Since its clinical application, femtosecond laser assisted cataract surgery (FLACS) has received widespread attention due to its high precision and repeatability in key steps such as capsulotomy, nucleus fragmentation, and corneal incision. Compared to the conventional phacoemulsification surgery, FLACS has advantages in improving the safety, controllability, and visual outcome accuracy of complex cases, which is in line with the development direction of cataract surgery towards precision and refraction. However, it is still constrained in terms of cost-effectiveness, surgical efficiency, and promotion limitations. The technical principles and development status of FLACS were summarized, its application value in surgical energy control, corneal endothelial protection, and complex and special types of cataract surgery were analyzed, the previous research results on FLACS in visual and refractive outcomes, incidence of complications, and time efficiency were summarized, and conclusions that FLACS and traditional phacoemulsification surgery have similar final visual function outcomes in the conventional phacoemulsification surgery were made. However, FLACS has potential advantages in some complex cases and specific surgical procedures.

The aim of this study is to investigate the patterns of corneal epithelial remodeling and related influencing factors after topography-guided laser in situ keratomileusis (TOPO-G LASIK).

A total of 119 patients (237 eyes) based on TOPO-G LASIK from May 2021 to July 2024 were retrospectively included in Beijing Tongren Hospital, Capital Medical University. There were 28 males (56 eyes) and 91 females (181 eyes) with an average age of 27.9±4.7 years (ranging from 18 to 40 years old). Patients were divided into the high myopia group (≤-6.00 D) and the moderate-to-low myopia group (>-6.00 D) based on the manifest refractive spherical equivalent (MRSE). The epithelial thickness (ET) of 17 regions in total within the 6 mm corneal range, which included 1 central zone (0 to 2 mm), as well as the inner ring zone (2 to 5 mm) and the outer ring zone (5 to 6 mm), was measured by the anterior segment optical coherence tomography preoperatively and 1, 3, 6, 12 months postoperatively. The age, visual acuity, MRSE, corneal thickness and epithelial thickness were all normally distributed and described as ±s. Paired t-tests were used in both groups before and after surgery, and independent sample t-tests were used between the two groups at different time points. And a mixed-effects model was applied to further explore the specific factors affecting postoperative ET changes.

The MRSE, uncorrected distance visual acuity, best corrected distance visual acuity, and central corneal thickness were (-7.66±1.29) D, (1.35±0.28) logarithm of the minium angle of resolution (logMAR), (-0.04±0.05) logMAR, and (535.12±22.98) μm in the high myopic group and (-4.27±1.26) D, (1.08±0.39) logMAR, (-0.05±0.04) logMAR, and (529.63±29.76)μm in the moderate-to-low myopic group. The uncorrected distant visual acuity of the moderate-to-low myopia group was better than that of the high myopia group (t=0.79, P<0.05), while no statistical differences were in the best corrected distance visual acuity and central corneal thickness (t=0.21, 0.21; P>0.05) between the two groups. The central 2 mm average ET of the two groups at 1, 3, 6, 12 months postoperatively was (55.17±4.19)μm, (57.73±4.41)μm, (57.94±3.99)μm, (58.35±3.70)μm, (53.99±4.45)μm, (54.74±3.24)μm, (55.36±3.36)μm, (56.66±4.34)μm, respectively; and the inner 2 to 5 mm ring average ET was (58.79±3.90)μm, (61.08±3.89)μm, (61.11±3.48)μm, (61.78±3.27)μm, (56.23±4.43)μm, (56.93±2.84)μm, (57.52±3.31)μm, (58.56±4.29)μm, respectively; and the outer 5 to 6 mm ring average ET was (56.84±3.57)μm, (58.94±3.12)μm, (58.55±3.18)μm, (59.32±2.87)μm, and (55.68±4.19)μm, (56.29±2.73)μm, (56.76±2.92)μm, (57.19±3.98)μm, respectively. Both groups increased compared with those preoperatively, and the high myopic group showed significant increases in the average corneal ET in the central 2 mm (t=0.20, 0.38, 0.38, 0.27; P<0.05), the inner ring 2 to 5 mm zone (t=0.43, 0.62, 0.55, 0.53; P<0.05), and the outer ring 5 to 6 mm zone (t=0.27, 0.52, 0.58, 0.41; P<0.05) at 1, 3, 6, 12 months postoperatively compared with the moderate-to-low myopic group. The superotemporal, temporal, inferotemporal, and inferior ET of the 2 to 5 mm and 5 to 6 mm zones gradually increased over time, and the increase in the high myopic group was higher than that in the moderate-to-low myopic group. The results of the mixed-effects model analysis showed that the ablation depth and MRSE were negatively correlated with Δ2 mm ET (β=-1.27, -1.87; P<0.05); the follow-up time at 3, 6, 12 months postoperatively was positively correlated with Δ2 mm epithelium (β=1.72, 1.92, 2.70; P<0.05). The interaction effect of cutting depth and follow-up time was positively correlated with Δ2 mm ET. There was statistical significance at 3 months and 6 m (β=0.60, 0.73; P<0.05).

