in the rat visual cortex increases postnatally and reaches adult levels by postnatal week 7. Chronic FLX treatment downregulates these expressions. Combined 4-week FLX treatment and BFD exerts a more significant inhibitory effect on the PNNs+/PV+/total PV+ ratio than either intervention alone.

Abstract:AIM: To describe the alterations of the vitreous pathology and anterior chamber (AC) angle structures following transscleral cyclophotocoagulation (TSCP) and better understand the mechanism of post-laser intraocular pressure (IOP) reduction in angle-closure glaucoma (ACG). METHODS: Porcine eyes ex vivo and rabbit eyes in vivo were used. In porcine eyes, permeability rates of the anterior vitreous cortex (AVC) and anterior hyaloid membrane (AHM) were assessed using Schirmer’s strips. Permeability rates in the circumlental space were compared with or without TSCP bursts. Fluorescein diffusion times from the vitreous to the AC were compared between eyes with and without TSCP. In rabbit eyes, changes in IOP and AC angle structures under ultrasound biomicroscopy (UBM) were evaluated at intervals of 30min, 7d, and 14d after TSCP. Vitreous pathology was examined using scanning electron microscopy (SEM) immediately and 14d after TSCP. RESULTS: In porcine eyes (n=20), the median (range) permeability rates were 10.3 (range 9.8–10.8) mm/min for the AVC and 4.3 (range 3.9–4.9) mm/min for the AHM (P=0.009). Permeability rates in the circumlental space were 4.2 (range 3.8–4.9) mm/min in areas without TSCP, 6.2 (range 5.7–6.8) mm/min in areas with non-burst TSCP, and 11.3 (range 10.9–11.8) mm/min in areas with burst TSCP (P=0.002). The median (range) fluorescein diffusion time was 5 (range 3–8)min in eyes undergoing TSCP, whereas it was 40min (range 35–68) in eyes without TSCP (P<0.001). In rabbit eyes (n=20), SEM showed immediate localized damage to the AHM, AVC, and posterior lens zonules in areas subjected to TSCP bursts, and obvious lens zonule loss with cellular infiltration and possible vitreous liquefaction by post-op day 14. Persistent widening of AC angles was noted at postoperative days 7 and 14, although a significant reduction in IOP was only observed at postoperative day 7. CONCLUSION: TSCP-induced damage on the zonules, AHM, and AVC potentially enhances fluid outflow from the vitreous, leading to a widened AC angle and vitreous liquefaction in rabbits. These observations offer insights into mechanisms of TSCP in lowering IOP and pathogenic roles of vitreous in ACG.

Abstract:AIM: To explore the methylation status of MSH6 in retinoblastoma (RB) and its impact on clinicopathological features and diagnosis. METHODS: Differentially expressed genes were identified through bioinformatics screening of the GSE24673 and GSE125903 datasets, combined with GeneCards database analysis. A total of 102 RB patients and 62 trauma-enucleated controls between January 2018 and December 2023 were enrolled, with their clinicopathological data and retinal tissues collected. The mRNA and methylation levels of MSH6 in retinal tissues were detected using real-time quantitative polymerase chain reaction (PCR) and methylation-specific PCR. Western blot analysis was conducted in one pair of RB and control tissues for preliminary protein-level validation of MSH6 expression. Based on the methylation status of MSH6, RB patients were categorized into two groups: low-methylation and high-methylation. Both univariate and multivariate analyses were conducted to identify independent factors influencing the methylation levels using clinicopathological data. Receiver operating characteristic (ROC) curves were applied to evaluate the diagnostic potential of MSH6 methylation in RB. RESULTS: Bioinformatics analysis of public datasets revealed that MSH6 expression was downregulated across multiple cancers, RB. Consistently, in clinical RB tissues, MSH6 mRNA expression was significantly lower than that in control retinal tissues, whereas the promoter methylation level of MSH6 was markedly higher (both P<0.001), indicating that promoter hypermethylation may contribute to transcriptional silencing of MSH6 in RB. Patients with higher MSH6 methylation levels showed more advanced pathological classification and a higher frequency of metastasis. Multivariate logistic regression confirmed that metastatic status (P=0.008, OR=3.51) and pathological classification (P=0.005, OR=3.7) were independent factors associated with MSH6 methylation. Receiver operating characteristic (ROC) analysis demonstrated that MSH6 methylation could effectively distinguish RB tissues from non-tumorous controls (AUC=0.847, sensitivity=78.43%, specificity=80.65%), suggesting that MSH6 hypermethylation may serve as a potential diagnostic biomarker for RB. CONCLUSION: The methylation level of the MSH6 gene may be a key factor in RB pathogenesis. The methylation status of the MSH6 gene is closely associated with clinicopathological features and shows diagnostic potential.

