Abstract:AIM: To develop different machine learning models to train and test diplopia images and data generated by the computerized diplopia test. METHODS: Diplopia images and data generated by computerized diplopia tests, along with patient medical records, were retrospectively collected from 3244 cases. Diagnostic models were constructed using logistic regression (LR), decision tree (DT), support vector machine (SVM), extreme gradient boosting (XGBoost), and deep learning (DL) algorithms. A total of 2757 diplopia images were randomly selected as training data, while the test dataset contained 487 diplopia images. The optimal diagnostic model was evaluated using test set accuracy, confusion matrix, and precision-recall curve (P-R curve). RESULTS: The test set accuracy of the LR, SVM, DT, XGBoost, DL (64 categories), and DL (6 binary classifications) algorithms was 0.762, 0.811, 0.818, 0.812, 0.858 and 0.858, respectively. The accuracy in the training set was 0.785, 0.815, 0.998, 0.965, 0.968, and 0.967, respectively. The weighted precision of LR, SVM, DT, XGBoost, DL (64 categories), and DL (6 binary classifications) algorithms was 0.74, 0.77, 0.83, 0.80, 0.85, and 0.85, respectively; weighted recall was 0.76, 0.81, 0.82, 0.81, 0.86, and 0.86, respectively; weighted F1 score was 0.74, 0.79, 0.82, 0.80, 0.85, and 0.85, respectively. CONCLUSION: In this study, the 7 machine learning algorithms all achieve automatic diagnosis of extraocular muscle palsy. The DL (64 categories) and DL (6 binary classifications) algorithms have a significant advantage over other machine learning algorithms regarding diagnostic accuracy on the test set, with a high level of consistency with clinical diagnoses made by physicians. Therefore, it can be used as a reference for diagnosis.

Abstract:AIM: To explore the relationship between matrix metalloproteinases (MMPs) expression levels in the tumor and the prognosis of uveal melanoma (UM) and to construct prognostic prediction models. METHODS: Transcriptome sequencing data from 17 normal choroid tissues and 53 UM tumor tissues were collected. Based on the differential gene expression levels and their function, MMPs family was selected for establishing risk-score system and prognostic prediction model with machine learning. Tumor microenvironment (TME) analysis was also applied for the impact of immune cell infiltration on prognosis of the disease. RESULTS: Eight MMPs were significantly different expression levels between normal and the tumor tissues. MMP-2 and MMP-28 were selected to construct a risk-score system and divided patients accordingly into high- and low-risk groups. The prediction model based on the risk-score achieved an accuracy of approximately 80% at 1-, 3-, and 5-year after diagnosis. Besides, a Nomogram prognostic prediction model which based on risk-score and pathological type (independent prognostic factors after Cox regression analysis) demonstrated good consistency between the predicted outcomes at 1-, 3-, and 5-year after diagnosis and the actual prognosis of patients. TME analysis revealed that the high-risk group exhibited higher immune and stromal scores and increased infiltration of tumor-associated macrophages (TAMs) and regulatory T cells compared to the low-risk group. CONCLUSION: Based on MMP-2 and MMP-28 expression levels, our prediction model demonstrates accurate long-term prognosis prediction for UM patients. The aggregation of TAMs and regulatory T cells in the TME of UM may be associated with an unfavorable prognosis.

Abstract:AIM: To investigate the effects of nintedanib on epithelial-mesenchymal transition (EMT) in cells derived from pterygium, aiming to explore its potential as a pharmacological intervention for pterygium treatment. METHODS: Primary human pterygium epithelial cells (hPEC) and human conjunctival epithelial (hCJE) cells were isolated from patients, cultured, and characterized. The impact of nintedanib on transforming growth factor beta (TGF-β)-induced EMT was assessed by examining the expression of EMT markers such as vimentin and E-cadherin. Additionally, the modulation of the miR-23b-3p/transforming growth factor beta receptor 2 (TGFBR2)/Smad2 pathway by nintedanib was investigated to elucidate its potential antifibrotic mechanism. RESULTS: The expression of miR-23b-3p gene in hCJE cells was significantly higher than that in hPEC cells. Nintedanib effectively mitigated TGF-β-induced EMT in cells derived from pterygium, as evidenced by the downregulation of vimentin and upregulation of E-cadherin. When the nintedanib concentration exceeded 1 μmol/L, it significantly suppressed the proliferation of hPEC cells and significantly inhibited the migration distance of hPEC cells within 48h (P<0.01). The immunoprecipitation experiment showed that nintedanib modulated the TGFBR2 protein’s response to TGF-β independently of miR-23b-3p. Both nintedanib and transfection with miR-23b-3p mimic significantly inhibited the expression levels of phosphorylated Smad2, snail homolog 1 (Drosophila, SNAIL), and SNAI2 (also known as SLUG, snail family transcriptional repressor 2) proteins. CONCLUSION: Nintedanib is found to modulate the miR-23b-3p/TGFBR2/Smad2 pathway, suggesting a novel antifibrotic mechanism. These findings collectively highlight nintedanib’s therapeutic potential in managing pterygium, marking a significant step toward non-surgical treatment options. Nintedanib may offer a targeted pharmacological treatment that could complement or reduce the need for surgical interventions.

