Abstract:AIM: To investigate the refractive and the histological changes in guinea pig eyes after posterior scleral reinforcement with scleral allografts. METHODS: Four-week-old guinea pigs were implanted with scleral allografts, and the changes of refraction, corneal curvature and axis length were monitored for 51d. The effects of methylprednisolone (MPS) on refraction parameters were also evaluated. And the microstructure and ultra-microstructure of eyes were observed on the 9d and 51d after operation. Repeated-measures analysis of variance and one-way analysis of variance were used. RESULTS: The refraction outcome of the implanted eye decreased after operation, and the refraction change of the 3 mm scleral allografts group was significantly different with control group (P=0.005) and the sham surgical group (P=0.004). After the application of MPS solution, the reduction of refraction outcome was statistically suppressed (P=0.008). The inflammatory encapsulation appeared 9d after surgery. On 51d after operation, the loose implanted materials were absorbed, while the adherent implanted materials with MPS group were still tightly attached to the recipient’s eyeball. CONCLUSION: After implantation of scleral allografts, the refraction of guinea pig eyes fluctuated from a decrease to an increase. The outcome of the scleral allografts is affected by implantation methods and the inflammatory response. Stability of the material can be improved by MPS.

Abstract:AIM: To evaluate the role of reactive oxygen species-endoplasmic reticulum stress (ROS-ERS) in the cellular protection of G protein-coupled receptor 120 (GPR120/FFAR4) against high glucose (HG) induced human retinal vascular endothelial cell (HRVEC) injury and its underlying mechanisms. METHODS: HRVECs were divided into the control group, GW9508 (an agonist of GPR120) group, HG group, and HG+GW9508 group. The cell proliferation and apoptosis were assessed by cell counting kit-8 and annexin V-FITC/PI apoptosis detection kit, respectively. Western blotting analysis was performed to assess the protein expressions of Bax, Bcl-2, activating transcription factor 6 (ATF6), PKR-like endoplasmic reticulum kinase (PERK), and inositol-requiring enzyme 1 (IRE1). The ROS assay kit was used for the detection of ROS production. Then the cells were transfected with siRNA of GPR120 and the ROS level and protein levels of ATF6, PERK, and IER1 were compared. RESULTS: GW9508 promoted the proliferation of HRVECs, which was significantly reduced by the stimulation of HG. GW9508 remarkably reduced the apoptosis rate of HRVECs under HG and the expression of proapoptotic protein Bax, while increased the expression of antiapoptotic protein Bcl-2. Under HG condition, a significant increase of ROS production was noticed in HRVECs, and GW9508 treatment greatly decreased it. The over-expressions of ERS-related proteins ATF6, PERK, and IER1 under HG were down-regulated by GW9508 treatment. After successfully transfected with siGPR120, the effects of GW9508 on the production of ROS as well as the expressions of ATF6, PERK, and IER1 were reversed. CONCLUSION: GPR120 protects HRVECs against HG induced apoptosis, and suppressing ROS-ERS pathway is one of the mechanisms involved. Activation of GPR120 may be considered as a potential therapeutic target for diabetic retinopathy.

Abstract:AIM: To compare the effects of manipulating light levels versus manipulating the spectral content of short wavelengths (blue light) of ambient lighting on refractive development in young rabbits. METHODS: A total of 32 healthy 3-week-old rabbits were randomly assigned to one of the four groups with 8 in each group for 12wk: Control group (NC) under low blue light (output ratio of blue light 1.8%) at low illuminance (341 lx), HI group under low blue light (output ratio of blue light 1.6%) at high illuminance (5057 lx), simulating natural light (S-NL) group under high blue light (output ratio of blue light 4.9%) at high illuminance (5052 lx), and MB group under high blue light (output ratio of blue light 5.2%) at low illuminance (342 lx). The lighting in each group were provided by light emitting diode (LED) lamps emitting visible light (range 380-780 nm) in addition to (or not) LED lamps only emitting short wavelength (range 380-500 nm). Refraction, axial length, and corneal curvature radius were assessed by retinoscopy, ultrasonography and keratometry, respectively. Average data of both eyes for each animal were used as single values and compared among groups. RESULTS: During the 12-week intervention, all animals had an emmetropization period. The decrease of refraction in rabbits in HI group was similar to S-NL group, both slower than that of NC group (P<0.001). At the 12th week, the refraction (3.000±0.267 D) and vitreous cavity depth (7.421±0.168 mm) of S-NL was similar to HI group (3.250±0.267 D, 7.264±0.256 mm), significantly different from NC group (1.937±0.291 D, 7.825±0.313 mm; P<0.001 for both). High blue light at low illuminance had little effect on refraction change. At the end of intervention, the difference of refraction (2.219±0.281 D) and vitreous cavity depth (7.785±0.229 mm) in MB group were not statistically significant (P=0.311, P=0.749) compared with NC group. The other components were less affected by lighting conditions (P>0.05). CONCLUSION: The light levels per se but not the rich in spectral content of short wavelengths determine the inhibitory effect of ambient lighting on myopia development in rabbits.

