To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated four-haptic intraocular lenses (IOLs). This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress double-needle suture technique with intralamellar knot burial via Hoffman pockets. Clinical outcomes assessed included pre- and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), spherical equivalent (SE), suture duration, IOL centration, and perioperative complications. A total of 10 eyes from 10 patients (6 males) were included. The mean age at the time of IOL refixation was 53.10±13.07y (range: 28-68y). The mean interval between initial IOL implantation and dislocation was 8.44±3.54y. The mean postoperative follow-up duration was 11.45±10.30mo. Surgical time averaged 15.3±1.77min, with no intraoperative complications. The mean axial length was 27.16±4.35 mm, with high myopia (HM) as the leading comorbidity (4/10 eyes). Postoperative BCVA significantly improved compared to preoperative values (P=0.025). Postoperative SE was significantly improved compared with preoperative (P=0.01). All IOLs remained centered throughout follow-up. This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs. The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration, avoids conjunctival dissection, and could be adopted into routine surgical practice.

To clarify the clinical correlations and causal relationships between lipid metabolism and the progression of thyroid-associated ophthalmopathy (TAO). This case-control study retrieved clinical data from 2018 to 2023. A total of 2591 patients were enrolled, including 197 patients with TAO (case group) and 2394 patients with hyperthyroidism without TAO (control group). Serum lipid parameters, including triglycerides, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and the HDL/total cholesterol ratio, as well as thyroid function markers, were compared between the two groups. Correlation analyses were performed to evaluate the associations between serum lipid levels and key ocular manifestations of TAO, including exophthalmos degree, clinical activity score, and disease severity. Furthermore, Mendelian randomization (MR) analysis was conducted using genome-wide association study (GWAS) datasets, with hyperthyroidism as the exposure variable and serum lipid parameters as the outcome variables, to infer the causal relationship between hyperthyroidism, lipid metabolism, and TAO progression. The TAO group consisted of 101 males and 96 females, while the hyperthyroidism group included 706 males and 1688 females. Compared with the control group, patients with TAO had significantly higher levels of triglycerides (1.83±1.21 vs 1.40±1.08 mmol/L, P<0.01), total cholesterol, LDL, and HDL. Correlation analysis showed that triglyceride levels were positively correlated with exophthalmos degree, whereas HDL levels were inversely correlated with exophthalmos degree. No significant associations were found between serum lipid levels and clinical activity score (P>0.1). MR analysis confirmed that hyperthyroidism exerted a causal effect in reducing serum triglycerides [inverse-variance weighting odds ratio (OR)=0.035, 95% confidence interval (CI): 0.01-0.12] and total cholesterol (OR=0.085, 95%CI: 0.02-0.34), with no evidence of horizontal pleiotropy (MR-PRESSO P>0.05). Elevated serum triglyceride levels are an independent risk factor for TAO severity, especially exophthalmos, and triglyceride metabolism is inversely regulated by thyroid function.

