Abstract:AIM: To identify early biomarkers associated with glaucomatous visual field (VF) progression in patients with normal-tension glaucoma (NTG). METHODS: This study included patients were divided into two groups based on disease progression status. Tear samples were collected for proteomic analysis. Data-independent acquisition (DIA) mass spectrometry combined with bioinformatic analyses was performed to identify and validate potential protein biomarkers for NTG progression. Additionally, differentially expressed proteins (DEPs) were evaluated using mediating effect models and receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 19 patients (20 eyes) with NTG participated in this study, including 10 patients (4 males and 6 females; 10 eyes) in the progression group with mean age of 67.70±9.03y and 10 patients (4 males and 6 females; 10 eyes) in the non-progression group with mean age of 68.60±7.58y. A total of 158 significantly differentially expressed proteins were detected. UniProt database annotation identified 3 upregulated proteins and 12 downregulated proteins. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that these DEPs were mainly enriched in pathways such as oocyte meiosis. Gene Ontology (GO) enrichment analysis revealed functional clusters related to cellular processes. Weighted gene co-expression network analysis (WGCNA) indicated that the core proteins were primarily involved in the neurodegeneration-multiple diseases pathway and cellular processes. Mediating effect analysis identified PRDX4 (L) as a potential protein biomarker. ROC curve analysis showed that GNAI1 had the largest area under the curve (AUC=0.889). CONCLUSION: This study identifies 15 differentially expressed proteins in the tear fluid of NTG patients, including PRDX4 (L). PRDX4 (L) plays a key role in oxidative stress.

Abstract:AIM: To identify metastasis-associated prognostic genes and construct a robust molecular signature for survival prediction in uveal melanoma (UVM) patients. METHODS: Transcriptomic data and clinical information from 80 UVM patients in the Cancer Genome Atlas (TCGA)-UVM cohort and an external Gene Expression Omnibus (GEO) microarray dataset (GSE73652; 8 non-metastatic vs 5 metastatic cases) were analyzed to identify differentially expressed genes (DEGs). Functional enrichment, protein-protein interaction (PPI) network construction, and survival analyses identified seven metastasis- and prognosis-related genes. Their expression was further examined using public single-cell RNA-seq data (GSE139829; 11 tumors). Experimental validation was performed in UVM cell lines (92.1, OMM1, MEL270) and adult retinal pigment epithelial (ARPE-19) cells using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting to confirm transcriptomic trends. A LASSO Cox model was applied to construct a metastasis-related risk Score signature. Tumor immune microenvironment characteristics were evaluated via single-sample gene set enrichment analysis (ssGSEA) and ESTIMATE. Somatic mutation and copy number variation (CNV) profiles were also examined. RESULTS: Seven key genes (UBE2T, KIF20A, DLGAP5, KLC3, TPX2, UBE2C, AURKA) were significantly associated with overall survival and used to construct a metastasis-related riskScore signature, which effectively stratified patients into high- and low-risk groups and served as an independent prognostic factor. qRT-PCR and Western blot results confirmed that the expression levels of selected key genes in UVM cell lines showed significant differences compared to ARPE-19 cells, which were largely consistent with the transcriptomic findings. The high-risk group exhibited reduced immune infiltration and stromal activity. Single-cell analysis revealed these genes were predominantly expressed in a tumor cell cluster characterized by BAP1 loss and high metastatic potential. Mutation and CNV analyses further supported the relevance of these genes to UVM progression. CONCLUSION: This study establishes and validates a seven-gene signature associated with metastasis and prognosis in UVM. The findings provide a framework for understanding molecular determinants of tumor progression and immune microenvironment alterations, and may offer guidance for future mechanistic studies and therapeutic exploration.

Abstract:AIM: To examine the ocular toxicity linked to sildenafil usage and the possible protective benefits of adenosine triphosphate (ATP) against this toxicity in rats. METHODS: Twenty-four male albino Wistar-type rats were divided into four equal groups (n=6/group) as follows: healthy group (HG), ATP-only group (ATPG), sildenafil-only group (SILG), and ATP+sildenafil group (ATP+SLD). ATPG and ATP+SLD groups were injected intraperitoneally with ATP (4 mg/kg), while SILG and HG groups were injected with saline (0.9% NaCl) by the same route as a solvent. One hour after the administration of ATP and solvent, sildenafil (10 mg/kg) was administered orally to the SILG and ATP+SLD groups. This procedure was repeated once a day for 4wk. The animals were then sacrificed, eyeballs were removed and oxidant and antioxidant parameters were measured biochemically. Additionally, the ocular tissues were evaluated histopathologically. RESULTS: Sildenafil increased oxidant (malondialdehyde) levels and decreased antioxidant levels (total glutathione, superoxide dismutase, catalase) in rat ocular tissues and caused severe oxidative stress. In addition, sildenafil has been shown histopathologically to cause oxidative damage in retinal layers. ATP treatment suppressed oxidative stress and attenuated histopathological damage in the retinal layers. CONCLUSION: ATP protects retinal tissue against sildenafil-induced ocular oxidative damage in rats and may contribute to the development of novel approaches to prevent or treat this damage.

