International Journal of Ophthalmology-IJO is a global ophthalmological scientific publication and a peer-reviewed open access periodical (ISSN 2222-3959 print, ISSN 2227-4898 online). This journal is sponsored by Chinese Medical Association Xi’an Branch and published by the IJO Press. It has been indexed in SCIE, PubMed, PMC, CA, IC, Scopus, EMBASE and DOAJ, and was selected for China's Science and Technology Journal International Influence Enhancement Plan (D-class projects). IJO’s JCR IF in 2024 is 1.8 (Q3), Five-year Impact Factor is 1.8, CiteScore in 2024 is 2.8. IJO was established in 2008, with editorial office in Xi’an, China. It is a monthly publication and accept contributions from all over the world, both basic and clinical research.
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Le-Wei Tang, Hui-Yan Mao, Mei-Min Lin, Si Zhu, Qiang-Jie Huang, De-Fu Chen, Wei-He Zhou, Yuan-Bo Liang
2026(1):1-10 ,DOI: 10.18240/ijo.2026.01.01
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.
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Yi-Ming Guo, Zhan-Pei Bai, Jia-Qi Wang, Juan Huang, Jun-Han Wei, Yi-Jin Han, Yang Liu, Lu Ye
2026(1):11-24 ,DOI: 10.18240/ijo.2026.01.02
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.
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Ibrahim Cicek, Busra Caliskan, Bulent Yavuzer, Durdu Altuner, Tugba Bal Tastan, Taha Abdulkadir Coban, Ezgi Karatas, Halis Suleyman
2026(1):25-33 ,DOI: 10.18240/ijo.2026.01.03
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.
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Qian-Ling Zhang, La-Mei Yuan, Xin-Yue Deng, Wen Zheng, Jun-Hui Yi, Hong-Bo Xu, Hao Deng
2026(1):34-41 ,DOI: 10.18240/ijo.2026.01.04
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.
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Foroozan Narooie-Noori, Masoud Khorrami-Nejad, Nabaa Ayad, Hesam Hashemian
2026(1):42-47 ,DOI: 10.18240/ijo.2026.01.05
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.
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Shang Li, Jing-Yi Wang, Shi-Jing Deng, Xiao-Dan Hu, Fei Luo, Ying Jie
2026(1):48-55 ,DOI: 10.18240/ijo.2026.01.06
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.
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Aditya Kelkar, Jai Kelkar, Subhasree Dutta, Mounika Bolisetty, Harsh Jain, Nikhil Labhsetwar
2026(1):56-62 ,DOI: 10.18240/ijo.2026.01.07
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.
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Junyoung Lee, Jihun Kim, Hwayoung Kim, Sangwoo Moon, EunAh Kim, Sanghun Jeong, Hojin Yang, Jiwoong Lee
2026(1):63-68 ,DOI: 10.18240/ijo.2026.01.08
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.
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Ying Liu, Jie Yang, Rui-Xue Zhang, Yao Lu, Wei Sang, Jin-Wei Xi, Jun Jia, Dan-Ping Guo, Yuan He
2026(1):69-76 ,DOI: 10.18240/ijo.2026.01.09
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.
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Xuan Li, Xiao-Feng Hao, Li-Ke Xie, Jin-Hua Luo, Meng-Jiao Zhang
2026(1):77-82 ,DOI: 10.18240/ijo.2026.01.10
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.
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Zi-Ye Chen, Yu-Qing Wu, Bao-Yi Liu, Yuan Ma, Zhuang-Ling Lin, Run-Ping Duan, Lan Jiang, Chinling Tsai, Zhuo-Jun Xu, Tao Li
2026(1):83-89 ,DOI: 10.18240/ijo.2026.01.11
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.
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Mosaad Alhassan, Tasneem Samman, Hatoun Badukhen, Muhamad Alrashed, Balsam Alabdulkader, Essam Almutleb, Tahani Alqahtani, Ali Almustanyir
2026(1):90-96 ,DOI: 10.18240/ijo.2026.01.12
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.