Abstract:AIM: To investigate the association between active corneal epithelial dendritic cells (CEDCs) and ocular pain in patients with dry eye disease (DED). METHODS: This cross-sectional study enrolled 67 DED patients, who were divided into two groups based on numerical rating scale (NRS) scores: the mild pain group (n=44) and the moderate-to-severe pain group (n=23). In vivo confocal microscopy (IVCM) was used to image the subbasal layer of the central cornea. Corneal nerve characteristics were analyzed using ACCMetrics software, while CEDCs were quantified manually with Image J software. Regression and correlation analyses were performed to assess the impact of active CEDCs on ocular pain. Additionally, the Luminex method was employed to compare the concentrations of inflammation-related cytokines in tears between patients with ≥2 CEDCs and those with <2 CEDCs. Differences in cytokine levels between the two groups were analyzed using Student’s t-test. RESULTS: The study included 44 eyes of 44 patients with mild ocular pain (12 males and 32 females) and 23 eyes of 23 patients with moderate-to-severe ocular pain (3 males and 20 females). The mean age was 36.2±13.5y in the mild pain group and 39.7±12.4y in the moderate to severe pain group. There were no significant differences in age or sex between the two groups (P=0.30; P=0.19). Multivariable regression analysis showed that older age [odds ratio (OR) =1.05, 95% confidence interval (CI) 1.00–1.11] and a higher number of CEDCs (OR=1.80, 95%CI 1.17–2.76) were associated with ocular pain. Patients with ≥2 CEDCs had significantly higher tear concentrations of interleukin (IL)-6 (P<0.05), IL-8 (P<0.05), and tumor necrosis factor (TNF)-α (P<0.05) compared to those with <2 active CEDCs. CONCLUSION: The findings suggest that infiltrating CEDCs in the corneal subbasal layer are a potential risk factor for ocular pain in DED.

Abstract:AIM: To assess the refractive and functional outcomes of a novel trifocal intraocular lens (IOL) with smooth micro phase technology. METHODS: This prospective, single-arm, single-center, observational study included patients who underwent cataract surgery with the implantation of the AT ELANA 841P (Carl Zeiss Meditec, Berlin, Germany) IOL. Visual acuity (VA) at distance, intermediate, and near were evaluated 1- and 3-month postop as well as refractive outcomes. Monocular and binocular defocus curve, binocular contrast sensitivity (M&S® Technologies) and patient satisfaction with the Catquest-9SF questionnaire were measured at 3-month postop. RESULTS: In total, 46 eyes (23 patients) were bilaterally implanted with the IOL. Mean patient age was 59.86±5.55y. At 1-month postop, monocular corrected VA for distance, intermediate, and near were -0.15±0.09, 0.11±0.10, and 0.15±0.12 logMAR, respectively. These outcomes remained stable at the 3-month follow-up (P>0.05). Spherical equivalent (SE) at 1- and 3-month postop remained stable (P>0.05). Following surgery, 91% of the eyes at 1mo and 95% of the eyes at 3mo were within ±0.5 D of SE. Monocular defocus curve showed that the lens can be categorized as a steep transition IOL. The contrast sensitivity function revealed high values at low spatial frequencies and decreased values at high spatial frequencies. The results of the Catquest-9SF questionnaire showed that all patients were fairly or very satisfied with their vision after surgery. CONCLUSION: The AT ELANA 841P IOL offers excellent visual outcomes across distance, intermediate, and near ranges, along with satisfactory contrast sensitivity. Additionally, the lens is associated with high patient satisfaction and minimal visual difficulties during daily activities.

