In the face of the high prevalence of fundus diseases and the insufficient grassroots diagnostic resources, artificial intelligence (AI) is bringing transformative changes to the three-tiered diagnostic screening system. AI-based fundus imaging screening leverages automated analysis techniques to enhance the efficiency and accuracy of grassroots screening. Remote image interpretation, powered by AI, breaks geographical barriers and facilitates the sharing of medical resources. Additionally, the AI-assisted referral mechanism optimizes patient triage through intelligent assessment. These three components synergistically construct an intelligent diagnostic and treatment loop, offering new pathways to improve the prevention and treatment of fundus diseases and promote the implementation of tiered medical care. However, it is important to note that AI technology still faces challenges in clinical validation and data security, which urgently need to explore solutions.

The aim of this study is to evaluate the efficacy and safety of VSL scleral lenses in the treatment of irregular astigmatism.

A total of 10 patients (11 eyes) with corneal irregular astigmatism who underwent VSL scleral lens fitting at Peking University Third Hospital from January to December 2024 were included. There were 5 males (5 eyes) and 5 females (6 eyes) with an mean age (22.4±13.9) years (ranging from 6 to 44 years). The VSL scleral lenses were customized by optometrists based on patients′ ocular conditions, with parameters determined by corneal topography, anterior segment optical coherence tomography (AS-OCT), and slit-lamp examination to ensure lens fitting properly. Baseline measurements were recorded after a 2-hour trial period confirmed efficacy and absence of discomfort. Follow-up visits were conducted at 1 week, 1 month, and every 3 months thereafter. The best-corrected visual acuity (BCVA) using a standard logarithmic acuity chart, intraocular pressure measurements, anterior segment photography, AS-OCT, corneal topography, patient-reported comfort, ocular symptoms, and daily artificial tear usage were evaluated. The gender, age, ocular history, lens parameters, objective metrics, and subjective feedback were collected. Visual acuity, intraocular pressure, refractive error, BCVA, and complications were analyzed using frequency and percentage distributions.

The mean follow-up duration of all patients (11 eyes) was (7±2.8) months. The indications for scleral lens fitting included irregular astigmatism after corneal transplantation (4 patients, 4 eyes) and keratoconus (8 patients, 9 eyes), accounting for 36% and 82%, respectively. In keratoconus patients, the mean of K1 values was (45.5±4.8)D (ranging from 39.7 to 57.8 D); the mean of K2 was (50.6±5.9)D (ranging from 46.1 to 67.5 D; and the mean of thinnest corneal thickness was (488.3±72.6)μm (ranging from 301 to 584 μm). The mean of daily wear duration was (10.2±2.5)hours (ranging from 6 to14 hours). During follow-up, the best BCVA achieved with scleral lenses ranged from 0 to 0.3 logarithm of the minimum angle of resolution (logMAR), with a mean value of (0.06±0.11) logMAR and a mean improvement of (0.52±0.39) logMAR. After scleral lens fitting, 8 patients (9 eyes) reported significant subjective visual improvement, and 3 patients (3 eyes) showed reduced artificial tear usage, accounting for 81.8% and 27.3%, respectively. Three pediatric patients (3 eyes) exhibited enhanced visual acuity and comfort during amblyopia training with scleral lenses. The mean comfort score was (8.7±1.49) scores, with 5 patients (5 eyes) rating maximum comfort, accouting for 45.5%. No adverse events were observed.

The VSL scleral lenses significantly improved BCVA, alleviated ocular discomfort, and demonstrated favorable wearing comfort and high safety in patients with corneal irregular astigmatism. The VSL scleral lenses may enhance amblyopia training efficacy in children with corneal irregularities.

The aim of this study is to explore the changes in retinal vascular fractal dimension in patients with glaucoma and stroke.