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Xin-Xin Hao, Yang-Xu Tao, Xiang Xu, Ming-Ming Liu, Yang Li
2026(1):97-104 ,DOI: 10.18240/ijo.2026.01.13
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.
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Jing Li, Liang-Yuan Xu, Nan Wang, Rui Liu, Shan-Feng Zhao, Ting-Ting Ren, Qi-Han Guo, Bin Zhang, Hong Zhang, Hai-Han Yan, Yu-Fei Zhang, Jian-Min Ma
2026(1):105-114 ,DOI: 10.18240/ijo.2026.01.14
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.
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Marlene E. Long, Lily A. Nyamai, Marina Marinkovic, Nanda Horeweg, Brian W. Fleck, Martine J. Jager
2026(1):115-122 ,DOI: 10.18240/ijo.2026.01.15
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.
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Ran Gao, Yu Han, Jie Qin, Yu-Shan Xu, Yu Li, Xiao-Tong Lyu, Feng-Ju Zhang
2026(1):123-131 ,DOI: 10.18240/ijo.2026.01.16
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.
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Ya-Jing Zheng, Ji-Fa Kuang, Fei-Lan Chen, Wen-Bin Huang
2026(1):132-139 ,DOI: 10.18240/ijo.2026.01.17
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.
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Nian-En Liu, Xiao-Tong Xu, Xiao-Bing Yu
2026(1):140-148 ,DOI: 10.18240/ijo.2026.01.18
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.
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Yi-Han Zhang, Ying Guo, Shu-Jie Zhang, Chen Zhao
2026(1):149-159 ,DOI: 10.18240/ijo.2026.01.19
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.
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Parisa Alsadat Dadkhah, Hamed Taheri, Masoud Noroozi, Asma Rasouli, Zahra Sheikh, Saba Imanparvar, Saeed Zivari Lashkajani, Nahid Samadi, Javad Nadem, Behzadmehr Amirian, Goharsharieh Alishiri, Ata Akhtari Kohnehshahri, Arshia Shafiei, Amirreza Heydarlou, Reza Khademi, Anahita Rahmati, Niloofar Deravi
2026(1):160-174 ,DOI: 10.18240/ijo.2026.01.20
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.
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2026(1):175-180 ,DOI: 10.18240/ijo.2026.01.21
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.
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Abdo Karim Tourkmani, Jorge L. Alio del Barrio, Hao Zhang, Jorge L. Alio
2026(1):181-184 ,DOI: 10.18240/ijo.2026.01.22
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.
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Roman Lischke, Sarah-Maria Krause, Teresa Rauchegger, Gertrud Haas, Michal Koubek, Yvonne Nowosielski, Matus Rehak
2026(1):185-192 ,DOI: 10.18240/ijo.2026.01.23
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.
Volume ,2026 Issue 1
Basic Research
Clinical Research
Investigation
Mendelian Randomization
Bibliometric Research
Review Article
Brief Report
Letter to the Editor
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Algorithm of automatic identification of diabetic retinopathy foci based on ultra-widefield scanning laser ophthalmoscopy
Jie Wang, Su-Zhen Wang, Xiao-Lin Qin, Meng Chen, Heng-Ming Zhang, Xin Liu, Meng-Jun Xiang, Jian-Bin Hu, Hai-Yu Huang, Chang-Jun Lan
Abstract:
● AIM: To propose an algorithm for automatic detection of diabetic retinopathy (DR) lesions based on ultra-widefield scanning laser ophthalmoscopy (SLO). ● METHODS: The algorithm utilized the FasterRCNN (Faster Regions with CNN features)+ResNet50 (Residua Network 50)+FPN (Feature Pyramid Networks) method for detecting hemorrhagic spots, cotton wool spots, exudates, and microaneurysms in DR ultra-widefield SLO. Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate. Feature fusion was carried out by the feature pyramid network FPN, which significantly improved lesion detection rates in SLO fundus images. ● RESULTS: By analyzing 1076 ultra-widefield SLO images provided by our hospital, with a resolution of 2600×2048 dpi, the accuracy rates for hemorrhagic spots, cotton wool spots, exudates, and microaneurysms were found to be 87.23%, 83.57%, 86.75%, and 54.94%, respectively. ● CONCLUSION: The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO, providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.