Abstract:AIM: To compare surgical efficacy based on residual peripheral anterior synechiae (PAS) extent after viscogonioplasty (VGP) combined with phacoemulsification and intraocular lens implantation (PEI) in patients with primary angle-closure disease (PACD) and identify risk factors for extensive postoperative PAS. METHODS: This prospective cohort study included 73 eyes of 61 patients with PACD undergoing PEI with VGP. Patients were divided into Group A (PAS<90°, n=39) and Group B (90°≤PAS≤180°, n=34) based on PAS extent at the end of surgery. PAS progression rates were assessed using a linear mixed-effects model. Logistic regression analyzed risk factors for PAS≥180° at 12mo postoperatively. RESULTS: Both groups showed significant PAS progression at 12mo (P<0.001). Group A had smaller PAS extent than Group B at all time points (P<0.001). PAS progression rates were similar between groups (P=0.335). No significant differences were found in intraocular pressure (IOP), IOP-lowering medications, or surgical success rates (P>0.05). Female [odds ratio (OR)=0.211, P=0.046], preoperative medication number (OR=1.017, P=0.029), and PAS extent at the end of surgery (OR=1.017, P=0.018) were risk factors for PAS≥180° at 12mo. CONCLUSION: Residual PAS extent at the end of surgery predicts postoperative extensive PAS formation but has limited effect on PAS progression rate and IOP control. Female, multiple preoperative IOP-lowering medications, and larger residual PAS extent are independent risk factors for extensive PAS at 12mo postoperatively.

Abstract:AIM: To evaluate the surgical outcomes of the perfluorocarbon liquid (PFCL)-assisted inverted multilayer internal limiting membrane (ILM) flaps covering technique in macular hole retinal detachment (MHRD) in high myopia with axial length (AL) ≥30 mm. METHODS: In this retrospective, interventional, consecutive comparative study, 44 MHRD eyes were divided into two groups: the PFCL-assisted inverted multilayer ILM flaps covering technique group (Group 1, 21 eyes) and the ILM peeling group (Group 2, 23 eyes). The follow-up period was >12mo. Postoperative outcomes, including retinal reattachment, macular hole (MH) closure, and best-corrected visual acuity (BCVA), were assessed. Statistical analysis using the Mann–Whitney U test and Fisher’s exact test was conducted to compare differences between groups. RESULTS: There were no statistically significant differences in baseline preoperative clinical characteristics, including age, sex, AL, diopters, duration of symptom, lens status, posterior staphyloma presence and extent of RD. Retinal reattachment rates were higher in Group 1 (90.5%) than in Group 2 (82.6%), without statistical significance (P=0.667). MH closure rates were significantly higher in Group 1 (85.7%) than in Group 2 (17.4%; P<0.001). The Group-1 BCVA (logMAR) improved significantly from 2.13±0.91 preoperatively to 1.21±0.66 postoperatively (P=0.026). The Group 2 BCVA improved significantly from 1.91±0.53 preoperatively to 1.19±0.41 postoperatively (P=0.032). However, there were no significant differences in visual-acuity improvement between groups (P=0.460). CONCLUSION: This technique offers a more effective approach for improving MH closure rates and postoperative visual function in MHRD with AL≥30 mm in high myopia.

Abstract:AIM: To evaluate whether fluid-air exchange is an effective treatment for unclosed macular hole (MH) after primary vitrectomy. METHODS: This retrospective study included patients with an unclosed MH within 1–2wk after vitrectomy. Patients were divided into the vitrectomy, fluid-air exchange, and observation groups according to the secondary treatment. The anatomical outcomes and postoperative visual acuity were recorded. RESULTS: The analysis included 25 eyes in 25 patients (16 females) aged 37–74y (vitrectomy group, n=10; fluid-air exchange group, n=9; observation group, n=6). Closure rate after secondary treatment was 100% in the vitrectomy group, 88.9% in the fluid-air exchange group and 33.3% in the observation group. Optical coherence tomography images obtained at the last follow-up revealed that continuity of the external limiting membrane (ELM) was significantly more common (P=0.004) in the fluid-air group (8/9 eyes, 88.9%) than in the vitrectomy group (2/10 eyes, 20.0%) and that macular morphology was better in the fluid-air group than in the vitrectomy group. No serious complications were observed after secondary treatment. CONCLUSION: Fluid-air exchange is an alternative option to repeat vitrectomy for patients with an unclosed MH after initial vitrectomy with elevated macular edge.