Abstract:AIM: To conduct a genetic analysis of Han-Chinese patients with isolated congenital ptosis (ICP) and identify the genetic variants related to the condition. METHODS: Sixty-five unrelated patients with ICP were enrolled. Comprehensive clinical examinations, whole exome sequencing (WES), and Sanger sequencing were used to reveal the potential genetic causes. Combined with public and in-house control databases, multiple bioinformatics prediction tools, and conservation analysis, the potential variants were further analyzed. AlphaFold 3, an accurate modelling prediction tool, was utilized to generate three-dimensional structural models of both wild-type and mutated proteins. RESULTS: Three novel heterozygous variants in the zinc finger homeobox 4 gene (ZFHX4), c.5145C>A (p.N1715K), c.10382C>T (p.A3461V), and c.10795G>A (p.A3599T), were identified in three patients, respectively. Bioinformatics analyses suggested that these variants are likely to exert deleterious effects, supporting their potential involvement in the pathogenesis of ptosis. CONCLUSION: The novel heterozygous ZFHX4 variants are identified as disease-associated variants in three patients with ptosis, suggesting that ZFHX4 may be a disease-causing gene for autosomal dominant ICP with incomplete penetrance or a susceptibility gene. These findings expand the variant spectrum of ZFHX4, improve understanding of the pathogenesis of ZFHX4-related ptosis, and may contribute to the genetic counseling and disease management, as well as the development of experimental treatments.

Abstract:AIM: To compare the tear film quantity and stability parameters in keratoconus (KCN) and normal eyes using test breakup time (TBUT), noninvasive TBUT (NITBUT), and Schirmer test. METHODS: All participants (n=166), including patients with KCN and age-matched healthy individuals with normal corneas, were recruited from those referred to Farabi Eye Hospital, Iran, in 2023. To better account for genetic and environmental factors, the control group comprised healthy individuals who were relatives of KCN patients and had normal corneal topography. Tear quantity parameters were evaluated in the following order: NITBUT, TBUT, and Schirmer tests. RESULTS: The mean age of cases in KCN (61.7% males) and normal (63.5% males) participants was 27.54±5.44y (range 19 to 38) and 27.52±5.63y (range 20 to 38), respectively (P=0.976). NIBUT, TBUT, and Schirmer’s tests were significantly lower in KCN group compared to normal controls (all P<0.001). The mean difference for NIBUT was -7.81s (P<0.001), and for TBUT was -7.61s (P<0.001). Schirmer test values were also significantly lower in the KCN group, with a mean difference of -5.61 mm compared to normal people (P<0.001). CONCLUSION: Our findings demonstrate significant tear film impairment in KCN. The reductions in NIBUT, TBUT and Schirmer scores highlight an underlying tear film dysfunction in KCN that extends beyond the morphological changes of the cornea.

Abstract:AIM: To evaluate the efficacy and safety of decellularized conjunctival stroma (DCS) as a novel biomaterial by comparing its grafting outcomes with amniotic membrane (AM) when used for conjunctival reconstruction after primary pterygium excision. METHODS: This randomized, parallel-controlled study with allocation concealment enrolled 40 patients with primary pterygium. Participants were randomly assigned to two groups using the sealed envelope method: the DCS group (n=20) and the AM group (n=18), receiving DCS and AM grafts respectively. Slit-lamp photography of the operative eyes was performed preoperatively and at 1, 3, 5, 7, 10, 30, 90, and 180d postoperatively. Best-corrected visual acuity (BCVA) and symptom scores were recorded simultaneously. In vivo confocal microscopy was conducted at 3 and 6mo postoperatively. RESULTS: All participants exhibited improved postoperative symptoms. The mean age was 60±9y (male/female ratio: 6/14) in the DCS group and 56±12y (male/female ratio: 7/11) in the AM group. The average epithelial healing time was 9.89±3.54d in the DCS group and 8.17±1.34d in the AM group (P=0.084). One recurrence case was observed in each group. Postoperative graft hemorrhage was significantly more severe in the DCS group than in the AM group only at 30d postoperatively (P=0.011). In vivo confocal microscopy revealed conjunctival epithelial cell growth in both groups at 90d postoperatively, while clear corneo-conjunctival cell boundaries were observed until 180d postoperatively. CONCLUSION: DCS used in primary pterygium surgery has a safety profile comparable to AM. It promotes rapid postoperative conjunctival healing, achieves a relatively low pterygium recurrence rate, and yields outcomes similar to AM. DCS provides a novel biomaterial option for conjunctival reconstruction after pterygium excision and the treatment of other conjunctival injuries.

