Abstract:AIM: To investigate F96, a N-acylethanolamine acid amidase (NAAA) inhibitor, as a novel drug for treating dry eye disease (DED) and to enhance its corneal retention time by utilizing nanometer micelles to improve therapeutic efficacy. METHODS: The study compared nanomicelles encapsulating doxorubicin with an aqueous solution of doxorubicin to assess the ability of the nanomicelles to prolong drug retention on the ocular surface. Dry eye was induced in mice through subcutaneous injections of scopolamine hydrobromide. The efficacy of F96 was evaluated using various clinical assessments, including the phenol red cotton test, Oregon green dextran staining, periodic acid-Schiff (PAS) staining, and Terminal dUTP Nick-End Labeling (TUNEL) assay. RESULTS: Doxorubicin micelles exhibited significantly prolonged retention compared to the aqueous solution. By 15min, the corneal fluorescence intensity of the micelle group was markedly higher than that of theaqueous solution group (P<0.05), and this enhanced effect persisted for at least 4h. Furthermore, mice treated with F96 demonstrated superior outcomes in tear production, corneal staining, and goblet cell density compared to the control groups. Specifically, F96-mPPP significantly increased tear secretion (3.35±0.45 vs 1.85±0.51 mm in the vehicle group, P<0.001), restored conjunctival goblet cell density (54.5±4.5 vs 31.3±3.0, P<0.01), and reduced corneal fluorescein staining scores (3.4±0.32 vs 6.5±0.72, P<0.001). Additionally, F96-mPPP treatment markedly decreased TUNEL-positive cells in the corneal epithelium, indicating suppression of apoptosis. CONCLUSION: F96 nanometer micelles have the potential to serve as a promising novel approach for effectively alleviating ocular surface damage in the treatment of dry eye disease.

Abstract:AIM: To develop a 5-fluorouracil (5-FU) mesoporous poly(lactic) acid (PLA) delivery system for glaucoma filtration surgery suitable for a single subconjunctival implantation. METHODS: The 5-FU was infiltration-loaded into mesoporous PLA. In vitro and in vivo release experiments and ocular toxicology evaluation of the formulation were performed. The antiproliferative effect of this 5-FU-PLA tablet after glaucoma filtration surgery in rabbits was evaluated. Pathology, immunohistochemistry, and Western blot were used to further validate the inhibitory effect of this sustained release system. RESULTS: Various drug formulations were tested, and two 5-FU-PLA tablets, namely 1.5P15 (5-FU 1.5 mg+PLA 15 000 Da) and 2.5P15 (5-FU 2.5 mg+PLA 15 000 Da), had the most suitable release profiles in vitro. Further in vivo studies confirmed the safety and sustained-release profiles of both drugs. Both 5-FU-PLA tablets, relative to the free drugs, significantly inhibited tissue proliferation after glaucoma filtration and improved surgical success. Western blot showed that transforming growth factor-β (TGF-β) and connective tissue growth factor (CTGF) were inhibited by 5-FU after filtration surgery, with the effects of the 5-FU-PLA tablets being more lasting. CONCLUSION: The tested 5-FU-PLA tablets provide a sustained release of 5-FU, which may be used for a single subconjunctival implantation to inhibit proliferation after filtration surgery.

Abstract:AIM: To investigate the role of Forkhead box protein P3 (FOXP3) in choroidal melanoma (CM) metastases and elucidate its underlying mechanisms. METHODS: FOXP3 protein expression was analyzed in CM clinical specimens and cell lines. A stable FOXP3 knockout cell line and a transient FOXP3-overexpressing cell line were established, with transfection efficiencies confirmed by Western blotting (WB). Functional assays, including monoclonal formation, cell counting kit-8 (CCK-8) proliferation, migration, invasion, and in vivo tumorigenesis assays in nude mice, were performed to assess the biological effects of FOXP3. Additionally, WB was employed to evaluate epithelial-mesenchymal transition (EMT) markers and the activation of the Wnt5a/CaMKII signaling pathway. RESULTS: FOXP3 expression was significantly elevated in both CM clinical specimens and cell lines. Functional analyses revealed that FOXP3 enhanced CM cell proliferation, migration, and invasion in vitro and promoted tumorigenesis in vivo. Mechanistically, FOXP3 upregulated EMT-related proteins and activated the Wnt5a/CaMKII signaling pathway. Rescue experiments further confirmed that the oncogenic effects of FOXP3 were mediated via modulation of the Wnt5a/CaMKII axis. CONCLUSION: This study identifies FOXP3 as an oncogenic driver in CM, promoting tumor progression through the Wnt5a/CaMKII signaling pathway. These findings provide new insights into the molecular mechanisms of CM pathogenesis and highlight FOXP3 as a potential therapeutic target.