Abstract:AIM: To identify risk factors for postoperative blindness in patients with primary rhegmatogenous retinal detachment (RRD) at their first presentation to a tertiary center, using a large clinical database to improve understanding of this adverse outcome. METHODS: Electronic health records of patients with primary RRD from the Eye Hospital of Wenzhou Medical University were retrospectively analyzed. Postoperative blindness was defined according to the World Health Organization (WHO) criteria for legal blindness. Potential risk factors included demographic characteristics, preoperative clinical features, and surgical variables. Univariable and multivariable logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for each risk factor. RESULTS: A total of 532 patients were included in the cohort, of whom 62 (12.0%; 28 males, 34 females) developed postoperative blindness at the final follow-up. Among these 62 patients, 30 had high myopia and 32 did not. The mean age of participants was 49.0±16.4y, with 275 subjects (52%) being male and 133 patients (25%) having the condition in the right eye. In the multivariable model for all patients, the following factors were associated with an increased risk of postoperative blindness: higher preoperative logarithm of the minimum angle of resolution visual acuity (logMAR VA; OR=1.09 per 0.1 logMAR unit increase, 95%CI 1.03-1.15); inferior or superior retinal breaks (OR=2.42, 95%CI 1.12-5.24); and macular holes or superior retinal breaks (OR=8.46, 95%CI 3.45-20.75). In the subgroup of patients with high myopia, risk factors for postoperative blindness included: pseudophakia/aphakia versus phakia (OR=6.33, 95%CI 1.41-28.31); macular holes or superior retinal breaks (OR=15.15, 95%CI 3.07-74.85); and proliferative vitreoretinopathy (PVR; OR=21.41, 95%CI 2.14-214.57). In the subgroup of patients without high myopia, increased risk of postoperative blindness was associated with: higher preoperative logMAR VA (OR=1.11 per 0.1 logMAR unit increase, 95%CI 1.04-1.18); and inferior or superior retinal breaks (OR=2.90, 95%CI 1.19-7.06). CONCLUSION: Using a large real-world clinical database, we identified distinct risk factors for postoperative blindness in patients with primary RRD-including differences between those with and without high myopia. These findings emphasize the need to target specific risk factors in clinical practice to mitigate and reduce the incidence of postoperative blindness in this patient population.

Abstract:AIM: To evaluate clinical characteristics, treatment patterns and long-term quality of life (QoL) among children with retinoblastoma (RB) managed at a single tertiary center in China. METHODS: Totally 62 consecutive patients (71 eyes) diagnosed with RB were retrospectively reviewed. The mean age at first visit was 22.13±17.87mo; 35 (56.45%) were male. Unilateral disease occurred in 53 patients (85.48%) and bilateral disease in 9 (14.52%). According to the international intraocular retinoblastoma classification (IIRC), eyes were staged as A (n=6), B (n=9), C (n=9), D (n=21), E (n=19), and extraocular (n=7). Treatments followed stage-based indications. QoL at follow-up was assessed using validated pediatric ophthalmic instruments completed by patients and/or parents. RESULTS: The mean follow-up duration was 42.9±6.49mo. Overall survival was 90.32% (56/62), mortality was 9.68% (6/62). The overall globe-preservation rate was 64.79% (46/71), and 71.88% (46/64) for intraocular RB. Eye salvage by IIRC stage was 100% for A–C, 71.43% (15/21) for D, and 36.84% (7/19) for E; no eyes were preserved in extraocular disease. Compared with the globe-preservation group, enucleated children had significantly lower scores in appearance, social functioning, and role domains on QoL measures (P<0.05). Across all PedEyeQ domains, children with preserved globes scored higher than those who underwent enucleation (P<0.05). CONCLUSION: Most children in this cohort present with intermediate-to-advanced disease, which limit eye-preservation opportunities. While survival approached contemporary benchmarks, QoL deficits are most pronounced in appearance, social participation, and role functioning after enucleation. Additionally, parents of children who underwent enucleation often experience heightened anxiety about their child’s vision and social integration. These findings underscore the need for earlier detection and integrated psychosocial support alongside stage-appropriate therapy.

