Conventional surgical teaching techniques face several challenges, highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice. The recent rapid advancement of computer technology has enabled the integration of virtual reality (VR) into medical training, thereby revolutionizing ophthalmic surgical education through VR-based educational methods. VR technology offers a safe, risk-free environment for trainees to practice repeatedly, enhancing surgical skills and accelerating the learning curve without compromising patient safety. This research outlines the application of VR technology in ophthalmic surgical skills training, particularly in cataract and vitreoretinal surgery. Including assessing the effectiveness of intraocular surgery training systems, evaluating skills transfer to the operating room, comparing it with wet lab cataract surgery training, and enhancing non-dominant hand training for cataract surgery, among other aspects. Additionally, this paper will identify the limitations of VR technology in ocular surgical skills training, offer improvement strategies, and detail the advantages and prospects, with the objective of guiding subsequent researchers.

To identify key genes and inflammatory signaling pathways involved in the anti-inflammatory effects of Hedysarum polybotrys polysaccharide (HPS) in a rat model of endotoxin-induced uveitis (EIU). EIU was induced in Wistar rats through subcutaneous injection of lipopolysaccharide (LPS, 200 µg) and the rats were then randomly assigned to EIU group (n=5) and the HPS intervention group (n=5). HPS (400 mg/kg, intraperitoneally) or its carrier was administered 24h and 1h prior to EIU induction. Eyes were examined and enucleated 24h post-induction, and total RNA was extracted from the iris-ciliary body. Gene expression microarrays were used to identify differentially expressed genes (DEGs), followed by bioinformatics analyses, including gene ontology (GO) and pathway analysis. Key findings were not experimentally validated at the mRNA or protein level. A total of 322 DEGs were identified, comprising 254 mRNA and 68 lncRNA genes. GO analysis revealed significant functional categories, including response to LPS. Pathway analysis identified key signaling pathways involved in uveitis, such as cytokine-cytokine receptor interactions. Notably, 16 mRNA and 7 lncRNA DEGs emerged as central nodes in the gene correlation network. HPS exerts its anti-inflammatory effects through coordinated signaling pathways, offering insights into potential therapeutic targets for managing uveitis.

To examine the ocular toxicity linked to sildenafil usage and the possible protective benefits of adenosine triphosphate (ATP) against this toxicity in rats. Twenty-four male albino Wistar-type rats were divided into four equal groups (n=6/group) as follows: healthy group (HG), ATP-only group (ATPG), sildenafil-only group (SILG), and ATP+sildenafil group (ATP+SLD). ATPG and ATP+SLD groups were injected intraperitoneally with ATP (4 mg/kg), while SILG and HG groups were injected with saline (0.9% NaCl) by the same route as a solvent. One hour after the administration of ATP and solvent, sildenafil (10 mg/kg) was administered orally to the SILG and ATP+SLD groups. This procedure was repeated once a day for 4wk. The animals were then sacrificed, eyeballs were removed and oxidant and antioxidant parameters were measured biochemically. Additionally, the ocular tissues were evaluated histopathologically. Sildenafil increased oxidant (malondialdehyde) levels and decreased antioxidant levels (total glutathione, superoxide dismutase, catalase) in rat ocular tissues and caused severe oxidative stress. In addition, sildenafil has been shown histopathologically to cause oxidative damage in retinal layers. ATP treatment suppressed oxidative stress and attenuated histopathological damage in the retinal layers. ATP protects retinal tissue against sildenafil-induced ocular oxidative damage in rats and may contribute to the development of novel approaches to prevent or treat this damage.

To evaluate long-term visual field (VF) prediction using K-means clustering in patients with primary open angle glaucoma (POAG). Patients who underwent 24-2 VF tests ≥10 were included in this study. Using 52 total deviation values (TDVs) from the first 10 VF tests of the training dataset, VF points were clustered into several regions using the hierarchical ordered partitioning and collapsing hybrid (HOPACH) and K-means clustering. Based on the clustering results, a linear regression analysis was applied to each clustered region of the testing dataset to predict the TDVs of the 10th VF test. Three to nine VF tests were used to predict the 10th VF test, and the prediction errors (root mean square error, RMSE) of each clustering method and pointwise linear regression (PLR) were compared. The training group consisted of 228 patients (mean age, 54.20±14.38y; 123 males and 105 females), and the testing group included 81 patients (mean age, 54.88±15.22y; 43 males and 38 females). All subjects were diagnosed with POAG. Fifty-two VF points were clustered into 11 and nine regions using HOPACH and K-means clustering, respectively. K-means clustering had a lower prediction error than PLR when n=1:3 and 1:4 (both P≤0.003). The prediction errors of K-means clustering were lower than those of HOPACH in all sections (n=1:4 to 1:9; all P≤0.011), except for n=1:3 (P=0.680). PLR outperformed K-means clustering only when n=1:8 and 1:9 (both P≤0.020). K-means clustering can predict long-term VF test results more accurately in patients with POAG with limited VF data.