To construct an intelligent segmentation scheme for precise localization of central serous chorioretinopathy (CSC) leakage points, thereby enabling ophthalmologists to deliver accurate laser treatment without navigational laser equipment. A dataset with dual labels (point-level and pixel-level) was first established based on fundus fluorescein angiography (FFA) images of CSC and subsequently divided into training (102 images), validation (40 images), and test (40 images) datasets. An intelligent segmentation method was then developed, based on the You Only Look Once version 8 Pose Estimation (YOLOv8-Pose) model and segment anything model (SAM), to segment CSC leakage points. Next, the YOLOv8-Pose model was trained for 200 epochs, and the best-performing model was selected to form the optimal combination with SAM. Additionally, the classic five types of U-Net series models [i.e., U-Net, recurrent residual U-Net (R2U-Net), attention U-Net (AttU-Net), recurrent residual attention U-Net (R2AttU-Net), and nested U-Net (UNet++)] were initialized with three random seeds and trained for 200 epochs, resulting in a total of 15 baseline models for comparison. Finally, based on the metrics including Dice similarity coefficient (DICE), intersection over union (IoU), precision, recall, precision-recall (PR) curve, and receiver operating characteristic (ROC) curve, the proposed method was compared with baseline models through quantitative and qualitative experiments for leakage point segmentation, thereby demonstrating its effectiveness. With the increase of training epochs, the mAP50-95, Recall, and precision of the YOLOv8-Pose model showed a significant increase and tended to stabilize, and it achieved a preliminary localization success rate of 90% (i.e., 36 images) for CSC leakage points in 40 test images. Using manually expert-annotated pixel-level labels as the ground truth, the proposed method achieved outcomes with a DICE of 57.13%, an IoU of 45.31%, a precision of 45.91%, a recall of 93.57%, an area under the PR curve (AUC-PR) of 0.78 and an area under the ROC curve (AUC-ROC) of 0.97, which enables more accurate segmentation of CSC leakage points. By combining the precise localization capability of the YOLOv8-Pose model with the robust and flexible segmentation ability of SAM, the proposed method not only demonstrates the effectiveness of the YOLOv8-Pose model in detecting keypoint coordinates of CSC leakage points from the perspective of application innovation but also establishes a novel approach for accurate segmentation of CSC leakage points through the "detect-then-segment" strategy, thereby providing a potential auxiliary means for the automatic and precise real-time localization of leakage points during traditional laser photocoagulation for CSC.

To investigate the potential causal associations between 41 inflammatory cytokines and myopia using a two-sample Mendelian randomization (MR) approach. Publicly available genome-wide association study (GWAS) datasets were utilized for this two-sample MR analysis. Inflammatory cytokine-related GWAS data were extracted from The University of Bristol's Research Data Repository, and myopia-related GWAS data were obtained from the FinnGen project. Single nucleotide polymorphisms (SNPs) associated with inflammatory cytokines were systematically selected as instrumental variables (IVs) based on three rigorous criteria: relevance, independence, and exclusion of pleiotropy. Five MR methods were employed for causal inference: the inverse-variance weighted (IVW) method as the primary analysis, supplemented by MR-Egger regression, weighted median estimator, simple mode, and weighted mode approaches. Sensitivity analyses were performed to evaluate the robustness of the causal estimates. A total of 773 myopia-associated SNPs were identified. MR analysis revealed that higher levels of macrophage inflammatory protein 1-α (MIP-1α) were associated with a 17% reduced risk of myopia [odds ratio (OR)=0.83; 95% confidence interval (CI): 0.69-0.99; P<0.05]. In contrast, elevated levels of eotaxin (OR=1.26; 95%CI: 1.07-1.47; P<0.01), stromal cell-derived factor-1α (SDF-1α; OR=1.68; 95% CI: 1.08-2.62; P<0.05), and interleukin-2 receptor subunit alpha (IL-2Rα; OR=1.25; 95%CI: 1.01-1.53; P<0.05) were significantly associated with an increased risk of myopia. Sensitivity analyses confirmed the reliability of these results. This study provides evidence supporting a causal relationship between specific inflammatory cytokines and myopia. MIP-1α may act as a protective factor against myopia, while eotaxin, SDF-1α, and IL-2Rα are potential risk factors for myopia. These findings emphasize the critical role of inflammatory pathways in the pathogenesis of myopia, offering novel insights for the development of preventive and therapeutic strategies for myopia.