Abstract:AIM: To compare objective dry retinoscopy and subjective refraction measurements in patients with mild keratoconus (KCN) and quantify any differences. METHODS: This cross-sectional study was done on 68 eyes of 68 patients diagnosed with mild KCN. Objective dry retinoscopy using autorefractometer and subjective refraction measurements were performed. Sphere, cylinder, J0, J45, and spherical equivalent values were compared between the two techniques. RESULTS: The mean age of 68 patients with mild KCN was 21.32±5.03y (12–35y). There were 37 (54.4%) males. Objective refraction yielded significantly more myopic sphere (-1.44 D vs -0.57 D), higher cylinder magnitude (-2.24 D vs -1.48 D), and more myopic spherical equivalent (-2.56 D vs -1.31 D) compared to subjective refraction (all P<0.05). The mean differences were -0.87 D for sphere, -0.76 D for cylinder, and -1.25 D for spherical equivalent. No significant differences were found for J0 and J45 values, indicating agreement in astigmatism axis (P>0.05). CONCLUSION: In patients with mild KCN, objective dry retinoscopy overestimates the degree of myopia and astigmatism compared to subjective refraction. The irregular cornea in KCN likely impacts objective measurements. Subjective refraction allows compensation for irregularity, providing a more accurate correction. When determining refractive targets, the tendency of objective methods to overcorrect should be considered.

Abstract:AIM: To compare the cup-to-disc ratio (CDR) and optic disc morphology between eyes with congenital cataract and eyes without cataract in children under 3 years old. METHODS: This study included 63 patients with bilateral congenital cataract (mean age of 55.72±46.50wk, 44 were male), 33 patients with unilateral cataract (mean age of 56.63±33.23wk, 16 were male), and 31 age-matched healthy children (mean age of 55.80±29.29wk, 17 were male). Fundus photographs were taken with the RetCam 3 system. The horizontal-to-vertical disc diameter ratio (HVDR) was used as an index to describe the oval form of the optic disc. RESULTS: The horizontal cup-to-disc ratio (HCDR), vertical cup-to-disc ratio (VCDR) and HVDR of cataract eyes in unilateral groups were significantly smaller than those of the normal eyes (P<0.05). In the unilateral group, the HCDR, VCDR and HVDR of cataract eyes were significantly smaller than those in fellow eyes (P<0.05). The HVDR of eyes in the bilateral group was significantly smaller than those in the age-matched normal eyes (P<0.001). The form of optic disc of the cataract eyes in both the bilateral and unilateral groups was more vertical-oral than the normal eyes in the unilateral and the age-matched groups (P<0.05). CONCLUSION: Our results show that eyes with congenital cataract has a smaller HVDR and the form of the optic disc tended to be vertical-oval in young children.

Abstract:AIM: To compare analysis of the impact of high altitude on corneal endothelial cells, and the prognosis in patients with cataract surgeries. METHODS: Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022 (average altitude=3000 m), and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included. The propensity score matching (PSM) method was applied to match the basic information of patients in both regions on a 1:1 basis. Corneal endothelial cell density (ECD), coefficient of variation (CV), hexagonal cell ratio (HEX), duration of surgery, and pre- and postoperative visual acuity (VA) were compared retrospectively, and correlation tests were done. RESULTS: Totally 223 pairs have been matched successfully. The HEX in the plateau group was higher than that in the plain group (61.95%±6.191% vs 44.91%±6.829%, P<0.001). For ECD and CV, no significant differences were observed between both groups (P>0.1). The pre- and postoperative VA of patients with cataract surgeries in the plateau group were lower (1.40±0.610 vs 0.71±0.514, P<0.001 & 0.68±0.479 vs 0.18±0.259, P<0.001), and the duration of surgery was longer than those in the plain group (27.06±14.900 min vs 16.03±8.033 min, P<0.001). No significant associations were found between the post-operative VA and the corneal endothelial parameters (P>0.05), while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery (P<0.05). CONCLUSION: The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells, but may lead to the compensatory increase of their functions. In plateau patients, no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.

