中华眼科杂志最新文献

Objective: To explore the influencing factors of intraocular residual astigmatism (RIA) after the implantation of non-toric intraocular lens (IOL), and to analyze the differences in the positional characteristics of the IOL and RIA between the eyes. Methods: This was a retrospective case series study. The data of 122 cataract patients (122 eyes, 67 right eyes and 55 left eyes) in the Eye Hospital of Tianjin Medical University from October 2022 to September 2023 were included. The patients' age was (68.80±8.82) years old, with 57 males and 65 females. All patients underwent phacoemulsification combined with the implantation of non-toric IOL. Swept-source optical coherence tomography (SS-OCT) was used to measure the decentration displacement, tilt vector of the lens and IOL, and anterior segment parameters before and 1 month after the surgery. The main indicators included the magnitude and direction of RIA, the tilt vector and decentration displacement of the IOL. Results: The absolute value of the overall RIA was (0.67±0.39) D. The absolute value of RIA in the left eyes [(0.81±0.43) D] was significantly greater than that in the right eyes [(0.56±0.31) D, P<0.001]. The tilt angle of the IOL was 5.00°±1.54°. The tilt angle in the left eyes (5.51°±1.59°) was greater than that in the right eyes (4.58°±1.36°, P=0.001). RIA was positively correlated with the tilt angle of the IOL (r=0.22, P=0.016). Multiple regression showed that for every 1° increase in the tilt angle of the IOL, RIA increased by 0.06 D (β=0.06, P=0.016). The anterior chamber depth (r=-0.24, P=0.008) and axial length (r=-0.38, P<0.001) were negatively correlated with the tilt angle of the IOL, and the refractive power of the IOL (r=0.37, P<0.001) was positively correlated with the tilt angle. Conclusions: After the implantation of non-toric IOL, RIA is significantly correlated with the tilt angle of the IOL, but not with the decentration distance. IOL tilt is an important factor affecting the postoperative visual quality. Both the tilt angle of the IOL and RIA in the left eyes are significantly greater than those in the right eyes. The eye side may be an important factor affecting the position of the IOL and the postoperative visual quality.

With the intensification of global population aging, the demand for presbyopia correction continues to rise, and various types of presbyopia-correcting intraocular lenses (IOLs) are being increasingly applied in clinical practice. The experts form the Chinese Cataract and Refractive Surgery Society and Cataract Group of Chinese Ophthalmologist Association, based on the current evidence-based data and through thorough discussions, have reached a consensus regarding the definition and clinical application of presbyopia-correcting IOLs. This consensus aims to provide guidance for clinical practice, ensuring the appropriate utilization of presbyopia-correcting IOLs to meet the personalized visual needs of diverse patient populations.

This article highlights the significant impact of complications following intraocular lens (IOL) implantation on visual recovery and quality of life, urging a multifaceted approach to address these challenges. The author discusses the clinical complexities of IOL opacification, uveitis-glaucoma-hyphema syndrome, capsular block syndrome, and optical disturbances, which are often overlooked or misdiagnosed. A comprehensive strategy involving optimized IOL design, enhanced clinical recognition, and improved patient communication is advocated. Continued research into new materials and techniques, alongside standardized clinical practices, is proposed to improve surgical safety and patient satisfaction.

A 75-year-old female patient was diagnosed with primary acquired melanosis (PAM) of the conjunctiva in 2004. The patient voluntarily chose not to undergo any pharmacological or surgical interventions and only received follow-up observation. During a follow-up visit in 2021, a significant reduction in conjunctival melanin pigmentation was found. Anterior segment optical coherence tomography revealed a marked decrease in the high reflectivity of the corneal epithelial cell layer and a reduction in the highly reflective melanin granules within the corneal epithelium. In vivo confocal microscopy showed a decrease in the oval, short spindle-shaped, highly reflective melanin granules within the corneal epithelium compared to previous examinations, and these granules had not penetrated the basement membrane. These examination results collectively confirmed the reduction in conjunctival melanin pigmentation in the patient.

