Abstract:AIM: To explore the role of a previously-found MYH9 tail domain mutation (p.E1384Q) in the pathogenesis of congenital cataract. METHODS: The cell experiments were conducted in vitro. Wild-type (WT) MYH9 and p.E1384Q mutant fragments were constructed, which was then transiently transfected into Hek293T cell lines. Western blotting and quantitative real time polymerase chain reaction (qRT-PCR) were used to analyze the protein and mRNA level of non-muscle myosin IIA (NM IIA) and F-actin in transfected cells, and fluorescence microscopy was applied to explore the subcellular localization of NM IIA and F-actin. ‌Cell counting kit-8 (CCK8), wound-healing and double staining flow cytometry assays were performed to evaluate the proliferation, migration and apoptosis function of transfected cells, respectively. Transmission electron microscope was conducted to observe the alteration of organelle structure. RESULTS: The transiently-transfected WT and p.E1384Q mutant Hek293T cell lines was constructed. Western blot demonstrated that, comparing with MYH9WT group, the relative protein amount of NM IIA and F-actin significantly decreased in MYH9E1384Q cells (P<0.001). qRT-PCR analysis revealed that the relative mRNA amount of NM IIA and F-actin also significantly reduced in MYH9E1384Q cells when compared with MYH9WT. The immunofluorescence microscopy showed that the fluorescence signal of NM IIA and F-actin significantly decreased in E1384Q cells. The diffuse cytoplasmic distribution of NM IIA in MYH9WT was changed to be clumped distribution, presenting a “speckled” pattern characterized by aggregates of small size in MYH9E1384Q. Functional study revealed that the E1384Q mutation significantly inhibited cell proliferation (P=0.003) and migration (P<0.001), and promoted apoptosis (P<0.001). Electron microscope showed that the mutation remarkably decreased the number of mitochondria (P<0.001) and changed the phenotype of mitochondria. CONCLUSION: The missense gene mutation in MYH9 (p.E1384Q) causing congenital cataract results in decreased amount and altered subcellular distribution of NM IIA and F-actin, accompanied by decreased cell proliferation and migration, promotes apoptosis and mitochondrial alteration.

Abstract:AIM: To investigate the protective role of ghrelin against diabetic retinopathy (DR), focusing on its anti-ferroptotic mechanism in high glucose-induced retinal endothelial injury. METHODS: First, small interfering RNA (siRNA)-mediated interference was conducted to knockdown nuclear factor erythroid 2-related factor 2 (Nrf2). Using reverse transcription-polymerase chain reaction (RT-PCR), the expression level of Nrf2 was determined from human retinal microvascular endothelial cells (HRMECs) transfected with either si-NC or si-Nrf2. After that, cells were treated with 10 nmol/L ghrelin and then cultured in a high glucose (30 mmol/L) environment. EdU assay was utilized to assess cell proliferation, while transmission electron microscopy was employed to observe mitochondrial morphology. Flow cytometry was used to measure the level of intracellular reactive oxygen species (ROS), and biochemical assays were conducted to detect malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), and ferrous iron (Fe2+). Western blotting was used to identify the presence of ferroptosis-related proteins such as glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), Nrf2, and haem oxygenase-1 (HO-1). RESULTS: Under a high glucose environment, ghrelin could significantly promote the proliferation of HRMECs and mitochondrial status, remarkably decrease the levels of intracellular ROS and MDA, and up-regulate the level of GSH and SOD. Besides, ghrelin greatly reduced Fe2+ level in the cells while increased protein levels of GPX4 and SLC7A11. Subsequently, we found that high glucose induced inactivation of Nrf2/HO-1 axis and the protein expression profile were significantly promoted by ghrelin. Moreover, silencing of Nrf2 by siRNA delivery markedly diminished the changes induced by ghrelin in high glucose-induced HRMECs, shown as reduced cell proliferation and increased mitochondrial malformation, up-regulated ROS, MDA, Fe2+, GPX4 and SLC7A11, as well as down-regulated GSH, SOD, Nrf2 and HO-1. CONCLUSION: Ghrelin attenuates high glucose-induced injury of retinal endothelial cells via inhibiting ferroptosis, and activation of Nrf2/HO-1 pathway may be one of the mechanisms involved in this effect of ghrelin.