Abstract:AIM: To compare the efficacy of different administration regimens of compound tropicamide eyedrops (CTE) for pupil dilation for children with dark iris. METHODS: A prospective, comparative, randomized interventional study was conducted. Children in Group 1 received CTE 3 times with a 3min interval between each application. Children in Group 2 received CTE 4 times with a 5min interval between each application. We measured their pupil diameters at baseline (pre-drug instillation) and 30min and 60min post-drug instillation and assessed the pupillary light reflex at 60min post-drug instillation. RESULTS: In total, 194 eyes of 101 children were enrolled. The changes of pupil diameter at 30min and 60min post-drug instillation were 1.2±0.6 mm and 2.3±1.0 mm in Group 1, and 2.3±0.9 mm and 3.7±1.0 mm in Group 2, respectively. Group 2 showed a larger change in pupil size than Group 1 at 30min (P<0.01) and 60min (P<0.01). The effect of pupil dilation in Group 2 was 1.25 times that in Group 1. The change in pupil size was positively associated with age. A higher proportion of children in Group 1 had smaller pupil diameter and reactive pupils at the final time point, with only 33 children (33.7%) had final pupil size ≥6.5 mm, and only 9 children (9.2%) had non-reactive pupils. Children in Group 2 achieved larger pupil diameter and more non-reactive pupils at the final time point, with 84 children (87.5%) had final pupil size ≥6.5 mm, and only 22 children (22.9%) had reactive pupils. CONCLUSION: Increasing the frequency of compound tropicamide and lengthening the interval between eye drop applications can produce stronger mydriatic effects.

Abstract:AIM: To assess the efficacy and safety of ultrasound cyclo-plasty (UCP) in lowering intraocular pressure (IOP) among Chinese patients suffering from refractory glaucoma. METHODS: In this 12-month retrospective study, 28 patients with refractory glaucoma (IOP≥25 mm Hg) were treated with 8-second UCP using either 8 or 10 probe sectors. The principal measure of efficacy was the decrease in IOP at the following intervals after UCP: 1d, 1, 3, 6, and 12mo, with each measurement compared to baseline. RESULTS: Mean IOP (in mm Hg) was reduced from 46.8±8.9 to 24.5±3.2, 27.0±4.8, 29.1±4.6, 26.1±4.5, and 28.3±4.8 at 1d, 1, 3, 6, and 12mo postoperatively, respectively. Compared to baseline, IOP reductions at these time points were 45.0%, 39.9%, 35.3%, 41.4%, and 36.7%, respectively. Most patients experienced relief from ocular pain after surgery. No cases of choroidal detachment or hypotony was observed. CONCLUSION: UCP is effective in reducing IOP among Chinese patients with refractory glaucoma and shows a favorable safety profile.

Abstract:AIM: To assess the relationship between serological parameters and the prognosis of young patients with retinal vein occlusion (RVO) after intravitreal conbercept injection (IVC). METHODS: This study enrolled 100 young patients (≤50 years old) diagnosed with RVO-related macular edema (RVO-ME) who had been undergoing IVC at the 474 Hospital in Xinjiang between January 2022 and October 2023. Patients were categorized into two groups: 70 eyes in the effective group and 30 eyes in the ineffective group. The effective group comprised patients exhibiting a visual acuity improvement of ≥2 lines at the last follow-up, with resolved ME and central macular thickness (CMT) <300 μm. Conversely, the ineffective group included patients with visual acuity improvement of <1 line, persistent ME, and CMT ≥300 μm at the last follow-up. Serological parameters, including white blood cell count, neutrophil count, lymphocyte count, monocyte count, and mean platelet volume were assessed before treatment. The correlation between best-corrected visual acuity (BCVA) and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and systemic immune response index (SIRI) was analyzed. Additionally, the association between these serological parameters and the efficacy of IVC was explored. RESULTS: Three months after treatment, the effective group demonstrated a significant improvement in BCVA from 0.82±0.20 to 0.36±0.10, with a concurrent decrease in CMT from 661.28±163.90 to 200.61±82.45 μm (P<0.001). Conversely, the ineffective group exhibited minimal changes in BCVA (0.86±0.25 to 0.82±0.14) and CMT (669.84±164.95 to 492.13±138.67 μm, P<0.001). The differences in BCVA and CMT between the two groups were statistically significant (P<0.001). According to subgroup analysis, in patients with central RVO (CRVO), BCVA improved from 0.82±0.23 to 0.49±0.12 in the effective group and from 0.80±0.18 to 0.76±0.22 in the ineffective group (P<0.001). The CMT changes followed a similar pattern. In patients with branch RVO (BRVO), comparable trends in BCVA and CMT changes were observed between the effective and ineffective groups (P<0.001). Additionally, the effective group exhibited higher PLR and SII values than the ineffective group (P<0.05). Further CRVO and BRVO subgroups analysis exhibited consistent PLR and SII value trends. CONCLUSION: Compared to other inflammatory factors, elevated PLR and SII levels before treatment are better predictors of outcomes in young RVO-ME patients undergoing IVC treatment.

