Abstract:AIM: To analyze visual dysfunction in rats under simulated weightlessness (SW) by examining trans-laminar cribrosa pressure difference (TLCPD) and neuroimmune responses. METHODS: The 72 male Sprague-Dawley rats were randomly assigned into two groups (ground control and hindlimb unloading-simulated microgravity) using stratified randomization, with each group further subdivided into three exposure durations: SW 2-week (SW-2W), 4-week (SW-4W), and 8-week (SW-8W), n=12 per subgroup. At the designated time points for each group, intraocular pressure (IOP) and intracranial pressure (ICP) were measured, and the trans-laminar cribrosa pressure difference (TLCPD) was calculated. Additionally, optomotor response (OMR), electroretinography (ERG), and optical coherence tomography (OCT) were performed. The number of retinal ganglion cells (RGCs) was quantified via immunofluorescence, the activation of astrocytes and microglial cells was determined, and Sholl analysis was conducted to assess the function and morphology of microglial cells. Data were analyzed with SPSS and GraphPad Prism (P<0.05). RESULTS: Under prolonged simulated microgravity, rats exhibited a progressive increase in both IOP and ICP, with the most pronounced rise observed at 8wk. Concurrently, the TLCPD shifted from a negative value in controls to a positive value. These pressure alterations were associated with retinal dysfunction, as evidenced by significant reductions in ERG b-wave and photopic negative response (PhNR) amplitudes. OCT and histological analyses revealed subtle photoreceptor layer damage: while the inner nuclear layer (INL) thickness remained relatively unchanged, the outer nuclear layer (ONL) thinned significantly, and the nerve fiber layer-ganglion cell layer complex thickness (NFL-GCL) complex initially thickened before later thinning. Immunofluorescence further demonstrated marked neuroimmune activation, with astrocytes transitioning from having large cell bodies with small, elongated, sparse processes to a phenotype characterized by compact, enlarged nuclei and aggregated processes, alongside notable RGC loss. CONCLUSION: Based on the results from the simulated microgravity rat model, microgravity-induced changes in dual-chamber pressure, and neuroimmune responses in the retina may play a key role in visual dysfunction. Specifically, the activation of retinal neuroimmune cells (astrocytes and microglial cells) induced by mechanical stress appears to be central to retinal and optic nerve damage.

Abstract:AIM: To investigate the functions and potential mechanisms of obtusifolin in dry eye disease (DED) in a rat model. METHODS: A rat DED model was established via topical administration of benzalkonium chloride (BAC), followed by administration of obtusifolin. Conjunctival irritation score and tear production were measured to evaluate DED symptoms. Enzyme-linked immunosorbent assay (ELISA) was employed for determining inflammatory cytokine levels in rat conjunctiva. Periodic acid-Schiff staining and corneal fluorescein staining were implemented for assessing goblet cell numbers and corneal epithelial defects, respectively. Western blotting showed zonula occludens-1 (ZO-1), matrix metalloproteinase-9 (MMP-9), and mitogen-activated protein kinase (MAPK)/nuclear factor kappa B (NF-κB) signaling-related protein levels in the conjunctiva. RESULTS: Topical application of obtusifolin alleviated conjunctival irritation and enhanced tear production in BAC-induced DED rats. Obtusifolin attenuated conjunctival inflammatory response and goblet cell loss as well as corneal epithelial barrier disruption in DED rats. Obtusifolin suppressed extracellular signal-regulated kinase (ERK), p38, and NF-κB phosphorylation in the conjunctiva of DED rats. CONCLUSION: Obtusifolin ameliorates DED in rats possibly by alleviating inflammation via the inactivation of MAPK/NF-κB signaling.