Abstract:AIM: To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant (DEX-I) versus anti-vascular endothelial growth factor (VEGF) injections in patients with diabetic macular edema (DME) and visually significant cataract. METHODS: This nonrandomized, retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I (DEX-I group) and 47 eyes receiving anti-VEGF injections (anti-VEGF group). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured preoperatively and postoperatively at 1 and 3mo. RESULTS: The two groups had comparable baseline characteristics, with similar age (DEX-I: 66.83±7.27y; anti-VEGF: 66.81±6.79y) and gender distribution (51.9% vs 59.6% males). Both groups showed significant BCVA improvement at 1 and 3mo, with no significant intergroup differences. CMT reduction was significantly greater in the DEX-I group at 3mo (25.03% vs 14.07%; P=0.049), particularly in recalcitrant eyes (25.09% vs 11.10%; P=0.007). Postoperative intraocular pressure (IOP)>21 mm Hg was observed in 14.8% of DEX-I eyes and 4.25% of anti-VEGF eyes (P=0.08), normalizing by 3mo. DEX-I required no reinjection, while 29.79% of anti-VEGF eyes needed a fourth dose at 3mo. Complications were minimal, with one posterior capsular injury in the DEX-I group. CONCLUSION: Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME, with fewer required treatments. It is an effective strategy for managing cataract with DME, offering benefits, especially for recalcitrant cases. Both therapies have favourable safety profiles, but further long-term studies are needed for clinical guidance.

Abstract:AIM: To evaluate long-term visual field (VF) prediction using K-means clustering in patients with primary open angle glaucoma (POAG). METHODS: Patients who underwent 24-2 VF tests ≥10 were included in this study. Using 52 total deviation values (TDVs) from the first 10 VF tests of the training dataset, VF points were clustered into several regions using the hierarchical ordered partitioning and collapsing hybrid (HOPACH) and K-means clustering. Based on the clustering results, a linear regression analysis was applied to each clustered region of the testing dataset to predict the TDVs of the 10th VF test. Three to nine VF tests were used to predict the 10th VF test, and the prediction errors (root mean square error, RMSE) of each clustering method and pointwise linear regression (PLR) were compared. RESULTS: The training group consisted of 228 patients (mean age, 54.20±14.38y; 123 males and 105 females), and the testing group included 81 patients (mean age, 54.88±15.22y; 43 males and 38 females). All subjects were diagnosed with POAG. Fifty-two VF points were clustered into 11 and nine regions using HOPACH and K-means clustering, respectively. K-means clustering had a lower prediction error than PLR when n=1:3 and 1:4 (both P≤0.003). The prediction errors of K-means clustering were lower than those of HOPACH in all sections (n=1:4 to 1:9; all P≤0.011), except for n=1:3 (P=0.680). PLR outperformed K-means clustering only when n=1:8 and 1:9 (both P≤0.020). CONCLUSION: K-means clustering can predict long-term VF test results more accurately in patients with POAG with limited VF data.

Abstract:AIM: To investigate the etiology and clinical characteristics of hospitalized secondary glaucoma (SG) patients in northwestern China. METHODS: A cross-sectional study was conducted involving SG patients hospitalized between July 2024 and January 2025. Clinical data were collected, including medical history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, gonioscopic findings, and fundus examination. Demographic characteristics, etiological factors, and treatment modalities were analyzed. RESULTS: A total of 67 patients (82 eyes) were enrolled, aged 7 to 90y. Males accounted for 54.0% (36/67), and 22.4% (15/67) of patients had bilateral involvement. The predominant etiologies of SG were neovascular glaucoma (NVG; 25.4%), traumatic glaucoma (23.9%), uveitic glaucoma (20.9%), and lens-induced glaucoma (14.9%), collectively accounting for 85.1% of all cases. The peak age-specific incidence occurred in the 50–59 years age group (32.8%, 22/67), while NVG was prevalent across the 40–79 years age range. IOP of the 82 affected eyes was stratified into five severity tiers: 22–29 mm Hg (15 eyes, 18.3%), 30–39 mm Hg (14 eyes, 17.1%), 40–49 mm Hg (13 eyes, 15.9%), 50–59 mm Hg (20 eyes, 24.4%), and ≥60 mm Hg (20 eyes, 24.4%). The overall mean IOP was 45.2±12.3 mm Hg, indicating a significant pathological elevation. Surgical intervention was required in 46.3% of cases, predominantly for NVG, lens-induced glaucoma, and traumatic glaucoma—conditions prone to rapid IOP elevation. The etiologies with the highest surgical intervention rates were malignant glaucoma, pigmentary glaucoma, lens-induced glaucoma, and NVG. In contrast, uveitic glaucoma cases were primarily managed with targeted anti-inflammatory therapy, which effectively controlled IOP in the early disease stages and potentially obviated the need for surgery. CONCLUSION: This study identifies NVG, traumatic glaucoma, uveitic glaucoma, and lens-induced glaucoma as the four leading etiologies of SG in Northwestern China. These findings emphasize the critical need for targeted prevention strategies and evidence-based health education programs among high-risk populations. Implementation of such initiatives will improve early detection, enable ophthalmologists to deliver timely therapeutic interventions, and ultimately reduce preventable vision loss in this region.