To compare the efficacy of goniosynechialysis (GSL) under a microscope alone (GM) and under direct gonioscopy (GG) for chronic angle-closure glaucoma (CACG) coexisted with cataract. A prospective, single-center, and randomized controlled trial was conducted. Patients diagnosed as CACG and cataract were randomly allocated into either GM group or GG group. In GM group, the range of peripheral anterior synechiae (PAS) was confirmed through gonio-lens after phacoemulsification with intraocular lens implantation (PEI). PAS was separated only under a microscope. After separating the closed angle of 360° by this method, we used a surgical gonioscope to confirm the PAS range. If any remaining PAS was present, we would separate them with an iris repositor under the direct gonio-lens until angle of 360° was reopened. In GG group, PAS was separated under direct gonioscopy after PEI until angle of 360° was reopened. The range of residual PAS after GSLs was the primary outcome. Intraoperative complications (hyphema), intraocular pressure (IOP) and anti-glaucoma medication usage after operation were the secondary outcomes. Sixty eyes were included, each group comprising 30 eyes. The average age [GM group: 66.3±6.8y (12 males), GG group: 67.6±8.9y (7 males), P=0.550], the baseline IOP (GM group: 29.6±11.5 mm Hg, GG group: 32.4±12.2 mm Hg, P=0.366) and the average initial PAS extent (GM group: 8.9±2.6h, GG group: 9.4±2.5h, P=0.425) were similar in the two groups. In GM group, the PAS range reduced from 8.9±2.6h before operation to 7.2±2.9h after PEI and 3.3±2.2h after GSL. In GG group, the PAS range reduced from 9.4±2.5h before operation to 7.5±2.9h after PEI and 0.1±0.3h after GSL. The PAS after PEI was significantly reduced compared to the pre-operative PAS in both groups (all P<0.001). The extent of residual PAS after GSL in GM group was larger than that in GG group with significant statistical difference (P<0.001). Patients who underwent GSL without a gonioscope were more likely to develop hyphema than those who underwent GSL under direct gonioscopy. The difference of hyphema grade between the two groups was statistically significant (P=0.019). PEI alone can not open 360° of angle completely. PEI+GSL significantly reduced PAS range. But for patients with CACG, GSL under a microscope alone is more difficult to separate stable PAS completely and adequately than GSL under direct gonioscopy.

To explore the mechanisms underlying ocular infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we conducted a comprehensive review of current literature, focusing on viral entry pathways, receptor expression in ocular tissues, and associated clinical manifestations. This review encompasses studies published within the last five years with a focus on original research and systematic reviews that provide molecular, histological, or clinical evidence. The findings show that SARS-CoV-2 can infect ocular tissues through multiple receptors beyond angiotensin-converting enzyme 2 (ACE2), including transmembrane serine protease 2 (TMPRSS2), CD147, alanyl aminopeptidase N (ANPEP), dipeptidyl peptidase 4 (DPP4), angiotensin II receptor type 2 (AGTR2), and polymeric immunoglobulin receptor (PIGR), which are expressed in retinal, conjunctival, corneal, limbal, and photoreceptor cells. The virus may also reach ocular structures via neurovascular invasion. Clinically, patients with coronavirus disease 2019 (COVID-19) may present with a broad spectrum of ophthalmic manifestations, including conjunctivitis, hyperreflective lesions in the inner retinal layers, flame-shaped hemorrhages, cotton-wool spots, retinal pallor, hard exudates, and various forms of maculopathy, such as paracentral acute middle maculopathy and acute macular neuroretinopathy (AMN). These signs reflect both direct viral damage and secondary effects of systemic inflammation and microvascular injury. Understanding the molecular and clinical spectrum of ocular involvement is essential for early diagnosis, appropriate ophthalmologic care, and the prevention of long-term visual sequelae in patients affected by COVID-19.

Growth hormone-releasing hormone (GHRH) is a hypothalamic releasing hormone that plays a crucial physiological role in regulating the synthesis and release of anterior pituitary hormones. In recent years, studies have found that GHRH possesses functions like anti-inflammation, promoting cell proliferation, and facilitating cell migration. It participates in regulating the development of uveitis and diabetic retinopathy. Additionally, it also has an impact on the development of retinal ganglion cells by modulating the inflammatory response and mediating the immune response. Given the important roles of GHRH in ophthalmic diseases, elucidating the molecular regulation of the GHRH-GHRH receptor (GHRHR) signal and the innovative development of intervention pathways that directly or indirectly target GHRH serve as strong evidence of how basic research guides innovation and translation. In this review, research reports on GHRH in ophthalmic diseases including retinal diseases and uveitis were summarized and analyzed.