Abstract:AIM: To explore the changes in early retinal development after the occurrence of ischemia. METHODS: Human retinal organoids (hROs) of day 18 or day 30 were treated with oxygen-glucose deprivation and reperfusion (OGD/R) to simulate the retinal ischemia. All hROs were maintained normally until day 60 to evaluate changes in ischemic injuries during retinal development. Paraffin section staining was used for detecting changes in organoid structure and cell number. Real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot (WB) analyses were used to observe the change in the expression of retinal cell markers. RESULTS: In hROs, OGD/R induced the decrease of proliferating cells, inhibited the expression of proliferated marker Ki67 and promoted early apoptosis of retinal cells (P<0.05). Under OGD/R condition, the progenitor cell layer and ganglion cell layer of hROs lost normal structure, and the number of neural stem cells (SOX2+), retinal progenitor cells (CHX10+) and retinal ganglion cells (TUJ1+/BRN3+/ATOH7+) decreased (P<0.05). The expression of corresponding retinal cell markers also decreased (P<0.05). Organoids treated with OGD/R on day 30 had similar injuries in retinal structure and retinal cell markers to those on day 18. Long-term observations revealed that day 18-treated organoids remained disorganized progenitor and ganglion cell layers by day 60, with no recovery in proliferating cell nuclear antigen (PCNA) protein expression. RT-qPCR showed persistently low Ki67 transcription levels (P<0.001), while other retinal cell markers recovered or exceeded normal levels, indicating a limited self-repair happened in the development of hROs. In contrast, day 30-treated organoids exhibited normal structure and marker expression by day 60, with transcription levels of retinal cell markers returning to normal (P>0.05), demonstrating complete recovery from OGD/R damage. CONCLUSION: Retinal ischemia damage the retinal development in the short-term. After the restoration of retinal blood supply, the retinal ischemic damage can be recovered during subsequent development. However, retinal ischemic injuries at different developmental stages exhibit varying degrees of reversibility. The earlier ischemic injury occurs, the more difficult it is to repair retinal cell and structure damage.

Abstract:AIM: To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid. METHODS: Totally 20 patients with full thickness medial or central lower lid defects that could not be repaired by direct closure with or without cantholysis. A sliding full-thickness composite flap was created from the lateral part of the remaining lid to cover the defect. The posterior lamella of the induced lateral defect was repaired by either a periosteal flap alone or in combination with a free tarsal graft. Postoperative cosmetic and functional outcomes were evaluated. RESULTS: The mean age of the patients was 46.3±18.1y (20-70y). The defects ranged from 30%-80% of the lid width and resulted from the excision of lid tumors in 11 patients (55%) and from trauma in 9 (45%) patients. Postoperative complications included one case of lateral graft ectropion, 2 cases of lid retraction and 3 cases of marginal graft necrosis. Most of the patients had an acceptable final cosmetic outcome. CONCLUSION: Reconstruction of moderate-sized defects in the medial/central lower lid via a sliding flap yielded acceptable cosmetic and functional outcomes with high patient satisfaction. Large defects ≥50% of the horizontal length are at greater risk of complications. Reconstruction of medial defects by this technique was associated with a greater incidence of complications.

Abstract:AIM: To investigate the expression of interferon regulatory factors (IRFs) in peripheral blood mononuclear cells (PBMCs) of patients with Sjögren’s syndrome-related dry eye (SSDE) and to explore their correlation with clinical features, dendritic cell activation, and serological indicators. METHODS: A total of 53 SSDE patients and 62 non-Sjögren’s syndrome dry eye (NSSDE) patients were enrolled. Demographic and clinical data were collected, and comprehensive ophthalmic examinations were performed, including the ocular surface disease index (OSDI) questionnaires, Schirmer I test (SIT), tear break-up time (TBUT), corneal fluorescein staining score (CFS), and in vivo confocal microscopy (IVCM). PBMCs were isolated, and IRFs expression levels were analyzed using Western blotting (WB) and quantitative real-time polymerase chain reaction (qRT-PCR). Serological indicators, including antinuclear antibodies (ANA) and anti-Ro60, anti-Ro52, and anti-La autoantibodies, were detected. Statistical analyses evaluated correlations between IRFs expression and clinical parameters. RESULTS: Compared to NSSDE, the relative mRNA and protein expression of the IRF-8 was significantly upregulated in patients with SSDE (P<0.001), whereas no significant differences were observed in IRF-1, IRF-3, IRF-5, and IRF-7 (P=0.12, P=0.10, P=0.66, P=0.96). Correlation analysis revealed that IRF-8 expression was positively associated with CFS and OSDI scores (r=0.57, r=0.38, both P<0.05). Moreover, IRF-8 expression correlated with corneal dendritic cell (DC) density and size, and the number of dendrites (r=0.43, r=0.40, r=0.65, all P<0.05). IRF-8 expression was significantly elevated in patients positive for anti-Ro60, anti-Ro52 and anti-La autoantibodies (P<0.05). CONCLUSION: In SSDE, IRF-8 is upregulated and associated with clinical features, DC activation, and serological indicators. These findings suggest that IRF-8 plays a critical role in SSDE pathogenesis and may serve as a potential therapeutic target for diagnosis and treatment.