Abstract:AIM: To determine the therapeutic benefits of fenofibrate (Feno) on the dysfunction of high glucose (HG)-induced human retinal microvascular endothelial cells (HRMECs) and to elucidate the underlying molecular mechanism. METHODS: HRMEC dysfunction model was established by 48h glucose (30 mmol/L) treatment and treated with Feno/NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome activator (Nigericin). Cell viability/apoptosis were assessed by cell counting kit-8 (CCK-8)/terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay (TUNEL) staining and flow cytometry assays. Levels of apoptosis- (Bcl-2-associated X protein, Bax/B-cell lymphoma 2, Bcl-2), vascular permeability-(vascular endothelial growth factor, VEGF) and inflammasome activation-related proteins (NLRP3/cleaved caspase-1/apoptosis-associated speck-like protein containing a CARD, ASC), as well as inflammatory factors (interleukin, IL-6/IL-1β/tumor necrosis factor, TNF-α/IL-18) were determined with Western blot/enzyme linked immunosorbent assay (ELISA). Cell permeability/reactive oxygen species (ROS) level/superoxide dismutase (SOD) activity/malondialdehyde (MDA) content were assessed by Evans blue staining/2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) fluorescent probe/SOD kit/MDA kit. RESULTS: HRMEC dysfunction was successfully induced by HG, evidenced by decreased viability (P<0.001), increased apoptosis (P<0.001), permeability (P<0.001), and inflammatory factor levels (P<0.001). Feno treatment significantly ameliorated HG-induced HRMEC dysfunction (P<0.01). Meanwhile, HG induction increased ROS production (P<0.001) and MDA content (P<0.001) in HRMECs, while reducing SOD activity (P<0.001), indicative of oxidative stress. This was, however, abolished by Feno (P<0.05). Moreover, Feno eliminated activation of NLRP3 inflammasomes (P<0.05) in HG-induced HRMECs. Strikingly, activation of NLRP3 inflammasomes partially averted the inhibition of Feno on HG-induced HRMEC dysfunction (P<0.05). CONCLUSION: Feno represses oxidative stress and NLRP3 inflammasome activation, consequently alleviating HG-induced HRMEC dysfunction.

Abstract:AIM: To investigate the efficacy of Eleutherine bulbosa (Mill.) Urb. bulb extract (EBE) on the 3D human retinoblastoma cancer cells (WERI-Rb-1) spheroids and explore its apoptotic mechanism. METHODS: The 3D WERI-Rb-1 and human retinal pigmented epithelium cells (ARPE-19) spheroids were developed using type 1 murine collagen that was excised from the rat tail tendon and cultured via hanging drop and embedded techniques. The cytotoxic activity was examined by Alamar blue assay meanwhile, the morphological characteristics were assessed by 4’,6-diamidino-2-phenylindole (DAPI) and scanning electron microscopy (SEM). The mRNA and protein expressions of apoptotic and antioxidant signal transduction pathways were explored to ascertain its molecular mechanisms. The statistical analysis was carried out using GraphPad Prism. RESULTS: The Alamar blue assay portrayed higher half maximal inhibitory concentration (IC50) values of EBE and cisplatin on 3D WERI-Rb-1 model as compared to the previous study on 2D model. The results of DAPI and SEM illustrated apoptotic features upon treatment with EBE and cisplatin in a dose-dependent manner on 3D WERI-Rb-1 model. The mRNA and protein levels of apoptotic and antioxidant-related pathways were significantly affected by EBE and cisplatin, respectively (P<0.05). The regulation of gene and protein expressions of 3D WERI-Rb-1 spheroids differed from the 2D study, suggesting that the tumor microenvironment of extracellular matrix (ECM) collagen matrix hindered the EBE treatment efficacy, leading to apoptotic evasion. CONCLUSION: A significant inhibition effect of EBE is observed on the 3D WERI-Rb-1 spheroids. The presence of ECM causes an increase in cytotoxic resistance upon treatment with EBE and cisplatin.