Abstract:AIM: To assess and compare the conjunctival bacterial flora in patients with congenital ptosis (CP) to that of healthy individuals. METHODS: The study included 38 patients with CP and 42 healthy control subjects. Conjunctival cultures were collected using a cotton-tipped swab applied to the inferior conjunctival fornix. The samples were inoculated into blood agar, eosin methylene blue agar, chocolate agar for bacteria, and Sabouraud dextrose agar medium for fungi. RESULTS: The culture positivity rate was 68.4% in CP and 47.6% in the control group (P<0.001). Additionally, there was a significant difference in culture positivity between the eyes of patients with unilateral ptosis (P=0.039). In the CP group, the most common found microorganism was Staphylococcus epidermidis at 23.67%, followed by Haemophilus species at 21.04%, and Corynebacterium species at 15.78%. In the control group, Staphylococcus epidermidis and Corynebacterium species were both the most commonly isolated microorganisms, each accounting for 19.04%. More than one species of bacteria was grown in the cultures of 36.84% and 23.80% of the CP and control subjects, respectively. Gram-negative bacteria were more common in CP than in control subjects (P=0.031). CONCLUSION: Culture positivity is significantly higher in the ptotic eyes of CP. Potentially pathogenic microorganisms are more frequently isolated from the CP group compared with the healthy control group.

Abstract:AIM: To characterize the ocular surface characteristics in the Nepalese population across all age groups who have used digital screens for extended durations over several years. METHODS: In a cross-sectional, observational study, 144 digital screen users were assessed for dry eye disease (DED) using subjective and objective measures. The Ocular Surface Disease Index (OSDI) Questionnaire evaluated symptoms, followed by clinical assessments, including slit lamp biomicroscopy, tear breakup time (TBUT), Oxford Scheme grading, and Schirmer I test. DED was diagnosed if a patient had an OSDI score over 13 and at least two clinical signs (OSDI, Schirmer I test, or ocular staining). The prevalence of DED was calculated based on the proportion of patients meeting these criteria. RESULTS: Of the 144 participants (mean age: 34.6±15.2y), 78 (54.2%) were female. The use of digital screens varied between 2-8h (mean duration: 4.1±2.7h) per day. The mean OSDI score, TBUT score, and the Schirmer I scores were 22.7±10.5 (max-min: 24.4-20.9), 6.8±4.2s (max-min: 7.5-6.1), and 12.3±4.6 mm (max-min: 13.1-11.5) respectively with 95% confidence interval (β=1.96), and a two-tailed statistical significance level of 5% (α=0.05). With increased screen use, TBUT shortened and OSDI scores increased significantly (P<0.01), though Schirmer I scores were unaffected (P>0.05). The prevalence of DED ranged from 6.3% to 22.9% in those using screens for more than 2h, with an overall prevalence of 67.4% among digital screen users. CONCLUSION: There is a significant association between prolonged use of digital screens and clinical markers of dry eye signs and symptoms.

Abstract:AIM: To assess the corneal biometric parameters and endothelial cell characteristics in microcornea patients, and exploring their correlations. METHODS: This cross-sectional study included 28 patients of microcornea with uveal coloboma (MCUC), 13 patients of microcornea without coloboma (MCNC), and 30 age-matched healthy individuals (the control group). Corneal biometric parameters such as axial length (AL), anterior chamber depth (ACD), and white-to-white corneal diameter (WTW) were measured using the IOL Master. The corneal endothelial cell density (ECD), percentage of hexagonal cells (6A), average cell area (AVE), maximum cell area (MAX), minimum cell area (MIN), cell area standard deviation (SD), and coefficient of variation (CV) were collected by specular microscopy. RESULTS: This study included MCUC and MCNC patients with age- and sex-matched controls. All patients exhibited significantly reduced WTW (MCUC: 8.51±0.71 mm; MCNC: 9.08±0.42 mm) and worse logMAR BCVA (MCUC 0.62±0.43; MCNC 0.46±0.28) compared to controls (both P<0.001). The ECD was 3106.32±336.80 cells/mm² in the MCUC group and 2906.92±323.53 cells/mm² in the MCNC group, both significantly higher than the control group (2647.43±203.06 cells/mm², P<0.05). In contrast, the CV, AVE, SD, and ACD in the MCUC and MCNC groups were significantly lower compared to controls (P<0.01). In patients with microcornea, the WTW was negatively correlated with the ECD and 6A, but positively with the CV, MAX, AVE, and SD. The ACD was negatively linked to the ECD, but positively to the AVE. CONCLUSION: The corneal ECD and 6A are increased, while the CV is decreased in patients with microcornea, particularly in those accompanied by uveal coloboma. The ECD and morphology demonstrate close correlations with the WTW and ACD.

Abstract:AIM: To compare the accuracy of manual marking versus an image-guided system for toric implantable collamer lens (TICL) implantation and evaluate the short-term postoperative rotational stability of TICL and corneal surgically induced astigmatism vector (SIA). METHODS: Retrospective analysis was conducted on eyes with TICL alignment achieved through manual marking (n=75) or VERION image-guided system-assisted marking (n=83). Each group was further classified into horizontal and vertical subgroups based on implant orientation. Additionally, patients were categorized into superior and temporal incision subgroups according to the position of main corneal incision. The misalignment and rotational stability of TICL were analyzed using slit-lamp anterior segment photography. Surgical predictability, efficacy, safety, and corneal SIA were also evaluated. RESULTS: In general, the TICL implantation with manual and digital image-guided systems all achieved robust predictability, efficacy, and safety. The misalignment of TICL was comparable between the manual and VERION groups (0.16°±3.97° vs 0.52°±5.59°, P=0.633), while a significant difference was observed in the absolute misalignment of TICL between the two groups (3.02°±2.55° vs 4.28°±3.61°, P=0.043). There were no significant differences in the distribution of TICL misalignment between the manual and VERION groups or between horizontal and vertical implant orientation groups (P>0.05). Furthermore, different orientations of TICL placement did not show statistically significant differences in rotational stability (P=0.46). Statistically significant differences were found in anterior corneal SIA between the manual and VERION groups (0.46±0.27 vs 0.33±0.21 D, P=0.001), especially for superior incision position (0.60±0.27 vs 0.35±0.23 D, P<0.0001). The anterior SIA exhibited a significant difference between superior and temporal incisions in the manual group (0.60±0.27 vs 0.35±0.20 D, P<0.0001). CONCLUSION: Compared with the conventional manual marking method, this study indicates that the digital image-guided system with VERION is safe and effective in TICL implantation. The digital system offers the advantage of minimizing corneal SIA compared to the manual method.