Corneal epithelial remodeling after TOPO-G LASIK was mainly concentrated in the inferotemporal, inferior, and temporal regions of the inner and outer ring zones. The ET increase in the high myopia group was higher than that in the moderate-to-low group at all postoperative times. However, epithelial remodeling continued in both groups within 1 year after surgery and had not reached a stable state. Preoperative MRSE was the main determinant of postoperative epithelial remodeling. Ablation depth could not function independently of time, which influenced central epithelial remodeling through a time-dependent interaction effect with a more significant impact in the mid-to-long term. Therefore, enhanced mid-to-long-term follow-up is required.

The aim of this study is to investigate the changes of quality of life in patients with acute acquired comitant esotropia (AACE) before and after injection of botulinum toxin type A, and to analyze the related influencing factors.

A total of 39 patients (78 eyes) with AACE who received botulinum toxin type A injection at Beijing Tongren Hospital, Capital Medical University from January 2022 to March 2024 were enrolled, including 19 males (38 eyes) and 20 females (40 eyes) with a mean age of (23.67±13.06) years (ranging from 8 to 56 years). All patients underwent strabismus degree examination, binocular visual function examination, and completed the Amblyopia and Strabismus Quality of Life Evaluation (ASQE) questionnaire before treatment, as well as at 1, 3 and 6 months after injection. Age, strabismus degree and quality of life scores were described as ±s; gender, binocular simultaneous vision, fusion function and distant stereoscopic vision were described by case number and percentage. Generalized estimating equation was used to compare the quality of life scores, strabismus degree and binocular visual function at different time points, and Bonferroni method was adopted for post-hoc pairwise comparison. Univariate and multivariate linear regression analyses were performed to explore the influencing factors for the improvement of patients′ quality of life.

The total ASQE scores of patients were 62.92±1.51, 83.47±1.99, 82.61±2.52 and 83.31±2.54 at preoperative time, 1 month, 3 months, and 6 months postoperatively, respectively. The scores for the dimension of concern regarding the better-seeing eye at each time point were 66.26±5.64, 96.68±2.50, 88.76±3.59 and 92.71±3.66, respectively. The scores for the distance estimation dimension were 72.78±1.92, 90.14±1.80, 90.19±1.83, and 88.91±1.95, respectively. The scores for the visual disorientation dimension were 70.69±4.24, 86.71±3.34, 85.90±3.68, and 89.63±2.99, respectively. The scores for the diplopia dimension were 43.60±2.01, 72.59±3.32, 68.61±3.29, and 68.97±3.76, respectively. The scores for the social interaction and external appearance dimension were 55.87±3.53, 71.28±3.37, 75.47±3.70, and 77.74±3.85, respectively. There were significant improvements in the total and all five dimensional scores at all postoperative time points compared with the preoperative baseline (Wald χ² = 66.83, 24.58, 51.74, 15.71, 66.33, 25.18; P<0.05). The distance strabismus angles were (21.46±0.98)^△, (0.32±0.67)^△, (3.76±0.76)^△ and (4.78±1.08)^△ at each time point, respectively. The distance strabismus angle was significantly decreased at all postoperative follow-up time points compared with baseline (Wald χ² = 202.21, P<0.05). The near strabismus angles were (19.68±1.06)^△, (-0.09±0.54)^△, (2.56±0.74)^△ and (3.57±1.03)^△ at each time point, respectively. The near strabismus angle was significantly decreased at all postoperative follow-up time points compared with baseline (Wald χ² = 188.61, P<0.05). The prevalence of distant stereopsis was 58.97%, 89.74%, 89.74% and 89.74% at each time point, respectively. The prevalence was significantly elevated at all postoperative time points compared with baseline (Wald χ² = 15.57, P<0.05). The near stereoacuity was (2.58±0.04)log″, (2.02±0.06)log″, (2.05±0.07)log″ and (2.06±0.07)log″ at each time point, respectively. Near stereoacuity was significantly improved at all postoperative time points compared with baseline (Wald χ² = 44.27, P<0.05). The improvement degree of quality of life was significantly correlated with lower baseline quality of life score (t=-6.32, P<0.05), lower strabismus degree at the final follow-up (t=-3.90, P<0.05), and better near stereoacuity at the final follow-up (t=-2.10, P<0.05). In addition, the improvement of quality of life in female patients was significantly lower than that in males (t=-2.52, P<0.05).