Abstract:This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery. Preoperative assessments can greatly assist clinicians in determining surgical indications, assessing patient conditions, and offering valuable assistance in formulating surgical strategies and predicting outcomes. Developed by a collaborative team of experts from the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association, in conjunction with the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association, these guidelines have been formulated through extensive research and evaluation, incorporating the latest technological advancements and studies on a global and domestic scale in vitreoretinal surgery. After extensive deliberations and incorporation of up-to-date clinical data, these guidelines have been developed to assist in standardizing preoperative examinations for vitreoretinal surgery. The overarching goals include improving medical quality, maximizing resource allocation, offering decision-making assistance, and safeguarding patient rights. This document provides a comprehensive analysis of preoperative assessments for vitreoretinal procedures, covering principles, methodologies, and precautions related to a range of diagnostic techniques including ultra-wide-angle fundus imaging, fluorescein angiography, indocyanine green angiography, ophthalmic B-ultrasound examinations, ultrasound biomicroscopy, optical coherence tomography, optical coherence tomography angiography, orbital CT scan, orbital MRI, and ophthalmic electrophysiology tests such as electroretinograms, visually evoked potentials, and visual field testing.

Abstract:AIM: To investigate the factors influencing meibomian gland atrophy (MGA) in children with allergic conjunctivitis (AC). METHODS: In this cross-sectional study, 60 children with AC aged 6-17y and 20 age-matched children without signs or symptoms of ocular surface dysfunction were included. Information on the duration of AC, untreated time, electronic screen time (EST), outdoor exercise time, body mass index (BMI), and frequency of eye rubbing was collected using a health history form. The Standard Patient Evaluation of Eye Dryness (SPEED) score was used for dry eye assessment. Images of the meibomian glands (MGs) were obtained using Keratograph 5M, and the rate of meibomian gland atrophy (MGAR) was calculated using Image J. All subjects underwent routine eye examinations. RESULTS: The average age of the AC group was 10.43±2.75y (range 6-17y) and 10.35±3.42y (range 6-14y) in the control group. The MGAR in the AC group was 33.42%±11.91%, significantly higher than that in the control group (18.10%±11.74%, P<0.001). Moreover, the MGAR in younger children (aged 12 and below) was significantly higher than in older children (P<0.05). Multi-factor linear regression analysis revealed that EST non-projector was a risk factor for MGAR (β=0.332, 95%CI 0.04-0.22, P=0.004), while outdoor exercise time was a protective factor against MGAR (β=-0.407, 95%CI -0.39 to -0.10, P=0.001). The untreated time of AC was identified as a risk factor for MGAR (β=0.24, 95%CI 0.07-1.98, P=0.037), and the frequency of eye rubbing was associated with MG distortion score (P=0.00). CONCLUSION: Children with AC exhibit exacerbate MGA, with the degree of atrophy worsening as the untreated time of AC prolongs. Children under 12 years old show a higher MGAR, and EST non-projector negatively impacts MGA, while increased outdoor exercise time acts as a protective factor against MGA.

Abstract:AIM: To compare simultaneous corneal collagen cross-linking (CXL) with intracorneal ring segment (ICRS) implantation versus successive ICRS followed by CXL and detect the impact of the timing of CXL after ICRS implantation in the successive method. METHODS: This is a retrospective study of the records of three groups of patients. Group 1 of 28 patients were operated on with simultaneous ICRS implantation and CXL, group 2 of 32 patients had ICRS implantation followed by CXL after 1mo, and group 3 of 38 patients had ICRS implantation followed by CXL after 3mo. The three groups had follow-up visits after 6, 12, and 24mo. RESULTS: The preoperative data, age, and gender differences among 3 groups revealed no significant differences. The postoperative spherical equivalent and best-corrected visual acuity were improved significantly in all groups compared to the baseline, which were more evident in groups 1 and 2. The differences between preoperative and postoperative mean values of mean of K readings (Km) and maximum K reading (Kmax) at 6mo were 4.66 and 4.1 D in group 1, 4.43 and 4.64 D in group 2, but 3.2 and 3.4 D in group 3, respectively. The spherical aberrations and the vertical coma showed significant postoperative changes in all groups, and trefoil showed nonsignificant changes. CONCLUSION: Simultaneous and sequential ICRS implantation and CXL at 1mo has similar Km and Kmax better postoperative changes than when both surgeries were done at three-month intervals.