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Abstract:
AIM: To explore the correlation between several blood cell-associated inflammatory indices including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and the presence and severity of diabetic retinopathy (DR). METHODS: We searched for eligible studies from PubMed, EMBASE, Web of Science and CNKI up to December 13, 2017. Standardized mean difference (SMD) calculated with confidence interval (CI) of 95% was used to estimate the values of those indices. RESULTS: A total of 31 studies were included in the present Meta-analysis. As compared with type 2 diabetes mellitus (T2DM) patients without DR, the values of MPV, PDW, NLR, and PLR were higher in patients with DR (SMD=0.67; 95%CI: 0.36 to 0.98; SMD=0.51; 95%CI: 0.27 to 0.75; SMD=0.77; 95%CI: 0.49 to 1.05 and SMD=1.18; 95%CI: 0.07 to 2.28). Additionally, it was also observed that MPV was closely correlated with the severity of DR. CONCLUSION: MPV, PDW, NLR, and PLR could be recommended as diagnostic biomarkers for DR, and MPV could be applied to assess the severity of DR.
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Arshad Ali Lodhi, Sameen Afzal Junejo, Mahtab Alam Khanzada, Imran Akram Sahaf, Zahid Kamal Siddique
Abstract:
AIM: To evaluate the surgical outcome of congenital upper eyelid coloboma repair. · METHODS: All patients underwent complete ophthalmic and general examination before going to surgery, and then examination under anesthesia was performed to assess the site and size of eyelid defect, conjunctival involvement. The status of cornea and ocular motility with forced duction test was also being noted. The surgical procedure was performed according to the size of defect. · RESULTS: Out of 21 cases of congenital upper eyelid coloboma, 18 occurred in isolation with upper eyelid medial defect, 13 were bilateral and 5 were unilateral. Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects. All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age. Cosmetically surgical results were acceptable, except one that was already presented with opaque corneal. · CONCLUSION: In this study, overall surgical results were satisfactory except one that was presented late with compromised cornea.
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Veronica E. Giordano, Sergio E. Hernandez-Da Mota, Tania N. Adabache-Guel, Armando Castillejos-Chevez, Sonia Corredor-Casas, Samantha M. Salinas-Longoria, Rafael Romero-Vera, Juan M. Jimenez-Sierra, Jose L. Guerrero-Naranjo, Virgilio Morales-Canton
Abstract:
AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.
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Anteneh Amsalu, Kindie Desta, Demiss Nigussie, Demoze Delelegne
Abstract:
AIM: To assess the pattern of ocular manifestation and associated factors among human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART) at Hawassa University Referral Hospital, Southern Ethiopia. METHODS: A cross sectional study was conducted from January 2014 to April 2015. After obtaining informed written consent, 240 adult HIV/AIDS patients on HAART were randomly selected regardless of their ophthalmic symptoms, WHO status or CD4 count. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 20.0 software. RESULTS: The mean duration of HAART was 62.5mo. The prevalence of HIV related ocular manifestation was 14.2%. Seborrheic blepharitis (5%) was the most common ocular manifestation, followed by squamoid conjunctival growth (3.8%). The rate of ocular manifestation was significantly higher among study participants who had CD4+ count <200 cells/μL (AOR=3.83; 95%CI: 1.315-11.153), low duration of HAART (AOR=3.0; 95%CI: 1.305-6.891) and who had primary school education [odds ratio (OR) =2.8; 95%CI: 1.105-7.099]. Prevalence of visual impairment and blindness was 10.9% and 5.8%, respectively. CONCLUSION: HAART may be the reason for the decline in the prevalence of ocular manifestation in HIV/AIDS patients in the study area. Ophthalmologic screening of HIV/AIDS patients, especially those with CD4 counts of <200/μL cells and in the first five years of HAART follow-up is recommended to reduce visual impairment and/or blindness.