Abstract:AIM: To evaluate the mid-term effects of topical latanoprost 0.005% on vessel density (VD) of the bulbar conjunctiva using anterior segment optical coherence tomography angiography (OCTA). METHODS: Thirty-four eyes of 21 patients and 18 eyes of 9 healthy subjects were recruited as the treatment and control groups, respectively. The treatment group was instructed to apply generic latanoprost 0.005% once daily at night, while the control group received no medication. Anterior segment OCTA was performed on all eyes at baseline, 3wk, and 12wk after initiation of latanoprost. The superficial bulbar conjunctival VD was measured in the superior, inferior, temporal, and nasal quadrants. A linear mixed model was used to compare the change in the VD between groups. RESULTS: The change in the VD was not different between groups in temporal, and nasal quadrants at 3-week and 12-week time points. The VD in the superior bulbar conjunctiva was significantly increased after 12wk (P=0.029) while the change from baseline after 3wk was not different between groups (P=0.218). After adjustment for age and gender superior hemi (P=0.006) and center (P=0.016) of the inferior quadrant of bulbar conjunctiva showed increased VD after 12wk. CONCLUSION: The trend of changes in the superior and inferior conjunctival VD is increased following topical latanoprost administration and these changes can be quantified using anterior segment OCTA.

Abstract:AIM: To explore whether plasma proteins serve as potential therapeutic targets for primary open angle glaucoma (POAG) based on a Mendelian randomization (MR) study. METHODS: Large-scale protein quantitative trait loci (pQTLs) data from the Icelandic deCODE database and two large POAG Genome-Wide Association Study (GWAS) summary datasets were used in this study. Causal associations between plasma proteins and POAG were identified using summary-data-based MR (SMR) analysis and the heterogeneity in dependent instruments (HEIDI) test. Colocalization analysis was then conducted to assess the genetic associations between these two factors. Phenotype-wide MR analysis was performed to validate protein targets as potential drug targets and to evaluate potential side effects. Finally, protein-protein interactions (PPI) were studied, and the Drug-Gene Interaction Database (DGIDb) was used to identify associations between drugs and the identified proteins. RESULTS: Four proteins (SVEP1, TMEM190, ROBO1, and ENPP5) were identified as potential drug targets in this study. Phenome-wide MR analysis showed that SVEP1, ROBO1, and ENPP5 were not associated with adverse effects, while TMEM190 was linked to nerve root and plexus disorders, as well as subarachnoid hemorrhage. Ticagrelor was suggested as a potential new drug for the treatment of glaucoma by regulating SVEP1. CONCLUSION: Four plasma proteins—SVEP1, TMEM190, ROBO1, and ENPP5—are identified as potential therapeutic targets for POAG through an MR approach. Phenome-wide MR analysis reveals that SVEP1, ROBO1, and ENPP5 are not associated with adverse effects, while TMEM190 is linked to nerve root and plexus disorders, as well as subarachnoid hemorrhage. Ticagrelor is proposed as a potential therapeutic drug for glaucoma by regulating SVEP1. These findings highlight the potential of plasma proteins as drug targets for POAG and provide valuable insights for further research.

Abstract:AIM: To preliminary explore the safety and effectiveness of artificial iris implantation. METHODS: Fourteen patients with iris defects who underwent artificial iris implantation at Hainan Boao Super Hospital from June 2020 to September 2021 were retrospectively analyzed for safety and effectiveness of the surgery by comparing the preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), ocular axial length (AL), anterior chamber depth (ACD), patient satisfaction of photophobia and appearance improvement, and postoperative complications. RESULTS: The mean age was 37.21±14.85 (7-60)y, including 13 males and 1 female. The mean follow-up period was 4.64±2.32 (1-10)mo. The mean AL was 24.00±1.06 (21.68-25.58) mm. The postoperative mean anterior chamber depth measured was 4.07±0.75 (2.61-5.07) mm. The mean BCVA was 0.69±0.65 logMAR preoperatively and 0.46±0.60 logMAR at the last follow-up time (P=0.36). There was no significant differences in the IOP preoperative and postoperative (14.14±3.10 and 13.65±3.08 mm Hg, respectively, P=0.69). The preoperative ECD was 1674.09±566.11 per 1 mm2, and the postoperative ECD was 1439.45±425.15 per 1 mm2 (P=0.21). No obvious corneal opacity or corneal decompensation was observed in all patients. The preoperative and postoperative photophobia scores were 8.50±1.55 and 4.50±1.94, respectively (P<0.05), and the preoperative and postoperative appearance defect scores were 6.58±2.98 and 2.75±1.69, respectively (P<0.05). Among the 14 patients, one had artificial iris displacement, two had a transient IOP rise after treatment of antiglaucomatous eyedrops. No complications were observed during surgery. CONCLUSION: The novel artificial iris material is safe, which can significantly improve the appearance defects and photophobia, improve the postoperative visual acuity to a certain extent. This surgery had a high patient satisfaction rate with few and controllable postoperative complications. At the same time, the artificial iris, with its diverse configurations, variable colors, arbitrary cutting, and various surgical procedures, fully realizes personalized treatment, which solves the clinical problem of iris defect.