Abstract:AIM: To examined the effects of a high-fat diet (HFD) on retinal pathological changes and dysfunction using peroxisome proliferator-activated receptor-alpha (PPARα) knockout mice. METHODS: For four months, C57BL/6J and PPARα knockout mice received either HFD or a standard diet (SD). A fluorometric method was used to determine the retinal triglycerides. The retinal malondialdehyde (MDA) content was measured. Hematoxylin-eosin was used to evaluate retinal pathological changes. Protein expression was analyzed by Western blot and immunofluorescence, while mRNA expression was evaluated by quantitative reverse transcription-polymerase chain reaction. Electroretinogram was used to assess retinal function. RESULTS: HFD resulted in increased fatty acid β-oxidation in the inner retina, particularly retinal ganglion cells (RGCs), as well as increased weight and accumulation of retinal triglyceride. Retinal fatty acid β-oxidation and triglyceride accumulation were affected by PPARα−/− abnormalities. PPARα knockdown increased the infiltration and activation of inflammatory cells, as well as it upregulated the nuclear factor kappa B (NF-κB) signaling pathway and corresponding proinflammatory cytokine levels in the most retina subjected to the HFD. In the HFD mice, oxidative stress levels were elevated in the inner retina, particularly in the HFD PPARα−/− mice. HFD-induced RGCs apoptosis initiation was exacerbated by PPARα deficiency. Lastly, HFD feeding resulted in the lower amplitudes of scotopic a-wave, b-wave and photopic negative response (PhNR) wave, particularly in HFD PPARα−/− mice. CONCLUSION: In HFD-fed mice retina, particularly in the inner retina, PPARα knockout increases lipid metabolic abnormalities, inflammatory responses, oxidative stress, apoptosis initiation and dysfunction.

Abstract:AIM: To compare the efficacy of 3% diquafosol sodium (DQS) eye drops at different frequencies in dry eye (DE) after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: In this prospective study, DE patients after FS-LASIK were randomly divided into two groups. All patients were administered routine anti-inflammatory and anti-infective drugs after FS-LASIK. Additionally, both groups were treated with DQS, at frequencies of 4 (DQS4 group) and 6 (DQS6 group) times daily. Corneal fluorescein staining (CFS) score, non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), lipid layer thickness (LLT), and incomplete blink rate (IBR) were assessed in patients preoperatively and at 1wk, 1, and 3mo postoperatively. The Ocular Surface Disease Index (OSDI) questionnaire was also administered. RESULTS: Totally 119 patients (238 eyes) were randomly divided into the DQS4 group (60 individuals with 120 eyes) and DQS6 group (59 individuals with 118 eyes). From 1wk to 1mo after FS-LASIK, the CFS score in the DQS6 group decreased with statistical significance (P=0.014), while the DQS4 group showed an upward trend. Comparing with preoperative values, the NIBUT of both groups was significantly prolonged at various time points after FS-LASIK (P<0.05). Within 1mo post FS-LASIK, both groups had significantly higher OSDI scores compared with preoperative values (P<0.05). At postoperative 3mo, the DQS4 group recovered to a level similar to that before surgery (P>0.05), while the DQS6 group remained a little higher than preoperative values (P>0.05). The TMH levels in the DQS4 group increased significantly at 1wk postoperatively (P<0.05), while there was no statistically significant change in the TMH levels in the DQS6 group (P>0.05). There was no significant difference in IBR and LLT between the two groups within 1mo postoperatively. At postoperative 3mo, the LLT in the DQS4 group was significantly higher than that in the DQS6 group (P<0.05). CONCLUSION: Within 1mo post-FS-LASIK, applying DQS six times daily is superior to four daily applications in improving CFS score, and in increasing NIBUT meanwhile. After 1mo, applying DQS four times daily also effectively alleviate DE symptoms and improve DE signs. Therefore, we recommend DE patients using DQS eye drops 6 times daily within 1mo after FS-LASIK, and maintaining it 4 times daily until 3mo postoperatively.

Abstract:AIM: To investigate the response of the anterior and posterior corneal surface in femtosecond laser-assisted convex stromal lenticule addition keratoplasty (SLAK) combined with cross-linking (CXL) for treating keratoconus at the first 3mo of follow-up. METHODS: In this prospective observational study, 20 eyes of 20 keratoconus patients who underwent SLAK combined with CXL were included. The morphological indices in keratometry and elevation data were recorded from the Sirius at baseline and 1 and 3mo postoperatively. The mean values of maximum keratometry (Kmax), flat keratometry (K1), and steep keratometry (K2) at the central, 3-mm, 5-mm, and 7-mm areas were measured from the curvature map. The changes in anterior and posterior corneal elevation under the best-fit sphere (BFS) radius at seven points horizontally of the center, 3-mm, 5-mm, and 7-mm area from the center at both nasal (N) and temporal (T) side were measured from elevation map. RESULTS: For the front corneal curvature, K1, and K2 at 3-mm, 5-mm, and 7-mm of the anterior corneal surface increased significantly 1mo postoperatively (all P<0.05) and remained unchanged until 3mo (P>0.05). For the back corneal curvature, K1 and K2 along the 3-mm back meridian significantly decreased after month 1 (P=0.002, 0.077, respectively). Posterior K2-readings along the 5-mm and 7-mm did not change after surgery (P>0.05). Anterior BFS decreased 1mo (P<0.001) postoperatively but remained unchanged until 3mo after SLAK (P>0.05). There was no change in posterior BFS before and after the surgery (P>0.05). Anterior elevation at N5, N3, central, and T5 points and posterior elevation at central and T7 points shifted backward 1mo postoperatively (all P<0.05) and remained stable until 3mo (P>0.05). CONCLUSION: The myopic SLAK combined with CXL is an economical alternative for stabilizing the corneal surface in severe keraoconus. “Pseudoprogression” occurs in the early phase postoperatively, but it is not an indicator of keratoconus progression.