Abstract:AIM: To examine whether rs2472493 and rs248032 in the ABCA1 gene, rs3785176 in the PMM2 gene, and rs11827818 in the ARHGEF12 gene contribute to primary open angle glaucoma (POAG) in an Iranian population. METHODS: Totally 82 POAG patients and 172 healthy controls were enrolled. The selected gene polymorphisms were analyzed using TaqMan SNP Genotyping Assay using deoxyribonucleic acid (DNA) extracted from blood samples. Allelic and genotypic frequencies were evaluated using the Chi-square test. The association between the genotypes of single nucleotide polymorphisms (SNPs) and POAG was assessed using multiple logistic regression models. The linkage disequilibrium and haplotype block structure were assessed using the Haploview 4.2 software. RESULTS: The results showed a significant association between allele frequencies of rs2472493 in the ABCA1 gene locus and POAG [odds ratio (OR)=1.58, 95% confidence intervals (CI)=1.04-2.39, P=0.031]. The rs3785176 in the PMM2 gene was also associated with POAG in additive and over dominant genotypes. Moreover, haplotype analysis showed a significant association of two estimated haplotypes of rs2472493/rs2487032 with POAG. The AA haplotype showed a reduction in POAG risk (OR=0.41, 95%CI=0.202-0.834, P=0.012), while the GG haplotype was associated with the disease. In addition, this study could not discover any association between genotype and allele frequency of rs248032 in the ABCA1 gene, and rs11827818 in ARHGEF12 gene and POAG. CONCLUSION: rs2472493 in the ABCA1 gene can be considered a genetic susceptibility locus for POAG. The haplotype constructed with ABCA1 gene SNPs (rs2472493/rs2487032) is associated with POAG.

Abstract:AIM: To investigate the choroidal vascular index (CVI) and the choroidal structural changes beyond the subfoveal area (analyzed across a 20 mm×24 mm scanning area) in eyes with chronic central serous chorioretinopathy (cCSC) eyes with macular neovascularization (MNV) using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). METHODS: This retrospective comparative study included 46 cCSC with MNV eyes (With MNV group), 52 cCSC without MNV eyes (Without MNV group), and 40 age-matched healthy controls. UWF SS-OCTA imaging with a 20 mm×24 mm protocol was used to quantify CVI across 9 subfields (superotemporal, superior, superonasal, temporal, central, nasal, inferotemporal, inferior, and inferonasal). The CVI was compared among the groups. RESULTS: With MNV group demonstrated significantly older mean age than Without MNV group (56.2±6.1 vs 47.5±8.6y, P<0.001). The CVI was significantly lower in the With MNV group than in the Without MNV group, except in the superotemporal, superior, and temporal regions (all P<0.05). Notably, despite MNV-associated CVI reductions, the With MNV group maintained a higher CVI than the control group in all 5 subfields (superior, temporal, central, inferior, and inferonasal; all P<0.05). In the central region, the CVI (%) in With MNV, Without MNV, and control groups were 35.63±3.33, 37.37±2.07, and 32.67±5.00 (P<0.05), respectively. CONCLUSION: CVI decreases, and choroidal structural changes extend beyond the subfoveal area in cCSC with MNV eyes, providing with an imaging evidence for the important role of choroidal ischemia in the pathogenesis of MNV in cCSC.

