International journal of ophthalmology最新文献

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.

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.

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 10^th VF test. Three to nine VF tests were used to predict the 10^th 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.

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.

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.

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.

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.

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.

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.

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.