Objective: To investigate the efficacy and safety of limbal relaxing incisions (LRI) combined with implantable Collamer lens (ICL) implantation and Toric ICL (TICL) implantation in correcting high myopia with astigmatism. Methods: A prospective nonrandomized controlled clinical study was conducted. Patients with high myopia and astigmatism who underwent ICL implantation at Beijing Tongren Eye Center of Beijing Tongren Hospital Affiliated to Capital Medical University from March 1, 2022 to February 15, 2023 were enrolled in this study. These patients were divided into the TICL group (TICL implantation) and the LRI group (LRI combined with ICL implantation). The uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (recorded as the logarithm of the minimum resolution angle), refractive power, corneal and anterior chamber conditions, surgically induced astigmatism, and target-induced astigmatism before and 1 and 3 months after surgery were observed. The correction index, efficiency index, and safety index were calculated, and predictability was observed. Statistical analysis was conducted using the independent sample t-test, Mann Whitney U test, and linear regression equation. Results: Twenty patients (20 right eyes) were included in the TICL group, and 17 patients (17 right eyes) were included in the LRI group. There was no statistically significant difference in preoperative visual acuity, refractive error, corneal astigmatism, corneal and anterior chamber conditions between the two groups (all P>0.05). At 1 and 3 months postoperatively, the UDVA of the TICL group [-0.10 (-0.10, 0.00), 0.00(-0.08, 0.00)] showed statistically significant differences compared to the preoperative value [1.30 (1.11, 1.49)] (both P<0.05). The postoperative UDVA in the LRI group [-0.10 (-0.10, 0.00), -0.08 (-0.08, -0.04)] also showed statistically significant differences compared to the preoperative value [1.30 (1.22, 1.46)] (both P<0.05). The difference in UDVA between the LRI group and the TICL group at 3 months postoperatively was statistically significant (P<0.05). The corneal astigmatism degree in the LRI group at 3 months postoperatively [(-0.87±0.47) D] was significantly different from that before surgery [(-1.32±0.91) D] (P<0.05). There was no statistically significant difference in the safety index (1.17±0.17 and 1.16±0.14) and efficacy index (1.12±0.18 and 1.18±0.16) between the two groups at 3 months postoperatively (both P>0.05). The achieved correction of refractive power of all operated eyes in both groups was within ±0.50 D of the attempted correction of refractive power at 3 months. There was no statistically significant difference in surgically induced astigmatism and target-induced astigmatism between the two groups (both P>0.05), and the correction index of both groups was slightly greater than 1. There were no complications during or aft

Objective: To evaluate the accuracy of the Barrett Universal Ⅱ, Haigis, and SRK/T formulas for intraocular lens (IOL) power calculation in cataract patients with axial length >28 mm undergoing phacoemulsification combined with capsular tension ring implantation. Methods: A retrospective case series study was conducted. Data from 26 eyes (26 patients) with cataract (axial length>28 mm), treated at the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, from January to October 2023 were analyzed. Patients had a median age of 59 years (interquartile range: 51-63), with 14 males and 12 females. All patients underwent biometric measurements using the IOL Master, had uneventful surgeries without intraoperative or postoperative complications, and completed objective refraction at 1 month postoperatively. Primary outcomes included mean prediction error (MPE), mean absolute error (MAE), and the percentage of eyes with prediction errors within ±0.25 D,±0.50 D, and ±1.00 D. Inter-group comparisons were performed using the one-way ANOVA with Bonferroni correction, and categorical data were analyzed using the Chi-square test. Results: The Barrett Universal Ⅱ formula yielded the smallest MPE of (-0.08±0.28) D, compared to (0.35±0.43) D for Haigis and (0.31±0.47) D for SRK/T. The MAE was lowest with Barrett Universal Ⅱ (0.22 D), significantly lower than Haigis (0.43 D) and SRK/T (0.45 D) (P<0.05). Within the ±0.25 D prediction error range, Barrett Universal Ⅱ achieved 19/26 eyes (73.08%), significantly higher than Haigis (10/26, 38.46%) and SRK/T (8/26, 30.77%) (P<0.05). For the ±0.50 D range, Barrett Universal Ⅱ included 24/26 eyes (92.31%), surpassing Haigis (17/26, 65.38%) and SRK/T (16/26, 61.54%) (P<0.05). Within ±1.00 D, Barrett Universal Ⅱ achieved 26/26 eyes (100%), compared to Haigis (25/26, 96.15%) and SRK/T (24/26, 92.31%). Conclusions: In cataract patients with axial length >28 mm and capsular tension ring implantation, the Barrett Universal Ⅱ formula is recommended for its superior accuracy in IOL power calculation, with an MPE closer to zero, lower MAE, and significantly higher percentages of eyes within ±0.25 D and ±0.50 D prediction error ranges compared to Haigis and SRK/T.