Abstract:AIM: To use two-sample Mendelian randomization (MR) method to study uveitis causal association with wet age-related macular degeneration (wAMD) risk from the genetic level. METHODS: Two-sample MR analysis was used to assess the causal role of uveitis on wAMD risk, using the 8 genetic variants associated strongly with uveitis as instrumental variables. Besides, eight MR methods [inverse variance weighted (IVW), weighted median, MR-Egger regression, weighted mode, simple mode, robust adjusted profile score (RAPS), contamination inverse-variance weighted method, and debiased inverse-variance weighted method] were used to get the whole causal estimate for multiple instrumental single nucleotide polymorphism (SNPs). The MR analysis was based on Europeans. RESULTS: Uveitis was related to a higher risk of wAMD [odds ratio (OR): 1.08, 95% confidence interval (CI) 1.03–1.12; P=1.03×10-3] with the IVW method. No heterogeneity and directional pleiotropy were detected. On the contrary, no significant results were detected in reverse MR analysis. CONCLUSION: Uveitis is related to an increased risk of wAMD. Due to the high blindness rate of wAMD, understanding and controlling the risk factors of AMD is of great significance for reducing its incidence and early diagnosis and treatment.

Abstract:AIM: To quantitatively assess central macular thickness (CMT), macular neovascularization (MNV) area, vascular tortuosity (VT), and vascular dispersion (VDisp) in neovascular age-related macular degeneration (nAMD), type 1 and type 2 MNV, by means of optical coherence tomography (OCT) and OCT angiography (OCTA) techniques. METHODS: In this retrospective and observational case series, patients were classified into type 1 or type 2 MNV groups. A comprehensive panel of OCT and OCTA metrics was evaluated, including CMT, MNV area, VT, and VDisp. All subjects underwent a standardized intravitreal conbercept (IVC) regimen [3+pro re nata (PRN)] with a 12-month follow-up. MNV area was obtained by manual measurements with OCTA software, and VT and VDisp were calculated by automated analysis with Image J software. RESULTS: A total of 101 participants were included, with 51 patients in the type 1 MNV group (mean age 67.32±9.12y) and 50 patients in the type 2 MNV group (mean age 64.74±5.21y). The mean number of IVC injections was 3.98±1.53 for type 1 MNV and 3.73±0.81 for type 2 MNV. Both subtypes exhibited significant improvements in visual acuity, accompanied by marked reductions in CMT and MNV area (P<0.05) at 12mo after treatment. In type 2 MNV, VT significantly decreased (P<0.05), whereas no significant change was observed in VT for type 1 MNV. VDisp did not significantly changed in either sybtypes. Moreover, in type 1 MNV, final best-corrected visual acuity (BCVA) using logMAR correlated positively with both pre- and post-treatment CMT, while in type 2 MNV, a significant positive correlation was found between the number of injections and final CMT. CONCLUSION: This study shows that conbercept treatment significantly improves visual acuity and macular structure in both type 1 and type 2 MNV with reductions in CMT and MNV area. The significant reduction in VT in type 2 MNV suggests its potential as a biomarker for disease activity. The findings imply the quantitative assessment useful for the stratification, prognostication, and personalized management of MNV in nAMD.