Abstract:AIM: To evaluate the therapeutic effects of ranibizumab on optic disc and macular microvascular perfusion in central retinal vein occlusion (CRVO) with macular edema (ME). METHODS: Optical coherence tomography angiology (OCTA) parameters, including optic disc vessel density (VD; including whole-disc VD, intra-disc VD, and peripapillary VD), superficial/deep capillary plexus (SCP/DCP) VD, and central macular thickness (CMT) were analyzed. Additional assessments included best-corrected visual acuity (BCVA) via Early Treatment Diabetic Retinopathy Study (ETDRS) chart and hemorheological profiling. CRVO patients received monthly intravitreal ranibizumab injections for three consecutive months. Pre- and post-treatment parameters were statistically compared. RESULTS: The study comprised 60 CRVO-ME patients (28 males; 32 females), aged 50–78y (mean 63.3±7.6y) and 60 age-/sex-matched healthy controls. As compared with participants exhibiting normal funduscopic findings, CRVO patients demonstrated significantly elevated levels of low-shear-rate whole blood viscosity (LSR-WBV), high-shear-rate whole blood viscosity (HSR-WBV), and aggregation index (AI, all P<0.05). In CRVO-affected eyes, vertical cup-to-disc (C/D) ratio and optic cup volume were significantly smaller, whereas retinal nerve fiber layer (RNFL) thickness was significantly greater, compared to both unaffected contralateral eyes and normal control eyes (all P<0.05). Following treatment, VD of the entire optic disc (P<0.05), intra-disc VD (P<0.05), and peripapillary VD (P<0.05) all increased significantly relative to baseline. CMT decreased significantly (P<0.05), whereas macular SCP-VD and macular DCP-VD showed non-significant slight reductions (P>0.05). At baseline, BCVA of CRVO eyes correlated with whole-disc VD (r=-0.276, P=0.033), intra-disc VD (r=-0.342, P=0.009), and peripapillary VD (r=-0.335, P=0.007), with intra-disc VD demonstrating the strongest association. Besides, BCVA improvement, after the treatment, correlated positively with whole-disc VD (r=0.342, P=0.008) and intra-disc VD (r=0.396, P=0.002). CONCLUSION: Optic disc blood perfusion is more closely associated with visual acuity than macular perfusion, suggesting intra-disc VD may serve as a potential biomarker for monitoring visual acuity changes in CRVO. Multiple ranibizumab injections significantly improve optic disc perfusion but may have exerted detrimental effects on the macula. CRVO patients shows higher hemorheological parameters than those with normal fundi. Reduced vertical C/D ratio and optic cup volume may be linked to CRVO incidence, potentially acting as susceptibility factors.

Abstract:AIM: To investigate the effects of shortening the duration of silicone oil tamponade on retinal structure and function in patients undergoing silicone oil removal (SOR) after surgery for primary rhegmatogenous retinal detachment (RRD). METHODS: A total of 58 eligible patients were enrolled and randomly assigned to two groups based on tamponade duration: the short-term group (30-45d) and the conventional group (≥90d). Comprehensive evaluations were performed before and after SOR, including slit-lamp examination, best-corrected visual acuity (BCVA) measurement, intraocular pressure (IOP) testing, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), microperimetry, electroretinography (ERG), and visual evoked potential (VEP) assessment. RESULTS: A total of 33 patients (23 males and 10 females; 33 eyes) were enrolled in the short-term SO tamponade group with mean age of 52.45±9.35y, and 25 patients (15 males and 10 females; 25 eyes) were enrolled in the conventional SO tamponade group with mean age of 50.80±12.06y. Compared with the conventional group, the short-term silicone oil tamponade group had a significantly lower incidence of silicone oil emulsification and cataract progression, with no significant difference in retinal reattachment success rate. Structurally, short-term tamponade was associated with increased thickness of the retinal ganglion cell layer (RGCL) in the nasal and superior macular regions and improved recovery of superficial retinal vascular density in these areas. Functionally, the short-term group showed better BCVA and retinal sensitivity both before and 1mo after SOR; additionally, the P100 amplitude in VEP tests was significantly increased in this group. CONCLUSION: Shortening the duration of silicone oil tamponade effectively reduces damage to retinal structure and function without compromising the success rate of retinal reattachment in patients with primary RRD.