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Zhi-Chun Zhao, Ying Zhou, Gang Tan, Juan Li
Abstract:
In recent years, people have become increasingly attentive to light pollution influences on their eyes. In the visible spectrum, short-wave blue light with wavelength between 415 nm and 455 nm is closely related to eye light damage. This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality. Therefore, the effect of Blu-rays on ocular is becoming an important concern for the future. We describe blue light’s effects on eye tissues, summarize the research on eye injury and its physical prevention and medical treatment.
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Ji Jin, Lei Chen, Gao-Qin Liu, Pei-Rong Lu
Abstract:
AIM: To analyze the retinal proteomes with and without conbercept treatments in mice with oxygen-induced retinopathy (OIR) and identify proteins involved in the molecular mechanisms mediated by conbercept. METHODS: OIR was induced in fifty-six C57BL/6J mouse pups and randomly divided into four groups. Group 1: Normal17 (n=7), mice without OIR and treated with normal air. Group 2: OIR12/EXP1 (n=14), mice received 75% oxygen from postnatal day (P) 7 to 12. Group 3: OIR17/Control (n=14), mice received 75% oxygen from P7 to P12 and then normal air to P17. Group 4: Lang17/EXP2 (n=21), mice received 75% oxygen from P7 to P12 with intravitreal injection of 1 μL conbercept at the concentration of 10 mg/mL at P12, and then normal air from P12 to P17. Liquid Chromatography-Mass Spectrometry (LC-MS)/MS data were reviewed to find proteins that were up-regulated after the conbercept treatment. Gene ontology (GO) analysis was performed of conbercept-mediated changes in proteins involved in single-organism processes, biological regulation, cellular processes, immune responses, metabolic processes, locomotion and multiple-organism processes. RESULTS: Conbercept induced a reversal of hypoxia-inducible factor 1 signaling pathway as revealed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and also induced down-regulation of proteins involved in blood coagulation and fibrin clot formation as demonstrated by the Database for Annotation, Visualization and Integrated Discovery (DAVID) and the stimulation of interferon genes studies. These appear to be risk factors of retinal fibrosis. Additional conbercept-specific fibrosis risk factors were also identified and may serve as therapeutic targets for fibrosis. CONCLUSION: Our studies reveal that many novel proteins are differentially regulated by conbercept. The new insights may warrant a valuable resource for conbercept treatment.
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Xi-Teng Chen, Hui Huang, Yan-Hua Chen, Li-Jie Dong, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM:To identify the genetic defects in a Chinese family with achromatopsia.METHODS:A 2.5-year-old boy, who displayed nystagmus, photophobia, and hyperopia since early infancy, was clinically evaluated. To further confirm and localize the causative mutations in this family, targeted region capture and next-generation sequencing of candidate genes, such as CNGA3, CNGB3, GNAT2, PDE6C, and PDE6H were performed using a custom-made capture array.RESULTS:Slit-lamp examination showed no specific findings in the anterior segments. The optic discs and maculae were normal on fundoscopy. The unaffected family members reported no ocular complaints. Clinical signs and symptoms were consistent with a clinical impression of autosomal recessive achromatopsia. The results of sequence analysis revealed two novel missense mutations in CNGA3, c.633T>A (p.D211E) and c.1006G>T (p.V336F), with an autosomal recessive mode of inheritance.CONCLUSION: Genetic analysis of a Chinese family confirmed the clinical diagnosis of achromatopsia. Two novel mutations were identified in CNGA3, which extended the mutation spectrum of this disorder.
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Abstract:
Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today’s world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician’s responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of optical coherence tomography, frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.