Abstract:AIM: To evaluate the efficacy and safety of concurrent intravitreal ranibizumab (IVR) and extended-release dexamethasone injections (Dex-I) in naïve and refractory patients with retinal vein occlusion macular edema (RVO-ME). METHODS: This was a prospective, interventional, and open-label clinical trial. There were two groups: naïve and refractory patients (received ≥5 times of previous IVR within one year prior to enrollment) enrolled. Patients received IVR and Dex-I concurrently and re-combination therapy was required if one or more retreatment criteria were met. IVR and Dex-I were given pro re nata (PRN). The mean changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured as main outcomes. RESULTS: Totally 63 patients (63 eyes) completed the entire follow-up (31 naïve and 32 refractory patients). At month 12, the change in BCVA was greater in the naïve group than in the refractory group [19.67±11.7 (95%CI: 15.03, 24.31) letters vs 11.74±11.18 (95%CI: 7.32, 16.16) letters, P=0.014). There was no difference between the two groups of mean macular thickness reduction [364.26±215.29 (95%CI: 279.09, 449.43) μm vs 410.19±204.34 (95%CI: 329.35, 491.02) μm, P=0.43). The mean co-injection numbers were 2.52±0.58 (95%CI: 2.29, 2.75) and 2.33±0.55 (95%CI: 2.11, 2.55) in both groups (P=0.24), respectively. The retreatment interval was 115.81±13.79 d (95%CI: 110.36, 121.27) and 122.74±14.06 d (95%CI: 119.93, 133.56) in both groups (P=0.073). There was no significant difference in the incidence of glaucoma or the progression of cataracts between the two groups. CONCLUSION: In both naïve and refractory RVO-ME patients, IVR combined with Dex-I is effective. The initial combination therapy for naïve patients demonstrates more efficient improvement in BCVA and may reduce total injection numbers compared to refractory patients.

Abstract:AIM: To investigate the change of diabetic macular edema (DME) post vitrectomy and its risk factors. METHODS: This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy (PDR) with gradable optical coherence tomography (OCT) imaging from January 2018 to March 2022. The incidence of post vitrectomy DME (PV-DME) was defined as patients with a central retinal thickness (CRT) >300 µm by OCT among patients without preoperative DME. RESULTS: The cumulative incidence of PV-DME at 3mo was 40.1% (89/222), with its majority subtype of single diffused retinal thickening (66.2%) followed by single cystoid macular edema (27.0%). Multivariate Cox regression analysis indicated that a thicker preoperative CRT [hazard ratio (HR)=1.01, 95% confidence interval (CI) 1.00-1.02] and intraoperative internal limiting membrane peeling (HR=3.18, 95%CI 1.85-5.47) were associated with the presence of PV-DME, while intraoperative intravitreal injection of triamcinolone acetonide (HR=0.28, 95%CI 0.13-0.57) was protective against PV-DME. In eyes with preoperative DME (n=143), the CRT decreased gradually from 468.3±177.7 μm preoperatively to 409.5±151.0 μm (P=0.027), 377.4±141.9 μm (P<0.001), and 368.0±157.6 μm (P<0.001) at 7d, 1 and 3mo postoperatively, respectively. Multivariate linear regression analysis indicated that only a thicker preoperative CRT (β=0.77, 95%CI 0.63-0.92) was associated with a decreasing postoperative CRT. CONCLUSION: PV-DME is a very common postoperative complication in patients with PDR. Triamcinolone acetonide could prevent its formation. Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling.

Abstract:AIM: To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion (RVO) with macular edema (ME) at a minimum of 60mo follow-up. METHODS: In this retrospective cohort study, the data about best corrected visual acuity (BCVA), central macular thickness (CMT), serous macular detachment (SMD), hard exudate, hyperreflective foci (HRF), cystoid degeneration, pearl necklace sign, epiretinal membrane (ERM), disorganization of retinal inner layers (DRIL), ellipsoid zone and external limiting membrane (EZ-ELM) integrity, intraocular pressure (IOP) and lens condition were recorded. RESULTS: Thirty-eight eyes of 38 patients were included in the study. Thirteen patients presented with central RVO (CRVO) and 25 with branch RVO (BRVO). The mean follow-up time was 69.9±15.8mo, and the mean number of injections was 7.9±4.0. The mean BCVA gain was 25.0±36 letters, and this difference was statistically significant (P=0.021). The BCVA gain was 19.4±20.4 letters in the CRVO group, and 26.5±38.6 letters in the BRVO group (P=0.763). Besides, 21 (55.2%) of the patients achieved ≥15 letters improvement. At the end of the follow-up period, SMD was not observed in any of the patients (P=0.016). Hard exudate, HRF number were decreased; while DRIL, ERM and EZ-ELM defects were increased but not significantly. CONCLUSION: Intravitreal dexamethasone monotherapy is an effective and safe treatment option for the treatment-naive RVO-ME patients in the long-term follow-up.