From April 2020 to October 2020, 95 patients (95 eyes) with glaucoma who were treated at Beijing Tongren Hospital affiliated to Capital Medical University, 97 patients (97 eyes) with stroke who were diagnosed in the Neurology Department of Beijing Tongren Hospital, 100 healthy subjects (100 eyes) were recruited in the same period. Among them, there were 51 male patients (51 eyes) and 44 female patients (44 eyes) with an average age of (55.6±7.8) years (ranging from 46 to 69 years) in the glaucoma group; 63 male patients (63 eyes) and 34 female patients (34 eyes) with an average age of (64.7±5.6) years (ranging 58 to 73 years) in the stroke group; 50 male cases (50 eyes) and 50 female cases (50 eyes) with an average age of (52.4±6.4) years (ranging from 40 to 60 years) in the control group. All subjects underwent routine ophthalmic examinations, fundus photography, visual field and optical coherence tomography examinations, and computer-aided image analysis and measurements of retinal vessel diameter width, vessel curvature, and vessel fractal dimension were applied. The measurement values of retinal nerve fiber layer (RNFL) thickness and retinal vascular parameters were tested using Kolmogorov Smirnov method to conform normal distribution, expressed as ±s, and compared between multiple groups using one-way analysis of variance. When the differences were statistically significant, LSD was further used for comparison between two groups. The relationship between retinal vascular parameters and RNFL thickness was analyzed using Pearson correlation analysis.

The average RNFL thickness in the glaucoma group, stroke group, and control group was (75.3±12.6) μm, (89.5±8.7) μm, and (103.6±6.2) μm, respectively, with statistically significant differences (F=148.516, P<0.05). The average RNFL thickness around the disc decreased in glaucoma group and stroke group, there was statistically significant difference between the glaucoma group and the stroke group compared to the control group (t=-4.362, -3.216; P<0.05). The arterial to venous width ratio in Zone B+ C, arterial to venous width ratio in Zone B, 6 larger arterial widths located in Zone B+ C, 6 larger arterial widths located in Zone B, 6 larger venous widths located in Zone B+ C, 6 larger venous widths located in Zone B, all vessel simple bending, all vessel curvature bending, arterial simple bending, arterial curvature bending, venous simple bending, venous curvature bending, all vessel fractal dimension, arterial fractal dimension, and venous fractal dimension were 0.552±0.216, 0.530±0.137, (8.491±2.039) pixels, (8.804±2.136) pixels, respectively, for the control group, glaucoma group, and stroke group (15.959±2.138) pixels, (15.934±2.962) pixels, 1.057±0.984, 0.033±0.002, 1.083±0.169, 0.027±0.026, 1.069±0.187, 0.042±0.006, 1.527±0.148, 1.295±0.065, 1.344±0.058, 0.558±0.111, 0.567±0.104, (8.852±1.931) pixels, (8.923±1.872) pixels, (16.015±2.787) pixels, (15.891±2.921) pixels, 1.069±0.251, 0.003±0.001 1.044±0.021, 0.003±0.001, 1.068±0.041, 0.044±0.002, 1.529±0.032, 1.286±0.051, 1.342±0.049, 0.609±0.108, 0.774±0.143, (10.082±2.151) pixels, (10.417±2.223) pixels, (16.548±2.885) pixels, (16.739±2.768) pixels, 1.221±1.378, 0.331±0.024, 1.262±1.605, 0.029±0.015, 1.082±0.209, 1.932±0.137 1.544±0.156, 1.331±0.039, and 1.367±0.035, showed statistically significant differences (F=108.973, 117.136, 104.762, 119.531, 113.538, 121.539, 119.968, 134.472, 125.162, 104.167, 76.106, 136.262, 109.421, 116.632, 43.279; P<0.05). Compared between the glaucoma group and the control group, vascular parameters of retinal arteriovenous width ratio (Zone B+ C), arterial width in Zone B+ C, arterial width in Zone B, retinal vein width in Zone B+ C, retinal vein width in Zone B, simple bending of all retinal blood vessels, curvature bending of all retinal blood vessels, simple bending of retinal arteries, curvature bending of retinal veins, fractal dimension of retinal blood vessels, and fractal dimension of retinal arteries, had shown that the differences were statistically significant (t=-3.326, -3.761, -3.964, -2.237, -2.453, -2.447, -3.895, -2.963, -3.871, -2.037, -2.363; P<0.05). The fractal dimension of retinal blood vessels in glaucoma patients was positively correlated with the thickness of RNFL around the disc, and the correlation was statistically significant (r=0.783, P<0.05). Compared between the stroke group and the control group, vascular parameters of retinal arteriovenous width ratio (Zone B+ C), arterial width in Zone B+ C, arterial width in Zone B, retinal vein width in Zone B+ C, retinal vein width in Zone B, simple bending of all retinal blood vessels, curvature bending of all retinal blood vessels, simple bending of retinal arteries, curvature bending of retinal veins, fractal dimension of retinal blood vessels, and fractal dimension of retinal arteries, had shown that the differences were statistically significant (t=-2.741, -3.153, -2.930, -2.041, -2.726, -2.323, -3.881, -3.267, -2.965, -2.024, -2.473; P<0.05). The fractal dimension of retinal blood vessels in stroke patients was positively correlated with the thickness of RNFL around the disc, and the correlation is statistically significant (r=0.645, P<0.05). The lower the fractal dimensionality of retinal vascular analysis in stroke patients, the lower the average RNFL thickness.