For patients with AACE, botulinum toxin type A injection can significantly reduce strabismus degree, improve stereoscopic visual function and quality of life. Female gender, higher baseline quality of life score, larger strabismus degree and poorer near stereoscopic visual function at final follow-up are independent risk factors for unsatisfactory improvement of quality of life.

The aim of this study is to investigate the intraoperative detection characteristics of occult peripheral retinal lesions and clinical treatment effects of pars plana vitrectomy (PPV) in patients with lens dislocation.

A total of 60 patients, 60 eyes, with lens dislocation who underwent surgical treatment in the Department of Ocular Trauma, Beijing Tongren Hospital Affiliated with Capital Medical University, from April 2024 to April 2025 were collected. Among them, 50 patients (50 eyes), were male and 10 patients (10 eyes), were female. The patients were 29 to 77 years old, with a mean age of 58.0±9.0 years. A 25 G transscleral three-port approach was established in all cases. According to the extent of lens dislocation, capsular support, and lens nucleus hardness, phacoemulsification combined with anterior vitrectomy or lensectomy combined with subtotal or complete vitrectomy was performed. Intraoperative 360° peripheral retinal examination with scleral indentation was performed in all eyes. Preoperative and postoperative uncorrected visual acuity, intraocular pressure, types of occult peripheral retinal lesions, and corresponding intraoperative management were recorded. For measurement data including age, uncorrected visual acuity and intraocular pressure, normality was assessed using the Shapiro-Wilk test. Normally distributed continuous variables were expressed as ±s, and preoperative and postoperative values were compared using the paired t-test. Categorical variables such as gender, lens dislocation cause, dislocation degree and presence of anterior chamber vitreous prolapse as well as detection status of intraoperative occult peripheral retinal lesions were expressed as cases (eyes) and percentages, and Pearson chi-square test was used for intergroup comparison. Univariate Logistic regression analysis was performed to identify factors associated with the detection of occult peripheral retinal lesions. Significant variables were incorporated into the multivariate binary Logistic regression model to screen independent risk factors for the occurrence of the lesions.

Among the 60 eyes, 14 cases (14 eyes), 23.3%, underwent phacoemulsification combined with anterior vitrectomy, and 46 cases (46 eyes), 76.7%, underwent lensectomy combined with subtotal or complete vitrectomy. Occult peripheral retinal lesions were detected in 32 cases (32 eyes), 53.3%, including retinal breaks in 7cases (7 eyes), 11.7%, peripheral retinal degeneration in 21 cases (21 eyes), 35.0%, ora serrata dialysis in 2 cases (2 eyes), 3.3%, and localized shallow retinal detachment in 2 cases (2 eyes), 3.3%. Intraoperative retinal photocoagulation was performed in 44 cases (44 eyes), 73.3%, and intravitreal air tamponade was performed in 8 cases (8 eyes), 13.3%. In-the-bag intraocular lens implantation combined with capsular tension ring implantation was performed in 14 cases (14 eyes), 23.3%; intrascleral intraocular lens fixation was performed in 35 cases (35 eyes), 58.3%; ciliary sulcus suture fixation was performed in 8 cases (8 eyes), 13.3%; and 3 cases (3 eyes), 5.0%, were left aphakic. The preoperative uncorrected visual acuity was (1.55±0.54) logMAR, and the postoperative uncorrected visual acuity was (0.87±0.73) logMAR. The difference was statistically significant (t=7.215, P<0.05). The preoperative intraocular pressure was (17.6±6.8) mmHg (1 mmHg=0.133 kPa), and the postoperative intraocular pressure was (13.8±3.9) mmHg. The difference was statistically significant (t=5.102, P<0.05). Multivariate binary Logistic regression analysis showed that age ≥60 years, traumatic lens dislocation and complete lens dislocation were independent risk factors for occult peripheral retinal lesions (OR=3.197, 4.158, 3.334, 95%CI: 1.001 to 10.212, 1.182 to 14.617, 1.005 to 11.067; P<0.05).