Abstract:AIM: To analyze the clinical and pathological features of 89 patients presenting as lacrimal gland prolapse (LGP). METHODS: This retrospective study included 89 patients presenting as LGP. Magnetic resonance imaging (MRI) scan was performed for all patients. Pathology and immunohistochemical staining of prolapsed tissue were performed during the surgery. The histopathological subtype was obtained, and the related clinical manifestations of different subtype were marked. RESULTS: Among the 89 patients involved, the histopathological subtype includes dacryoadenitis (43%; n=38), focal lymphocytes infiltration (20%; n=18), immunoglobulin G4 (IgG4)-related lacrimal gland inflammatory disease (15%; n=13), lacrimal gland (13%; n=12), and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (9%; n=8). As for manifestations of different subtypes, eyelid swelling was found the most frequent of lymphocytes infiltration (44%, n=8), and palpable lacrimal gland mass of dacryoadenitis (55%, n=21). All the IgG4-related lacrimal gland inflammatory disease (100%, n=13) and most dacryoadenitis (97%, n=37) presented as bilateral. CONCLUSION: LGP has the histopathological subtype most commonly as inflammation, followed by structural and lymphoproliferative changes. Most of patients present as eyelid swelling. Clinical manifestations can be significant to differentiate the diagnosis.

Abstract:AIM: To investigate the demographics, risk factors, clinical presentation, treatments and outcomes of Acanthamoeba keratitis (AK) in a tertiary referral hospital in central China. METHODS: In this noncomparative, retrospective study, a total of 21 AK patients were enrolled between April 2020 and March 2023. All patients underwent anterior segment photography, in vivo confocal microscopy (IVCM), best-corrected visual acuity (BCVA) and anterior segment optical coherence tomography (AS-OCT). RESULTS: The most common potential predisposing factors were contact lens wearing (71.4%), mostly were students, and organic trauma (23.8%), mainly by outdoor workers. And 80.9% of patients were initially misdiagnosed with herpes keratitis. The clinical features were radial keratoneuritis 42.8% (n=9), crude salt-like granular dense infiltration 28.6% (n=6), and corneal ring infiltration 28.6% (n=6). Fifteen patients were completely cured by medical therapy, and six patients with corneal ring infiltration feature were performed conjunctival flap covering surgery (CFCS), three of them later underwent secondary deep anterior lamellar keratoplasty (DALK). All patients completed their follow-up at the Union Hospital, with a total of 20 patients (95.2%) had improved visual acuity after treatment, 1 had no change. Corneal scarring and vascularization were the two most common complications of AK in this study, with incidence rates of 85.7% and 28.6%, respectively. CONCLUSION: In central China, AK occurs predominantly in contact lens wearers, mainly in students with myopia prevention and control. The radial keratoneuritis with crude salt-like granular dense infiltration can generally be effectively managed with medications. In contrast, corneal ring infiltration necessitates immediate surgical intervention. The CFCS combined with secondary DALK is effective for patients with high-risk AK in this condition.

Abstract:AIM: To explore the effect of Alpha angle and Kappa angle before multifocal intraocular lenses (MIOLs) implantation on postoperative visual quality of patients. METHODS: Before and 3mo after cataract surgery, Alpha angle and Kappa angle were collected using IOL Master 700, iTrace, and Pentacam for clinical observation. Postoperative visual quality indicators, including high-order aberrations (HOA), modulation transfer function (MTF) and point spread function (PSF), were collected using iTrace. multiple linear regression analysis was used to analyze the correlation of the Kappa angle and the Alpha angle with age, axial length (AL), anterior chamber depth (ACD), keratometry (K), lens thickness (LT) and corneal white to white distance (WTW). Pearson correlation coefficient was used to analyze the correlation between Alpha angle and Kappa angle; Bland Altman analysis was used to evaluate the consistency of pairwise detection results of three instruments. RESULTS: The Alpha angle was modeled as Alpha=2.230+0.003×age-0.036×AL-0.025×K-0.058×WTW and the Kappa angle was modeled as Kappa=0.685+ 0.003×age-0.013×K-0.061×WTW. The correlation between the total Alpha angle and Kappa angle of the three instruments was weakly positive (r=0.291, P=0.000). Comparing the measurement of Alpha angle and Kappa angle using three instruments, only IOL Master 700 and iTrace showed good consistency in measuring Kappa angle (P=0.4254). After 3mo of surgery, the Alpha angle and Kappa angle significantly decreased (P=0.011, 0.018; P=0.008, 0.036). △Kappa=1.136-0.021×AL-0.013×K. Kappa angle could positively predict HOA (β=0.18, P=0.000), MTF (β=0.171, P=0.000), PSF (β=0.088, P=0.000), Alpha angle cannot (P>0.05). CONCLUSION: The patients with older age, flatter K and shorter WTW should be alert to the possibility of larger Alpha angle and Kappa angle. Alpha angle should also consider the factor of AL. When selecting patients with MIOLs implantation, there is no need to consider the Alpha angle. Careful consideration should be given to the Kappa angle, and the preoperative standard of <0.5 mm can refer to △Kappa=1.136-0.021×AL-0.013×K and be appropriately relaxed.