Patients with glaucoma and patients with stroke have narrower retinal vessel diameter, decreased retianl vascular bending, and decreased retinal vascular fractal dimension. The parameters of retinal vascular in stroke patients show a trend similar to glaucoma patients. The fractal dimension of retinal vascular in glaucoma is correlated with the severity of glaucoma, lower retinal vascular fractal dimension and RNFL thickness are associated with stroke.

The aim of this study is to investigate the therapeutic efficacy of 0.05% cyclosporine A (CsA) eye drops in diabetes-associated dry eye disease.

A total of 60 patients (60 eyes) with moderate-to-severe dry eye associated with type 2 diabetes who visited the Ophthalmology Clinic of Peking University Third Hospital between October 2021 and August 2023 were selected. They were divided into a control group and an experimental group using a random number table, with 30 patients (30 eyes) in each group. Among them, there were 19 males (19 eyes) and 41 females (41 eyes) with a mean age of (65.5±8.7) years (ranging from 53 to 79 years). The control group received 0.1% sodium hyaluronate eye drops three times daily, while the experimental group received 0.1% sodium hyaluronate eye drops three times daily combined with 0.05% CsA eye drops twice daily. Before treatment, as well as at 1 month and 3 months after treatment, patients underwent slit-lamp examination, tear film breakup time (BUT) measurement, corneal fluorescein staining (CFS) scoring, lissamine green (LG) staining scoring, corneal sensitivity testing, Schirmer′s test Ⅰ (SⅠt), ocular surface disease index (OSDI) questionnaire assessment, and tear inflammatory factor testing. Age, OSDI scores, and SⅠt were expressed as ±s. Comparisons before and after treatment were performed using paired t-test, for intergroup were conducted using independent samples t-test, and within-group and between-group comparisons were analyzed using two-way ANOVA. BUT, CFS scores, mean corneal sensitivity, and LG scores were expressed as median M(Q1, Q3). Comparisons before and after treatment and between groups were performed using rank-sum tests, while within-group and between-group differences were assessed using the Scheirer-Ray-Hare test.

In the experimental group, OSDI scores, BUT, CFS scores, SⅠt, mean corneal sensitivity, and LG scores before treatment, after treatment for 1 month, 3 months were as follows: (35.05±12.45)points, 4.00(2.00, 6.50) s, 0.50(0.00, 3.75)points, (13.70±8.56) mm, 5.45(5.20, 5.80)points, 0.00(0.00, 2.00)points, (26.06±10.87)points, 4.00(3.00, 5.50) s, 1.00(0.00, 3.25)points, (14.03±9.00) mm, 6.00(5.60, 6.00)points, 0.00(0.00, 2.00)points, (10.98±10.61)points, 6.50(4.00, 9.00)s, 0.0(0.00, 2.25)points, (13.61±7.32) mm, 6.00(5.90, 6.00)points, 0.00(0.00, 1.00)points, respectively. In the control group, the corresponding values were (31.43±11.11)points, 3.00(2.75, 6.00)s, 1.00(0.00, 3.00)points, (12.30±7.87) mm, 5.75(5.38, 6.00)points, 0.00(0.00, 2.00)points, (31.33±14.64)points, 3.00(2.00, 7.00)s, 1.00(0.00, 3.00)points, (12.23±8.40) mm, 5.75(5.20, 6.00)points, 0.00(0.00, 1.00)points, and (12.97±13.69)points, 4.00(3.00, 6.25) s, 0.00(0.00, 3.00)points, (11.40±7.97) mm, 6.00(5.80, 6.00)points, 0.00(0.00, 2.00)points, respectively. Two-way ANOVA revealed statistically significant differences in OSDI scores within groups across timepoints (F=63.45, P<0.05), but no significant differences between groups or in interaction effects (F=0.20, 2.59; P>0.05). There were significant differences within groups and in interaction effects in BUT (H= 6.92, 4.09; P<0.05), but not between groups (H= 1.36, P>0.05). No significant differences were found in CFS scores, SⅠt, mean corneal sensitivity, or LG scores between groups, within groups, or in interaction effects (H= 0.04, 1.96, 2.60, 2.05, 0.10, 0.22, 1.85, 1.19, 1.70, 0.16, 0.52, 2.12; P>0.05). After treatment for 1 month, there was no significant difference in BUT between the two groups (Z=0.68, P>0.05). However, after treatment for 3 months, the difference in BUT between the two groups was statistically significant (Z=2.19, P<0.05).