Abstract:AIM: To find out intraoperative and postoperative outcomes of congenital cataract surgery in eyes with microcornea. METHODS: This retrospective consecutive case series study compared outcomes after congenital cataract surgery in eyes with/without microcornea. Infants (<1 year old) who underwent lensectomy surgery left aphakic were included. Microphthalmos was defined as an eye that has a horizontal corneal diameter less than or equal to 9.0 mm. RESULTS: There were 40 infants (54 eyes) in the microcornea group and 58 (87 eyes) in the control group. The two groups were age- and sex-matched. The microcornea group showed significantly smaller corneal diameter (P<0.001), steeper corneal keratometry (P=0.001), thinner lens thickness (P<0.001), and shorter axial length (AL, P<0.001). And microcornea increased the incidence of poor pupil dilation (P<0.01). The two groups showed no significant differences in postoperative intraocular pressure (IOP), best-corrected visual acuity, central corneal thickness (CCT), AL, and the incidence of strabismus and nystagmus at the last follow-up. CONCLUSION: Although microcornea have different features from normal ones, the one-year follow-up after surgery has shown that early surgical intervention for congenital cataracts in eyes with microcornea can result in favourable outcomes with an acceptable rate of postoperative complications. Regular follow-up and timely management of postoperative complications are crucial for successful outcomes.

Abstract:AIM: To compare health-related quality of life and vision-related quality of life between patients with cataracts and healthy controls. METHODS: This research was carried out as a cross-sectional study. Participants were selected from Rasoul Akram Hospital in Tehran, Iran, comprised of two groups: healthy individuals and those diagnosed with cataracts, using a simple random sampling technique. Following the interviews, participants completed the SF-36 health-related quality of life questionnaire and the VFQ-25 vision-related quality of life questionnaire. Comprehensive optometric and ophthalmic assessments, were conducted for all participants. RESULTS: This research involved a selection of 130 healthy individuals and 154 cataract patients who were candidates for cataract surgery. The average ages of the healthy individuals and cataract patients were 69.7±3.5 and 69.5±6.5y, respectively (P=0.837), with 42.3% of the healthy individuals and 44.8% of the cataract male patients (P=0.672). According to the SF-36 questionnaire, the quality of life regarding physical functioning, role limitations due to physical health, social functioning, pain, and general health were significantly worse among cataract patients. The composite physical index for cataract patients and healthy individuals was 70.7±9.08 and 78.53±8.17, respectively (P<0.001; effect size=0.90, 95%CI: 0.66-1.15), while the mental index showed no significant difference between the two groups (P=0.112; effect size=0.19, 95%CI: -0.04-0.42). All aspects of the VFQ-25 questionnaire were notably lower in cataract patients, with the mean final VFQ-25 scores being 56.49±14.81 for cataract patients and 92.9±4.64 for healthy individuals (P<0.001; effect size=3.21, 95%CI: 2.85-3.56). The VFQ-25 questionnaire indicated that the most significant effect size was associated with role difficulties and distance activities. More components from both questionnaires exhibited a substantial correlation with best-corrected visual acuity in cataract patients. CONCLUSION: Patients suffering from cataracts exhibit a significantly reduced health-related quality of life, especially concerning physical health and vision-related quality of life, compared to those without cataracts. Timely surgical treatment for these individuals can improve their overall quality of life.

Abstract:AIM: To evaluate the efficacy of second-stage phacoemulsification (PE) of complicated initial cataract after vitreoretinal surgery (VRS) in patients with advanced proliferative diabetic retinopathy (PDR). METHODS: Totally 216 patients with PDR and complicated initial cataract who underwent surgery were included. These patients were divided into four groups according to their management. In the 1st group patients were subjected to a two–step surgical procedure: VRS with silicone oil tamponade was performed as the first step, followed by the second step, PE+intraocular lens (IOL) implantation+silicone oil removal. In the 2nd group PE was performed simultaneously with VRS and silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. Patients Ia (n=17) and IIa (n=17) subgroups had their tear liquid samples being examined before surgery and on the 2nd day after the 1st phase. In subgroups Ib and IIb, an angiogenesis inhibitor was implanted 10-14d before VRS at a dose of 0.5 mg once. In the 3rd group patients were subjected to a two–step surgical procedure: VRS with gas tamponade performed as the 1st step in their treatment; followed by the 2nd step, PE and the IOL implantation. In the 4th group PE performed simultaneously with VRS with gas tamponade. RESULTS: Patients in subgroup Ia and group III had better functional results than those in subgroup IIa and group IV, respectively (P<0.001). More marked inflammatory response (2-3 points) was statistically significant in patients of the IIa subgroup (P<0.001) and group IV (P<0.001) in comparison with the patients in the Ia and group III respectively. The IIa subgroup (n=9; 14.5%) showed higher incidence of neovascular glaucoma (NVG) than the Ia (n=2; 3.2%), P=0.027. There also was a higher rate of NVG in group IV (n=6; 19.3%) compared to group III (n=1; 3.1%), P=0.04. Subgroup IIa revealed a 2 to 2.5 times higher concentration of interleukin 8 (IL-8), monocyte chemoattractant protein 1 (MCP-1), and inter-cellular adhesion molecule 1 (ICAM-1) compared to subgroup Ia. CONCLUSION: PE of initial cataract at the second stage after VRS in patients with advanced PDR provides a sparing approach to surgical treatment in this category of patients and allows to improve anatomical and functional results of VRS. In addition, it contributes to reduction of number and severity of postoperative complications.