Abstract:AIM: To evaluate alterations in conjunctival vascular density (CVD) and macular capillary density (MCD) in female patients with type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) using optical coherence tomography angiography (OCTA). METHODS: A total of 60 female participants were recruited, comprising 20 patients with T2DM, 20 patients with GDM, and 20 healthy age-matched controls (HCs). OCTA was used to assess superficial and deep retinal and conjunctival capillary plexuses. Subsequently, changes in MCD were analyzed using a circular segmentation method (C1-C6), a hemispheric quadrant segmentation method [superior right (SR), superior left (SL), inferior left (IL), and inferior right (IR)], and the early treatment diabetic retinopathy study (ETDRS) segmentation method (S, I, R, L). RESULTS: OCTA unequivocally demonstrated that the variations in CVD among HCs, T2DM, and GDM groups were statistically significant (P<0.001). In the superficial retinal capillary plexus (sRCP), significant differences were observed in the densities of total microvascular (TMI), microvasculature (MIR), and macrovascular (MAR) between patients with T2DM and HCs (P<0.05). Furthermore, the GDM group exhibited a more substantial reduction in MIR density compared to the T2DM group (P<0.01). In the deep retinal capillary plexus (dRCP), significant differences in the densities of TMI and MIR were identified between the T2DM group and HCs (P<0.05), with a notable difference in TMI density also observed between the GDM and T2DM groups (P<0.01). In the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve (AUC) for TMI in sRCP between the T2DM group and HCs was 0.975, with a 95% confidence interval (CI) of 0.941–1. The AUC for MIR was highest in dRCP, with an AUC value of 0.914 and a 95%CI ranging from 0.847 to 0.981. In comparing the GDM and T2DM groups, the AUC for I region was maximized in sRCP, achieving a value of 0.978 with a 95%CI of 0.953–1. Additionally, the AUC for R region was maximized in dRCP, reaching a value of 0.99 with a 95%CI of 0.975 to 1. CONCLUSION: The sRCP and dRCP densities show higher diagnostic sensitivity for T2DM and GDM. OCTA holds potential as a significant instrument for the early diagnosis and differentiation of T2DM and GDM.

Abstract:AIM: To report the incidence of epiretinal membrane (ERM) formation following panretinal photocoagulation (PRP) as the treatment for diabetic retinopathy (DR). METHODS: Retrospective cross-sectional study of patient charts between January 1st, 2010 to January 1st, 2017 with at least 1y follow-up data. All 809 patients treated with PRP for DR were evaluated for exclusion criteria and 73 eyes remained after exclusion for confounding variables related to ERM formation such as other procedures or diseases. Outcomes were determined through medical record review and masked review of optical coherence tomography (OCT) images. Cohen’s kappa was completed to determine if there was an agreement between masked retinal specialists on OCT evaluations. Univariate logistic regression was used to determine the unadjusted odds ratio for patient and procedural characteristics on the formation of ERMs. Multiple logistic regression was then completed on select variables that met the cutoff of 0.25 for a statistically significant contribution by the Wald test with the sequential addition of clinical variables that contributed positively to the model. RESULTS: Among the 73 eyes studied, 9.6% formed an ERM with an average time to formation of 1.4y. The minimum power uses during PRP was found to be statistically significant between non-ERM formers and ERM formers (P=0.044). When adjusting for all selected variables aside from minimum power used, multiple logistic regression determined that for every 10 mW increase in minimum power used during PRP, there is an increase in log odds of 1.009 (SE: 0.003, P=0.014). CONCLUSION: The incidence of ERM formation in 2y following treatment of DR with PRP is roughly 1 in every 10 eyes treated.