Abstract:AIM: To demonstrate the imaging findings of nonarteritic anterior ischemic optic neuropathy (NAION) using high-resolution magnetic resonance imaging (MRI) sequences. METHODS: A retrospective review of 4y of medical records and MRIs of nine patients suspected of having NAION who underwent orbit protocol MRI was conducted. The orbit MRI protocol included high-resolution three-dimensional (3D) T2-weighted imaging (HR 3D T2WI), high-resolution 3D contrast-enhanced T1-weighted imaging (HR-CE 3D T1WI), and high-resolution 3D T2-fluid-attenuated inversion recovery imaging (HR-CE 3D T2-FLAIR) and diffusion-weighted imaging, if applicable. To rule out other causes of optic neuropathy such as inflammatory optic neuritis, we evaluated the presence of optic disc swelling, contrast enhancement at the optic disc, and other abnormal findings on these sequences. RESULTS: Among the 715 patients, 9 were diagnosed with NAION. The median age of the patients was 62y (range, 46–79y), and five patients (56%) were men. Two of these patients demonstrated optic disc swelling on HR 3D T2WI and focal contrast enhancement on HR-CE 3D T1WI. Eight patients showed focal contrast enhancement on HR-CE 3D T2-FLAIR imaging. Among these patients, five showed a focal contrast enhancement only on HR-CE 3D T2-FLAIR imaging. The most frequent location of the focal contrast enhancement was the superomedial (n=5, 56%) followed by the medial (n=2, 22%) and central (n=2, 22%), and superior (n=1) aspects. In all three patients for whom diffusion-weighted imaging was available, there was no evidence of diffusion restriction in the optic disc. CONCLUSION: This study demonstrates the imaging finding of NAION using high-resolution MRI sequences. HR-CE T2-FLAIR imaging is particularly useful in detecting NAION when combined with other high-resolution MRI sequences. It can provide additional insights into the pathophysiology of NAION, which may aid in obtaining an appropriate diagnosis and follow-up.

Abstract:AIM: To evaluate the effects of polarized and non-polarized sunglasses on visual functions, including distance and near visual acuity, phoria, stereopsis and contrast sensitivity across five spatial frequencies (1.5, 3, 6, 12, 18 cycles/degree). METHODS: A before-after study was conducted on 45 emmetropic students from Shahid Beheshti University of Medical Sciences. Visual acuity, contrast sensitivity, stereopsis and phoria were measured under three conditions: without sunglasses, with non-polarized sunglasses and with polarized sunglasses. Tests were conducted under controlled glare conditions to simulate outdoor environments. RESULTS: A total of 45 participants were evaluated, comprising 17 males (37.8%) and 28 females (62.2%). The mean age was 21.67±2.31y (range 18-27y). The mean of distance and near visual acuity in all three conditions were equal to 0.00 logMAR. Contrast sensitivity generally decreased slightly with the use of non-polarized sunglasses compared to the no-sunglasses condition. The mean stereopsis with polarized sunglasses was 101.33±56.139 arc sec, which was worse than the no-sunglasses condition (94.33±46.632 arc sec) and better than the non-polarized sunglasses condition (105.67±58.965 arc sec), although these changes were not significant. In the phoria parameter, distance phoria appeared more affected than near phoria. CONCLUSION: Polarized and non-polarized sunglasses do not significantly affect visual acuity, stereopsis, or phoria under controlled glare conditions. Slight changes in contrast sensitivity are noted, but they are not statistically significant.