To evaluate the therapeutic effects of ranibizumab on optic disc and macular microvascular perfusion in central retinal vein occlusion (CRVO) with macular edema (ME). Optical coherence tomography angiology (OCTA) parameters, including optic disc vessel density (VD; including whole-disc VD, intra-disc VD, and peripapillary VD), superficial/deep capillary plexus (SCP/DCP) VD, and central macular thickness (CMT) were analyzed. Additional assessments included best-corrected visual acuity (BCVA) via Early Treatment Diabetic Retinopathy Study (ETDRS) chart and hemorheological profiling. CRVO patients received monthly intravitreal ranibizumab injections for three consecutive months. Pre- and post-treatment parameters were statistically compared. The study comprised 60 CRVO-ME patients (28 males; 32 females), aged 50-78y (mean 63.3±7.6y) and 60 age-/sex-matched healthy controls. As compared with participants exhibiting normal funduscopic findings, CRVO patients demonstrated significantly elevated levels of low-shear-rate whole blood viscosity (LSR-WBV), high-shear-rate whole blood viscosity (HSR-WBV), and aggregation index (AI, all P<0.05). In CRVO-affected eyes, vertical cup-to-disc (C/D) ratio and optic cup volume were significantly smaller, whereas retinal nerve fiber layer (RNFL) thickness was significantly greater, compared to both unaffected contralateral eyes and normal control eyes (all P<0.05). Following treatment, VD of the entire optic disc (P<0.05), intra-disc VD (P<0.05), and peripapillary VD (P<0.05) all increased significantly relative to baseline. CMT decreased significantly (P<0.05), whereas macular SCP-VD and macular DCP-VD showed non-significant slight reductions (P>0.05). At baseline, BCVA of CRVO eyes correlated with whole-disc VD (r=-0.276, P=0.033), intra-disc VD (r=-0.342, P=0.009), and peripapillary VD (r=-0.335, P=0.007), with intra-disc VD demonstrating the strongest association. Besides, BCVA improvement, after the treatment, correlated positively with whole-disc VD (r=0.342, P=0.008) and intra-disc VD (r=0.396, P=0.002). Optic disc blood perfusion is more closely associated with visual acuity than macular perfusion, suggesting intra-disc VD may serve as a potential biomarker for monitoring visual acuity changes in CRVO. Multiple ranibizumab injections significantly improve optic disc perfusion but may have exerted detrimental effects on the macula. CRVO patients shows higher hemorheological parameters than those with normal fundi. Reduced vertical C/D ratio and optic cup volume may be linked to CRVO incidence, potentially acting as susceptibility factors.

To investigate the etiology and clinical characteristics of hospitalized secondary glaucoma (SG) patients in northwestern China. A cross-sectional study was conducted involving SG patients hospitalized between July 2024 and January 2025. Clinical data were collected, including medical history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, gonioscopic findings, and fundus examination. Demographic characteristics, etiological factors, and treatment modalities were analyzed. A total of 67 patients (82 eyes) were enrolled, aged 7 to 90y. Males accounted for 54.0% (36/67), and 22.4% (15/67) of patients had bilateral involvement. The predominant etiologies of SG were neovascular glaucoma (NVG; 25.4%), traumatic glaucoma (23.9%), uveitic glaucoma (20.9%), and lens-induced glaucoma (14.9%), collectively accounting for 85.1% of all cases. The peak age-specific incidence occurred in the 50-59 years age group (32.8%, 22/67), while NVG was prevalent across the 40-79 years age range. IOP of the 82 affected eyes was stratified into five severity tiers: 22-29 mm Hg (15 eyes, 18.3%), 30-39 mm Hg (14 eyes, 17.1%), 40-49 mm Hg (13 eyes, 15.9%), 50-59 mm Hg (20 eyes, 24.4%), and ≥60 mm Hg (20 eyes, 24.4%). The overall mean IOP was 45.2±12.3 mm Hg, indicating a significant pathological elevation. Surgical intervention was required in 46.3% of cases, predominantly for NVG, lens-induced glaucoma, and traumatic glaucoma-conditions prone to rapid IOP elevation. The etiologies with the highest surgical intervention rates were malignant glaucoma, pigmentary glaucoma, lens-induced glaucoma, and NVG. In contrast, uveitic glaucoma cases were primarily managed with targeted anti-inflammatory therapy, which effectively controlled IOP in the early disease stages and potentially obviated the need for surgery. This study identifies NVG, traumatic glaucoma, uveitic glaucoma, and lens-induced glaucoma as the four leading etiologies of SG in Northwestern China. These findings emphasize the critical need for targeted prevention strategies and evidence-based health education programs among high-risk populations. Implementation of such initiatives will improve early detection, enable ophthalmologists to deliver timely therapeutic interventions, and ultimately reduce preventable vision loss in this region.

To compare the tear film quantity and stability parameters in keratoconus (KCN) and normal eyes using test breakup time (TBUT), noninvasive TBUT (NITBUT), and Schirmer test. All participants (n=166), including patients with KCN and age-matched healthy individuals with normal corneas, were recruited from those referred to Farabi Eye Hospital, Iran, in 2023. To better account for genetic and environmental factors, the control group comprised healthy individuals who were relatives of KCN patients and had normal corneal topography. Tear quantity parameters were evaluated in the following order: NITBUT, TBUT, and Schirmer tests. The mean age of cases in KCN (61.7% males) and normal (63.5% males) participants was 27.54±5.44y (range 19 to 38) and 27.52±5.63y (range 20 to 38), respectively (P=0.976). NIBUT, TBUT, and Schirmer's tests were significantly lower in KCN group compared to normal controls (all P<0.001). The mean difference for NIBUT was -7.81s (P<0.001), and for TBUT was -7.61s (P<0.001). Schirmer test values were also significantly lower in the KCN group, with a mean difference of -5.61 mm compared to normal people (P<0.001). Our findings demonstrate significant tear film impairment in KCN. The reductions in NIBUT, TBUT and Schirmer scores highlight an underlying tear film dysfunction in KCN that extends beyond the morphological changes of the cornea.