Abstract:AIM: To compare trabeculectomy with mitomycin C (MMC) alone to trabeculectomy with a combination of MMC and Ologen implant in glaucoma patients. METHODS: A retrospective cohort study including 94 eyes recruited in two groups [50 in the mitomycin C (MMC) group and 44 in the combined Ologen+MMC (OLO) group]. The medical charts of the patients were collected and analyzed at different time points: 1d, 10-30d, 3-5mo, 6-9mo, 1, 2, and 3y postoperatively. We assessed the intraocular pressure (IOP) reduction, cup-disc (CD) ratio, visual acuity (VA), bleb morphology, and complications. RESULTS: Both groups showed a significant reduction of the mean IOP from 28.8 to 10 mm Hg in 1 and 2y. However, no significant difference was noticed between both groups. We observed a stable visual acuity in 40% and 11.8%, improved in 20% and 41.2%, and worsened in 40% and 47.1% in the MMC and OLO groups, respectively. Complications were statistically significantly lower in the OLO group than in the MMC group. Bleb morphology showed statistically significant differences between the groups, with grade C blebs being more prevalent in the OLO group (43.2% in 1y) compared to the MMC group (16% in 1y) and flat blebs being more prevalent in the OLO group (43.2% in 2y) compare to MMC group (20% in 2y). Both MMC and OLO groups were effective in reducing IOP. CONCLUSION: The combined use of the Ologen implant and MMC may provide better outcomes in terms of preserving the optic nerve structure, reducing complications, and maintaining stable bleb morphology postoperatively.

Abstract:AIM: To evaluate complete blood count and biochemical parameters in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliation glaucoma (PEXG) and compare the results with healthy controls. METHODS: Forty-four patients with PEXS, 61 patients with PEXG, and 55 healthy subjects were enrolled in this retrospective study. All systemic and especially pseudoexfoliation-related ophthalmic examination findings of the participants were evaluated. Complete blood count, glucose, creatinine, and serum lipid values ​​were obtained. In line with these data, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, monocyte-to-high density lipoprotein (HDL) ratio (MHR), and mean platelet volume-to-platelet count ratio were obtained and comparison were made among groups. RESULTS: Diabetes mellitus and hypertension were significantly more common in the PEXS and PEXG groups than in the control group (P=0.021, P=0.016, respectively). In the analysis of complete blood count parameters, NLR and MHR values ​​were statistically significantly higher in PEXS and PEXG compared to the control group (P=0.037, P=0.025, respectively). In addition, glucose, low-density lipoprotein, and triglyceride values ​​were significantly higher in the PEXS and PEXG groups compared to the control group (P<0.001, P=0.035, P<0.001, respectively), and HDL value was significantly lower (P=0.031). CONCLUSION: The hematological inflammation biomarkers we evaluated in our study provide evidence that systemic inflammation and oxidative stress processes play an important role in the pathogenesis of PEXS and PEXG.

Abstract:AIM: To evaluate the choroidopathy in patients with systemic lupus erythematosus (SLE) using enhanced depth imaging spectral domain optical coherence tomography (EDI SD-OCT) and optical coherence tomography angiography (OCTA). METHODS: A total of 74 patients with SLE and 40 healthy volunteers were included in this cross-sectional study. SLE patients were further divided into three subgroups based on clinical and blood biochemistry findings. Ocular parameters obtained on ophthalmologic examination and optical imaging (EDI SD-OCT and OCTA) included the best corrected distance visual acuity (logMAR CDVA), subfoveal choroidal thickness (SCT), choroidal vascularity index (CVI) and vessel density (VD) of superficial capillary plexus (SCP) and deep capillary plexus (DCP). RESULTS: SLE patients had significantly lower values for CVI and VD of DCP (DVD) than control subjects. Amongst SLE patients, gender and chloroquine dose were found to be independent determinants of CVI while age predicted SCT. Steroid dose was a significant predictor for foveal VD of SCP (SVD), chloroquine dose for parafoveal SVD, gender for total DVD, and gender and steroid dose for perifoveal DVD. No correlation of logMAR CDVA and SCT was noted between SLE patients and control subjects. No correlation of SCT was noted with disease duration, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, hydroxychloroquine (HCQ) dose or steroid dose. No correlation of CVI was noted with patient age, disease duration, SLEDAI score, HCQ dose or steroid dose. No significant difference was noted between SLE subgroups in terms of any of the ocular parameters studied. CONCLUSION: The findings reveal the presence of ocular findings suggestive of early onset choroidopathy on EDI SD-OCT and OCTA in SLE patients, in the absence of ocular manifestations or active disease.

Abstract:AIM: To describe the influence of adding topical nepafenac to both; oral eplerenone and intravitreal aflibercept on serous foveal detachment in eyes with central serous chorioretinopathy (CSCR). METHODS: This retrospective cohort study included 31 eyes with non-resolving and recurrent CSCR that have been treated between 2015 and 2022 at Kasr Alainy Hospital. They were subdivided into Group A, which had been treated with a combination of systemic eplerenone, intravitreal aflibercept and topical nepafenac, and Group B, which had been treated with a combination of systemic eplerenone and intravitreal aflibercept (without topical nepafenac). Our outcome measures included changes in the best corrected visual acuity (BCVA), central subfield macular thickness (CMT) and serous detachment height (SDH) at baseline and at 2mo after treatment. RESULTS: Group A included 16 eyes. BCVA improved significantly from a logMAR of 0.62±0.44 to 0.42±0.47 (P=0.03), CMT decreased significantly from 401±61 to 301±100 µm, and SDH decreased significantly from 188±81 to 71±100 µm. Group B included 15 eyes. BCVA improved significantly from a logMAR of 0.68±0.39 to 0.55±0.62 (P=0.03), CMT decreased significantly from 411±39 µm to 334±92 µm, and SDH decreased significantly from 191±88 to 121±74 µm. There was a significant difference between changes in BCVA, CMT, and SDH between the two groups. CONCLUSION: Using topical nepafenac in combination with both systemic eplerenone, and intravitreal aflibercept may provide better results in the treatment of CSCR.

Abstract:AIM: To compare the proportion of rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (RRDCD) in the emergency surgery group with the routine inpatient surgery group and determine risk factors for RRDCD. METHODS: A total of 694 patients (694 eyes) diagnosed with RRD in the emergency surgery (the median duration of RRD was 5d) group were included from the Department of Ophthalmic Emergency, and 692 patients (eyes) in the routine inpatient surgery group (the median duration was 15d) were selected randomly from the Ocular Fundus Department. Demographics, refractive status, macular status, lens status, extent of retinal detachment, number of retinal breaks, duration of symptoms before surgery, and the incidence of RRDCD were compared. A logistic regression analysis was used to determine potential risk factors for RRDCD. RESULTS: Compared to the routine inpatient surgery group, the emergency surgery group had a significant less median time to surgery (P<0.001) and a decreased proportion of RRDCD (2.88% vs 10.84%, P<0.001). Logistic regression analysis revealed that a prolonged duration of RRD [OR 3.51, 95% confidence interval (CI) 1.98-6.23], pseudophakia/aphakia status [OR 2.74, 95%CI (1.50-4.98)], multiple retinal breaks [OR 1.67, 95%CI (1.03-2.70)], and a substantial extent of RRD [OR 11.58, 95%CI (7.12-18.84)] were independent risk factors for RRDCD. CONCLUSION: Emergency surgical pattern of RRD demonstrates a lower incidence of RRDCD. The adoption of an expedited surgical approach has the potential to reduce the duration of RRD, possibly correlating with a decreased risk of RRDCD development.

Abstract:AIM: To evaluate the efficacy and safety of combining posterior scleral contraction (PSC) with intravitreal perfluoropropane (C3F8) injection in high myopia with macular hole retinal detachment (MHRD). METHODS: A total of 22 participants (22 eyes) with high myopia [axial length (AL)≥26.5 mm] and MHRD who underwent PSC combined with intravitreal C3F8 injection, with at least 6mo of follow-up were retrospectively recruited. Outcome measures included best-corrected visual acuity (BCVA), AL, optical coherence tomography (OCT) findings, and adverse events. Retinal recovery was categorized as type I (macular hole bridging with retinal reattachment) or type II (reattachment without hole bridging). RESULTS: The mean age of participants was 62.1±8.8y and mean follow-up duration was 9.18±4.21mo. Complete retinal reattachment was observed in 11 eyes (50%) at postoperative day 1, 19 eyes (86.3%) at week 1, and all 22 eyes at month 1. Ten eyes (45.5%) achieved type I recovery and 12 eyes (54.5%) achieved type II. Mean BCVA improved from 1.68±0.84 logMAR before surgery to 1.21±0.65 logMAR after surgery (P<0.001), and AL was significantly reduced compared to baseline (29.07±2.05 vs 30.8±2.2 mm; P<0.001). No serious complications were reported. CONCLUSION: PSC combined with intravitreal C3F8 injection is a safe and effective treatment for MHRD in highly myopic eyes, especially for retinal detachment limited within the vascular arcade.

Abstract:AIM: To determine the utility of the RS-1 spectral domain optical coherence tomography (SD-OCT), which incorporates an “OCT Analysis Correction Parameter” for approximating axial length, in comparison with measurements obtained from the OA-2000. METHODS: Twenty-five right eyes of healthy individuals were included. Two horizontal line scans were conducted using the RS-1, and OCT Analysis Correction Parameters were recorded. Axial length was measured twice per eye using the OA-2000. Correlation between devices was assessed using Pearson correlation coefficient, coefficient of repeatability (CR%), and Bland-Altman analysis. RESULTS: High correlation was found between axial length measurements from RS-1 and OA-2000 (r=0.986, P<0.0001). The coefficient of repeatability was 1.56% for RS-1 and 0.115% for OA-2000. Mean axial length was 25.12±1.38 mm for RS-1 and 24.90±1.54 mm for OA-2000, with RS-1 showing a statistically significant larger value (paired t-test, P=0.0009). CONCLUSION: The axial length measurements of RS-1 demonstrate a strong positive correlation with those from the OA-2000. This indicates that it could potentially be used to forecast scan ranges and choose suitable databases according to axial length categories.

Abstract:AIM: To describe the clinical manifestations, imaging features and surgical treatments in 5 cases of extraocular muscle (EOM) dysplasia presenting as orbital space-occupying lesions (SOL). METHODS: Records from the 5 cases with EOM dysplasia between 2004 and 2016 were retrospectively reviewed and clinical data were recorded including family history, age at onset, age at surgery, visual acuity, cycloplegic refraction, ocular alignment and motility, stereoacuity, exophthalmos, anterior segment and fundus, orbital computed tomography (CT) or magnetic resonance imaging (MRI) scan, surgical methods and final outcomes. RESULTS: All 5 cases (1 male, 4 females) were unilateral (3 right, 2 left eyes). The average age was 5.4y (range 4-6y) with no family history. Patients had unilateral strabismus (horizontal and vertical), restricted eye movement, and eyelid changes (abnormal fissures, lagophthalmos, and/or entropion) in the affected eye. None had proptosis; 1 had 2-mm enophthalmos. Orbital CT/MRI showed irregular, ill-defined masses in EOM. Two anterior orbitotomies and 3 strabismus surgeries were performed, and pathology confirmed EOM dysplasia. After surgery, horizontal deviations, which ranged from exotropia (XT) 10 prism diopter (PD) to esotropia (ET) 10 PD (average 6 PD), decreased by an average of 18 PD, while vertical deviations, which ranged from 4 PD to 20 PD (mean 9.8 PD), decreased by an average of 23.2 PD. CONCLUSION: SOL from EOM dysplasia is non-familial and typically presenting unilaterally characterized by an irregular, diffusely infiltrating mass within the EOM. EOM involvement causes strabismus, restricted eye movement, eyelid changes, and enophthalmos likely due to cicatricial processes.

Abstract:AIM: To investigate whether blood urea nitrogen to serum albumin ratio (BAR) influences the onset and progression of diabetic retinopathy (DR) in diabetic patients. METHODS: The diabetic individuals were extracted from the National Health and Nutrition Examination Survey (NHANES) database spanning 1999 to 2018. The BAR was calculated as the ratio of blood urea nitrogen to serum albumin. To evaluate the association between BAR levels and DR, a generalized additive model and multivariate logistic regression analysis were performed. Additionally, subgroup analyses were conducted to determine whether other factors modified this association. RESULTS: The number of eligible individuals in the current research endeavor equaled 5798. The resulting data were indicative of the existence of a nearly linearly positive relationship between BAR levels and DR. Following confounding variable adjustment (age, gender, marital status, red blood cell, hemoglobin, lactate dehydrogenase, uric acid, creatinine, gender, red cell distribution width, high-density lipoprotein, glucose, sodium, glycated hemoglobin, hypertension, and total cholesterol), the multivariate investigation implied that an elevated DR risk correlated with elevated levels of BAR (OR: 1.46, 95%CI: 1.20-1.79). This relationship was noted to be reliable and stable across diverse analyses, following the conduction of sensitivity analysis (P for trend: 0.0002). Subgroup analysis showed no statistically significant interactions between BAR and most other risk factors for DR. CONCLUSION: The study provides evidence of a positive association between elevated BAR levels and an increased risk of DR in diabetic individuals.

Abstract:AIM: To describe ocular biometric parameters among Han and Uyghur myopic adults in Xinjiang, China. METHODS: A cross-sectional study was conducted. The different ocular biometric parameters collected using Pentacam were analyzed, including corneal curvature, corneal astigmatism (CA), horizontal corneal diameter (white-to-white, WTW), corneal volume (CV), pupil diameter (PD), anterior chamber angle (ACA), anterior chamber depth (ACD), anterior chamber volume (ACV) and axial length (AL). RESULTS: In total, 2932 participants were included in the final analysis, comprising 2310 Han and 622 Uyghur adults. Adults in the high myopia (HM) group had steeper K2, larger CA, smaller WTW and longer AL in both the Uyghur and Han adults (all P<0.05). The moderate myopia (MM) and HM group had deeper ACV, ACD and wider ACA than the low myopia (all P<0.05) in Han adults, however there were no differences in anterior chamber indices with Uyghur adults. In the Uyghur adults, we noticed that CV, WTW, and ACD were smaller, ACA was narrower, PD was larger, and AL was shorter (all P<0.05). We also noticed sex differences: males had flatter corneas, deeper ACD and ACV, and larger WTW than females (all P<0.05). In the correlation analysis, WTW was positively correlated with ACD and ACV but negatively correlated with K1, K2 and CV (all P<0.05). Narrower ACA was associated with larger PD (rU=-0.25, rH=-0.16, all P<0.01). CONCLUSION: The Han population have different biometric parameters in eyes with HM compared to the Uyghur population, and the Uyghur population may anatomically more susceptible to primary angle closure glaucoma than the Han population.

Abstract:AIM: To describe the optical coherence tomography (OCT) findings of the retinal nerve fiber layer thickness (RNFLT) and choroidal thickness (CT) in beta-thalassemia major. METHODS: A systematic search was conducted on PubMed, Cochrane, and Embase using a combination of specific key words. The records found were screened in two phases (title/abstract, and full-text screening). All the original observational cross-sectional studies conducted on beta-thalassemia major cases and controls reporting the RNFLT and CT were included. The Meta-analysis was run for comparing the OCT measurements between beta-thalassemia cases and controls including pooled effect size, confidence intervals (CI), quality assessment, and publication bias. The measurements included were RNFLT (average, and in various quadrants), and CT. RESULTS: A total of 10 studies were included in this Meta-analysis including a total of 684 individuals, 362 cases and 322 controls. The RNFLT and CT showed a significant reduction in the values of beta-thalassemia cases as compared to controls. The heterogeneity among the included studies was found to be 92.65% for the average RNFLT and 30.13% for the CT making it obvious to use random effects model for analyzing the RNFLT values while fixed effects model for the CT. The Egger’s test showed significant publication bias among all the parameters except for nasal RNFLT (P=0.507), and CT (P=0.281). The estimated average effect size for the average RNFLT was 1.04 (95%CI: 0.35 to 1.72, Z=2.961, P=0.003) and for CT was 0.74 (95%CI: 0.51 to 0.96, Z=6.523, P<0.001). CONCLUSION: This Meta-analysis concludes that the RNFLT and CT are significantly thinner in beta-thalassemia cases in comparison to healthy individuals. Therefore, the RNFLT and CT must be evaluated in routine clinical practice in order to avoid irreversible vision loss particularly in beta-thalassemia individuals.

Abstract:AIM: To systematically evaluate the association between nailfold capillaroscopic findings and diabetic retinopathy (DR) and compare findings in diabetic patients with and without DR. METHODS: PubMed, Web of Science, and Embase databases were searched from inception to February 2024. The quality of the included studies was evaluated using a National Institutes of Health (NIH) Quality Assessment tool for Observational Cohort and Cross Sectional Studies. Meta-analysis was conducted to compare the findings of nailfold capillaroscopy between diabetic patients with or without DR. Subgroup analysis was employed to investigate the source of heterogeneity. RESULTS: Totally 12 studies with 1349 diabetic patients were included, of which 628 had DR. The overall quality of included studies was acceptable. Patients with DR had increased arteriolar diameters [mean difference (MD): 2.68, 95% confidence interval (CI): 0.64-4.72] and a higher risk of developing nailfold capillaroscopic abnormalities, including bushy capillaries [odds ratio (OR): 2.82, 95%CI: 1.65-4.80], neoformation (OR: 4.61, 95%CI: 3.15-6.76), megacapillaries (OR: 8.37, 95%CI: 5.07-13.80), tortuosity (OR: 7.29, 95%CI: 2.76-19.22), microhemorrhages (OR: 6.16, 95%CI: 2.48-15.26), meandering capillaries (OR: 4.68, 95%CI: 1.05-20.80) and avascular areas (OR: 7.92, 95%CI: 2.68-23.38). The presence of tortuous capillary was more common in DR in India than in Turkey, while avascular area in the nailfolds was linked to DR only in India (OR: 11.28, 95%CI: 3.91-32.60). Among the nailfold capillaroscopic abnormalities, tortuosity, microhemorrhage, and meandering capillary showed no significant correlation with the severity of DR, except for avascular area (P=0.04). CONCLUSION: There are significant associations between nailfold capillaroscopic findings and the presence of DR, supporting its potential as a non-invasive technique for monitoring microvascular changes in diabetic patients. However, further research is needed to validate its utility as an early screening tool for microvascular complications in diabetes.

Abstract:Glaucoma, a degenerative optic neuropathy, causes retinal ganglion cell (RGC) apoptosis and irreversible vision loss. Current therapies often fail to stop disease progression despite lowering intraocular pressure, the main risk factor. Thus, neuroprotective strategies have gained interest. We performed a bibliometric analysis to determine global publishing trends and relationships among prolific authors, publications, institutions, funding agencies, and journals. We also analyzed author keywords to identify research hotspots in glaucoma neuroprotection. Further, based on keyword analysis, we reviewed most recent literature to understand mechanistic pathways underlying glaucoma-related pathophysiological responses leading to RGC loss. Bibliographic data were sourced from Scopus. Basic bibliographic features were characterized using Scopus’s functions. VOSviewer was used for mapping and visualizing bibliometric networks. The analysis included trends in publications since 2000, the most prolific countries, institutions, authors, and the strength of their linkages. A significant increase in publication output over the past two decades was noted. The United States leads in funding support, research output, and citation links, followed by China and the UK. Among the top 10 most cited authors, three are from Japanese institutions. Keyword analysis shows a focus on molecular targets related to ischemia, excitotoxicity, inflammation, and oxidative stress, with fewer emerging drug candidates and limited clinical trials. Based on the most recent literature, emerging molecular targets underlying these key pathophysiological mechanisms are summarized. In conclusion, while pathophysiology and molecular mechanisms are the current focus, there is not much progress in developing new drug candidates and conducting clinical trials.

Abstract:Artesunate is a derivative of artemisinin, and due to its high solubility, and it has a broader application in clinical settings. Extensive research has confirmed that artemisinin-based drugs show significant activities in anti-inflammatory, anti-tumor, anti-viral, and anti-angiogenesis aspects, suggesting that artesunate might have potential in treating retinal diseases. Currently, the etiology of most retinal diseases is not fully understood, and there is a lack of effective treatment methods. This paper summarized the research progress of artesunate in the treatment of retinal diseases, including retinoblastoma, choroidal melanoma, diabetic retinopathy, central retinal vein occlusion, proliferative retinopathy, and ocular neovascularization. In addition, the potential applications and future research directions of artesunate in the treatment of retinal diseases were also discussed.

Abstract:Macular pigment (MP) is a crucial pigment in the macular region. It plays an important role in filtering blue light, and exhibits anti-inflammatory and antioxidant properties. Macular pigment optical density (MPOD) is a key indicator for assessing the density of MP in the macular area and is closely associated with eye diseases, including age-related macular degeneration, diabetic retinopathy, and glaucoma. This review aims to explore the clinical significance of MPOD and its research value in ophthalmology and other medical fields. It summarizes the current MPOD measurement techniques, categorizing them into two main types (in vivo and in vitro), and discusses their respective advantages and limitations. Additionally, given the advancements in artificial intelligence (AI) and deep-learning technologies that offer new opportunities for improving MPOD assessment, this review analyzes the significant potential and future prospects of AI-based fundus image analysis in MPOD measurement. The goal of AI-based analysis is to provide faster and more accurate detection methods, thereby promoting further research and new clinical applications of MPOD in the field of ophthalmology.

Abstract:AIM: To describe an innovative surgical technique for pathologic myopia and macular holes accompanied by retinal detachment using allogeneic corneal stromal lenticule transplantation combined with pars plana vitrectomy. METHODS: The allogeneic corneal stromal lenticule was harvested through small incision lenticule extraction (SMILE) and stored at -30°C in advance. After pars plana vitrectomy, an allogeneic corneal stromal lenticule was thawed, trimmed into approximately 60 μm thick and 100 μm larger than the macular hole and transferred to cover the macular hole through the trocar. Autologous whole blood was dripped to seal the corneal stromal lenticule. The vitreous cavity was then filled with perfluoropropane (C3F8) or sterile air. RESULTS: The technique was performed on three eyes of three patients. The mean postoperative follow-up period was 77.3±50.0d. Postoperatively, the macular hole of all eyes was restored. All patients’ visual acuities also improved. No complications occurred during the follow-up period. CONCLUSION: The innovative corneal stromal lenticule transplantation technique provides convenient operations, less surgical invasion, effective results, and reliable safety for macular hole repair during follow-up time.

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