Abstract:AIM: To investigate the impact of renal dysfunction on clinical response to intravitreal conbercept injection (IVC) for diabetic macular edema (DME). METHODS: This retrospective study included a total of 100 eyes from 100 patients with DME treated with IVC with 3+PRN regimen. Based on the estimated glomerular filtration rate (eGFR), the patients were divided into normal renal function group (n=37), impaired renal function group (n=27), and renal insufficiency group (n=36). The main outcome measures were best-corrected visual acuity (BCVA) and central subfield macular thickness (CST). Clinical parameters included blood urea nitrogen, serum creatinine, serum uric acid, glycosylated hemoglobin (HbA1c), and hemoglobin. RESULTS: The mean follow-up time was 3.9mo. The mean number of IVCs was 2.07±1.22 in the three groups. Mean BCVA improved significantly from 0.81±0.49 logMAR at baseline to 0.72±0.52 logMAR in the three groups at the final visit (P<0.001). Mean CST decreased significantly from 427.85±148.99 µm at baseline to 275.31±108.31 µm at final visit (P<0.001). Patients in the normal renal function group had higher baseline hemoglobin levels and thinner baseline CST than those in the impaired renal function and insufficiency renal function group (all P<0.001). Patients in the normal renal function group had higher baseline hemoglobin levels and thinner baseline CST than those in the impaired renal function and insufficiency renal function group (all P<0.001). The three groups had no differences in baseline HbA1c levels (P>0.05). Good baseline BCVA (logMAR, P=0.001) and thicker baseline CST (P=0.041) were associated with visual acuity improvement. Higher eGFR (P<0.001), hemoglobin (P=0.032) and thicker baseline CST (P=0.017) were associated with macular edema retrogression in the conbercept-treated diabetic patients, which showed better anatomical response to IVC. CONCLUSION: Our results indicate that the renal dysfunction is the risk factor associated with the efficacy of IVC for DME.

Abstract:AIM: To compare the Ishihara test errors scores of colour vision deficiency (CVD) subjects when wearing four different types of red-tinted contact lenses (RCL) that differ in their transmittance as determined using a spectrophotometer. METHODS: Six congenital CVD subjects volunteered to participate in this study. Ishihara plates were used to determine the colour vision errors made, whereas Farnsworth-Munsell 100 Hue test was conducted to determine the total error scores (TES) and type of CVD. Four types of RCL (Types A, B, C and D) were inserted in the non-dominant eye and tested in a randomised manner by a masked operator. Errors scores in Ishihara test were determined at baseline without any contact lens and after wearing the four different RCL. The subjects were then divided into two groups based on the mean TES. RESULTS: Repeated measures ANOVA with Greenhouse-Geisser corrections showed that there was a highly significant effect of RCL type on Ishihara error score [F(2.056, 10.282)=30.214, P<0.001]. Error scores with RCL Type B were significantly lower than errors made when no lens was worn, and with RCL Type C and Type D (all P<0.001). Error scores with RCL Type B were also lower than those made with RCL Type A, however, they were not significantly different. For subjects with TES values less than 180, RCL type B showed the largest improvement in Ishihara error score (50%) compared to the other three RCLs. RCL type A showed the best performance in TES value of more than 180, with an improvement of 80% in Ishihara score. RCL Type A has the lowest transmittance at the confusion wavelength (450-568 nm), followed by RCL Types B, D and C. CONCLUSION: This study shows that RCL can improve Ishihara error scores. RCL with lower transmission at 450-568 nm and 90% transmittance beyond 637 nm are the most effective. Lenses which could block more light between 550-580 nm are more effective for colour defectives with more severe colour defects.

Abstract:AIM: To assess the alterations in the resting-state function connections between the two cerebral hemispheres in patients with optic neuritis (ON) and healthy controls (HCs). METHODS: A total of 12 ON patients (six males and six females) and 12 HCs (six males and six females) who were highly matched for sex, age, and educational level were recruited. They underwent functional magnetic resonance imaging (fMRI), testing and brain activities were assessed using the degree centrality (DC) method. Correlation analysis between the mean DC values in specific brain areas and behavior performances was analyzed as well. Linear correlations between A anxiety scale (AS) and depression scale (DS) values and DC values in brain regions of patients with ON were also analyzed. RESULTS: The areas that showed a higher DC value in ON patients were the right angular gyrus and bilateral precuneus, while the left insula and left superior temporal gyrus (LSTG) were regions that presented a lower DC value in ON patients. A receiver operating characteristic (ROC) curve analysis confirmed the accuracy of the area under the curve (AUC) assessment. Linear analysis showed anxiety scale (AS) and depression scale (DS) values in the left insula were both negatively correlated with DC values, while best corrected visual acuity logMAR-R (BCVA logMAR-R) showed a negative correlation with DC in the LSTG. CONCLUSION: The study explores altered brain activities of specific regions in patients with ON. The results provide clues for revealing the underlying mechanism of ON development.