Abstract:AIM: To assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec, Canada. METHODS: Preoperative severity data included mean visual field (VF) deficit, intraocular pressure (IOP), the number of topical glaucoma medication classes, and preoperative best corrected visual acuity (BCVA). The times from referral to procedure (referral time) and from listing date to procedure (waitlisting time) were calculated. RESULTS: This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30, 2019 (pre-pandemic period), and 201 eyes in the same timeframe in 2021 (pandemic period) at Saint-Sacrement Hospital in Quebec City. There was no significant difference in the severity data of surgical glaucoma across both periods (VF deficit: P=0.48; IOP: P=0.14; BCVA: P=0.24; topical medication classes: P=0.27). The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively (P=0.08). Delay data were also comparable. Mean referral time was 122±120d in 2019 versus 144±136d in 2021 (P=0.09), whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021 (P=0.13). CONCLUSION: Despite North America’s strictest pandemic restrictions, limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center. A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.

Abstract:AIM: To present the clinical outcomes in efficacy and safety of the Ahmed ClearPath® (ACP) 250 mm2 model as well as our surgical technique. METHODS: Single-center prospective interventional study of uncontrolled glaucoma eyes undergoing ACP implantation, as a standalone procedure or in combination with cataract phacoemulsification. Intraocular pressure (IOP) was evaluated prior to surgery and 1wk, 1, 3, 6mo and 1y postoperatively. In addition, the number of antiglaucoma drugs and intra and postoperative complications were assessed. RESULTS: A total of 30 eyes of 28 patients were included in the study. The patients were on average 72.8 (13.4) years old and 53.6% were male. Totally 40% of the eyes had primary open angle glaucoma, 16.7% had neovascular glaucoma, 16.7% had pseudoexfoliative glaucoma, 10% had glaucoma secondary to pars plana vitrectomy with silicone oil tamponade, 6.7% had aphakic glaucoma, 6.7% had primary congenital glaucoma and 3.3% had pigmentary glaucoma. Before surgery mean IOP was 26.1 (10.8) mm Hg and mean glaucoma medication use was 3.7 (0.5). At 1, 3, 6 and 12mo mean IOP was 16.1, 11.7, 11.8 and 11.5 mm Hg, respectively. Mean glaucoma medication use was 1.9, 1.5, 1.2 and 1.2, respectively. At 1y, complete surgical success was found in 46.7% patients (n=14) and qualified success in 53.3% (n=16). There were no intraoperative complications. Postoperative complications include choroidal effusion (n=5), transient hyphema (n=2), early hypotony with shallow anterior chamber (n=2) and late hemorrhagic choroidal detachment (n=1). CONCLUSION: The ACP appears to be an efficient surgical option for treating refractory glaucoma, achieving good IOP control and decreasing medication burden. The results obtained at 6mo are an important prognostic factor for long-term outcomes.

Abstract:AIM: To investigate the possible relationship between inflammatory biomarkers in the peripheral blood of patients with branch retinal vein occlusion (BRVO). METHODS: A total of 63 BRVO patients were enrolled in this cross-sectional observational study. Meanwhile, 63 age- and gender-matched cataract patients were included as controls. Complete blood count and biochemical tests were performed, and inflammatory biomarkers including platelet to lymphocyte ratio (PLR), red blood cell distribution width to albumin ratio (RAR), neutrophil to lymphocyte ratio (NLR), systemic immune inflammation index (SII), and monocyte to high density lipoprotein cholesterol ratio (MHR) were compared between the two groups. RESULTS: There were no significant differences between the two groups in terms of age, sex, and prevalence of diabetes mellitus. Compared with the controls, patients with BRVO had a higher prevalence of hypertension and higher body mass index (BMI). Red blood cell distribution width (RDW), triglycerides, MHR, NLR, and RAR were elevated, whereas lymphocyte count and high-density lipoprotein were decreased in the BRVO group. Multivariate logistic regression analysis revealed that NLR (adjusted OR=1.686, 95%CI 1.075-2.646), RAR (adjusted OR=8.930, 95%CI 1.911-41.730), and body mass index (BMI; adjusted OR=1.174, 95%CI 1.010-1.365) were significantly associated with the risk of BRVO. In the receiver operating characteristic analysis, the area under the curve for NLR, RAR, and BMI were 0.602, 0.630, and 0.603, respectively. The sensitivity and specificity were 61.9% and 60.3%, 38.1% and 82.5%, and 61.9% and 57.1%, respectively. CONCLUSION: Peripheral blood inflammatory biomarkers are elevated in BRVO patients, suggesting systemic inflammation involvement. NLR, RAR, and BMI are positively correlated with BRVO. Monitoring NLR and RAR and strict weight control may be beneficial for the prevention and treatment of BRVO.