Objective: To investigate the consistency between automatic corneal marking using a surgical navigation system and manual corneal marking assisted by a slit-lamp microscope. Methods: This was a retrospective case series study. Patient data from the Ophthalmology Outpatient Department of Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, from June 2021 to July 2023 were continuously collected. All patients underwent manual corneal marking assisted by a slit-lamp microscope, followed by automatic marking using a surgical navigation system. Patients were divided into two groups: the manual marking group and the automatic marking group. The manual marking group was further divided into three subgroups based on the marking measurement methods: manual marking (upper to lower edge), manual marking (lower to upper edge), and manual marking (midpoint). The horizontal meridian angle and the deviation of the central axis were calculated for the four marking methods using the image processing software. Statistical differences among the measurement methods were compared, and the consistency was evaluated using the Bland-Altman plots and intraclass correlation coefficient (ICC). Results: A total of 143 cataract patients (201 eyes) were included in the study, with an average age of (60.27±19.13) years, including 58 males and 85 females. The absolute mean deviations of the horizontal meridian angle for manual marking (upper to lower edge), manual marking (lower to upper edge), manual marking (midpoint), and automatic marking were 3.61°, 4.76°, 3.20°, and 2.45°, respectively, with statistically significant differences among them (P<0.001). The differences between automatic marking and the three manual marking methods were also statistically significant (P<0.05). The mean deviations of the central axis were 2.35, 2.35, 2.24, and 0.40 mm, respectively, with statistically significant differences among them (P<0.001). The deviation of the automatic marking method was significantly lower than that of the manual marking methods (P<0.001), while no significant difference was observed between the three edge-based manual marking methods (P>0.05). The ICC for the horizontal meridian angle between manual marking (midpoint) and automatic marking was 0.88, while the ICC for the central axis deviation was -0.04, indicating good consistency in the horizontal meridian angle between manual marking (midpoint) and automatic marking, but poor consistency in the central axis deviation. Conclusions: The horizontal meridian angle values of automatic corneal marking using a surgical navigation system and manual corneal marking (midpoint) assisted by a slit-lamp microscope showed good consistency. However, digital navigation automatic marking demonstrated significantly better control in the centralization of the radial offset, providing a robust basis for accurate axis positioning during

Objective: To screen and validate key proteins involved in the progression of meibomian gland carcinoma (MGC) influenced by thrombospondin 1 (THBS1) overexpression through proteomic analysis. Methods: It was an experimental study conducted from February 2023 to June 2024. After lentiviral transfection, MGC cells were divided into the THBS1 overexpression group and the control group. Proteins were extracted from both groups for 4D label-free quantitative proteomic analysis. Functional annotation of differentially expressed proteins (DEPs) and their regulated signaling pathways was performed via Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. Real-time quantitative polymerase chain reaction (RT-qPCR) and Western blotting were used to validate the mRNA and protein expression levels of the top 5 DEPs. Results: Following successful THBS1 gene overexpression in MGC cells, 666 proteins were screened based on the criteria of |log₂(fold change)|>1.5 and P<0.05. GO analysis showed that DEPs were mainly localized in the cytosolic matrix and exosomes (cellular component), involved in RNA binding and cadherin binding (molecular function), and associated with translation and intracellular protein transport (biological process). KEGG pathway analysis indicated significant enrichment in DNA replication and cell cycle pathways. RT-qPCR results showed mRNA expression levels of asparagine-linked glycosylation 1 homolog (ALG1), AP2-associated protein kinase 1 (AAK1), Aladin WD repeat nucleoporin (AAAS), SUMO-specific peptidase 3 (SENP3), and Serrate RNA effector molecule homolog (SRRT) in the THBS1 overexpression group were 0.48±0.05, 0.83±0.04, 0.90±0.01, 0.73±0.06, and 0.92±0.02, respectively, significantly lower than those in the control group (1.00±0.03, 1.00±0.01, 1.00±0.03, 1.00±0.03, and 1.00±0.02; all P<0.05). Western blotting confirmed protein expression levels of ALG1, AAK1, AAAS, SENP3, and SRRT in the THBS1 overexpression group were 0.53±0.04, 0.86±0.04, 0.40±0.11, 0.59±0.01, and 0.63±0.05, respectively, significantly reduced compared with the control group (1.00±0.01, 1.00±0.03, 1.00±0.19, 1.00±0.14, and 1.00±0.01; all P<0.05). Conclusion: Among the key proteins regulated by THBS1 overexpression in the MGC progression, the top 5 DEPs were ALG1, AAK1, AAAS, SENP3, and SRRT.