Abstract:AIM: To evaluate the efficacy of the total computer vision syndrome questionnaire (CVS-Q) score as a predictive tool for identifying individuals with symptomatic binocular vision anomalies and refractive errors. METHODS: A total of 141 healthy computer users underwent comprehensive clinical visual function assessments, including evaluations of refractive errors, accommodation (amplitude of accommodation, positive relative accommodation, negative relative accommodation, accommodative accuracy, and accommodative facility), and vergence (phoria, positive and negative fusional vergence, near point of convergence, and vergence facility). Total CVS-Q scores were recorded to explore potential associations between symptom scores and the aforementioned clinical visual function parameters. RESULTS: The cohort included 54 males (38.3%) with a mean age of 23.9±0.58y and 87 age-matched females (61.7%) with a mean age of 23.9±0.53y. The multiple regression model was statistically significant [R²=0.60, F=13.28, degrees of freedom (DF=17 122, P<0.001]. This indicates that 60% of the variance in total CVS-Q scores (reflecting reported symptoms) could be explained by four clinical measurements: amplitude of accommodation, positive relative accommodation, exophoria at distance and near, and positive fusional vergence at near. CONCLUSION: The total CVS-Q score is a valid and reliable tool for predicting the presence of various non-strabismic binocular vision anomalies and refractive errors in symptomatic computer users.

Abstract:AIM: To define the prevalence and anatomical patterns of paranasal sinus abnormalities (PSA) in thyroid-associated ophthalmopathy (TAO) and to test the hypothesis that TAO is partially driven by contiguous orbital inflammation rather than systemic autoimmunity or generalized orbital pressure. METHODS: Data included ophthalmic assessments and a panel of thyroid function and autoimmune biomarkers. Blinded radiological analysis of orbital computed tomography (CT) scans was performed to quantify sinus abnormalities and extraocular muscles (EOMs) involvement. Patients were categorized into two groups based on CT findings, those with no radiological evidence of sinus abnormalities (non-PSA control group) and those with identifiable PSA. Furthermore, ethmoid sinus mucosal biopsies from a subset of TAO patients and non-inflammatory controls were subjected to histopathological analysis. RESULTS: Totally 121 TAO patients (mean age 42.4±12.8y, range 10–78y), male:female=42:79, were included. PSA was identified in 44.6% (n=54) of patients, with a distribution anatomically restricted to the maxillary (50.0% isolated) and ethmoid sinuses (18.5% isolated; 29.6% combined). Compared to the non-PSA group (n=67), patients with PSA were significantly older (45.1±11.8 vs 40.3±13.2y; P=0.040) and were more likely to be male (55.6% vs 17.9%; P<0.001). They also had significantly higher proptosis (22.1±3.2 vs 20.7±2.9 mm; P<0.001). Medial/inferior rectus involvement was most frequent (88.4% vs 89.3%). Histopathological analysis of sinus mucosa from PSA patients provided direct evidence of pathology, revealing a dense, chronic lymphoplasmacytic infiltrate and submucosal edema, validating the radiological findings as a true inflammatory process. No significant correlation was found with systemic autoimmune markers, including thyroid-stimulating hormone (TSH) receptor antibodies (TRAb, median 4.86 vs 2.71 IU/L, P=0.104). CONCLUSION: TAO is associated with a high prevalence of PSA in a pattern consistent with the orbital anatomy. The correlation with ipsilateral muscle thickening combined with the lack of association with proptosis laterality or systemic biomarkers lend strong support to a model of contiguous inflammation over systemic autoimmunity, a hypothesis that warrants further validation through longitudinal and mechanistic studies.