Abstract:AIM: To comprehensively examine the clinical presentations, multimodal images, and long-term follow-up of Chinese patients with acute zonal occult outer retinopathy (AZOOR), a rare inflammatory disorder. METHODS: This was a retrospective study. A total of 20 patients (32 eyes) were included. The medical records and multimodal imaging, including wide-field fundus photography, wide-field fundus autofluorescence (FAF), and swept-source optical coherence tomography (SS-OCT) were analyzed. RESULTS: The study included 20 patients with a mean age of 38.2±10.9y, and females accounted for 60%. Lesions could involve peripapillary areas, macular region, and peripheral retina. The mean best-corrected visual acuity (BCVA) at presentation was 0.38±0.60 logMAR, with no significant difference in visual acuity between acute cases (within 6mo of onset) and chronic cases (beyond 6mo of onset; P=0.390). There was no statistically significant difference in visual acuity between eyes of acute case (within 6mo of onset) and the chronic case (beyond 6mo of onset). In some chronic case, FAF examination revealed the presence of a hyperautofluorescent (hyperAF) ring around the macular area (6/18), a phenomenon not observed in the acute case (P=0.024). A higher proportion of chronic cases showed predominantly hypoautofluorescent (hypoAF) lesions compared to the acute case (13/18 vs 2/14, P=0.0016). SS-OCT examination showed that both acute and chronic cases exhibited hyperreflective dots above the retinal pigment epithelium (RPE), and ellipsoid zone (EZ) and RPE damage. In the chronic case, eyes with hyperreflective dots above the RPE were more likely to exhibit EZ and RPE damage in the macular region compared to those without these dots. CONCLUSION: Multimodal imaging plays a crucial role in the follow-up of patients with AZOOR. In chronic cases of AZOOR, the presence of hyperreflective dots above the RPE indicates a higher likelihood of outer retinal involvement in the macular region. This study provides critical insights into the complex presentation and progression of AZOOR.

Abstract:AIM: To determine the diagnostic ability of various visual functions in patients with multiple sclerosis (MS) with and without optic neuritis (ON). METHODS: In this cross-sectional study, we assessed and compared refractive error, visual acuity (VA), and contrast sensitivity (CS) between patients with MS and a matched control group of healthy individuals. The MS patients were further categorized into those with ON and those without. RESULTS: A total of 133 eyes from 133 participants were assessed, including 66 individuals diagnosed with MS. The mean ages for the MS group and the healthy control group were 37.5±4.27y and 38.45±4.60y, respectively (P=0.346). Among the 66 patients with MS, 18 had ON. The presence of MS was associated with a decrease in best-corrected visual acuity (BCVA) and spherical component of refractive error (P<0.05), whereas ON did not lead to any further decline in these parameters (P>0.05). MS was linked to decreased CS at spatial frequencies of 6 and 18 cycles per degree (CPD; P<0.05), while ON in MS patients resulted in an additional decrease in CS at 3 CPD (P=0.03). The most significant sensitivity for distinguishing MS patients from healthy individuals as well as MS patients with ON from those without ON was found with cylindrical component [associated criterion (AC) >-0.75 D; 71.21%] and CS at spatial frequency of 6 CPD (AC ≤1.56; 72.22%), respectively. Conversely, the highest specificity for these diagnostic measures was associated with BCVA (AC >0 logMAR; 97.01%) and CS at a spatial frequency of 12 CPD (AC ≤0.60; 93.75%), respectively. CONCLUSION: MS significantly affects refractive error and CS, with ON further reducing CS. Assessing these visual parameters can improve MS monitoring and management.