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Ping-Ting Zhao, Ling-Jun Zhang, Hui Shao, Ling-Ling Bai, Bo Yu, Chang Su, Li-Jie Dong, Xun Liu, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM: To test the therapeutic effects of delayed treatment of mesenchymal stem cells (MSCs) in recurrent experimental autoimmune uveitis (rEAU). METHODS: The efficacy of different regimens of MSC administration in rEAU were tested by evaluation of clinical and pathological intraocular inflammation, as well as retinal structural and functional integrity using optical coherence tomography (OCT) and electroretinogram (ERG). The retinal sections were also immunostained with antibodies to glial fibrillary acidic protein (GFAP) and rhodopsin (RHO). RESULTS: Delayed treatment of MSCs effectively alleviated the severity of intraocular inflammation with relative intact of outer retinal structure and function. Moreover, double therapies with longer interval led to an even better clinical evaluation, as well as a trend of decrease in relapse and amelioration of retinal function. MSC therapies also effectively reduced GFAP expression and increased RHO expression in the retina. CONCLUSION: MSC administration can effectively treat developed diseases of rEAU, and multiple therapies can provide additional therapeutic benefits.
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Li-Fei Yuan, Guang-Da Li, Xin-Jun Ren, Hong Nian, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM:To determine the effects of rapamycin on experimental autoimmune uveoretinitis (EAU) and investigate of role of rapamycin on T cell subsets in the disease. METHODS:EAU was induced in rats using peptides 1169 to 1191 of the interphotoreceptor binding protein (IRBP). Rapamycin (0.2 mg/kg/d) was administrated by intraperitoneal injection for a consecutive 7d after immunization. Th1/Th2/Th17 cytokines, TGF-β1, and IL-6 produced by lymphocyteswere measured by ELISA, while Th17 cells and CD4+CD25+ regulatory T cells (Tregs) from rat spleen were detected by flow cytometry. RESULTS: Intraperitoneal treatment immediately after immunization dramatically ameliorated the clinical course of EAU. Clinical responses were associated with reduced retinal inflammatory cell infiltration and tissue destruction. Rapamycin induced suppression of Th1/Th2/Th17 cytokines, including IFN-γ, IL-2, IL-17, IL-4, and IL-10 release from T lymphocytes of EAU rats, in vitro. Rapamycin also significantly increased TGF-β1 production but had no effect on IL-6 productionof T lymphocytes from EAU rats in vitro. Furthermore, rapamycin decreased the ratio of Th17 cells/CD4+T cells and upregulated Tregs in EAU, as detected by flow cytometry. CONCLUSION: Rapamycin effectively interferes with T cell mediated autoimmune uveitis by inhibiting antigen-specific T cell functions and enhancing Tregs in EAU. Rapamycin is a promising new alternative as an adjunct corticosteroid-sparing agent for treating uveitis.
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Abstract:
AIM: To report various ocular lesions caused by accidental instillation of superglue.METHODS: Three cases of ocular injuries are described in children aged 6 years, 3 years and 8 months, following accidental instillation of superglue in the eye.RESULTS: In the first case there was sticking of eyelashes in the medial 1/3 of eyelids in both eyes. In the second case sticking of eye lashes was present in the lateral 1/3 of eyelids in the left eye. In the third case, superglue was present on the right cheek, above the right ear and sticking of eyelids in medial 1/3 in right eye. The eyelids were separated by pulling the lid margins with fingers in the first case and later on superglue was removed by trimming the eyelashes; and by direct trimming the eyelashes in second and third cases. There was no injury to other structures of anterior segment in the first two cases. However, removal of the superglue on the cornea resulted in corneal abrasion in the third case which healed with medical treatment and patching of the right eye.CONCLUSION: Accidental instillation of superglue is possible because of the appearance of the tube like eye ointment tube. Immediate medical aid will prevent ocular morbidity.