Abstract:AIM: To investigate the etiology of ocular pathogens and to establish the various pathogens present in human immunodeficiency virus (HIV) patients with cytomegalovirus retinitis (CMVR). METHODS: A total of 17 HIV-infected patients with concomitant eye disorders were enrolled. Patients were divided into CMVR group (10 patients, 18 eyes) and non-CMVR group (7 patients, 9 eyes) based on clinical manifestations and the presence of cytomegalovirus (CMV)-DNA in ocular specimens. The viral load of CMV was assessed using polymerase chain reaction in aqueous humor, vitreous fluid, and peripheral blood samples of patients in the CMVR group. Additionally, peripheral blood CD4+ T cell counts were measured in both groups. RESULTS: In the CMVR group, the CMV-DNA load in the vitreous and aqueous humor samples was substantially higher than in the peripheral blood samples (P<0.01). CMV-DNA load in the aqueous humor and vitreous samples of the two eyes in the CMVR group was determined to be statistically significant (10 patients, 16 eyes, P=0.018, 0.012). Peripheral blood CD4+ T cell counts in the CMVR group were adversely linked with the CMV-DNA load in both the aqueous humor and peripheral blood (P=0.005, 0.048). Compared with the non-CMVR group, the peripheral blood CD4+ T cell count in the CMVR group decreased significantly (P=0.014). The peripheral blood CD4+ T cell count exceeded 300 cells/μL in 85.71% of non-CMVR patients, whereas it was below 100 cells/μL in 90.00% of the CMVR group. The intraocular specimens of the patients who underwent CMVR testing did not include any additional infections. CONCLUSION: In HIV-associated CMVR patients, there may exist alternative, yet unidentified, infection pathways for intraocular CMV in addition to the conventional route. The substantial difference in CMV-DNA load between the eyes of most CMVR patients suggests that CMV may originate from different sources in each eye. The proportion of peripheral blood CD4+ T cells in HIV patients is negatively correlated with the quantity of CMV viruses in their eyes. The peripheral blood count of <100 cells/µL indicates a considerable increase in the risk of concurrent CMVR. Multi-ocular pathogen presentations are uncommon in HIV individuals with CMVR.

Abstract:AIM: To investigate changes in local brain activity after laser assisted in situ keratomileusis (LASIK) in myopia patients, and further explore whether post-LASIK (POL) patients and healthy controls (HCs) can be distinguished by differences in dynamic amplitude of low-frequency fluctuations (dALFF) in specific brain regions. METHODS: The resting-state functional magnetic resonance imaging (rs-fMRI) data were collected from 15 myopic patients who underwent LASIK and 15 matched healthy controls. This method was selected to calculate the corresponding dALFF values of each participant, to compare dALFF between the groups and to determine whether dALFF distinguishes reliably between myopic patients after LASIK and HCs using the linear support vector machine (SVM) permutation test (5000 repetitions). RESULTS: dALFF was lower in POL than in HCs at the right precentral gyrus and right insula. Classification accuracy of the SVM was 89.1% (P<0.001). CONCLUSION: The activity of spontaneous neurons in the right precentral gyrus and right insula of myopic patients change significantly after LASIK. SVM can correctly classify POL patients and HCs based on dALFF differences.

Abstract:AIM: To assess the visual outcomes and corneal biomechanical properties of myopia patients between laser in situ keratomileusis (LASIK) and LASIK combined with accelerated corneal crosslinking (LASIK Xtra). METHODS: This prospective study analyzed 52 consecutive myopia patients treated with LASIK Xtra and 45 consecutive myopia patients treated with LASIK. Only the right eyes in the two groups were analyzed. The uncorrected distance visual acuity (UDVA), keratometry values, postoperative central corneal thickness (CCT), corneal demarcation line depth, the corneal compensated intraocular pressure (IOPcc), Goldmann-correlated IOP (IOPg), corneal resistance factor (CRF) and corneal hysteresis (CH) from Ocular Response Analyzer (ORA) were analyzed. Further, the correlation between the demarcation line depth and ORA-related biomechanical parameters were analyzed. RESULTS: No significant differences in UDVA, postoperative CCT, or mean K values were found between the 2 groups at 1 to 12mo postoperative follow-up (all P>0.05). The changes of CRF was significantly lower in the LASIK Xtra group compared to the LASIK group (all P<0.05) at all the postoperative visits. The changes of CH were significantly higher in the LASIK Xtra group (all P<0.05). No significant differences were discovered regarding the changes of IOPcc and IOPg posperatively (all P>0.05). Out of 52 cases in the LASIK Xtra group, the demarcation line was present in 40 eyes (77%). The average depth of the demarcation was 220.73±42.70 μm (136 to 288 μm). No significant correlation was observed between the depth of the demarcation line and any of the ORA-related biomechanical parameters such as IOPcc, IOPg, CRF and CH at 12mo (all P>0.05). CONCLUSION: Both procedures demonstrate comparable outcomes in terms of visual acuity, refraction and ablation predictability. This study confirms that corneal biomechanical properties of the included patients weakened after both procedures, but the cornea after LASIK Xtra are stiffer than conventional LASIK.