Abstract:AIM: To investigate the ocular surface parameters in patients with moderate to high myopia. METHODS: This prospective study was conducted in May 2023, enrolling patients with moderate to high myopia (spherical equivalent refraction ≤-3.0 D). After completing the Ocular Surface Disease Index (OSDI) questionnaire, refractive parameters and non-invasive tear film parameters were measured, followed by the Schirmer I test and fluorescein sodium staining. The diagnosis of dry eye disease was based on OSDI score, non-invasive tear breakup time (NIBUT), Schirmer I test, and fluorescein sodium staining results, according to the 2020 Chinese Expert Consensus on Dry Eye. The Mann-Whitney U test was used to compare ocular surface parameters between moderate and high myopia, as well as between patients with and without dry eye. Pearson correlation analysis was employed to assess the relationship between the lipid/muco-aqueous layers and tear film parameters. A general linear mixed model (GLMM) was used to analyze the impact of refractive parameters on ocular surface parameters after adjusting for age and sex. RESULTS: A total of 35 eyes with moderate to high myopia (12 males; mean age, 30.30±5.45y) were included in the study. Among them, 26 eyes were classified as normal and 9 as dry eye. Of the 9 dry eye cases, 7 were observed in the high myopia group (n=18) and 2 in the moderate myopia group (n=17). Among the enrolled patients, those with high myopia demonstrated significantly higher OSDI scores than those with moderate myopia (P=0.0417). Patients with dry eye exhibited significantly shorter interblink intervals (P=0.0081) and higher OSDI scores (P=0.0001) than those without dry eye. Pearson correlation analysis revealed a significant positive correlation between lipid layer thickness (LLT) and tear meniscus height (r=0.395, P=0.023), and a significant negative correlation between the muco-aqueous layer thickness change rate (MALTR) and OSDI score (r=-0.466, P=0.016). After adjusting for age and sex using the GLMM, spherical refraction (SPH, β=-1.802, P=0.048) and axial length (AL, β=2.784, P=0.048) significantly impacted OSDI score. Corneal front astigmatism significantly influenced Schirmer I test results (β=8.377, P=0.024). The difference between central corneal thickness and the thinnest corneal thickness significantly affected LLT (β=-2.294, P=0.026). White-to-white diameter significantly impacted MALTR (β=-81.758, P=0.037). CONCLUSION: In moderate to high myopia, higher SPH and AL correlate with increased dry eye symptoms, which are associated with muco-aqueous and lipid layer alterations. Corneal regularity and diameter also affect tear film dynamics.

Abstract:AIM: To compare the effects of different types of negative pressure suction on the macular and optic disc retinal vessel density (VD) in myopic patients with different axial lengths (ALs) undergoing femtosecond laser-assisted excimer laser in situ keratomileusis (FS-LASIK) by optical coherence tomography angiography (OCTA). METHODS: A prospective, nonrandomized, controlled study. Participants underwent FS-LASIK surgery were divided into the short AL group (SAL, 22≤AL<26 mm) and the long AL group (LAL, 26≤AL<28 mm) according to the different ALs. Further, the two groups were divided into subgroups according to the corneal flap using VisuMax or WaveLight FS200 femtosecond laser (FS) platform. All patients underwent OCTA before the surgery and 1-day/1-week/1-month after the surgery. ANOVA statistically analyzed data with two-factor repeated measurement in SPSS. RESULTS: Totally 108 participants (108 eyes, 18–35y) were divided into SAL group [22 patients (4 males and 18 females) were treated with VisuMax, and 24 (3 males and 21 females) were treated with WaveLight FS200] and LAL group [34 patients (4 males and 30 females) were treated with VisuMax, and 28 patients (6 males and 22 females) were treated with WaveLight FS200]. In the LAL group, there was no significant difference in macular superficial capillary plexuses vessel density (SCP-VD) in the fovea and perifovea region, but compared with the VisuMax subgroup, SCP-VD in the parafoveal region (t=2.647, P=0.010) and the whole area (t=2.030, P=0.047) in WaveLight FS200 subgroup decreased at one day after the operation and increased to a preoperative level at 1-week and 1-month after operation. There was no significant difference between SCP-VD in the two SAL subgroups, neither of deep capillary plexuses vessel density (DCP-VD) and optic nerve head vessel density (ONH-VD) in the SAL and LAL groups. CONCLUSION: With the increase of AL and suction intensity, a transient decrease of SCP-VD in the macular region is observed at 1d postoperatively during FS-LASIK, and it increases to preoperative level at 1-week and 1-month postoperatively. However, the AL and suction intensity do not affect the macular DCP-VD and ONH-VD.

Abstract:AIM: To measure the contrast sensitivity (CS) using computer-based Chart2020 software pre- and post-white light exposure with and without blue-blocking lenses (BBLs). METHODS: The study included participants aged 18 to 25y (n=30 eyes), where baseline CS was measured before the experiment. Following this, the participants were exposed to two white light-emitting diodes (LEDs; 450 lx each), placed at a 45-degree angle from the participant’s eye and 80 cm from the light source. All participants were randomly divided into three groups (BBL1- Placebo lens, BBL2- Crizal Prevencia, BBL3- Duravision) by sequential randomisation, which was double-blinded. Post-light exposure, the CS was measured monocularly with a calibrated computer-based CS Chart-2020 software at different log units. RESULTS: CS measured using Chart-2020 software at 0.8, 1.5, 6, 12, and 18 cpd pre- and post-white LED exposure with and without BBLs showed a significant difference (P<0.05) in contrast threshold and log contrast at 6 cpd and 18 cpd (P<0.05) and showed no significant differences in 0.8, 1.5, 12 cpd (P>0.05). CONCLUSION: This study shows that exposure to white LEDs can diminish CS, while BBLs may ameliorate these negative effects.