Abstract:AIM: To investigate the clinical features and prognosis of patients with orbital inflammatory myofibroblastic tumor (IMT). METHODS: This retrospective study collected clinical data from 22 patients diagnosed with orbital IMT based on histopathological examination. The patients were followed up to assess their prognosis. Clinical data from patients, including age, gender, course of disease, past medical history, primary symptoms, ophthalmologic examination findings, general condition, as well as imaging, laboratory, histopathological, and immunohistochemical results from digital records were collected. Orbital magnetic resonance imaging (MRI) and(or) computed tomography (CT) scans were performed to assess bone destruction of the mass, invasion of surrounding tissues, and any inflammatory changes in periorbital areas. RESULTS: The mean age of patients with orbital IMT was 28.24±3.30y, with a male-to-female ratio of 1.2:1. Main clinical manifestations were proptosis, blurred vision, palpable mass, and pain. Bone destruction and surrounding tissue invasion occurred in 72.73% and 54.55% of cases, respectively. Inflammatory changes in the periorbital site were observed in 77.27% of the patients. Hematoxylin and eosin staining showed proliferation of fibroblasts and myofibroblasts, accompanied by infiltration of lymphocytes and plasma cells. Immunohistochemical staining revealed that smooth muscle actin (SMA) and vimentin were ‌positive in 100%‌ of cases, ‌while‌ anaplastic lymphoma kinase (ALK) showed ‌positivity in 47.37%‌. The recurrence rate of orbital IMT was 27.27%, and sarcomatous degeneration could occur. There were no significant correlations between recurrence and factors such as age, gender, laterality, duration of the disease, periorbital tissue invasion, bone destruction, periorbital inflammation, tumor size, fever, leukocytosis, or treatment (P>0.05). However, lymphadenopathy and a Ki-67 index of 10% or higher may be risk factors for recurrence (P=0.046; P=0.023). CONCLUSION: Orbital IMT is a locally invasive disease that may recur or lead to sarcomatoid degeneration, primarily affecting young and middle-aged patients. The presence of lymphadenopathy and a Ki-67 index of 10% or higher may signify a poor prognosis.

Abstract:AIM: To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies. METHODS: A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W. Kenya, amongst a semi-nomadic tribe (Maasai). Students in Grades 1-8 were included. Visual acuity was measured using the Snellen “tumbling E” chart at 6 m. Children with symptoms of refractive error underwent non-cycloplegic refraction. RESULTS: A total of 2036 children (1084 males) between the ages of 4-20y were examined. Conjunctival actinic changes were present in 22% (442/2036). Nine cases were seen with a potential squamous carcinoma. No overt classical ocular signs of vitamin A deficiency were noted, although 181 (8.9%) children complained of nyctalopia. Three hundred thirty-six (16.5%) children had a visual acuity worse than 6/12 in either eye, were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error. Refractive data led to an estimate of hyperopia of +1.00 D or more in 3.9% and of myopia of -0.50 D or more in either eye in 3.0% of the study population. CONCLUSION: Solar exposure- and dust-related conjunctival pathology is common. As this may develop into potentially sight- or even life-threatening conditions, it warrants further study, and preventive strategies may be needed. Complaints of nyctalopia were common and could suggest vitamin A deficiency. The prevalence of refractive errors is low in this rural African population.

Abstract:AIM: To investigate the association between functional outcomes and postoperative patient satisfaction 5y after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: This is a cross-sectional study. The patients underwent basic ophthalmic examinations, axial length measurement, wide-field fundus photography, and accommodation function testing. Behavioral habits data were collected using a self-administered questionnaire, and visual symptoms were assessed with the Quality of Vision (QoV) questionnaire. Postoperative satisfaction was also recorded. RESULTS: Totally 410 subjects [820 eyes, 160 males (39.02%) and 250 females (60.98%)] who had undergone SMILE or FS-LASIK 5y ago were enrolled. The mean (standard deviation, SD) age of all patients was 29.83y (6.69). The mean (SD) preoperative manifest SE was -5.80 (2.04) diopters (D; range: -0.88 to -13.75). Patient satisfaction at 5y after undergoing SMILE or FS-LASIK was 91.70%. Patients were categorized into two groups: dissatisfied group and satisfied group. Significant differences were observed between the two groups in terms of age (P=0.012), sex (P=0.021), preoperative degree of myopia (P=0.049), postoperative visual symptoms (frequency, P=0.043; severity, P<0.001; bothersome, P=0.018), difficulty driving at night (P=0.001), and accommodative amplitude (AMP, P=0.020). Multivariate analysis confirmed that female sex (P=0.024), severity of visual symptoms (P=0.009), and difficulty driving at night (P=0.006) were significantly associated with lower satisfaction. The dissatisfied group showed higher rates of starbursts, double or multiple images, and high myopia, but lower age. The frequency, severity, and bothersome of distortion exhibited decreased with increasing age. CONCLUSION: Patient satisfaction 5y after SMILE and FS-LASIK is high and stable. Difficulty driving at night, sex, and severity of visual symptoms are important factors influencing patient satisfaction. Special attention should be paid to younger highly myopic female patients, particularly those with starbursts and double or multiple images. It is crucial to monitor postoperative visual outcomes and provide patients with comprehensive preoperative counseling to enhance long-term satisfaction.