Abstract:AIM: To determine the differences in levels of systemic C-reactive protein (CRP) in patients with geographic atrophy (GA) and sex-based differences in CRP levels. METHODS: Blood samples from patients with GA and controls were collected in a prospective age-related macular degeneration (AMD) registry from August 2014 to June 2021. AMD was confirmed using multimodal imaging and the Beckman and Consensus of Atrophy Meeting criteria for GA. High-sensitivity serum CRP levels were measured using an automated nephelometer. A non-parametric (rank-based) linear regression model was fit with an interaction between sex and GA. RESULTS: There were 97 GA patients and 139 controls, with females comprising 55% and 66% of each cohort, respectively. There is no difference in CRP between cases and controls, with a median (interquartile range) of 1.2 (0.6-2.6) mg/L in GA patients versus 1.3 (0.8–2.9) mg/L in controls (P=0.52). Although females had higher CRP levels compared to males in both the GA and control groups, this difference did not reach statistical significance after adjustment for multiple comparisons. CONCLUSION: There is no significant difference in systemic CRP levels between GA cases and controls.

Abstract:AIM: To assess and compare the utility of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), and red blood cell distribution width (RDW) as potential biomarkers to predict the severity of diabetic retinopathy (DR) in the United States population. METHODS: The observational study enlisted patients diagnosed with DR from the National Health and Nutrition Examination Survey (NHANES) database, spanning the period from 2005 to 2008. The severity of DR was defined according to Early Treatment for Diabetic Retinopathy Study (ETDRs). The effect of NLR, PLR, SII, and RDW on proliferative diabetic retinopathy (PDR) were explored using multivariable logistic regression analysis model. Subgroup analysis and restricted cubic splines (RCS) were conducted to assess the robustness of the correlations across subgroups and to explore nonlinear relationships between four indices and PDR. The receiver operating characteristic (ROC) analysis was employed for the purpose of assessing and evaluating the predictive efficacy of NLR, PLR, SII, and RDW in determining the severity of DR. RESULTS: After adjusting for other confounders (age, gender, race, body mass index, diabetes duration, and HbA1c) in multivariable analysis, a unit increase of PLR×0.1, SII×0.01, and RDW would raise the risk for PDR by 15.6%, 22.2%, and 33%, respectively. Particularly, there was a 2.208-fold greater risk of PDR in individuals with an elevated NLR (OR=2.208, 95%CI, 1.348-3.617, P<0.001). RCS analyses showed positive relationships of four indices and PDR after segmented regression based on their own turning points. The results of ROC analysis revealed that PLR+RDW [area under the curve (AUC)=0.772, 95%CI: 0.669-0.874] had the best predictive value for PDR, compared with NLR+PLR+SII (AUC=0.697, 95%CI: 0.570-0.825) or RDW alone (AUC=0.736, 95%CI: 0.646-0.826). CONCLUSION: The combination of RDW and NLR demonstrates a promising ability to predict the severity of DR across the United States population, and it could be promisingly used in clinics for monitoring the progress of DR.

Abstract:AIM: To evaluate retinal microcirculation changes at the 3rd and 12th months following endoscopic endonasal surgery in patients with sellar region tumors using optical coherence tomography angiography (OCT-A). METHODS: This prospective longitudinal observational study included 78 eyes of 39 patients with sellar tumors and 78 eyes of 39 age- and gender-matched healthy controls. Standard automated perimetry and OCT-A were performed preoperatively and at 3- and 12-month follow-ups. Visual field (VF) recovery was assessed using mean deviation (MD) values, and correlations between preoperative structural parameters and postoperative visual outcomes were analyzed. RESULTS: Baseline OCT-A values revealed significantly reduced papillary and foveal vessel densities in almost all quadrants in sellar tumor patients compared to controls (P<0.05, respectively). While VF MD values improved significantly postoperatively (P<0.001), no significant improvement was observed in microvascular vessel density or retinal nerve fiber layer (RNFL) thickness (P>0.05, respectively); instead, a tendency toward reduction was noted over 12mo. Correlation analysis between postoperative MD values and preoperative parameters showed a strong positive correlation with the superior quadrant of papillary vessel density (r=0.703, P<0.001) and RNFL thickness (r=0.518, P<0.001). CONCLUSION: Although decompressive surgery improves visual function, retinal microvascular alterations appear to deteriorate over time. These findings suggest that irreversible neurovascular damage occurs despite surgical intervention, emphasizing the importance of early diagnosis and treatment in patients with chiasmal compression. OCT-A may serve as a valuable prognostic tool for assessing structural and functional recovery in these patients.