Objective: To investigate the clinical characteristics of abnormal vascular changes in the fundus of pediatric patients with congenital X-linked retinoschisis (XLRS). Methods: This retrospective case series study included pediatric patients (age≤18 years) diagnosed with XLRS at Beijing Tongren Hospital, Capital Medical University between December 2017 and November 2024. All eyes underwent wide-angle fundus photography with some patients additionally receiving fundus fluorescein angiography (FFA). The prevalence and patterns of vascular abnormalities were analyzed, along with their correlations with clinical outcomes. Statistical analyses employed Fisher's exact test, χ² test, or Mann-Whitney U test. Results: A total of 112 pediatric cases (218 eyes) were included, consisting of 110 right eyes and 108 left eyes. All patients were male, with a median age of 5.00 (4.00, 6.75) years (range: 9 months to 17 years). Abnormal vascular changes were detected in 139 eyes (63.8%) on fundus photography, including vascular sheathing (35.8%, 78/218), tortuosity (32.6%, 71/218), bridging vessels (29.4%, 64/218), exudation (9.2%, 20/218), and neovascularization (3.2%, 7/218). Among 85 FFA-evaluated eyes (44 patients), 96.5% (82/85) exhibited abnormalities, including nonperfusion areas (96.5%, 82/85), extra-macular leakage (94.1%, 80/85), and neovascularization (15.3%, 13/85). Vascular anomalies were observed in both schitic and non-schitic peripheral retina in 78.8% (67/85) of eyes, exclusively in schitic areas in 17.6% (15/85), and in non-schitic regions in 1.2% (1/85). One eye with exudative retinal detachment secondary to massive subretinal exudation achieved complete resolution following anti-VEGF therapy. Eyes with abnormal vascular changes demonstrated significantly higher rates of peripheral retinoschisis (100% vs. 58.2%), vitreous hemorrhage (33.1% vs. 7.6%), retinal detachment (24.5% vs. 6.3%) and tractional retinal detachment (20.1% vs. 2.5%) compared to unaffected eyes (all P<0.05). Worse median visual acuity was observed in eyes with peripheral retinoschisis [0.96 (0.70, 1.30) vs. 0.52 (0.46, 0.75)], vitreous hemorrhage [1.00 (0.70, 1.30) vs. 0.70 (0.52, 1.00)], retinal detachment [1.30 (1.00, 1.92) vs. 0.70 (0.52, 1.00)], abnormal vascular changes [1.00 (0.70, 1.30) vs. 0.70(0.52, 0.98)], vascular sheathing [1.00(0.70, 1.30) vs. 0.70(0.52, 1.00)], tortuous vessels [1.00 (0.70, 1.30) vs. 0.70 (0.52, 1.00)] compared to unaffected eyes (all P<0.05). Conclusions: Pediatric XLRS patients exhibit diverse fundus vascular abnormalities, predominantly vascular sheathing, tortuosity, and bridging vessels. Eyes with vascular abnormalities demonstrate significantly higher complication rates and worse visual acuity.