Abstract:AIM: To analyze the ocular findings of patients who received lifelong leptin therapy due to congenital leptin deficiency (CLD), an extremely rare condition. METHODS: A prospective, cross-sectional comparative study was performed on six patients with CLD and 13 healthy age- and sex-matched controls. The central corneal thickness (CCT), anterior chamber depth (ACD), axial length (AL), keratometry (K1, K2), optical coherence tomography (OCT), and OCT angiography parameters were compared between the leptin and control groups at the baseline visit. The change in these measurements in leptin patients over a two-year period was analyzed. RESULTS: CLD patients had lower mean AL, ACD, and CCT (P≤0.012 for all). Mean K1, K2 (P≤0.047 for both), choroidal thickness (P≤0.001), and central ganglion cell layer (GCL) thickness (P=0.029) were higher in the leptin group. Perifoveal superficial capillary plexus (SCP) density was decreased in all quadrants except the temporal region (P<0.05), and parafoveal deep capillary plexus (DCP) density was decreased in the superior hemisphere, temporal quadrant (P≤0.036 for both) and nasal quadrant (P=0.048) in the leptin group. During the two-year follow-up, no changes in anterior and posterior segment measurements were observed in the leptin patients, except for subfoveal choroidal thickness (P<0.001). CONCLUSION: CLD patients exhibit structural alterations in both the anterior and posterior segments of the eye, including notable changes in retinal and choroidal vasculature. However, there is limited evidence concerning the influence of leptin therapy on the eye.

Abstract:AIM: To investigate the prevalence and types of eyelid disorders among an elderly population in China, underscoring the significance of eyelid health for the aging demographic. METHODS: A cross-sectional epidemiological survey was conducted on 3038 individuals over the age of 50, all of whom were evaluated at the community health center. Each participant underwent routine ophthalmic examinations and eyelid morphology evaluations by an ophthalmologist. Eyelid disorders and morphology were assessed through slit-lamp examination and direct visual inspection. The study analyzed the characteristics of common eyelid disorders, including blepharoptosis, dermatochalasis, eyelid tumors, entropion, lower eyelid retraction (LER) and ectropion, as well as eyelid morphologies such as sunken and bulging eyelids. Descriptive statistics were used for demographic data, Chi-square test analyzed gender distribution differences, and logistic regression calculated odds ratios for blepharoptosis (P<0.05 considered significant). RESULTS: The study revealed that eyelid disorders were present in 1250 (41%) individuals, with blepharoptosis being the most common disorder (25%), followed by severe dermatochalasis (16%), eyelid tumors (9.3%), LER and ectropion (11%), and entropion (1.2%). Sunken eyelids were more prevalent in men (26%) than in women (17%). The study found significant associations between the presence of blepharoptosis and sunken upper eyelids [P=0.01, odds ratio (OR)=1.33], as well as male gender (P=0.038, OR=1.22). Additionally, the prevalence of blepharoptosis increased with age. CONCLUSION: Eyelid disorders are highly prevalent in older people and increase steeply with age. This study highlights the need for increased awareness of eyelid health among older individuals at risk for eyelid disorders and the importance of ophthalmic examination for early diagnosis and management of these disorders.

Abstract:AIM: To evaluate the prevalence of myopia and identify its associated risk factors among children and adolescents in Xi’an, China. METHODS: In a school-based cross-sectional design, students ranging from kindergarten to high school across Xi’an were enrolled. Ophthalmic examinations were performed to assess refractive status via non-cycloplegic refraction. Myopia was defined as SE≤-0.5 D, with stratification into mild (SE: ≤-0.5 to >-3.0 D), moderate (SE: ≤-3.0 to >-6.0 D), and high myopia (SE≤-6.0 D). Data on potential risk factors such as age, gender, and educational level were obtained through structured questionnaires. RESULTS: The study included 156 416 participants, with 81 389 boys (52.0%) and 75 027 girls (48.0%). The prevalence rates of myopia were 65.67% for boys and 68.83% for girls. Data collection occurred over two consecutive years, 2021 and 2022, with 78 849 and 77 567 participants, respectively. The prevalence of myopia was 67.65% in 2021 and decreased slightly to 66.71% in 2022. The high myopia rates were 3.85% and 3.43% for these years, respectively. Analysis revealed significant risk factors including gender, age, and educational level, with a distinct positive correlation between increased educational level and higher myopia prevalence. Notably, both genders exhibited a significant decrease in moderate myopia over the study period, with reductions of 1.7% and 1.2%. CONCLUSION: This comprehensive study underscores the substantial prevalence of myopia among school-aged children and adolescents in Xi’an, marking it as a significant public health concern. The correlation with higher educational levels suggests the need for targeted interventions aimed at myopia prevention and management. These findings contribute critically to the body of knowledge necessary for formulating effective public health strategies in Xi’an and potentially other similar regions.