A relatively high proportion of occult peripheral retinal lesions can be detected intraoperatively in patients with lens dislocation, suggesting that routine preoperative examination may underestimate posterior segment risk. Intraoperative 360° peripheral retinal examination should be emphasized, particularly in older patients and those with traumatic lens dislocation, complete lens dislocation, or limited preoperative fundus visualization. Systematic intraoperative exploration with scleral indentation can facilitate timely detection and management of retinal breaks, ora serrata dialysis, localized shallow retinal detachment, and high-risk peripheral retinal degeneration, and may help reduce the risk of postoperative retinal complications.

The aim of this study is to investigate the structural characteristics of gut microbiota in patients with primary moderate-to-severe dry eye disease (DED) and analyze their correlation with ocular surface functional parameters.

A total of 30 patients (30 eyes) with moderate-to-severe DED who attended the Department of Ophthalmology of the Second Affiliated Hospital of Baotou Medical College from May 2024 to September 2025, and 30 age-and gender-matched healthy controls (30 eyes) recruited during the same period were enrolled. Among the DED patients, there were 15 males (15 eyes) and 15 females (15 eyes), aged 22 to 67 years, with a mean age of (41.5±14.3) years. Among the controls, there were 15 males (15 eyes) and 15 females (15 eyes) with a mean age of (42.5±16.5) years (ranging from 20 to 69 years). The ocular surface disease index (OSDI) questionnaires were collected from all subjects. Non-invasive tear break-up time (NIBUT-f), non-invasive average break-up time (NIBUT-av), tear meniscus height (TMH), and conjunctival redness were measured using an ocular surface comprehensive analyzer, and the Schirmer Ⅰ test was performed. Fecal samples were collected, and 16S ribosomal RNA gene high-throughput sequencing was used to analyze the Alpha diversity, Beta diversity, and species composition of gut microbiota. Measurement data conforming to normal distribution, including OSDI score, NIBUT-av, TMH, and Schirmer Ⅰ test values, were expressed as ±s, with comparisons between groups performed using the independent samples t-test. Measurement data not conforming to normal distribution were expressed as [M(P25, P75)], with comparisons between groups performed using the Mann-Whitney U test. Count data were expressed as rates (%), with comparisons between groups performed using the χ² test. The overall structure of gut microbiota between the two groups was analyzed using permutational multivariate analysis of variance. Spearman′s rank correlation analysis and linear regression models were applied to explore the associations between the relative abundance of differential bacterial genera and ocular surface clinical parameters.