To investigate the impact of depression-like behavior on ocular surface homeostasis in a mouse model, with a focus on dry eye-like alterations. Male C57BL/6J mice (10-12 weeks old) were randomly assigned to control or restraint stress (RS) groups. The RS group underwent three intermittent 24-hour restraint sessions to induce depressive-like behavior. Behavioral testing, tear secretion measurement, and corneal Oregon Green Dextran (OGD) staining were performed. Postmortem analyses included histological evaluation of lacrimal glands, goblet cell quantification using periodic acid-Schiff staining, and assessment of key inflammatory and apoptotic markers: interleukin (IL)-17, matrix metalloproteinases (MMP)-3, MMP-9, IL-13, interferon (IFN)-γ, and cleaved caspase-3 and -8. Repeated RS induced depression-like behavior and significant ocular surface changes. RS-treated mice showed increased corneal OGD uptake and upregulation of gene/protein expression of IL-17, MMP-3, and MMP-9 (P<0.05). Goblet cell density and IL-13 protein expression were reduced, while IFN-γ protein expression was elevated (P<0.05). Cleaved caspase-3 and -8 levels were significantly increased in both cornea and conjunctiva. Tear volume and lacrimal gland size were unchanged; however, mild inflammatory infiltration was observed in lacrimal glands. Repeated RS leads to ocular surface inflammation and dry eye-like pathology, including corneal barrier disruption, goblet cell loss, and epithelial apoptosis. These findings suggest that depression contributes to the pathogenesis of dry eye disease via immune-mediated mechanisms.

To evaluate the predictive value of pan-immune-inflammation value (PIV) in the diagnosis of proliferative diabetic retinopathy (PDR) and its association with the stage of PDR. This observational case-control study included participants who underwent routine complete blood count testing. Inflammation-related indices, including neutrophil-to-lymphocyte ratio, systemic immune-inflammation index (SII), and PIV, were derived and analyzed. Receiver operating characteristic curve (ROC) analysis was applied to assess the diagnostic performance of these indices in distinguishing patients with PDR, with sensitivity, specificity, area under ROC, and optimal threshold values calculated. In addition, binary logistic regression analysis was performed to evaluate the association between inflammatory indices and PDR stage. This study included 205 patients: 60 with diabetes without retinopathy (mean age: 61.81±10.76y), 80 with PDR (mean age: 61.63±10.03y) and 65 healthy controls (mean age: 59.52±5.88y). The PDR group had significantly higher white blood cell (WBC, P<0.001), monocyte (MONO, P=0.009) and neutrophil (NEU) counts (P<0.001). SII and PIV had the highest sensitivity and area under ROC for predicting patients with PDR (0.822, 0.846, respectively). The optimal cut-off values for discriminating patients with PDR were determined to be >527.12 and >299.08 for SII and PIV, respectively. The logistic regression analysis demonstrated that a decrease in lymphocyte (LYM) count and an increase in platelet count (PLT), glycated haemoglobin (HbA1c), SII, and PIV were all significantly associated with the development of high-risk PDR (all P<0.05). PIV was more stable than independent MONO, LYM, PLT and NEU levels in predicting both the diagnosis and stage of PDR. The optimal cut-off value for PIV to discriminate patients with high-risk PDR was found to be >345.87 area under ROC=0.871, with sensitivity of 0.827 and specificity of 0.812. PIV is a reliable, valuable, and inexpensive blood index that can be used for early detection and staging of PDR. PIV may therefore be essential to be used for the follow-up of diabetic patients.