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Yang-Qing Huang, He Huang, Rong-Zhi Huang
Abstract:
AIM:To introduce a new near-vision chart for children aged 3-5 years old and its clinical applications.METHODS:The new near-vision chart which combined the Bailey-Lovie layout with a newly devised set of symmetry symbols was designed based on Weber-Fechner law. It consists of 15 rows of symmetry symbols, corresponding to a visual acuity range from 1.3 to 0.1 logMAR. The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle, square, triangle，and cross, which matched the preschool children''s cognitive level. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 15 lines. The progression rate of the optotype size between two lines was 1.2589 and two smaller groups of optotypes ranging from 0.7 to -0.1 logMAR were included for repetitive testing. A near visual acuity was recorded in logMAR or decimal, and the testing distance was 25 cm.RESULTS:This new near-vision chart with pediatric acuity test optotypes which consists of 4 different symbols (triangle, square, cross, and circle) met the national and international eye chart design guidelines. When performing the near visual acuity assessment in preschoolers (3-5 years old). It overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling ''E'' or Landolt ''C'', which the subjects were prone to lose interest in. Near vision may be recorded in different notations:decimal acuity and logMAR. These two notations can be easily converted each other in the new near-vision chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the Chinese national standard logarithmic near-vision chart (r=0.932, P<0.01), but also indicated good test-retest reliability (89% of retest scores were within 0.1 logMAR units of the initial test score) and a high response rate.CONCLUSION:The results of this study support the validity and reliability of near visual acuity measurements using the new near-vision chart in children aged 3-5y over a wide range of visual acuities, and the new eye chart was especially suitable for the detection of amblyopia risk factors and low vision examination in children (3-5y of age). It can be applied in routine clinical practice.
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Ali Ihsan Incesu, Güng?r Sobac?
Abstract:
Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today's world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician's responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of OCT (optical coherence tomography), frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.
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Blake F. Webb, Jadon R. Webb, Mary C. Schroeder, Carol S. North
Abstract:
AIM: To estimate the prevalence and risk factors for vitreous floaters in the general population.METHODS: An electronic survey was administered through a smartphone app asking various demographic and health questions, including whether users experience floaters in their field of vision. Multivariate logistic regression analysis was used to determine risk factors.RESULTS:A total of 603 individuals completed the survey, with 76% reporting that they see floaters, and 33% reporting that floaters caused noticeable impairment in vision. Myopes were 3.5 times more likely (P=0.0004), and hyperopes 4.4 times more likely (P=0.0069) to report moderate to severe floaters compared to those with normal vision. Floater prevalence was not significantly affected by respondent age, race, gender, and eye color.CONCLUSION:Vitreous floaters were found to be a very common phenomenon in this non-clinical general population sample, and more likely to be impairing in myopes and hyperopes.
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Bora Yüksel, Sultan Kaya ünsal, Sevgi Onat
Abstract:
AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft. METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months. RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.
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Abstract:
Photobiomodulation (PBM), also known as low level laser therapy, has recently risen to the attention of the ophthalmology community as a promising new approach to treat a variety of retinal conditions including age-related macular degeneration, retinopathy of prematurity, diabetic retinopathy, Leber’s hereditary optic neuropathy, amblyopia, methanol-induced retinal damage, and possibly others. This review evaluates the existing research pertaining to PBM applications in the retina, with a focus on the mechanisms of action and clinical outcomes. All available literature until April 2015 was reviewed using PubMed and the following keywords: “photobiomodulation AND retina”, “low level light therapy AND retina”, “low level laser therapy AND retina”, and “FR/NIR therapy AND retina”. In addition, the relevant references listed within the papers identified through PubMed were incorporated. The literature supports the conclusion that the low-cost and non-invasive nature of PBM, coupled with the first promising clinical reports and the numerous preclinical-studies in animal models, make PBM well-poised to become an important player in the treatment of a wide range of retinal disorders. Nevertheless, large-scale clinical trials will be necessary to establish the PBM therapeutic ranges for the various retinal diseases, as well as to gain a deeper understanding of its mechanisms of action.