Abstract:AIM: To investigate the impact of preoperative anterior corneal topographic parameters on the morphology of the postoperative effective optical zone (EOZ) in patients undergoing keratorefractive lenticule extraction (KLEx) and wavefront-guided LASIK (WG-LASIK). METHODS: This retrospective study included 310 eyes from patients who underwent either KLEx (via small incision lenticule extraction, 171 eyes) or WG-LASIK (139 eyes). Patients were stratified into subgroups based on the median values of spherical equivalent (SE) and anterior corneal topographic parameters. Postoperative EOZ parameters were measured 1mo after surgery and compared across subgroups. Correlation analysis and multivariable linear regression analysis were performed to explore the associations between preoperative anterior corneal topographic parameters and EOZ parameters. RESULTS: A total of 310 eyes were included (KLEx: 171 eyes from 88 patients; WG-LASIK: 139 eyes from 82 patients). The mean age was 30.65±5.67y in the KLEx cohort and 29.06±5.94y in the WG-LASIK cohort. In the KLEx cohort, SE, preoperative mean keratometry (Km), steep keratometry (K2), and anterior corneal astigmatism (K2-K1) were positively correlated with the postoperative optical zone reduction ratio (RR=EOZ/planned optical zone ×100%; all P<0.01). Multivariable regression identified SE [β=0.027, 95% confidence interval (CI): 0.022-0.032, P<0.001], Km (β=0.009, 95%CI: 0.002-0.016, P=0.014), and anterior corneal astigmatism (β=0.031, 95%CI: 0.013-0.049, P<0.001) as significant predictors of RR (R²=0.456, P<0.001). In the WG-LASIK cohort, SE was positively correlated with RR (P<0.01); K2 and anterior corneal astigmatism were positively correlated with both RR (P<0.05) and EOZ eccentricity (P<0.01). Multivariable regression showed SE (β=0.015, 95%CI: 0.007-0.023, P<0.001) and anterior corneal astigmatism (β=0.029, 95%CI: 0.012-0.047, P=0.001) were significant predictors of RR (R²=0.121, P<0.001). CONCLUSION: Preoperative anterior corneal topographic parameters, particularly anterior corneal astigmatism, significantly affect postoperative EOZ morphology in both KLEx and WG-LASIK. Additionally, Km is a predictor of EOZ reduction specifically in KLEx.

Abstract:AIM: To compare refractive error and angle of deviation in patients with basic esotropia and basic exotropia. METHODS: A retrospective review was conducted on the medical records of patients with basic-type strabismus. Demographic data, refractive error, best-corrected distance visual acuity (BCVA), and the horizontal and vertical angle of deviation between basic esotropia and exotropia patients were compared. RESULTS: Among the 7129 patients (mean age 22.98±14.81y) evaluated, 44.7% (3185 cases, 54.9% male) exhibited basic-type esotropia, while 55.3% (3944 cases, 53.9% male) presented with basic-type exotropia. Basic esotropia cases exhibited more hyperopic spherical equivalent measurements in both eyes (right: 0.53±3.07 vs left: 0.56±2.98 D) than those with basic exotropia (right eye: -0.33±2.84 vs left eye: -0.24±2.68 D, P<0.001 for both eyes). Patients with basic esotropia had significantly greater horizontal deviation angles (near: 36.08±18.87 PD and far: 35.56±18.75 PD) compared to those with basic exotropia (near: 33.75±16.11 PD and far: 33.26±15.90 PD, P<0.001). Conversely, patients with basic exotropia had slightly higher vertical deviation angles (near: 1.67±5.80 PD and far: 1.72±5.89 PD) compared to those with basic esotropia (near: 1.12±4.57 PD and far: 1.12±4.58 PD, P<0.001). Patients with basic esotropia underwent surgical intervention at younger ages compared to basic exotropia individuals (19.68±15.99 vs 25.66±13.20, P<0.001). CONCLUSION: Basic esotropia patients present more hyperopic refractive errors, better visual acuity, larger horizontal yet smaller vertical ocular misalignments, and tend to undergo strabismus surgery at younger ages relative to basic exotropia cases.