Abstract:AIM: To compare the subjective refraction data with auto-refraction findings in high astigmatisms. METHODS: In a cross-sectional study, sampling was done from in different geographic regions in Iran using a multistage random cluster sampling method. All study participants underwent cycloplegic auto-refraction and subjective refraction using the red-green test. RESULTS: In this study, 277 eyes of 158 students aged 8 to 15y were analyzed. According to the results, the mean difference between subjective refraction and autorefraction in measuring sphere, cylinder, spherical equivalent, J0, and J45 was -0.18±0.76, -0.36±0.40, -0.36±0.79, 0.15±0.20, and 0.05±0.21 respectively. The correlation of these two refraction methods in measuring the aforementioned indices was 0.963, 0.898, 0.960, 0.931, and 0.948 respectively. The 95% limits of agreement of the two methods in measuring the above indices were -1.66 to 1.31, -1.14 to 0.42, -1.91 to 1.19, -0.24 to 0.54, and -0.36 to 0.47 respectively. The agreement between the two methods decreased with increasing cylinder power, and the best agreement was found in myopic individuals. CONCLUSION: The measurements obtained by autorefractometer have a significantly higher cylinder average compared to subjective refraction. However, in the cylinder range of 4–5 diopters, the values of J0 and J45 do not have a high correlation.

Abstract:AIM: To evaluate the prevalence and the causes of blindness, severe visual impairment (SVI), and visual impairment (VI) and to investigate the frequency of cataract surgery in people aged ≥50y in Yueqing, Zhejiang Province, China. METHODS: A population-based, cross-sectional study was performed using the Rapid Assessment of Avoidable Blindness technique. Eight-seven clusters, each consisting of 50 people aged ≥50y, were selected by probability-proportionate-to-size sampling. Three outreach teams conducted door-to-door visits. Visual acuity (VA) was measured using a tumbling E chart. Lens status and causes of VI were assessed by ophthalmologists for individuals with a VA of <6/12 in either eye. A standardized questionnaire was used to collect information about cataract surgeries. RESULTS: Of 4350 eligible individuals, 4120 were examined with a 94.7% response rate. Age- and gender-adjusted prevalence of blindness, SVI, and VI were 0.5% (95%CI, 0.3%–0.7%), 0.7% (95%CI, 0.4%–1.0%), and 4.8% (95%CI, 4.2%–5.5%), respectively. Age was associated with an increased prevalence of VI, and the most common cause of VI was untreated cataracts, with the main barriers to cataract surgery being a lack of knowledge or awareness about cataracts. Of the 415 eyes operated on for cataracts, 68 (16.4%) eyes had a poor outcomes (VA<6/60) and 303 (73.0%) had a good outcomes (VA>6/18). CONCLUSION: Prevalence rates of blindness, SVI, and VI in Yueqing are lower than other reported Chinese population-based studies. Cataracts remain the most common cause of blindness and VI.