Abstract:AIM: To investigate the ocular biological characteristics of children with myopia and rapid axial length (AL) changes prescribed spectacles with highly aspherical lenslets (HAL). METHODS: Data were collected from 156 children (252 eyes) with myopia and HAL treatment who were aged 7-13 and had rapid AL changes. The participants were divided into groups with AL reduction and elongation according to the changes in AL within 6mo. Paired t-tests were used to compare the ocular biological parameters at baseline and after rapid changes post-HAL treatment. Pearson’s correlation analysis was used to determine the association between the ocular parameters and AL changes. RESULTS: The ocular biological parameters significantly changed in the children with myopia and rapid AL changes after HAL treatment. In the group with AL reduction, the anterior chamber depth (ACD) and vitreous chamber depth (VCD) decreased. The crystalline lens thickness (CLT) increased, corneal flat keratometry (FK) decreased, and steep keratometry (SK) increased (all P<0.001). The eyes in the group with AL elongation had increased ACD and VCD and steepened SK, but the CLT or FK findings were not different. AL change was negatively associated with baseline astigmatism (r=-0.171; P=0.007). CONCLUSION: In the eyes with HAL treatment, decreased ACD and VCD, thickened CLT, flattened FK, and steepened SK are observed during AL reduction. Lower baseline astigmatism is associated with AL reduction. The AL reduction may suggest the potential efficacy of HAL intervention in myopia control, while providing evidence for optimizing personalized myopia management strategies. Further longitudinal studies are warranted to validate whether rapid AL changes predict sustained treatment efficacy.

Abstract:AIM: To investigate short-term changes in choroidal thickness in response to peripheral myopic defocus induced by two designs of multifocal corneal gas permeable contact lenses (MFGPCL) in young adults. METHODS: Seventeen participants, with a mean age of 24.5±4y, underwent choroidal thickness and vascularity index measurements using enhanced depth imaging optical coherence tomography (EDI OCT) at baseline, one day, and one week following MFGPCL wear. Two center-distance MFGPCL designs with similar center zone diameters of 3.0 mm but different peripheral add powers (low add: +1.5 D and high add: +3.0 D) were tested. Each participant was randomly assigned to wear one of the two MFGPCL designs. Measurements of total, luminal, and stromal choroid thickness were obtained in five eccentric regions (6 mm towards the periphery) in all quadrants. RESULTS: Significant thickening in total choroidal thickness were observed after one week of wearing both high add (+10±6 µm) and low add (+7±5 µm) MFGPCLs, with no statistically significant difference between the two groups (P=0.42). Choroidal thickening was consistent across eccentric regions and quadrants, with no significant differences based on eccentricity or quadrant (all P>0.05). Both lens designs induced choroidal thickening, with no significant difference between them in total choroidal thickness (P=0.18 for quadrants, P=0.51 for eccentric regions). CONCLUSION: Peripheral myopic defocus induced by MFGPCLs lead to significant choroidal thickening, including total, luminal, and stromal components. This study highlights the need for future research to explore the dose-response relationship between peripheral myopic defocus and choroidal thickening, utilizing choroidal response as a potential biomarker.

Abstract:AIM: To compare the visual and optical outcomes following femtosecond laser in situ keratomileusis (FS-LASIK) using an aberration neutral profile with asymmetric offset (AO) and pupil center (PC) treatments. METHODS: In this randomized double-blind clinical trial study, 48 (24 cases) and 38 eyes (19 cases) underwent myopic astigmatism and hyperopic astigmatism LASIK. One eye of each individual was randomly assigned to AO centration and the fellow eye underwent the PC-centered method. The clinical outcomes including uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), safety and efficacy indexes, subjective spherical equivalent (SE) and corneal high-order aberrations (HOAs) were measured at baseline and 6mo postoperatively. RESULTS: In the myopic group, the mean preoperative SE and astigmatism were -4.12±0.87 (-2.88 to -6.00) diopter (D) and -0.88±0.79 (0 to -2.75) D, respectively. In the hyperopic group, the mean preoperative SE and astigmatism were 0.93±0.59 (-0.25 to 2.25) D and -0.73±1.00 (0 to -4.25) D, respectively. At 6mo postoperatively, the safety and efficacy indexes were similar for centration in myopic and hyperopic LASIK groups. In the myopic group, significant changes were found in horizontal trefoil (P=0.041) and oblique trefoil (P=0.031) in favor of AO centration treatment. CONCLUSION: Femtosecond-LASIK is a safe and efficacious procedure for treatment of myopic and hyperopic astigmatism. AO-centered and PC-centered approaches provide similar visual and refractive outcomes. Myopic astigmatism LASIK with AO centration leads to slightly better corneal aberration outcomes.