Abstract:AIM: To analyze the general profile, clinical symptoms, pathological features, and prognostic characteristics of extranodal Rosai-Dorfman disease (RDD) with ocular involvement. METHODS: This was a retrospective series of case study. Clinical data from 35 cases who had extranodal RDD with ocular involvement were collected for analysis, including 5 cases diagnosed at our hospital and 30 reported in the literature which searched via PubMed, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP), and WanFang Data database from database creation to April 2023. Lesion location, clinical presentation, pathological presentation, treatment modality, follow-up time, and prognosis were recorded. RESULTS: Lesions of five cases were located in the orbit, eyelid, lacrimal gland, or conjunctiva. The main presenting features were proptosis, eyelid swelling, and conjunctival hyperemia with decreased vision. Four patients underwent surgical resection, one received surgery and adjunctive immunosuppression, and none experienced recurrence during follow-up. A total of 30 cases were retrieved from the literature. The mean age was 41.4y, and 66.7% were male. The lacrimal gland and conjunctiva/subconjunctiva were the most commonly affected sites (each 20.0%). Most patients received surgical management (50.0%) or immunosuppressive therapy (20.0%). Only one recurrence (3.3%) was reported during follow-up. CONCLUSION: When symptoms like ocular protrusion and visual acuity loss occur, RDD should be considered in the differential diagnosis. The diagnosis of RDD primarily depends on pathological histology, which serves as the key basis for confirmation. Although RDD generally has a favorable prognosis, long-term follow-up of patients is still essential to closely monitor for potential recurrence.

Abstract:AIM: To report two cases of Jalili syndrome (JS) harboring a novel mutation in the CNNM4 gene, review previously published studies on JS, and analyze factors potentially associated with visual acuity in patients with JS. METHODS: Two JS patients from a non-consanguineous Chinese family underwent comprehensive ophthalmic evaluations. Next-generation sequencing (NGS) was performed to identify pathogenic variants, and Sanger sequencing was used for validation. A literature search was conducted to retrieve studies on JS published up to January 31, 2025; only studies with detailed records of visual acuity and mutation sites were included. Correlations between visual acuity and age, as well as between visual acuity and mutation domain, were analyzed. RESULTS: A total of 53 patients with detailed visual acuity and mutation site records from previous studies were included in the analysis. The mean logarithm of the minimum angle of resolution (logMAR) visual acuity was 1.15 (range: 0.69-2.00). Spearman’s correlation analysis showed a positive correlation between visual acuity (logMAR) and age (rs=0.502, P<0.001). No association was found between logMAR visual acuity and mutation domain (P=0.748). The 6-year-old proband and her 3-year-old brother carried a novel homozygous missense variant c.949A>C (p.Ser317Arg) in CNNM4. Both patients presented with reduced visual acuity, pendular nystagmus, photophobia, night blindness, color vision loss, macular atrophy, and amelogenesis imperfecta. Optical coherence tomography (OCT) revealed atrophy of the outer retinal layers, and electroretinography (ERG) showed extinguished cone and rod responses. Fundus autofluorescence (FAF) and fundus fluorescein angiography (FFA) of the proband demonstrated bilateral retinal pigment epithelium (RPE) defects around the optic disc, vascular arcades, and macular region. At the latest follow-up (30mo), the proband’s condition remained stable: best-corrected visual acuity was 2.00 logMAR (right eye) and 1.30 (left eye), with no changes in fundus appearance. The younger brother had a best-corrected visual acuity of 1.52 logMAR in both eyes at the latest follow-up, accompanied by severe bilateral macular atrophy and obvious dentin discoloration due to progressive enamel thinning. CONCLUSION: This study reports a novel homozygous missense variant c.949A>C (p.Ser317Arg) in CNNM4 in a Chinese JS family. Visual acuity in JS patients deteriorates with increasing age.

Abstract:AIM: To identify differences in clinical features between thyroid eye disease (TED) patients with and without strabismus. METHODS: This retrospective, single-center, consecutive case series study was conducted on TED patients who were determined to be surgical candidates. The patients’ cohort were divided into two groups based on the presence or absence of strabismus. Demographics and complete eye examinations were recorded and compared between the TED and TED with strabismus groups. RESULTS: A total of 76 patients with TED were enrolled, including 58 males (76.3%) with a mean age of 52.68±10.45y. The 55 patients (male:female=2:1) were found to have TED with strabismus, while the remaining 21 patients (male:female=4:1) had TED without strabismus. There was nearly a four times greater likelihood of lid retraction being associated with TED without strabismus (OR=4.1, P=0.018) and they showed higher prevalence of proptosis (95.2%) than the TED strabismus group (63.6%, P<0.001). In the TED-strabismus group, 20% of patients had abnormal head posture (AHP), while none were identified in the TED group (P=0.029). Despite the higher incidence of vision-threatening complications such as dysthyroid optic neuropathy (19% vs 8.1%) and exposure keratopathy (4.8% vs 1.8%) in the TED group than in the TED-strabismus group, the difference did not reach statistical significance (P>0.05). The most common types of strabismus were hypotropia (36%) and esotropia (29%), respectively. CONCLUSION: Strabismus-associated TED is characterized by a lower prevalence of proptosis and lid retraction, but a higher incidence of compensatory AHP. Identifying these differences may aid in risk stratification and early intervention for TED patients, particularly those at risk for restrictive strabismus.

Abstract:AIM: To analyze ocular parameters and refractive status in children aged 3-12y and to explore differences in these parameters across age groups with identical refractive status for studying refractive progression. METHODS: Demographic characteristics, cycloplegic refraction data, and ocular parameters of the participants were collected. Changes in ocular parameters were described according to different age groups. After adjusting for refractive factors, the relationship between age and ocular parameters was explored. Standard regression coefficients (β) obtained from multiple linear regressions were used to compare the magnitude of the effect of age on the parameters and ocular components on refractive power. RESULTS: Data were collected from the right eyes of 1504 participants. Lens thickness (LT) decreased with age, whereas the axial length (AL) and anterior chamber depth (ACD) increased. In the high-hyperopia group, changes in age were only associated with AL and LT. In the low-myopia group, the increase in age was also associated with corneal astigmatism. In the overall model, the β value for LT was the highest at 0.41, whereas β for ACD and AL was significant in all groups except for the high-hyperopia group. The β value of the LT on refractive power in children was slightly greater in the low age group than in the high age group. CONCLUSION: Among children with the same refractive status, the older the age, the longer the axis length and the thinner the lens. The lens affected refractive power in children in the younger age group more than in the older age group. The ocular parameter most affected by age was LT.

Abstract:Retinoblastoma (RB) is the most common intraocular malignancy in children. In recent years, advancements in chemotherapy-based comprehensive treatment approaches and diagnostic technologies have significantly improved long-term survival rates, shifting treatment goals from saving lives toward preserving vision and enhancing quality of life. In major RB treatment centers in China, survival rates have reached levels comparable to those in developed countries. However, in some underdeveloped regions, RB continues to pose a serious threat to affected children. To further improve survival rates and quality of life for RB patients and their families in China, a series of essential measures should be implemented. These include strengthening public education to raise awareness of RB, enhancing diagnostic efficiency, promoting standardized treatment protocols, providing genetic counseling and prenatal assessment for high-risk populations, and fostering the training of specialized healthcare professionals.

Abstract:AIM: To evaluate the clinical features of primary lacrimal gland pleomorphic adenoma (LGPA). METHODS: This was a 2-center, retrospective, observational study of primary LGPA patients who underwent tumor resection. Ophthalmic examinations and orbital computed tomography (CT) and/or magnetic resonance imaging (MRI) were performed. RESULTS: Totally 18 patients (10 males and 8 females, mean age 56.3±13.8y) were enrolled. Initial symptoms were unilateral proptosis in 8 patients, diplopia in 3 patients, and pressure sensation and no chief complaint in 2 patients each. The best-corrected visual acuity of the affected eye was 0.26±0.44 logMAR, and the intraocular pressure (IOP) of the affected and healthy eyes was 20.1±9.9 and 15.8±4.3 mm Hg, respectively. The difference in degree of proptosis between the affected and healthy eyes was 4.1±2.2 mm based on the Hertel ocular protrusion meter. One case had a history of breast cancer. Seventeen of 18 patients with an orbital lacrimal gland origin underwent total tumor excision by anterior/lateral orbitotomy. CONCLUSION: Orbital LGPA can complicate IOP elevation, and require total tumor excision by orbitotomy. In rare cases, systemic malignancy may complicate LGPA, and in such cases total removal of the lacrimal gland tumor should be considered at the initial surgery.

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