Abstract:AIM: To evaluate the visual outcomes of implantable collamer lenses (ICLs) and identify the possible risk factors for ICL axis misalignment, and consequently, repositioning, explanting, or exchanging at a specialized eye hospital in Saudi Arabia. METHODS: The medical records of 813 eyes with different refractive errors corrected with ICL implantation were identified and included in this single-arm retrospective cohort study. The following data were collected: demographic characteristics, primary diagnosis, preoperative refraction, anterior chamber depth (ACD), white-to-white (WTW) measurement, endothelial cell density (ECD), and axial length. Patients’ satisfaction and complaints, and their postoperative refraction, vault depth, and axis alignment with the preoperative target, were reviewed during the postoperative period. Collectively, these data were correlated with symptomatic axis rotation and the need for repositioning, explantation, or exchange due to high or low ICL vaults. RESULTS: Of 813 eyes, 27 (3.32%), 13 (1.59%), and 11 (1.35%) required ICL repositioning, ICL explantation only without exchange, and ICL explantation with the placement of a new ICL, respectively. The mean follow-up period was 37.5mo. The main cause of explanation or exchange was incorrect WTW measurement in seven (29.17%) eyes, followed by high vault in four (16.56%) eyes. ICL repositioning was required in 27 (3.32%) eyes with considerable rotation. Only 2 (0.24%) eyes developed cataracts that required ICL removal, and retinal complications were reported in 7 (0.86%) eyes. Long-term glaucoma and corneal decompensation were not observed in this cohort. CONCLUSION: With a high safety profile and reversibility, ICL implantation is a good alternative to corneal-based refractive surgery in eyes unsuitable for laser vision correction. The rate of secondary procedures in our study was 6.26%. Old age is a risk factor for secondary surgical interventions in the repositioning group, whereas abnormal vault and toric ICL rotation in the explantation group necessitated subsequent surgical procedures. Overall, ICL implantation demonstrates a good efficacy index and safety profile in patients with diverse refractive errors.

Abstract:AIM: To investigate the effect of the percent tissue altered (PTA) on the safety after laser-assisted in situ keratomileusis (LASIK) based on linear creep characteristics. METHODS: The linear creep characteristics of the cornea were characterized by the generalized Kelvin-Voigt constitutive relationship with five parameters. Then, the displacement and stress distribution on the anterior and posterior surfaces of the cornea were analyzed by constructing the eye model with different PTA. RESULTS: When PTA was above 39%, the vertex displacements under physiological intraocular pressure (IOP, 15 mm Hg) exceeded that of the preoperative glaucoma under average IOP. That is, an excessively high displacement value was found. In addition, with the increase of PTA, the central cornea was stretched thinner and more obviously due to IOP. When PTA was above 39%, the stress at the center of the anterior surface of the residual stroma was more than 20% larger than that of the normal human eye. The residual stroma was forced to stretch more severely due to excessive stress on the anterior surface. This resulted in deformation of the stroma and induced corneal ectasia. Meanwhile, the postoperative vertex displacement increased with the decrease in viscosity ratio. CONCLUSION: PTA less than 39% is the safe range for LASIK surgery. This study may provide a reliable numerical basis for postoperative corneal dilatation and the outcomes after refractive surgery.

Abstract:AIM: To assess early visual outcomes and corneal stability following small incision lenticule extraction (SMILE) in eyes with a pre-planned residual stromal thickness (RST) ranging from 280 to 300 μm. METHODS: This retrospective study was designed to evaluate 82 eyes from 82 patients, all of whom had a pre-planned RST of 280 to 300 μm and normal corneal topography prior to undergoing SMILE surgery. The mean preoperative spherical equivalent (SE) was -4.82±1.30 D. A standard follow-up protocol was conducted between 1 to 6mo postoperatively. Visual outcomes were recorded using uncorrected visual acuity (UCVA) and subjective refraction. The curvature of the anterior and posterior corneal surfaces, as well as the posterior elevation at the thinnest point (PTE) were derived from the Pentacam system. RESULTS: At the final follow-up, the efficacy index was 1.14±0.15, the safety index was 1.20±0.13. The mean preoperative UDVA was 0.78±0.16 logMAR, which improved significantly to -0.07±0.06 logMAR postoperatively (P<0.001). The preoperative mean SE was -4.82±1.30 D, which decreased to -0.14±0.30 D by the last visit. The curvature of the anterior cornea at the flat meridian (AK1) were 42.62±1.02 D preoperatively, 38.56±1.37 D and 38.59±1.39 D at 1 and 6mo after operation, respectively. Corresponding measurements at the steep meridian (AK2) were 43.55±1.14 D preoperatively, 39.18±1.46 D and 39.22±1.50 D at 1 and 6mo after operation, respectively. Both AK1 and AK2 remained stable at 1 and 6-mo postoperative intervals (P=0.126 and 0.082, respectively). There were no observed changes in the curvature of the posterior cornea at the flat meridian or at the steep meridian, or the PTE before and after surgery. CONCLUSION: SMILE represents a safe and effective procedure for the correction of myopia and astigmatism in eyes featuring a pre-planned RST ranging from 280 to 300 μm accompanied by normal corneal topography, on the premise of strict control of surgical indications.