Abstract:AIM: To explore the causal links among circulating inflammatory proteins (CIPs) and the varying severities of diabetic retinopathy (DR). METHODS: This research utilized a two sample Mendelian randomization (MR) approach to explore the causal relationships between 91 CIPs and various severities of DR: background DR (BDR) or non-proliferative DR (NPDR), and proliferative DR (PDR). Single-nucleotide polymorphisms (SNPs) related to the 91 CIPs as exposure factors were identified. These SNPs were selected from an extensive genome-wide association study (GWAS) analyzing large genomic datasets. Genetic variation data of various DR phenotypes provided by the FinnGen collaboration were utilized as outcomes. Inverse-variance weighting (IVW) was used as the main MR analysis. Robustness of study results was evaluated through a series of sensitivity analyses, employing the MR-pleiotropy-test and mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) to confirm the absence of pleiotropy. RESULTS: In a bidirectional MR analysis, we uncovered a complex relationship between CIPs and DR. Elevated levels of tumor necrosis factor ligand superfamily member 14 (TNFSF14), latency associated peptide transforming growth factors beta-1 (LAP-TGF-beta1), interleukin-10 (IL-10), and vascular endothelial growth factor A (VEGF-A) were associated with a reduced risk of NPDR. Conversely, elevated levels of fibroblast growth factor 23 (FGF-23) were associated with an increased risk of NPDR. Concentrations of adenosine deaminase (ADA), matrix metalloproteinase-10 (MMP-10), eotaxin, and IL-10 showed elevated levels and were linked to a reduced risk of NPDR. On the other hand, the levels of oncostatin-M, beta-nerve growth factor (β-NGF), and interleukin-7 (IL-7) were elevated and associated with an increased risk of SNPDR. Elevated levels of ADA, MMP-10, and macrophage colony-stimulating factor 1 (CSF1) were linked to a lower likelihood of PDR. Conversely, elevated levels of Caspase 8 and glial cell line-derived neurotrophic factor (GDNF) were associated with an increased risk of PDR. In reverse MR analysis, DR affected the expression of these factors. CONCLUSION: Our research demonstrates evidence supporting a potential causal link between key inflammatory factors and the risk and prognosis of various DR phenotypes. These findings emphasize the regulation of inflammatory factors responses as a strategic approach for preventing and managing DR. Altogether, our results validate the pathogenic role of inflammatory factors dysregulation in DR and support the rationale for exploring immunotherapeutic targets further.

Abstract:AIM: To evaluate the effectiveness of 532, 577, and 810 nm lasers as an initial treatment for non-resolving central serous chorioretinopathy (CSC). METHODS: Following the Cochrane Collaboration Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, randomized clinical trials (RCTs), non-randomized cohorts, observational studies, and case series (>10 cases) assessing these lasers for non-resolving CSC with ≥3mo of follow-up were included. Non-resolving CSC was defined as persistent subretinal fluid (SRF) for >3-6mo. Searches were conducted in PubMed, the Cochrane Library, and Embase (January 17, 2025). Two authors independently performed data extraction and assessed the risk of bias. The primary outcome was SRF resolution on optic cherence tomography (OCT) at 3-6mo. Central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were secondary outcomes. A random-effects model was employed to calculate pooled proportions with 95% confidence intervals (CIs), and heterogeneity was assessed using I² and Q statistics. RESULTS: Twenty-four studies (3 RCTs, 21 non-RCTs) involving 829 non-resolving CSC eyes (77.6% male, mean age 45.36y) were included. SRF resolution was 59% (95%CI: 0.51-0.67; I2=72.6%), showing no significant difference between lasers. Trim-and-fill adjustment raised SRF resolution to 65% (95%CI: 0.44-0.81). CRT significantly decreased by 126.32 µm (95%CI: 95.99-156.65; P<0.0001; I2=95.7%), with the largest reduction noted for the 810 nm laser. BCVA change was 0.10 logMAR (95%CI: -0.03 to 0.22; P=0.13; I2=96.6%), indicating no significant visual improvement. CONCLUSION: This Meta-analysis supports the use of 532, 577, and 810 nm subthreshold micropulse lasers as equally effective in resolving SRF in non-resolving CSC.

Abstract:This review is to elucidate the retinal toxicity following intraocular injections of cefuroxime, including possible risk factors, clinical manifestations, visual prognosis and treatment. Refereed publications were retrieved from PubMed, the Cochrane Library, and EMBASE databases, using the search terms cefuroxime, retina, macular edema, serous retinal detachment, toxic, cataract surgery. The screening was not limited by publication date, country or study type. We screened out 51 articles out of which 32 met the inclusion criteria for this systematic review. Data regarding sample size calculation reporting and trial characteristics were extracted for each trial. Retinal toxicity can be caused by both high and standard doses of cefuroxime injections in different ethnic groups, with risk factors including overdose, blood-retinal barrier disruption, anterior and posterior chamber connection. The typical clinical manifestations of retinal toxicity are cystoid macular edema and extensive serous retinal detachment, mainly involving the outer nuclear and outer plexiform layers, with a good prognosis for visual acuity in most cases, but in a small number of cases, the prognosis is not satisfactory. In conclusion, though the current use of intracameral injection antibiotics in cataract surgery is gradually increasing, the potential risks should not be ignored. Unexplained poor vision on the first day after cataract surgery can be supplemented with macular optical coherence tomography to rule out cefuroxime-related retinal toxicity.

Abstract:Autism spectrum disorder (ASD) represents a neurodevelopmental disorder that has been the focus of numerous studies on the central nervous system (CNS). The embryological origin of the brain and retina is shared, with the axons of retinal ganglion cells (RGC) developing into the optic nerves that enter the brain through the dorsal lateral geniculate nucleus (LGN) of the thalamus, LGN, and other visual cortices. Given the evidence that individuals with ASD exhibit impairments in the visual mechanisms, including deficits in emotional face recognition, and difficulty in maintaining gaze control as well as eye contact, some studies have documented retinal alterations in individuals with ASD. These have been identified through ophthalmic assessments, including optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), and electroretinography (ERG). With the improvements in ASD animal models, it is possible to obtain a better understanding of vision dysfunction in ASD by analyzing the molecular mechanisms of retinal function and structure abnormalities. This review aims to provide a summary of the recent research on ocular alterations in ASD patients and animal models, intending to contribute to further investigation of the eye-brain connection and communication.

Abstract: