Normal corneal endothelial function is one of the basic conditions to maintain corneal transparency.Corneal endothelium is a monolayer of hexagonal cells，which plays a key role in regulating corneal hydration and transparency.All kinds of internal eye surgery may cause varying degrees of damage to corneal endothelial cells，leading to postoperative corneal edema，even corneal endothelial decompensation，which seriously affects vision.In recent years，with the extensive development of internal eye surgery，the incidence of corneal endothelial decompensation has increased year by year.Identifying whether corneal edema after internal eye surgery is irreversible corneal endothelial decompensation is of great significance to decide whether to use drug conservative treatment to promote the regression of corneal edema or to carry out corneal endothelial keratoplasty in time to improve the prognosis of visual acuity.For the patients with postoperative corneal edema，early surgery is worried about over treatment；late operation missed the opportunity of corneal endothelial keratoplasty.Therefore，the“early”and“late”of corneal endothelial keratoplasty for corneal edema after internal eye surgery is a topic worthy of wide attention and discussion.The pros and cons and the basis were reviewed.

Objective

The aim of this study is to observe the long-term clinical effect of laser peripheral iridotomy（LPI）combined with capsule tension ring（CTR）implantation in cataract patients with primary angle closure glaucoma（PACG）.

Methods

A total of 100 patients（100 eyes）with senile cataract complicated with PACG were retrospectively collected from Cataract Glaucoma Department of Shanghai Xinshijie Eye Hospital from June to December 2019.There were 52 males（52 eyes）and 48 females（48 eyes）with an average age of（71.7±8.3）years（ranged from 54 to 90 years）.Patients were divided into study group and control group according to with or without CTR.Both groups of patients underwent LPI combined with cataract surgery，and CTR was implanted in the study group，while not implanted in the control group.The visual acuity，intraocular pressure（IOP），corneal endothelial cell density，and anterior chamber depth of two groups of patients before surgery，after LPI treatment，and after cataract surgery for 1 day，1 month，and 4 years were compared.Gender and ocular data were presented as cases and percentage and used for comparison between groups by chi-square test.Count data such as visual acuity，IOP，corneal endothelial cell count，and anterior chamber depth were described as for data consistent with normal distribution.Independent sample t test was used for inter-group comparison，and paired t test was used for intra-group comparison.Data that did not conform to normal distribution were described by M（Q1，Q3），and used for inter-group comparison by Mann-Whitney U test，and for intra-group comparison was used by Wilcoxon signed rank test.

Results

There were 54 patients（54 eyes）in the study group.Among them，there were 26 males（26 eyes）and 28 females（28 eyes）with an average of（71.3±8.5）years old（ranged from 54 to 90 years old）；there were 31 cases（31 eyes）in the right eye and 23 cases（23 eyes）in the left eye.The phacoemulsification surgery time for cataracts was 17.00 to 39.00 seconds，with an average of（27.76±5.30）seconds.The refractive error of artificial intraocular lens（IOL）ranged from 9.00 to 30.00 D，with an average of（21.25±4.13）D.There were 46 patients（46 eyes）in the control group.Among of them，there were 26 males（26 eyes）and 20 females（20 eyes）；there were 23 cases（23 eyes）in the right eye and 23 cases（23 eyes）in the left eye.The age range was 54 to 87 years old，with an average of（72.1±8.0）years old.The phacoemulsification surgery time for cataracts was 21.00 to 43.00 seconds，with an average of（29.72±4.99）seconds.The IOL refractive power was 10.00 to 30.00 D，with an average of（21.43±4.20）D.There was no statistically significant difference in gender and eye distribution between the study group and the control group（χ²=0.70，0.55；P＞0.05）.There was no statistically significant difference in age and phacoemulsification surgery time between the study group and the control group（t=-0.45，-1.89；P＞0.05）.There was no statistically significant difference in IOL refractive power comparison（Z=-0.052，P＞0.05）.The uncorrected distance visual acuity of the study group and the control group after surgery for 1 day and 4 years was0.20（0.10，0.30）logarithm of the minimum angle of resolution（logMAR），0.20（0.10，0.30）logMAR，0.30（0.20，0.30）logMAR，0.30（0.20，0.40）logMAR，respectively.The differences were statistically significant（Z=-2.672，-3.562；P＜0.05）.At 4 years after surgery，uncorrected distance visual acuity in both groups was better than the baseline，and the differences were statistically significant（Z=-6.359，-5.829；P＜0.05）.The IOPof the study group and the control group at 4 years after surgery was 16.50（13.75，18.00）mmHg（1 mmHg=0.133 kPa）and 18.00（15.00，20.00）mmHg，respectively，and the difference was statistically significant（Z=-2.873，P＜0.05）.At 4 years after surgery，IOP of both groups was lower than the baseline，and the differences were statistically significant（Z=-5.893，-4.512；P＜0.05）.The IOP of the study group at 4 years after cataract surgery was significantly lower than that after LPI treatment，and the difference was statistically significant（Z=-4.124，P＜0.05）.The anterior chamber depth was（2.75±0.28）mm and（2.65±0.22）mm respectively in the study group and the control group after cataract surgery for 4 years，and the difference was not statistically significant（t=1.955，P＞0.05）.After surgery for 4 years，the anterior chamber depth in both groups was greater than the baseline，with statistical significance（t=-28.106，-29.694；P＜0.05）.Compared with LPI treatment，there were significant differences in anterior chamber depth between the study group and the control group at 4 years after cataract surgery（t=-25.933，-26.930；P＜0.05）.The corneal endothelial cell count after cataract operation for 4 years was（2095.50±312.81）/mm² and（1977.15±251.12）/mm²，respectively，and the difference was statistically significant（t=2.061，P＜0.05）.The corneal endothelial cell count in the study group after cataract surgery for 4 years was lower 10.79% than the baseline，and the difference was statistically significant（Z=-6.393，P＜0.05）. The control group reduction was 15.57%， and the difference was statistically significant（t=13.959，P＜0.05）.There were no abnormal IOL between the study group and the control group after cataract surgery for 4 years in two groups，and the long-term safety of IOL between the study group and the control group was good.

Conclusions

LPI combined with phacoemulsification and IOL the study group and the control group implantation for cataracts patients with PACG can significantly improve the visual acuity，reduce IOP，increase anterior chamber depth，and have good corneal safety.At the same time，the application of CTR in cataract surgery can significantly reduce the IOP，and has less impact on corneal endothelial cells.

Objective

To investigate the clinical efficacy and safety of epithelium-off accelerated comeal collagen cross-linking（ACXL）and epithelium-on ACXL in the treatment of progressive keratoconus.

Methods

A total of 69 patients（102 eyes）with progressive keratoconus at the Department of Ophthalmology and Corneal in Chengdu East Aier Eye Hospital from January 2020 to March 2022 was included.There were 40 males（58 eyes）and 29 females（44 eyes）with a mean age of（21.6±6.9）years（ranging from 10 to 48 years）.The patients were divided into43 cases（62 eyes）in the corneal thinnest point thickness（TCT）≥450μm group and 26 cases（40 eyes）in the 400μm≤TCT＜450μm group according to TCT，with the former being treated with Epi-off ACXL，and the latter with Epi-on ACXL.The two groups were compared in uncorrected visual acuity（UCVA），best corrected visual acuity（BCVA），refractive status，corneal transparency，maximumkeratometry value of the anterior corneal surface（Kmax），TCT，corneal endothelial cell counts and intraocular pressure were analysed preoperatively and after surgery for 1，3，6 and 12 months.The UCVA，BCVA，spherical diopter，cylinder diopter，TCT，Kmax and corneal endothelial cell counts were tested for conformity with normal distribution and expressed as，and compared before and after surgery using one-way repeated measures ANOVA，and when the differences were statistically significant then further LSD-t tests were used；the preoperative and postoperative corneal endothelial counts within the group were compared using paired t test.

Results

The BCVA and Kmax of patients in the Epi-on ACXL group at preoperative，1，3，6 and 12 months postoperatively were（0.27±0.13）logarithm of the minimum angle of resolution（logMAR），（0.26±0.17）logMAR，（0.22±0.13）logMAR，（0.22±0.14）logMAR，（0.18±0.14）logMAR，（62.96±10.91）D，（63.01±10.13）D，（62.76±10.42）D，（62.44±10.29）D，（61.83±9.40）D.There were a statistically significant difference between the preoperative and postoperative BCVA and Kmax in patients with Epi-on ACXL（F=6.848，2.678；P＜0.05）.After LSD-t test，BCVA at 3，6 and 12 months postoperatively was increased compared with preoperatively，and the difference was statistically significant（t=3.250，5.414，6.485；P＜0.05）；Kmax at 12 months postoperatively was decreased compared with preoperatively，and the difference was statistically significant（t=2.672，P＜0.05）.The preoperative，1，3，6，and 12 months postoperative examinations of cylinder diopter，TCT，and Kmax in patients in the Epi-off ACXL group were（-3.79±1.92）D，（-3.87±2.19）D，（-3.66±2.14）D，（-3.36±2.09）D，（-3.20±2.14）D，（488.29±34.20）μm，（475.55±31.20）μm，（477.71±30.97）μm，（479.76±28.82）μm，（486.18±30.83）μm，（52.49±6.31）D，（53.58±6.63）D，（52.35±5.30）D，（52.13±5.43）D，（51.63±5.17）D.The difference in columnar lens refraction，TCT and Kmax in patients in the Epi-off ACXL group was statistically significant when compared preoperatively and postoperatively（F=4.618，12.133，12.794；P＜0.05）.By LSD-t test，postoperative cylinder diopter was lower at 12 months postoperatively compared with preoperative，and the difference was statistically significant（t=-3.499，P＜0.05）；TCTwas lower at 1 month，3 months，and 6 months postoperatively compared with preoperative，and the difference was statistically significant（t=6.995，4.997，3.893；P＜0.05）；and Kmax at 1 month and 12 months postoperatively compared with preoperative，the difference was statistically significant（t=-5.963，3.533；P＜0.05）.There were no complications of UV light induced eye injury in all patients after crosslinking.After operation，all patients had ocular pain，and their symptoms were significantly relieved the next day.After ACXL，corneal haze appeared in 1 case（1 eye）and 3 patients（3 eyes）in the two groups，accouting for 1.61% and 7.50%，respectively；the former subsided after surgery for 3 months and the cornea returned to transparency；the latter subsided after surgery for 3 months and the cornea returned to transparency，and 1 case（1 eye）with central corneal stromal linear haze for latter patients，which did not affect BCVA.After surgery，there were 7 cases（10 eyes）and 12 cases（18 eyes）of dry eye in the two groups，accouting for 16.13%and 45.00%，respectively.1 case（1 eye）with Epi-on ACXL failure underwent keratoplasty.

Conclusions

According to the patient's TCT，the appropriate choice of Epi-off ACXL or Epi-on ACXL should be made，taking into account the effectiveness and safety of ACXL.Both cross-linking methods can stabilize the condition of keratoconus at 12 months postoperatively，and have good effectiveness and safety for the treatment of progressive keratoconus.

Objective

To explore the correlation between dry eye symptoms，signs and anxiety and depression.

Methods

A total of 83 patients（166 eyes）in the Department of Ophthalmology of Peking University Third Hospital from June 2021 to December 2021 were collected.There were 9 males（18 eyes） and 42 females（84 eyes）with the average age of（51.0±16.1）years（ranged from 24 to 83 years）.According to the diagnostic criteria of dry eye，the patients were divided into dry eye group and control group.The dry eye symptoms of the subjects were evaluated by the ocular surface disease index questionnaire（OSDI）.The anxiety and depression scores of the patients were measured by the hospital anxiety and depression rating scale（HADS）.The infrared images of meibomian gland and corneal nerve images were collected by Oculus Keratograph 5M eye surface analyzer and corneal confocal laser scanning microscope，respectively.The meibomian gland area index and corneal nerve density were measured by ImageJ software.After examination，the OSDI score，HADS anxiety score，HADS depression score，meibomian gland index and corneal nerve density of the patients conformed to the normal distribution，and were expressed as.The difference of each index between the dry eye group and the control group was tested by independent sample t test.The correlation between the dry eye symptoms，signs and HADSscore in the dry eye group was analyzed by Pearson.The prediction model of dry eye symptoms and signs on hads score was analyzed by binary Logistics regression.

Results

The OSDI scores of patients in the dry eye group and the control group were（22.7±18.0）and（28.8±16.4）points，respectively，with a statistically significant difference（t=1.54，P＜0.05）.The meibomian gland index of patients in the dry eye group and the control group was（0.19±0.06）and（0.22±0.07），respectively，with a statistically significant difference（t=-2.20，P＜0.05）.The corneal nerve density of patients in the dry eye group and the control group was（2346.7±783.0）μm/mm² and（2419.8±386.5）μm/mm²，respectively，with a statistically significant difference（t=0.56，P＜0.05）.The HADSanxiety scores of patients in the dry eye group and the control group were（7.5±4.4）and（1.9±1.8）points，respectively，with a statistically significant difference（t=9.49，P＜0.05）.The HADSdepression scores of patients in the dry eye group and the control group were（7.5±3.1）and（3.5±2.6）points，respectively，with a statistically significant difference（t=6.08，P＜0.05）.The HADS anxiety score in patients with dry eye syndrome showed a weak positive correlation with OSDI score，a weak negative correlation with corneal nerve density，and a moderate negative correlation with meibomian gland index.All these correlations were statistically significant（r=0.37，-0.35，-0.43；P＜0.05）.The HADS depression score of patients in the dry eye group showed a moderate positive correlation with the OSDI score，and a moderate negative correlation with the meibomian gland index.The correlation was statistically significant（r=0.45，-0.52；P＜0.05）.Multivariate binary Logistics regression analysis revealed that the OSDI score，corneal nerve density，and meibomian gland index had statistically significant effects on the HADSanxiety score（OR=1.10，95%CI：1.04 to 1.16；P＜0.05），（OR=0.90，95%CI：0.81 to 0.98；P＜0.05），and（OR=0.87，95%CI：0.78 to0.95；P＜0.05）.Among them，the OSDI score was a risk factor for HADS anxiety score，while corneal nerve density and meibomian gland index were protective factors for HADS anxiety score.The impact of OSDI score and meibomian gland index on HADSdepression score was statistically significant（OR=1.07，95%CI：1.02 to 1.13；P＜0.05）and（OR=0.90，95%CI：0.82 to0.97；P＜0.05）.Specifically，OSDIscore was a risk factor for HADSanxiety score，while meibomian gland index was a protective factor for HADSanxiety score.

Conclusions

Dry eye patients are more likely to suffer from anxiety and depression than healthy individuals.OSDI score，corneal nerve density，and meibomian gland area index are significantly correlated with HADSscores.

Objective

The aim of this study is to assess the correlation between the changes of spherical equivalent and myopia progression in children with refractive error.

Methods

From January 2021 to December 2023，a total of 124 cases（248 eyes）of children and adolescents with refractive error were collected from the Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University.Among them，there were 63 males（126 eyes）and 61 females（122 eyes）with an average age of（10.0±2.1）years（ranged from 6 to 15 years）.According to age，they were divided into 6 to 9 years old group，9 to 12 years old group and 12 to 15 years old group.According to the ratio axial length to spherical equivalent（AL/CR），they were divided into AL/CR＜3 group，3≤AL/CR≤3.2 group and AL/CR＞3.2 group.All patients were measured for axial length，corneal curvature flatness K value，and corneal curvature steepness K value by optical biometry.Spherical equivalent，AL/CR，SE change（ΔSE）and AL change（ΔAL）were measured and calculated by non-contact computer optometry.The detection rate of myopia was represented by percentages and compared usingχ² test.The patients'age，axial length，AL/CR，equivalent spherical diopter，corneal curvature，ΔAL、ΔSE andΔSE/ΔAL conformed to a normal distribution，and were described by.The parameters among the three groups were tested by one-way ANOVA.When the differences among three groups are statistically significant，two-by-two comparisons between the groups were made.The correlation betweenΔSE andΔAL were performed Pearson correlation coefficient and linear regression analysis.The validity of the linear regression equation was tested by ANOVA.

Results

A total of 124 children（248 eyes）were enrolled.The rate of myopia was 58% and the rate of hyperopia was 30%.The detection rate of myopia significantly increased with age and there was a significant difference between them（χ²=12.61，P＜0.05）.In 6 to 9 years old group，9 to 12 years old group and 12 to 15 years old group，the axial length（AL）of patients were（23.04±1.28）mm，（23.98±0.54）mm，and（24.44±1.18）mm.The AL/CR of patients were 2.90±0.20，3.04±0.20，and 3.08±0.17.The corneal curvature of patients were（43.63±1.72）D，（43.48±1.78）D，and（42.75±1.63）D.There were differences in AL and AL/CR among different age groups with statistically significant（F=20.37，13.75；P＜0.05），while the corneal curvature exhibited no significant differences（F=0.61，P＞0.05）.Linear regression equation was constructed with age as the independent variable andΔSE/ΔAL as the dependent variable，denoted by y=0.034x+1.448.After the validity analysis，there was a significant difference between them（F=3.949，P＜0.05）.Linear regression equation was constructed withΔAL as the independent variable andΔSE as the dependent variable in the overall and different age groups，denoted by y=0.034x+1.448.After the validity analysis，there was a significant difference between them（F=491.2，P＜0.05）.Among children in three age groups：6 to 9 years old，9 to 12 years old and 12 to 15 years old，the univariate linear regression equation was denoted by y=-1.472x-0.013、y=-1.617x-0.090 and y=-1.729x-0.025.The myopia progression would increase by-1.60 D if the axial length increased for every 1 mm in children aged 6 to 15 years old.Linear regression equation was constructed with ΔAL as the independent variable andΔSE as the dependent variable in different AL/CR groups，denoted by y=-1.490x-0.108，y=-1.642x-0.070 and y=-1.896x-0.059.The myopia progression would increase respectively by-1.49 D，-1.64 D and-1.90 D if the axial length increased for every 1 mm in different AL/CR groups（AL/CR＜3，3≤AL/CR≤3.2 and AL/CR＞3.2）.Pearson correlation analysis showed that the correlation between the differences inΔSE/ΔAL and AL/CR，ΔSE/ΔAL and AL was statistically significant（r=-0.208，-0.106；P＜0.05）.

Conclusions

The myopia progression is closely corelated to the axial length elongation in the children aged between 6 to 15 years old.The myopia progression would increase by-1.60 D if the axial length increased for every 1 mm.ΔSE/ΔAL is significantly corelated to age，AL/CR and axial length.The elongation of axial length can be used as a critical indicator to predict the development of refractive errors.

After strabismus surgery，the changes of extraocular muscles and ciliary vessels will affect the blood flow in the anterior segment，and then indirectly affect the blood circulation in the posterior part of the eyeball.In recent years，new progress has been made in the study of retinal and choroidal changes after strabismus surgery by using color Doppler ultrasound，fundus photography，optical coherent tomography and optical coherent tomography angiography（OCTA），but there is still room for exploration.The latest research progress from the perspective of different examination techniques was reviewed，in order to provide direction for future research and help strabismus patients better understand the possible expected effect after surgery.

Glaucoma is a disease characterized by narrowing of the optic disc edge and visual field damage caused by various factors leading to optic nerve damage.Glaucoma nerve damage not only affects retinal ganglion cells，but also involves extensive neurodegenerative changes in the visual pathway and central nervous system.Glaucoma has similar pathological changes to other central nervous system diseases such as multiple sclerosis，and demyelination changes are involved in the pathological process of glaucoma nerve damage.Therefore，studying the mechanism of demyelination and remyelination function，promoting myelin formation and remyelination，and finding new treatment pathways for glaucoma from the perspective of neuroprotective strategies are of great significance.

Age-related macular degeneration（AMD）is one of the leading causes of blindness among old adults worldwide.There are two types of advanced AMD：neovascular AMD and map atrophy，both of which are associated with severe progressive visual impairment.Major risk factors for AMD include smoking，nutritional factors，cardiovascular disease，and genetics，etc.It has been domonstrated that the incidence of AMD has an increasing trend，especially for the young population.It is necessary for accurate diagnosis of AMD to combinate of slit-lamp microscopy with auxiliary examinations，including retinography，fundus fluorescein angiography，and optical coherence tomography.Treatment for neovascular AMD includes intraocular injection of anti-vascular endothelial growth factor drugs，combination with other therapies，including inhibition of other angiogenic factors， regenerative therapy， local therapy and dietary supplementation of antioxidants.However，the current treatment effect of the disease is not good enough.Therefore，it is of great value to explore its pathogenesis from the aspects of lipid deposition，inflammation and complement system.

Diabetes causes diabetic retinopathy（DR），which is an important cause of blindness and low vision in adults.Advanced glycation end products（AGE）are molecules produced by non enzymatic modification of large molecules such as proteins，lipids，and nucleic acids through translation by glucose or other sugars.Binding of AGE to the receptor for advanced glycosylation end products（RAGE）can produce a series of pathological mechanisms，which are important factors involved in the occurrence and progression of DR.AGE inhibitors，AGE blockers，and RAGE inhibitors are potential therapeutic targets for DR in the future.The correlation between AGE and DR was reviewed in this paper，aiming to provide insights for the diagnosis and treatment of DR.

Metformin is the first-line drug for the treatment of type 2 diabetes at present.It has been demonstrated that metformin also has other effects such as anti-aging，anti inflammatory，anti-cancer，weight loss，and cardiovascular protection.Disruption of oxidative stress homeostasis is an important mechanism in age-related cataracts，and the antioxidant stress mechanism of metformin is also considered to play a role in preventing cataract.The effects of metformin on lens aging of the age-related cataract was reviewed from the aspect of oxidative metabolism of crystalline lens，the pathogenesis of cataracts and the protective role of metformin in lens aging with the aim of providing new ideas for the clinical management of cataract.