Abstract:AIM: To evaluate the efficacy of combined orbital radiation and periorbital triamcinolone acetonide injection for patients with Graves’ orbitopathy (GO) who experienced treatment failure with glucocorticoid pulse therapy (GPT). METHODS: A total of 57 eligible patients (35.09% males, mean age of 51.19±11.90y) were included in this case-series study. The medical information collected during each visit was evaluated and analyzed. RESULTS: Significant improvement was observed in patients six months after radiation therapy. Both the clinical activity score and the efficacy score showed substantial improvement (P<0.001). Furthermore, there was significant resolution of extraocular muscle inflammation on magnetic resonance imaging at three and six months after radiation therapy. The initial high signal intensity ratio (SIR) max was found to be associated with greater improvement in SIR sum (P<0.001, B=2.002, 95%CI: 1.377 to 2.628), while the presence of sight-threatening stage or moderate to severe diplopia negatively influenced the improvement of SIR sum (P=0.045, 0.008, 0.006; B=-1.966, -1.478, -0.997; 95%CI: -3.886 to -0.045, -2.552 to -0.403, -1.694 to -0.300; respectively). CONCLUSION: The combination therapy demonstrates significant effectiveness in treating patients with GO who experienced severe ocular inflammation and have previous GPT failure. Noticeable improvement is observed as early as one month after initiating radiation therapy, and patients with more severe inflammatory states showes greater benefit from the treatment.

Abstract:AIM: To evaluate changes in corneal light scattering and anterior segment parameters in newly diagnosed rheumatoid arthritis (RA) patients who achieved remission with systemic treatment, compared to healthy controls. METHODS: A cross-sectional study was conducted at a tertiary care hospital, in ophthalmology, and rheumatology departments. A total of 42 RA patients (13 men and 29 women) and 56 healthy individuals (23 men 33 women) underwent comprehensive ophthalmologic evaluations, including Scheimpflug corneal densitometry and Pentacam HR measurements. Those who initiated systemic treatment for RA were monitored at first, third, and sixth-month follow-ups. Participants who achieved remission at each follow-up assessment were included. RESULTS: Significant differences in corneal densitometry were observed, with higher values in RA patients, particularly in the middle and posterior layers. Anterior segment parameters such as anterior chamber volume and angle were significantly reduced in RA patients compared to other groups (P<0.001). Following systemic treatment and achievement of remission, these parameters showed regression toward normal values. CONCLUSION: The study underscores the potential utility of corneal densitometry and anterior segment analysis as sensitive indicators of subclinical ocular involvement in RA, offering insights into disease progression and treatment efficacy. These findings highlight the importance of early detection and regular monitoring in preventing vision-threatening complications in RA patients.

Abstract:AIM: To develop a nomogram to predict the risk of visual impairment (VI) in patients with chronic kidney disease (CKD). METHODS: Totally 897 patients with CKD were selected from the National Health and Nutrition Examination Survey (NHANES). The training and validation sets were divided in a 7:3 ratio. Multivariate logistic regression and bidirectional stepwise regression was used to select the factor of developing nomogram. The performance of the nomogram was evaluated by receiver operator characteristic curve, calibration curve and decision curve analysis (DCA). RESULTS: Age, diastolic blood pressure, glucose, serum creatinine, income at or above poverty, and history of smoking were included in the nomogram. And the area under the receiver operating characteristic curve of the training and validation sets were 0.684 and 0.640, respectively. The fit of the model was demonstrated the calibration curve, and DCA showed the value of clinical application. CONCLUSION: The nomogram may help to screening the probability of VI in patients with CKD. Larger samples are needed to validate and improve the model to increase its efficacy.