Abstract:AIM: To comprehensively assess the relationship between asthma and myopia based on the National Health and Nutrition Examination Survey (NHANES) database combined with Mendelian randomization (MR). METHODS: Initially, 20 497 subjects from the complete questionnaire cycle in the NHANES database from 2005 to 2008 were included. By exclusion criteria, 8460 subjects were screened with 1676 myopia samples and 6784 control samples. Subsequently, baseline characteristics, association analyses, risk stratification analyses, and receive operating characteristic curve (ROC) were used to investigate the associations between covariates and myopia. Then, the causal relationship was explored in depth by MR analysis, and was estimated the reliability by sensitivity analyses and directionality tests. RESULTS: Baseline characteristics illustrated a significant difference between myopia and controls for both asthma and covariates (excluding gender; P<0.05). The results in all three models indicated that asthma was strongly associated with myopia and the effect on myopia was not significantly confounded by other covariates [model 3: odd ratio (OR)=1.31; 95%CI=1.07-1.62; P=0.0133]. The risk stratification analysis again verified that asthma remained strongly associated with myopia and was a risk factor for myopia (P<0.05, OR>1). ROC proved that the model was accurate in its prediction [area under curve (AUC)=0.7]. Subsequently, the causal relationship between them was statistically significant (P<0.05) according to the inverse variance weighted (IVW) method in MR. Scatterplot showed that asthma and myopia had significant positive causality and were not affected by confounders. Forest plot displayed an increasing risk of myopia on asthma (OR>1). The funnel plot demonstrated compliance with Mendel’s second law. Sensitivity analysis and directional analysis further confirmed the confidence of the MR analysis results and a unidirectional causal relationship between them. CONCLUSION: A significant association and causality between asthma and myopia is found through the NHANES database and MR analysis, which is important implications for public health policy development and clinical practice.

Abstract:AIM: To explore the causal relationship between several possible behavioral factors and high myopia (HM) using multivariable Mendelian randomization (MVMR) approach and to find the mediators among them with mediation analysis. METHODS: The causal effects of several behavioral factors, including screen time, education time, time spent outdoors, and physical activity, on the risk of HM using univariable Mendelian randomization (MR) and MVMR analyses were first assessed. Genome-wide association study summary statistics of serum metabolites were also used in mediation analysis to determine the extent to which serum metabolites mediate the effects of behavioral factors on HM. RESULTS: MR analyses indicated that both increased time spent outdoors and a higher frequency of moderate physical activity significantly reduced the risk of HM. Further MVMR analysis confirmed that moderate physical activity independently contributed to a lower risk of HM. Additionally, MR analyses identified 13 serum metabolites significantly associated with HM, of which 12 were lipids and one was an amino acid derivative. Mediation analysis revealed that six lipid metabolites mediated the protective effects of moderate physical activity on HM, with the highest mediation proportion observed for 1-(1-enyl-palmitoyl)-GPC (p-16:0; 30.83%). CONCLUSION: This study suggests that in addition to outdoor time, moderate physical activity habits may have an independent protective effect against HM and pointed to lipid metabolites as priority targets for the prevention due to low physical activity. These results emphasize the importance of physical activity and metabolic health in HM and underscore the need for further study of these complex associations.

Abstract:AIM: To summarize publication trends in the field of strabismus over the past 30y and predict future research hotspots. METHODS: A total of 2915 English-language articles and reviews on strabismus, published between 1993 and 2022, were retrieved from the Web of Science Core Collection. Bibliometric analyses were performed using VOSviewer and CiteSpace software to explore publication trends, as well as the contributions and collaborative networks of countries/regions, authors, institutions, and journals. RESULTS: The annual number of publications on strabismus showed a consistent upward trend. The United States (USA) maintained a leading position in this research field while Republic of Korea and China emerged as rapidly advancing contributors over the last decade. The University of California, Los Angeles ranked as the most productive institution, and Jonathan M. Holmes from USA was the most productive author. Journal of AAPOS was the leading journal with the most strabismus publications, whereas the two most highly cited articles were both published in Ophthalmology. Co-occurrence analysis identified pivotal keywords and burst terms, including intermittent exotropia (IXT), acute acquired comitant esotropia (AACE), functional magnetic resonance imaging (fMRI), and surgical treatment, which were confirmed as predominant and frontier topics. CONCLUSION: This study provides a comprehensive bibliometric analysis of strabismus research, revealing the evolution of research hotspots over the past 30y and outlining several cutting-edge directions for future investigation.

