中华眼科杂志最新文献

Conjunctival homeostasis is crucial for ocular health; however, the lack of highly biomimetic in vitro models has hindered research on the mechanisms of conjunctival diseases. Organoid technology, which can simulate the in vivo microenvironment, recapitulate 3D structures and key functions, provides a new tool for this field, and this review focuses on the research of conjunctival organoids. Research on organoids began in 1907, and conjunctival organoids derived from adult stem cells were first established in 2024. Currently, four core culture methods have been developed, including the induction of functional conjunctival cells from induced pluripotent stem cells (iPSC), construction of 3D-printed bilayered tissue-engineered conjunctiva, development of full-thickness models containing goblet cells, and establishment of high-throughput preparation models. Among these, iPSC differentiation can yield functional epithelial cells, and the high-throughput model has also completed in-situ transplantation verification in mice. Conjunctival organoids have three main applications: facilitating the study of pathogenesis by simulating inflammation or viral infection, supporting drug screening, and serving as transplant donors-their survival and integration capabilities have been verified in mice. Nevertheless, current research still has limitations, such as a single cell type, restricted cell sources, complex culture processes with high costs, and unproven safety after transplantation. In the future, this field needs to focus on optimizing culture systems, constructing multi-cell models, innovating biomaterials, and promoting standardization. Meanwhile, it should expand application scenarios such as gene-edited disease models and microfluidic drug evaluation to advance the translation of conjunctival organoids from basic research to clinical practice.

A 35-year-old male patient presented with decreased visual acuity in both eyes for 4 years. His medical history included hypertension, type 2 diabetes mellitus, renal failure, and kidney transplantation. In 2021, he was diagnosed with primary hyperoxaluria based on genetic testing, which revealed a homozygous variant of the AGXT gene (c.32C>G). During this ophthalmic examination, decreased corrected visual acuity was noted in both eyes; fundus examination showed crystalline deposits in the retina and perimacular ring-shaped pigment deposition. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) indicated abnormalities in retinal structure and blood vessels. Systemic examination revealed elevated 24-hour urinary oxalic acid. His second eldest sister carried the same homozygous variant of the AGXT gene with renal symptoms. The final diagnoses were: bilateral oxalate retinopathy, bilateral diabetic retinopathy, primary hyperoxaluria, and type 2 diabetes mellitus. The patient refused laser treatment, and no significant changes in the lesions were observed during the 3-month follow-up. This case suggests that primary hyperoxaluria caused by AGXT gene variation can lead to ocular oxalate deposition, and diagnosis should be made by combining genetic testing and imaging examinations, with long-term follow-up required.

Presbyopia refers to a degenerative disease in which the ability of the eye to accommodate gradually decreases with age. As the public demand for better quality of life rises, presbyopic correction surgery has become a clinical hotspot, with various surgery plans, techniques, and designs emerging in clinical practice. Based on the technical principles of how presbyopic surgery compensates for accommodation loss in presbyopia, this article elaborates on the selection of presbyopic correction surgery plans and the designs of corneal laser presbyopic surgery, with a focus on the application of extended-depth-of-focus technology in corneal laser presbyopic surgery, so as to further explore related theoretical and clinical problems and provide reference for relevant clinical work.

A case of atopic keratoconjunctivitis complicated by non-infectious corneal ulcer in a 14-year-old female child. The patient had a history of allergic conjunctivitis, allergic rhinitis, and atopic dermatitis since childhood. She presented with redness, photophobia, lacrimation, and decreased vision in the left eye. After examination, she was diagnosed with corneal ulcer in the left eye, atopic keratoconjunctivitis in both eyes, and meibomian gland dysfunction in both eyes. After admission, the patient was treated with a variety of medications and underwent corneal lesion resection+amniotic membrane covering surgery. After regular follow-ups, the eye condition improved significantly one year later, and the allergic symptoms did not recur during the 7-year follow-up. This case is characterized by a young onset age, unilateral lesion, misdiagnosable corneal mucus plaque, and an unusual location of giant papilla. Moreover, good therapeutic effects were achieved through prevention and control, providing a reference for clinical practice.

Lacrimal gland adenoid cystic carcinoma (LGACC), the most prevalent malignant epithelial tumor of the lacrimal gland, exhibits high invasiveness and poor prognosis. Despite aggressive local therapies, the 5-year and 10-year survival rates remain at 50% and 20% respectively. This review comprehensively synthesizes histopathological features, molecular mechanisms, and therapeutic advances in LGACC. Histopathological analysis highlights three classical subtypes (tubular, cribriform, and solid) with distinct prognostic implications, particularly emphasizing the detrimental survival impact of tumors undergoing high-grade transformation. At the molecular level, in-depth elucidation reveals the pivotal roles of NOTCH pathway mutations and MYB overexpression in driving oncogenesis through hyperactivation of receptor tyrosine kinase, PIP3/AKT, and ATR/BRCA signaling cascades. Current evidence demonstrates persistent therapeutic challenges: expanded surgical resection fails to significantly improve survival outcomes, while local excision combined with adjuvant therapies still faces substantial recurrence (80% at 5 years) and metastasis rates (66.9%). Emerging breakthroughs in targeted therapies warrant attention, including antisense oligonucleotides targeting MYB-NFIB fusion genes, clinical trial data of NOTCH inhibitors (e.g., AL101), and PARP inhibitor-based combinatorial regimens leveraging DNA damage repair mechanisms. By integrating fundamental research and clinical translational evidence, this review provides a theoretical framework for optimizing LGACC diagnosis and treatment paradigms.

This article focuses on the application of adaptive optics (AO) technology in the observation of photoreceptor cells (PRs) in the macular area. Firstly, the principle and development process of AO technology are described. It can actively measure and correct optical aberrations to achieve high-resolution imaging. Since its invention, it has been increasingly used in ophthalmic research. Then, a detailed review is presented on the observation results of PRs by AO in healthy individuals and various ophthalmic diseases, including the performance characteristics of PRs in inherited retinal diseases, retinal degenerative diseases, uveitis involving PRs, and other lesions. At the same time, the current shortcomings of AO technology are analyzed in depth, such as small-sample research, non-standardized parameters, and limited clinical applications. The aim is to comprehensively summarize the research progress of AO in the observation of PRs in the macular area and provide a reference for subsequent related research and clinical applications.

Currently, the clinical application of various refractive correction surgeries has provided more options for patients, and posterior chamber phakic intraocular lens (PC-PIOL) implantation has also become one of the therapeutic options with proven efficacy. However, the potential risks of this procedure still warrant high vigilance. Some self-media outlets claim that PC-PIOL implantation is a "regret-free" surgery causing no ocular damage, stating that the implanted lens can be removed at any time to restore the eye to its preoperative state. This claim equates the "reversibility" of the surgery with "the ability to regret (and remedy it)", which is essentially a misinterpretation of the procedure's core characteristics. Such misinterpretation may lead physicians and patients to lower their vigilance against surgical risks, paving the way for subsequent medical disputes. This article illustrates that postoperatively, intraocular structures and parameters-including intraocular pressure, corneal endothelial cells, and the anterior lens capsule-are affected to varying degrees. The risks of postoperative complications (e.g., cataracts, glaucoma, corneal endothelial decompensation, and intraocular infection) should not be overlooked. Additionally, it is important to prioritize surgical safety by: conducting thorough preoperative evaluations, maintaining close doctor-patient communication, strictly adhering to surgical standards during the operation, and implementing coordinated postoperative management. This article clarifies that "reversible" does not mean "regret-free", and that safeguarding the best interests of patients is the core responsibility of medical professionals.