Abstract:AIM: To estimate if nanopore targeted sequencing (NTS) could identify pathogens causing postoperative endophthalmitis and further determine the feasibility of clinical application of NTS. METHODS: A total of 55 patients (55 eyes) with postoperative endophthalmitis were retrospectively included in this study with their medical records. Intraocular fluid samples were examined by NTS and microbial culture. All included patients had undergone examinations including measurement of best corrected visual acuity (BCVA) and intraocular pressure (IOP), slit-lamp biomicroscopy, and indirect ophthalmoscopy; additionally, they underwent B-ultrasound, anterior segment photography, and fundus photography if necessary. RESULTS: Among 55 patients with postoperative endophthalmitis, the age was 65.25±15.04y and there were 30 female (54.54%) patients. Forty-one (74.54%) vitreous humor samples and fourteen (25.45%) aqueous humor samples were sent for both NTS and microbial culture. NTS had a notable higher detection rate than microbial culture in detecting pathogens (90.91% vs 38.18%, χ2=33.409, P<0.001). NTS exhibited high sensitivity of pathogen detection in both microbial culture positive and negative samples (100% and 85.29%, respectively). In 16 of 21 (76.19%) patients who showed culture-positivity, their results corresponded with those of NTS. Moreover, in two patients (9.52%), NTS showed a better species resolution than microbial culture; in three patients (14.28%), NTS identified additional pathogens. As for fungus, the positive detection rate of NTS was significantly higher than that of microbial culture (20% vs 3.64%, χ2=7.066, P=0.008). Also, NTS could detect multi-infection by bacteria and fungi than microbial culture (32.73% vs 0, χ2=21.522, P<0.001). NTS could detect bacteria as well as fungi simultaneously within 48h in all patients. Meanwhile, NTS had a shorter detection time than microbial culture (1.13±0.34 vs 2.67±0.55d, Z= -9.218, P<0.001). After the NTS results were obtained, 15 patients received additional intravitreal/intracameral anti-infection treatment. At follow-up, there was a statistically significant improvement in the visual acuity relative to the baseline (Z=−5.222, P<0.001). CONCLUSION: NTS can provide rapid identification and highly sensitive detection of pathogens among patients with postoperative endophthalmitis, which can guide anti-infection treatment and improve visual prognosis.

Abstract:AIM: To report the demographic and systemic characteristics of patients, clinical progression of endophthalmitis, and the efficacy of various treatment strategies, with a focus on identifying key factors for preserving vision in eyes with endogenous endophthalmitis due to Klebsiella pneumoniae (K. pneumoniae) liver abscess. METHODS: In this single-center, retrospective case series of 18 patients with endogenous endophthalmitis due to K. pneumoniae liver abscess were analyzed. Ophthalmologic features of endophthalmitis at early, intermediate and advanced stages were obtained from eyes with endophthalmitis of different severities. Prompt vitrectomy was considered primarily for all eyes except for very early endophthalmitis. Intravitreal injections of antibiotics were performed in eyes with endophthalmitis in the very early stages and in eyes where vitrectomy was not available, and additional control of infection was needed after vitrectomy. Evisceration was performed in eyes with corneoscleral perforation, advanced endophthalmitis, perforation with preseptal or orbital cellulitis, uncontrolled infection, or severe pain with no vision. RESULTS: Mean (±standard deviation) age of the 18 patients with endophthalmitis was 64.5±12.2 (range: 32-84)y, and 14 patients (77.8%) were males. Endophthalmitis tended to involve the retinal parenchyma first and then progressed into the vitreous cavity and anterior segments. However, it presented a tendency to cause massive subretinal abscesses even after vitrectomy with silicone oil tamponade. Very high intraocular pressure with new vessels on the iris (41.7%) were also commonly observed. Although all but three patients had systemic disease such as diabetes or hypertension, visual prognosis after treatment did not appear to depend significantly on underlying comorbidities. A final best-corrected visual acuity better than 20/60 was achieved only when lesions were detected very early, with relatively good initial visual acuity, likely reflecting lower bacterial inoculation in the eye. CONCLUSION: Detection of early endophthalmitis lesions appears to be the only way to preserve good vision in patients with K. pneumoniae liver abscesses. Therefore, proper guidelines for ophthalmologic screening remain to be established for subjects at a high risk of endophthalmitis.

Abstract:AIM: To investigate the prevalence and characteristics of myopia in school-aged students and effects of environmental and genetic factors on the progression of myopia. METHODS: A total of 2422 students aged between 5 and 18y from nine schools in Baiyun District of Guangzhou, China were sampled using a stratified sampling method in 2020. Among them, 1066 students participated in the follow-up survey the following year. Data were obtained based on ocular examinations and a questionnaire survey conducted during two visits. Factors potentially influencing the progression of myopia were analyzed. RESULTS: During the year assessed in this study, the percentage of students with myopia increased from 58.4% to 64.8% (P=0.002). Spherical equivalent (SE) progressed from -1.44±1.91 diopters (D) at baseline to -1.66±1.10 D (P=0.005). A generalized estimating equation (GEE) model revealed that age [adjusted odds ratio (aOR)=1.298, P<0.001], residential students (aOR=2.428, P=0.018), parental myopia (one myopic parent: aOR=1.553, both parents myopic: aOR=2.609, P<0.001), frequent reading of books or viewing of screens in direct sunlight (aOR=3.502, P=0.023), using only overhead lighting for reading and writing at night (aOR=1.633, P=0.011), parental restrictions on exercise time (aOR=2.286, P=0.012), and having less than 2h of outdoor exercise per day during the past week (aOR=1.584, P=0.019) were all identified as independent risk factors for progression of myopia. CONCLUSION: Our findings in this study indicate that age, residential students, parental myopia, indoor lighting environment, and physical activity have significant effects on the progression of myopia, providing evidence for further in-depth mechanistic interpretation and efficient intervention strategies for school-age children in this area.

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Abstract:Glaucoma filtration surgery (GFS) stands as the most effective intervention for reducing intraocular pressure, a critical component in glaucoma management. Despite its pivotal role, the scarring of the filtration bleb remains the primary impediment to successful GFS outcomes. Perioperative utilization of antimitotics, while frontline in combating fibrosis and modulating the wound healing process, carries the risk of vision-threatening complications. Given the complexity of the wound healing cascade and the potential insufficiency of targeting a single molecule, there is an imperative to expand therapeutic modalities through combination therapies. This review offers a comprehensive elucidation of the fibrogenesis post-GFS, a synthesis unprecedented in the available literature, and aims to inform the broadening of therapeutic strategies for GFS.

Abstract:The uveitis-glaucoma-hyphema (UGH) syndrome, initially described in 1978, presents as an iatrogenic complication associated with contact between intraocular implant and ocular tissue. This syndrome encompasses a spectrum of clinical manifestations, including intraocular inflammation, elevated intraocular pressure, and recurrent hemorrhage. Advances in cataract surgery techniques reduced the incidence of early intraocular lens (IOL) dislocation while inversely increased rates of delayed dislocation. The primary etiology of UGH syndrome is IOL subluxation. Weakness of the ciliary zonules or unstable IOL fixation techniques may predispose the eye to iris-lens contact. Other contributing factors include Soemmering’s ring formation, abnormal iris and ciliary body anatomy, positional changes, and improper positioning of glaucoma implants. Clinical examination and imaging modalities such as ultrasound biomicroscopy and anterior segment optical coherence tomography supports diagnosis of UGH. Treatment options range from observation and medical therapies to invasive procedures such as laser therapy, IOL repositioning, or replacement. Endoscopy provides direct visualization for identifying causes intraoperatively, aiding in tailored surgical approaches towards minimal intervention. In conclusion, UGH syndrome poses a complex clinical challenge, emphasizing the importance of understanding its etiology, accurate diagnosis, and personalized management strategies to mitigate its impact on visual function and ensure favorable outcomes.

Abstract:To review the existing deep learning applications for diagnosing diabetic retinopathy and retinopathy of prematurity diseases, the available public retinal databases for the diseases and apply the International Journal of Medical Informatics (IJMEDI) checklist were assessed the quality of included studies; an in-depth literature search in Scopus, Web of Science, IEEE and ACM databases targeting articles from inception up to 31st January 2023 was done by two independent reviewers. In the review, 26 out of 1476 articles with a total of 36 models were included. Data size and model validation were found to be challenges for most studies. Deep learning models are gaining focus in the development of medical diagnosis tools and applications. However, there seems to be a critical issue with most of the studies being published, with some not including information about data sources and data sizes which is important for their performance verification.

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