No statistically significant differences were observed between the two groups in age or gender distribution (t=-0.25, χ²=0.00, P>0.05). The OSDI score, conjunctival redness score, NIBUT-f, NIBUT-av, TMH, and Schirmer I test values in the DED group were (44.93±6.11) points, (2.75±0.53) points, (3.70±0.64) s, (6.34±0.54) s, (0.10±0.03) mm, and (3.61±1.93) mm/5 min, respectively, while those in the control group were (10.76±5.50) points, (1.60±0.51) points, (13.74±1.55) s, (16.73±0.69) s, (0.26±0.04) mm, and (13.45±1.32) mm/5 min, respectively, with statistically significant differences between the two groups (t=22.76, 8.52, 32.76, 64.81, 17.29, 23.02; P<0.05). Alpha diversity analysis showed that the Chao1 index reflecting species richness and the Shannon index reflecting species diversity in the DED group were 91 (71 to 107) and 2.61 (2.37 to 3.06), respectively, while those in the control group were 160 (149.5 to 170) and 3.41 (3.25 to 3.73), respectively, with statistically significant differences between the two groups (Z=-6.34, -5.87; P<0.05). Principal coordinate analysis based on the Bray-Curtis distance matrix revealed that the DED group and control group samples formed distinct independent clusters in spatial distribution, with a clear boundary in the intergroup microbial community structure. The first principal coordinate explained 30.4% of the total variance, and the second principal coordinate explained 11.8% of the total variance. Permutational multivariate analysis of variance showed a statistically significant difference in the overall gut microbiota structure between the two groups (R²=0.267, P<0.05). At the phylum level, the gut microbiota of both groups was dominated by Firmicutes and Bacteroidetes. The relative abundances of Proteobacteria and Firmicutes in the DED group and control group were 20.2% vs 2.1% and 49.8% vs 68.2%, respectively, with statistically significant differences (t=5.01, 3.48; P<0.05). At the order and family levels, the increase in Proteobacteria abundance was mainly driven by the significant elevation of Enterobacterales and Enterobacteriaceae. The relative abundances of Enterobacteriaceae and Bacteroidaceae in the DED group and control group were 17.7% vs 0.7% and 24.9% vs 12.5%, respectively, with statistically significant differences (t=4.66, 3.48; P<0.05). The abundance of Ruminococcaceae under Firmicutes in the DED group and control group was 10.2% and 27.1%, respectively, with a statistically significant difference (t=6.62, P<0.05). At the genus level, the relative abundances of Bacteroides, Parabacteroides, and Faecalibacterium in the DED group and control group were 26.4% vs 1.5%, 12.9% vs 0.4%, and 7.6% vs 23.8%, respectively, with statistically significant differences (t=3.57, 3.81, 7.47; P<0.05). At the species level, Escherichia coli and Bacteroides vulgatus were identified as the key species driving the structural differences between the two groups, with abundances of 15.8% vs 3.3% and 0.02% vs 0.3%, respectively, showing statistically significant differences (t=4.53, 4.47; P<0.05). The relative abundance of short-chain fatty acid-producing Faecalibacterium prausnitzii in the DED group and control group was 3.9% and 8.8%, respectively, with a statistically significant difference (t=3.45, P<0.05). Spearman rank correlation analysis and linear regression analysis revealed that, in terms of subjective symptoms, the relative abundances of Butyricimonas and Faecalibacterium were significantly negatively correlated with the OSDI score (r=-0.75, -0.60; P<0.05); the relative abundance of Parabacteroides was significantly positively correlated with the OSDI score (r=0.50, P<0.05). Regarding objective ocular surface parameters, the relative abundance of Prevotellaceae was significantly positively correlated with NIBUT-av (r=0.78, P<0.05); the relative abundance of Butyricimonas was significantly positively correlated with TMH (r=0.67, P<0.05); and the relative abundance of Prevotellaceae was significantly positively correlated with Schirmer I test values (r=0.77, P<0.05). In most control subjects, Firmicutes was the dominant phylum, while its relative abundance decreased in the DED group. Meanwhile, the relative abundance of Proteobacteria in the DED group was higher than that in the control group. The gut microbiota structure of DED patients showed a shift, characterized by increased Proteobacteria and decreased Firmicutes. The abundances of potential opportunistic pathogens such as Bacteroides and Parabacteroides were increased in the DED group, while beneficial bacteria such as Faecalibacterium and Ruminococcus, which produce short-chain fatty acids, were markedly reduced.

Patients with primary moderate-to-severe DED exhibit significant gut microbiota dysbiosis, characterized by increased relative abundance of opportunistic pathogens and decreased abundance of beneficial bacteria such as butyrate-producing genera. The alterations in specific gut microbiota are closely associated with the exacerbation of subjective ocular surface symptoms, decreased tear film stability, and reduced tear secretion. Modulating gut microbiota balance may emerge as a potential novel target for DED intervention.