0.05% CsA eye drops can improve clinical symptoms, enhance tear film stability, and promote tear secretion repair in diabetes-associated dry eye. The mechanism may be related to reducing ocular surface inflammation, and long-term treatment can enhance therapeutic efficacy.

The aim of this study is to investigate the effect of extracellular vesicles isolated from T regulatory cells (rEXS) on the inner blood-retinal barrier (IBRB).

BV2 microglial cells were divided into five groups: control (no LPS or rEXS), LPS-stimulated (100 ng/ml LPS), and three rEXS-treated groups (10 μg/ml, 20 μg/ml, and 50 μg/ml rEXS+ 100 ng/ml LPS). A co-culture system of BV2 cells and human umbilical vein endothelial cell (HUVEC) was used to simulate retinal vessels, with groups divided as follows: HUVEC control (no BV2), co-culture (BV2+ HUVEC), co-culture stimulated (BV2+ HUVEC+ 100 ng/ml LPS), and co-culture exosome (BV2+ HUVEC+ 50 μg/ml rEXS). ELISA was used to measure interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and IL-10 levels, while Western blot analyzed zona occludens (ZO)-1 and occludin expression. Data were expressed as ±s and compared by one-way ANOVA and LSD post-hoc test.

Nanoparticle tracking analysis showed that rEXS had a characteristic size range of 50 to 155 nm, with a peak at 106 nm and 155 nm. The rEXS concentration was 4.74×10¹⁰particles/ml. Specific markers were detected in rEXS. Transmission electron microscopy confirmed rEXS particles were approximately 100 nm in diameter. The TNF-αconcentrations in the control group, LPS-stimulated group, 10 μg/ml rEXS groups, 20 μg/ml rEXS groups, 50 μg/ml rEXS groups were (1035.96±32.36)pg/ml, (2965.25±4.08)pg/ml, (2960.41±35.65)pg/ml, (2863.32±30.55)pg/ml, (2586.32±33.25)pg/ml; IL-1βwere (2.60±0.05)pg/ml, (17.18±0.13)pg/ml, (10.98±0.06)pg/ml, (6.39±0.04)pg/ml, (4.05±0.06)pg/ml; IL-10 were (28.24±2.66)pg/ml, (24.55±0.77)pg/ml, (33.96±3.58)pg/ml, (34.29±4.32)pg/ml, and (48.32±1.55)pg/ml, respectively. There were significant differences between them (F=23.01, 1.96, 29.53; P<0.05). In the co-culture system, compared with relative control group, the ZO-1 expression levels in the co-culture group, co-culture stimulated group, co-culture exosome group were (1.28±0.010), (0.8±0.02), and (1.23±0.01); occludin were (1.37±0.04), (0.81±0.02), (1.18±0.03), respectively. There were significant differences between them (F=808.3, 222.2; P<0.05).

The results of the present study revealed that rEXS may have a protective effect on the IBRB by inhibiting the release of TNF-α and IL-1β cytokines, promoting IL-10-mediated anti-inflammatory effects, and alleviating LPS-induced tight junction disruption.

To explore the distribution characteristics and influencing factors of spring immune conjunctivitis patients in Beijing.