Abstract:Overt and harmful diabetes mellitus (DM) has detrimental effects on individuals and, by extension, the community. Among the microvascular DM complications is diabetic retinopathy (DR). DR may cause irreversible vision deterioration in cases of poor blood glucose regulation. Changes in vascular permeability are key trigger points for diabetic macular edema (DME), a condition characterized by the accumulation of fluid in the macula. The development of vascular endothelial growth factor (VEGF) pathway inhibitors has provided a pathogenesis-based treatment approach for DME. Optical coherence tomography (OCT) provides high-resolution imaging of the anatomy, including the aging of DME and its structural damage, in distinct morphologic subtypes of macular edema, thereby supporting the assessment of macular edema treatment. The availability of repeated OCT monitoring provides clinical reassurance through the treatment. OCT angiography (OCTA) provides retinal blood flow maps with high spatial resolution. The ability promotes an understanding of disease pathogenesis and facilitates the implementation of new therapeutic methods. This review compares the potential of OCT and OCTA in the diagnosis and treatment of DME, as well as their respective therapeutic applications.

Abstract:Rhegmatogenous retinal detachment (RRD) is a serious ocular condition marked by the separation of the neuroretina from the retinal pigment epithelium (RPE). The pathogenesis of RRD involves intricate molecular and cellular mechanisms, including inflammation, cell migration, and the activation of proliferative signaling pathways. One of the most challenging complications of RRD is proliferative vitreoretinopathy (PVR), which refers to the proliferation and contraction of fibrocellular membranes on the retinal surface and in the vitreous cavity. PVR is a major cause of surgical failure in RRD, as it can lead to recurrent retinal detachment and severe vision loss. However, the pathogenesis of PVR is not yet fully understood, and the treatment options are quite limited. Recent advances in analytical techniques have offered valuable insights into the molecular alterations present in the subretinal fluid (SRF) of patients with RRD. This review seeks to consolidate the current knowledge regarding the SRF profile in RRD and PVR, emphasizing potential biomarkers and therapeutic targets.

Abstract:AIM: To describe the technique and the outcomes of manual Bowman layer and stroma transplant-onlay (BLST-o) for 2 cases of radial keratotomy (RK). METHODS: Two patients with visual fluctuations and corneal irregularity due to RK were offered manual BLST-o as an alternative to penetrating keratoplasty (PKP). Visual acuity, refraction, corneal topography, corneal aberrometry, and corneal optical coherence tomography (OCT) pre- and postoperative were analyzed. Histology was obtained for 1 case. RESULTS: Both patients had corneal anatomical and morphological improvement, with elimination of the visual fluctuations. In one case, a subsequent excimer laser treatment improved corneal shape further, thus improving vision. The other case, whereas initially improved, developed epithelial ingrowth following suture removal. The latter was explanted and had a xenogeneic implant. The explanted sample was sent for histology, showing a viable graft of Bowman layer and anterior stroma. CONCLUSION: Manual BLST-o is a potential option for the management of symptoms post RK. These grafts may facilitate subsequent treatments such as laser corrections, and may not preclude from other interventions after explantation.

Abstract:AIM: To report and analyze cases of sterile intraocular inflammation (IOI) following intravitreal faricimab injections in patients treated for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). METHODS: This double-center case series included nine eyes of six patients who developed uveitis after faricimab therapy. Comprehensive clinical evaluation was performed, including slit-lamp examination, intraocular pressure (IOP) measurement, fluorescein and indocyanine green angiography (ICGA), and laboratory tests. Inflammatory responses were treated with topical or systemic corticosteroids, and patients were monitored for visual acuity and inflammatory activity. RESULTS: The incidence of IOI was 0.8% per patient (Innsbruck) and 0.23% (Czechia), with inflammation typically occurring between the third and sixth injection (mean interval: 10d post-injection). Inflammatory presentations ranged from anterior uveitis to posterior segment involvement. One notable case demonstrated novel choroidal hypofluorescent lesions on angiography, suggesting deeper ocular involvement. The mean patient age was 76y; five of six affected patients were female. All cases responded to local and systemic corticosteroids, with full recovery of initial visual acuity. CONCLUSION: Sterile IOI after faricimab appears to be a rare but relevant adverse event. Although the incidence falls within expected ranges for anti-vascular endothelial growth factor (anti-VEGF) agents, the observed choroidal involvement represents a potentially new safety signal. Prompt diagnosis and corticosteroid therapy are effective in all cases. Our findings support the need for vigilant post-marketing surveillance and further studies to better understand the underlying mechanisms and risk factors of faricimab-associated inflammation.

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