Abstract:AIM: To investigate the effect of pharmacological pupil alterations on intraocular lens (IOL) power calculations. METHODS: A systematic review and Meta-analysis of studies published before December 2023 in the PubMed, Embase, and Cochrane library databases on the accuracy of pharmacological pupil changes on IOL power calculation was performed. The primary outcome was the results of IOL power calculations before and after the use of medications. Subgroup analyses were performed based on participants’ basic characteristics, such as age, axial length (AL), and whether miosis or mydriasis were used as classification criteria for further analyses. Each eligible study was evaluated for potential risk of bias by the AHRQ assessment scale. The study was registered on PROSPERO (CRD 42024497535). RESULTS: A total of 3062 eyes from 21 studies were eligible. There was no significant difference in the IOL power calculation before and after pharmacological pupil changes using any of the Hoffer Q (WMD=0.055, 95%CI=-0.046–0.156; P=0.29), SRK/T (WMD=0.003, 95%CI=-0.073–0.080; P=0.93), Haigis (WMD=-0.030, 95%CI=-0.176–0.116; P=0.69), Holladay 2 (WMD=-0.042, 95%CI=-0.366–0.282; P=0.80), and Barrett Universal II (WMD=0.033, 95%CI=-0.061–0.127; P=0.49) formulas. On the measurement of parameters related to IOL power calculation, for either miosis or mydriasis AL (P=0.98 and 0.29, respectively), lens thickness (P=0.96 and 0.13, respectively), and mean keratometry (P=0.90 and 0.86, respectively) did not present significant differences, while anterior chamber depth (P=0.07 and <0.01, respectively) and white-to-white distance (P=0.01 and 0.04, respectively) changed significantly between the two measurements prior and posterior. At the same time, despite there being some participants with the difference between the before and after calculations greater than 0.5 diopter, there was no significant difference in the incidence rate between these formulas. CONCLUSION: There is no significant effect of pharmacological pupil changes on the IOL power calculation. It will considerably reduce the visit time burden for patients who require cataract surgery.

Abstract:AIM: To reveal the research hotspots, trends, and future prospects of lacrimal duct obstruction disease (LDOD) from 1900 to 2024 through the bibliometric and visualized analysis, providing a directional guidance for research in this field. METHODS: The Web of Science Core Collection database was used to retrieve relevant literature. Data analysis and visualization were conducted using VOSviewer 1.6.20 and CiteSpace 6.3.1, including annual publication volume, trends, research areas, country/region and institution distribution, journal and co-cited journal analysis, author and co-cited author analysis, keyword and burst keyword analysis, etc. RESULTS: The study included a total of 1481 articles, revealing an overall upward trend in research on LDOD, with ophthalmology being the predominant field. While the United States previously led research efforts, India and China have emerged as key contributors since 2015. Mohammad Javed Ali stands out as the most influential author in this research area. Ophthalmic Plastic and Reconstructive Surgery has published the highest number of related articles, whereas Ophthalmology has the highest co-citation. The current focal points of research include minimally invasive and precise modifications to dacryocystorhinostomy, along with intubation, new materials for stents, and disease pathogenesis. CONCLUSION: LDOD research has garnered widely attention and exhibits a steady upward trend. Since 1900, the United States, China, and India have been the leading contributors to this field. Ophthalmologists continue to be the primary driving force behind LDOD research. The findings of this study suggest that at the forefront of LDOD research, our focus has long been on refining and innovating surgical treatment. The minimally invasive and precise modification of lacrimal surgery, represented by dacryocystorhinostomy, is the ongoing developmental direction of this field. Rapid interdisciplinary integration and in-depth exploration of pathogenesis and allergic inflammation will lead to the emergence of new materials, innovative technologies, and safer clinical treatment protocols.

Abstract:The immune system is involved in many age-related pathological changes, also plays an important role in tissue regeneration after injury. But no immune involvement has been discussed regarding cataract since it is presumed that lens has no source of immune cells as an avascular zone. Latest research has challenged the longstanding view of the lens as an immune-privileged tissue, revealing the presence of resident immune cells and active immune responses within the lens. Thus, we summarized the immune involvement in maintaining lens homeostasis, which may be a deleterious role in the induction of lens opacification if inappropriately activated. Furthermore, bioengineer-based immunomodulatory therapies to fine-tune the micro immune environment within lens may be future strategies for in situ lens regeneration, as a novel treatment for cataract.

Abstract:As a non-invasive surgical procedure ultrasound cyclo-plasty (UCP) has gained attention among ophthalmologists in recent years. Derived from the application of high-intensity focused ultrasound, it has been utilized for the treatment of various types of glaucoma, demonstrating notable efficacy and safety. This review focuses on the efficacy and safety of UCP in treating glaucoma among Asian populations. By summarizing and analyzing existing literature on indications, therapeutic outcomes, and safety profiles, this review further highlights the unique advantages of UCP in glaucoma treatment compared to traditional surgical approaches. These advantages include broader indications, non-invasive nature, quantifiable treatment, excellent intraocular pressure-lowering effects, fewer adverse reactions, and high safety. Additionally, by introducing the underlying mechanism of action, this review explores the factors influencing its therapeutic efficacy, providing theoretical insights for clinical practice and demonstrating UCP’s potential in glaucoma management.

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