13 086 patients with spring immune conjunctivitis who visited the emergency department of Chongwenmen Branch of Beijing Tongren Hospital in March each year from 2021 to 2025 were selected as the research subjects. Among them, there were 6223 males and 6863 females with a median age of 34 (14, 43) years old (ranging from 2 to 90 years old). Patients were divided into three groups based on their age: underage group, young group, middle-aged group, and elderly group. The daily number, age, gender, diagnosis, and medication treatment information of patients with this disease in the Donghua Digital Hospital Information Management System were retrieve and recorded. The pollen concentration, maximum temperature, wind force level, and rainfall or sleet weather monitoring data of the Beijing Meteorological Bureau for the day were reviewed and recorded. The number of patients did not follow a normal distribution according to the Kolmogorov Smirnov test, and was represented by median and interquartile range, and 90% percentile M (Q1, Q3, 90%). The pollen concentration and maximum temperature follow a normal distribution, was represented by ±s. The correlation between the number of patients and pollen concentration, maximum temperature, wind intensity, and rainfall or sleet weather, and draw a logarithmic line graph was evaluated by Spearman correlation coefficient. Single factor generalized linear regression was used to analyze the correlation between the number of patients and climate factors such as pollen concentration, maximum temperature, wind intensity, and rainfall or sleet weather. Further, the variables selected from single factor screening were included in the multi factor generalized linear regression analysis to control for confounding factors and explore the correlation between each factor and the number of patients in depth.

Among all 13 086 patients with spring immune conjunctivitis, there were 3951, 6463, 2187, and 485 patients in the underage group, young group, middle-aged group, and elderly group, respectively, accounting for 30.2%, 49.4%, 16.7%, and 3.7%, respectively. There were 6223 males and 6863 females, accounting for 47.6% and 52.4%, respectively. The number of patients in March 2021, March 2022, March 2023, March 2024, and March 2025 were 2551, 1886, 2180, 2901, and 3568, respectively, accounting for 19.5%, 14.4%, 16.6%, 22.2%, and 27.3%. The range of patient numbers was 3 to 449, 7 to 321, 4 to 208, 5 to 560, and 3 to 521, respectively. The number of patients in the 90^th percentile was 53 (20, 81 206), 35 (21, 60 212), 59 (41, 108 131), 46 (24, 128 173), and 79 (43, 140 308), respectively. The average pollen concentrations were (549.4±611.7) grains/1000 mm^2, (735.7±1175.7) grains/1000 mm^2, (818.7±847.6) grains/1000 mm^2, (835.7±1618.5) grains/1000 mm^2, and (1234.1±2202.6) grains/1000 mm^2, respectively. The average maximum temperatures are (13.9±5.2) ℃, (13.3±4.2) ℃, (16.7±4.5) ℃, (15.3±5.2) ℃, and (15.4±5.9) ℃, respectively. The daily wind speeds were 0 to 4, 1 to 3, 1 to 4, 0 to 4, and 1 to 4, respectively. The types of precipitation are light rain, light rain or sleet, light rain, light rain or sleet, and light rain or sleet. The Spearman correlation analysis results showed that the number of patients was significantly correlated, moderately correlated, moderately correlated, and weakly correlated with pollen concentration, maximum temperature, rainfall or sleet weather, and wind intensity, respectively, with statistical significance (r=0.734, 0.460, 0.452, 0.232; P<0.05). The results of single factor generalized linear regression analysis showed that the number of patients was affected by pollen concentration, maximum temperature, and rainfall or sleet weather, and the correlation analysis had statistical significance (β=0.047, 7.856, 94.316; 95%CI: 0.039 to 0.056, 5.021 to 10.691, 56.621 to 132.012; P<0.05). The number of patients was not affected by wind intensity, and the correlation was not statistically significant (β=14.440, P>0.05). The results of multiple generalized linear regression analysis showed that there was a statistically significant correlation between the number of patients and pollen concentration, maximum temperature, and rainfall or sleet weather (β=0.038, 3.564, 69.460; 95%CI: 0.029 to 0.047, 1.175 to 5.954, 40.754 to 98.166; P<0.05).

The epidemiological characteristics of spring immune conjunctivitis patients in Beijing are slightly higher in females than males. Mainly targeting minors and young people, with a small proportion occurring in middle-aged people, and occasional cases in the elderly population. The number of patients is affected by pollen concentration, maximum temperature, and rainfall or sleet weather, while the effect of wind is not significant.