Retinoic acid-related orphan receptor alpha (RORα) is an important member of the nuclear receptor superfamily and functions as a transcriptional regulator involved in a wide range of biological processes, including oxidative stress regulation, maintenance of mitochondrial function, inflammatory and immune homeostasis, lipid and energy metabolism, as well as tumor initiation and progression. Emerging evidence in recent years has further demonstrated that RORα plays critical roles in maintaining ocular tissue homeostasis, such as corneal epithelial differentiation, and participates in the pathogenesis of several ocular diseases, including age-related macular degeneration and uveal melanoma. The major biological functions of RORα and recent advances in understanding its roles in ocular tissues and ocular diseases were summarized in this paper. Particular emphasis was placed on the potential regulatory functions of RORα in retinal, uveal, and ocular surface-related disorders. In addition, the research value of RORα as a novel molecular target and its potential clinical implications in ophthalmic diseases were discussed.

Retinopathy of prematurity (ROP) is a common yet preventable and treatable cause of childhood blindness. Fundus examination serves as a critical tool for early diagnosis, treatment, and follow-up of ROP. Notably, economic development and advances in medical technology have led to significant progress in ROP screening, including refinements in screening criteria, techniques, indications, and equipment portability. The current research and advances in ROP screening, discusses methodologies and their clinical significance, and analyzes challenges in current practice was reviewed, aiming to inform clinical decision-making.

Tilt and decentration of an intraocular lens (IOL) within the capsular bag may induce higher-order aberrations, glare, reduced contrast sensitivity, and monocular diplopia; presbyopia-correcting and toric IOL are particularly sensitive to misalignment. Accurately evaluating the spatial positions of the natural crystalline lens before surgery and IOL after surgery is of great significance for the selection of functional IOL, the formulation of surgical plans, and the interpretation of postoperative visual quality. CASIA2 combines swept-source optical coherence tomography (OCT) with anterior segment three-dimensional reconstruction technology, enabling simultaneous identification of the anterior and posterior surfaces of the cornea, iris, lens, or IOL, and calculating the tilt, decentration, and orientation using built-in algorithms. CASIA2 swept-source anterior segment OCT uses the corneal topographic axis as a reference and enables three-dimensional quantification of crystalline lens and IOL position without pharmacologic dilation. The relationship between preoperative crystalline lens position and postoperative IOL position, as well as the value of combining preoperative CASIA2 measurements with ocular biometry for risk stratification of postoperative IOL malposition and individualized IOL selection, remains unclear. The clinical relevance of IOL tilt and decentration, the measurement principles and technical advantages of CASIA2, the positional characteristics of the crystalline lens and postoperative IOL, and associated factors including ocular biometry, high myopia, previous vitrectomy, and IOL design were summarized. The predictive value of preoperative crystalline lens position was also discussed.

Multidrug-resistant bacterial keratitis poses a serious threat to vision. In recent years, as pathogens have become increasingly resistant to antibiotics, complications such as corneal melting and perforation may still occur even when bacterial keratitis (BK) is diagnosed and treated promptly. Therefore, it is critical to explore new therapeutic approaches to combat the growing challenge of drug-resistant infectious keratitis. Corneal collagen cross-linking (CXL), originally established for the treatment of keratoconus and post-refractive ectasia, has now been introduced as an adjunctive modality for infectious keratitis caused by multidrug-resistant organisms. To distinguish its application in infectious keratitis from that in ectatic disorders, CXL used for infectious keratitis has been termed photoactivated chromophore for infectious keratitis-corneal cross-linking (PACK-CXL). Current evidence indicates that PACK-CXL, as an adjunct to antibiotic therapy, is effective in treating BK. The therapeutic mechanisms of PACK-CXL and its clinical application in BK was summarized in this paper.

Fundus arterial thrombosis is one of the acute and critical diseases in ophthalmology. It can quickly cause irreversible damage to the retina, leading to a sudden drop in vision and even permanent blindness. Moreover, this disease often indicates systemic basic lesions, which greatly increases the risk of thrombotic events in important organs of the body and seriously threatens the visual function and life and health of patients. The hypercoagulable state caused by abnormal coagulation function is an important pathological basis of retinal artery thrombosis. In recent years, the technology of coagulation test has continued to develop. Various coagulation test items play a key role in the early screening, etiology traceability and severity assessment of the disease. At the same time, it can provide an important reference for the clinical formulation of individualized anticoagulant and thrombolytic therapy. Based on this, the application value and research progress of various coagulation tests in the diagnosis and treatment of fundus arterial thrombosis were reviewed in this paper.