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Wen-Bin Huang, Qian Fan, Xiu-Lan Zhang
Abstract:
Glaucoma is one of the leading causes of visual impairment and blindness. Improved knowledge of the pathogenesis of this disease has allowed the exploration of new therapeutic methods. In general, elevated intraocular pressure (IOP), oxidative stress, and vascular insufficiency are accepted as the major risk factors for the progression of glaucoma. Many natural compounds have been found beneficial for glaucoma. Nutritional therapies are now emerging as potentially effective in glaucomatous therapy. One nutritional supplement with potential therapeutic value is cod liver oil, a dietary supplement that contains vitamin A and omega-3 polyunsaturated fatty acids (PUFAs). Vitamin A is important for preserving normal vision and it is a well-known antioxidant that prevents the oxidative damage that contributes to the etiology and progression of glaucoma. Vitamin A is also a crucial factor for maintaining the integrity of conjunctival and corneal ocular surfaces, and preventing the impairment of ocular epithelium caused by topical antiglaucomatous drugs. Omega-3 fatty acids are beneficial for glaucoma patients as they decrease IOP, increase ocular blood flow, and improve optic neuroprotective function. In this article, we propose that cod liver oil, as a combination of vitamin A and omega-3 fatty acids, should be beneficial for the treatment of glaucoma. However, further studies are needed to explore the relationship between cod liver oil and glaucoma.
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Jun Yi, Jun Yun, Zhi-Kui Li, Chang-Tai Xu, Bo-Rong Pan
Abstract:
· Congenital cataract is a crystallin severe blinding disease and genetic factors in disease development are important. Crystallin growth is under a combination of genes and their products in time and space to complete the coordination role of the guidance. Congenital cataract-related genes, included crystallin protein gene (CRYAA, CRYAB, CRYBA1/A3, CRYBA4, CRYBB1, CRYBB2, CRYBB3, CRYGC, CRYGD, CRYGS), gap junction channel protein gene (GJA1, GJA3, GJA8), membrane protein gene (GJA3, GJA8, MIP, LIM2), cytoskeletal protein gene (BF-SP2), transcription factor genes (HSF4, MAF, PITX3, PAX6), ferritin light chain gene (FTL), fibroblast growth factor (FGF) and so on. Currently, there are about 39 genetic loci isolated to which primary cataracts have been mapped, although the number is constantly increasing and depends to some extent on definition. We summarized the recent advances on epidemiology and genetic locations of congenital cataract in this review.
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Juan-Juan Li, Yun-Peng Li, Zhu-Lin Hu
Abstract:
We describe the successful treatment in a patient with bilateral congenital aniridia and cataract by insertion of capsular tension rings and IOL.
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Abstract:
AIM: To compare the efficacy for preventing exposure keratopathy of three forms of eye care (artificial tear, moist chamber and polyethylene covers) for intensive care patients. METHODS: Eighty-four patients in Intensive Care Unit (ICU) were randomized to three treatment groups, including artificial tears group, moist chambers group and polyethylene film group. Patients of artificial tear group received two drops of carboxymethylcellulose drops to each eye every 2 hours. The moist chambers and the polyethylene were changed every 12 hours or as needed if they became unclean or torn. The corneal fluorescein stains were performed daily. RESULTS: No of 28 patients (0%) in the polyethylene group and one of the 27 patients (3.70%) in the moist chamber group had exposure keratopathy, compared to 8 of the 29 patients (27.59%) in the artificial tear group. There were statistical significance between the artificial tear group and the moist chamber group (P=0.02), and the artificial tear group and the polyethylene group (P =0.003). The time on eye care every day of the artificial tear group, the moist chamber group and the polyethylene group was 26.69±2.39 minutes, 35.33±2.63 minutes and 7.48±0.87 minutes, respectively. The eye care of the polyethylene group were statistically more time-save than that of the artificial tear group (P<0.001) and the moist chamber group (P<0.001). CONCLUSION: Polyethylene covers are more effective and more time-saving in reducing the incidence of corneal damage in intensive care patients
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