In recent years, with the advancement of aesthetic concepts and the increasing demand for beauty, aesthetic surgeries related to the eyes have gradually become a popular and emerging topic. Double eyelid surgery, the application of beauty products, and injectable aesthetics are the primary methods of eye-related aesthetic surgeries. Common complications of double eyelid surgery include asymmetry of the double eyelids, disappearance of the double eyelids, hematoma, infection, ptosis, dry eye, and keratitis related to buried sutures. Complications caused by beauty products include infectious ocular surface diseases, immune-related ocular surface diseases, hypopigmentation of the eyelids due to melanocyte reduction, and uveitis. Complications of injectable aesthetics include retinal artery occlusion, tissue edema, characteristic bluish-gray changes in the eyelid injection area, delayed nodules, periorbital swelling, and ptosis. Currently, the research on the pathogenesis of various complications in eye-related aesthetic surgeries is not yet fully understood, and there is room for improvement in their prevention and treatment measures. The methods of eye-related aesthetic surgeries require further development in material selection, surgical innovation, and optimization studies. Additionally, there is a need for the early establishment of expert consensus and standards regarding the techniques of double eyelid surgery, the use of beauty products, and injectable aesthetics. In this paper, the principles of these aesthetic methods and the pathogenesis, treatment methods, and preventive measures for their associated ocular complications was reviewed.

Diabetic retinopathy (DR) is the main cause of visual impairment in working-age adults, with a complex pathogenesis involving structural damage and functional impairment of the retinal neurovascular unit (RNVU). Neurotrophic factor (NTF), as important molecules regulating neuronal survival, differentiation and vascular stability, has shown potential therapeutic value in the neurovascular protection of DR in recent years. The principal pathological alterations of the RNVU associated with DR was delineated, the protective roles and mechanisms of NTFs against RNVU injury, and the advancements in research concerning NTFs in mitigating hyperglycemia-induced RNVU damage alongside their prospective clinical applications were elucidated and emphasized, aiming to provide a theoretical basis for further experimental research and clinical treatment in this paper.

Chemical warfare has always been a potential threat to war or armed conflict. Chemical warfare agents act on the whole body or specific organs, causing irreversible damage and corresponding acute or chronic ocular manifestations. The Centers for Disease Control and Prevention in the United States classifies chemical agents into 10 categories: corrosive agents, nerve agents, asphyxiating agents, corrosives, blood agents, disabling agents, metal agents, riot control agents, toxic alcohol, and biotoxins. Corrosive toxins include mustard gas, Louis gas, and phosgene oxime; asphyxiant toxins include phosgene and chloropicrin. The irritation to the ocular surface could be caused after exposure to erosive toxins, and in severe cases, for corneal opacity, corneal ulcers, and corneal edema; the pupil constriction, blurred vision, and increased tear secretion after exposure to nerve agents; the tearing, conjunctival congestion, blepharospasm, photophobia, conjunctivitis, and periorbital edema after exposure to riot control agents. After exposure to chemical warfare agents, emergency treatment mainly involves leaving the toxic environment, and the main treatment methods include detoxification treatment, local eye drops, and ocular surface reconstruction. The ocular manifestations and treatment strategies of chemical warfare agents was reviewed in this paper.

Diabetic macular edema (DME), a severe complication of diabetic retinopathy, exhibits an increasing occurrence rate in parallel with the rising prevalence of diabetes mellitus. It has emerged as a leading cause of vision loss, imposing substantial economic burdens on society and families. It has demonstrated that the conventional treatments, such as intravitreal anti-vascular endothelial growth factor (VEGF) injections and laser photocoagulation, had limited efficacy in certain refractory patient populations. In recent years, significant advancements have been achieved in both mechanistic studies and clinical management of DME: novel anti-VEGF agents featuring dual-target inhibition exhibit superior efficacy in improving retinal morphology with longer intervals of injection and lower complications. Corticosteroid therapy offers a viable alternative for refractory cases, though clinicians must remain vigilant against complications such as elevated intraocular pressure and cataract formation. Combination therapies, integrating anti-VEGF agents with dexamethasone, laser photocoagulation, or adjunctive medications, reduce injection frequency and exert synergistic therapeutic effects. Vitrectomy with internal limiting membrane peeling remains controversial regarding anatomical improvement in refractory DME; however, it holds potential in alleviating mechanical traction and clearing inflammatory mediators. Further refinement via subretinal injection techniques may enhance the clearance of hard exudates. Emerging technologies, including artificial intelligence assisted prediction of anti-VEGF response and gene therapy, present promising avenues for personalized treatment and sustained intervention. Despite these advances, the pathophysiology of DME remains incompletely elucidated. Future research should prioritize the development of long-acting therapeutics, precision medicine strategies, and multicenter clinical validation to optimize visual outcomes for patients.