Abstract:AIM: To conduct a comprehensive bibliometric analysis of age-related macular degeneration (AMD) research from 2002 to 2022, identifying key contributing countries, institutions, authors, journals, and research hotspots to inform future research directions. METHODS: Publications related to AMD were retrieved from the Web of Science Core Collection (WoSCC) database for the period January 1, 2002, to December 31, 2022. The search was limited to English-language articles and reviews. Bibliometric analysis was performed using Microsoft Excel 2021 for data management and annual publication analysis. Visualization and network analyses were conducted using VOSviewer, CiteSpace, and the Bibliometrix package in R. Collaboration networks among countries, institutions, authors, and journals were mapped. Keywords were analyzed for co-occurrence to identify research hotspots. Metrics such as H-index, total link strength (TLS), and citation counts were used to assess impact. RESULTS: A total of 16 715 publications were analyzed, showing a consistent increase in AMD research output over the past 20y, peaking at 1445 publications in 2021. The United States was the leading contributor with 31.8% of total publications, followed by China and the United Kingdom. The University of Melbourne emerged as the most productive institution with the highest TLS, indicating strong international collaborations. Professor Frank G. Holz was identified as the most influential author based on H-index and publication count. Investigative Ophthalmology & Visual Science was the most prolific journal and had the highest citation impact. Keyword co-occurrence analysis revealed four main research clusters: pathogenesis, therapy, epidemiology, and diagnosis. Emerging research hotspots included anti-vascular endothelial growth factor (VEGF) therapies, optical coherence tomography angiography, and artificial intelligence (AI) applications in diagnosis. CONCLUSION: The bibliometric analysis highlights significant growth and collaborative efforts in AMD research globally. Key contributors have advanced understanding in pathogenesis, therapeutic strategies, epidemiology, and diagnostic technologies. Future research should focus on interdisciplinary collaborations, novel therapeutic targets, personalized medicine, and technological innovations such as AI to effectively address the challenges posed by AMD.

Abstract:AIM: To review the success rates and complications of interventions for functional epiphora in adults. METHODS: A systematic review of English-language articles from the electronic databases PubMed, SCOPUS, and Google Scholar. The primary outcome was subjective resolution or improvement of epiphora symptoms. Secondary outcomes were treatment-related adverse events. Subjects above 18 years of age who underwent surgical or non-surgical treatment for functional epiphora (exhibited symptoms of epiphora with a patent lacrimal system) were included. Articles were excluded if they were 1) case reports; 2) abstract only studies; 3) published in a language other than English. Data extraction was performed independently by two authors. The Effective Public Health Practice Project checklist was used for quality assessment of the included studies. RESULTS: A total of 762 articles were identified; 28 met the study criteria. Most studies employed silicone tube intubation alone or as an adjuvant procedure to dacryocystorhinostomy (DCR). Other interventions included lacrimal probing, balloon dacryoplasty, lateral tarsal strip and botulinum toxin A. DCR had the highest success rate, as well as the longest mean follow-up time. Complications were minor, transient, and mostly stent-related. CONCLUSION: This updated systematic review on the success rates of interventions for functional epiphora in adults proposes the following management algorithm. Dacryocystography (DCG) should be performed in all patients with functional epiphora. If DCG is abnormal, we advocate DCR. If DCG is normal, proceed with dacryoscintigraphy (DSG). We perform DCR for post-sac delay on DSG and lateral tarsal strip for pre-sac delay. Botulinum toxin A is an off-label, short-term treatment option in those with normal DSG.

Abstract:The rapid development and increasing popularity of smartphones have led to their gradual integration as essential aids in medical examinations and teaching tools. The smartphone ophthalmoscope (SO) is one of them. Specifically, SO is comprised of a smartphone and an attachment. The smartphone serves as a versatile device for recording and transmitting information, while the attachment functions as a tool for phone fixation as well as focus adjustment and providing light resources, albeit with slight variations across different devices. Presently, the convenience, universality, and transferability of SO have greatly expanded its potential in fields of clinical practice and ocular teaching. The review provides a concise overview of the contemporary SO devices, elucidates the diseases amenable to assessment via SO, and outlines the various applications of SO in clinical practice and teaching.

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