Primary angle-closure glaucoma (PACG) has traditionally been regarded as an ocular disorder, but accumulating evidence suggests broader central nervous system involvement. Although previous neuroimaging studies have identified static functional abnormalities, the dynamic properties of large-scale brain networks and their associated molecular signatures in PACG remain insufficiently understood. We applied Leading Eigenvector Dynamics Analysis to resting-state functional MRI data from 44 patients with PACG and 57 healthy controls to characterize recurrent whole-brain dynamic states. State-specific temporal metrics and spatial patterns were further evaluated using multiple machine learning models. To explore potential biological correlates, imaging-derived spatial patterns were linked to cortical gene expression profiles from the Allen Human Brain Atlas using partial least squares regression, followed by pathway enrichment, cell-type enrichment, and neurotransmitter receptor/transporter mapping analyses. Compared with healthy controls, PACG patients showed prolonged dwell time in one recurrent dynamic state, suggesting reduced flexibility of large-scale brain dynamics. Machine learning models showed promising classification performance within the current dataset, with the most informative features primarily located in default mode network regions. Transcriptomic decoding revealed enrichment of genes related to synaptic signaling, ion channel activity, neurotransmitter transport, and neuronal communication. Cell-type enrichment analyses further implicated excitatory neurons, inhibitory neurons, and astrocytes. In addition, a significant spatial association with VMAT2 suggested that monoaminergic systems may be relevant to the observed imaging phenotype. PACG is associated with altered large-scale brain dynamics, particularly involving default mode network-related state instability. These imaging abnormalities show spatial associations with molecular, cellular, and neurotransmitter-related signatures.

Association Between Pseudoexfoliation Glaucoma and Central Serous Chorioretinopathy.

Anterior segment, static and dynamic pupillography changes in patients with primary open-angle glaucoma using different types of topical antiglaucomatous agents.

Effects of Optic Nerve Head Structures on Retinal Nerve Fiber Layer Defects in Primary Open Angle Glaucoma Eyes: Analyses Using Retinal Optical Texture Analysis.

To compare graft survival and alloimmune responses in murine endothelial keratoplasty (EK) versus penetrating keratoplasty (PK) and to elucidate the immunological mechanisms that underlie the differential graft outcomes. Allogeneic EK and PK were performed in BALB/c recipient mice using fully disparate C57BL/6 donors; syngeneic EK recipients served as controls. Graft clarity was monitored over 16 weeks by slitlamp biomicroscopy and scored using standardized opacity grading. Anterior segment optical coherence tomography (AS-OCT) was used to measure central corneal thickness. Graft survival was assessed using Kaplan-Meier analysis. Immunohistochemistry and confocal microscopy were performed to evaluate corneal endothelial cell (CEnC) integrity through ZO-1 staining. T-cell-mediated alloimmunity was assessed using intracellular IFN-γ staining (flow cytometry) and ELISPOT assays targeting both direct and indirect antigen presentation pathways. PK allografts exhibited significantly higher corneal opacity and lower survival (50%) than allogeneic EK grafts (71.4%, P < 0.0001). AS-OCT showed that corneal edema was highest in rejected PK grafts at 4 weeks and in rejected EK grafts at 16 weeks, with EK displaying a more gradual increase in thickness. Flow cytometry revealed significantly greater frequencies of IFN-γ + CD4 + T cells in PK recipients compared with EK recipients ( P < 0.001). ELISPOT assays demonstrated a more robust Th1 response in PK through both the direct and indirect sensitization pathways. Corneal endothelial cell (CEnC) density was significantly reduced in rejected EK and PK grafts compared with their respective accepted counterparts ( P < 0.01), whereas CEnC density was comparable between accepted EK and PK grafts. EK grafts exhibit higher graft survival rates and significantly reduced activation of host T-cell responses compared with PK grafts, which may be attributed to lower frequencies of graft-borne antigen presenting cells, thus resulting in a milder Th1-mediated immune response.

PURPOSE. To evaluate the clinical effectiveness of combined mechanical trabecular peeling and phacoemulsification (PE) in patients with primary open-angle glaucoma (POAG) and complicated cataract. METHODS. The study included 72 patients (72 eyes) with POAG and complicated cataract (46 women, 26 men). Early stage POAG was present in 52 (72.2%) eyes, and moderate stage POAG in 20 (27.7%) eyes. Patients were divided into two groups. In the main group (37 patients, 37 eyes), subjects underwent mechanical trabecular peeling combined with phacoemulsification and intraocular lens (IOL) implantation. The control group (35 patients, 35 eyes) underwent isolated phacoemulsification with IOL implantation. Baseline intraocular pressure (IOP) measured by Maklakov tonometry was 23 [19; 24] mm Hg in the main group and 23 [21.0; 25.0] mm Hg in the control group (p=0.553). The number of hypotensive medications used preoperatively was 2 [0; 4] in the main group and 2 [0; 3] in the control group (p=0.135). The follow-up period was 12 months. RESULTS. At 12 months, IOP in the main group was 18.0 [18.0; 20.0] mm Hg with complete discontinuation of hypotensive therapy. In the control group, IOP was 20.0 [19.5; 22.5] mm Hg, with additional hypotensive therapy required in 9% of cases. The reduction in IOP from baseline was 15.37% in the main group and 11.46% in the control group (p=0.031). A significant difference between groups was observed in the ease of outflow coefficient (p=0.007). CONCLUSION. The developed combined technique of phacoemulsification with mechanical trabecular peeling results in a 15.37% reduction in IOP from baseline at 12 months postoperatively, exceeding the hypotensive effect of isolated PE. The method is associated with a minimal risk of complications and may be recommended for the treatment of patients with early and moderate POAG and complicated cataract.

To identify the impact of physical activity (PA) on the incidence of anxiety disorders among patients diagnosed with open-angle glaucoma (OAG). A claims dataset extracted from the Korean National Health Insurance Service consisted of 131,195 individuals who were diagnosed with oOAG between 2011 and 2015. Their PA levels prior to and after OAG diagnosis were determined, and Cox proportional hazards models were used to calculate hazard ratios (HR) of anxiety disorders depending on their PA levels. The OAG patients included in the study were 58.9 ± 12.6 years old (59.6% males), and 34.4% (n = 27,238; 62.0 ± 11.5 years old, 50.9% males) patients developed anxiety disorders. The average time to anxiety disorders diagnosis was 45.79± 33.14 months. Patients who had high PA levels after glaucoma diagnosis had 9% lower hazard of anxiety disorders diagnosis compared to those patients with low PA levels (HR 0.914, 95% confidence intervals [CI] 0.892-0.937). Elevating PA levels from low to high after OAG diagnosis also led to 6% reduction in the hazard of anxiety disorders among OAG patients (95% CI 0.902-0.971). Patients who maintained high PA levels after OAG diagnosis were also at lower risks of anxiety disorders(HR 0.899, 95% CI 0.871-0.927). Regular PA among OAG patients may contribute to a healthier emotional well-being.

To assess the relationship between the PACS Plus criteria and patients who develop primary Acute Angle Closure Glaucoma (AACG). This was a retrospective single-centre study including adult patients with a diagnosis of primary AACG recorded between 3rd June 2015 and 3rd June 2025. Secondary causes of acute angle closure were excluded. Following the search, electronic records were screened for PACS Plus criteria and graded as 'PACS Plus' or 'PACS Minus'. The number and type of PACS Plus criteria met by each patient were recorded. The database search found 137 patients with AACG, of which 83 met the inclusion criteria and had sufficient data for grading. 45 patients (54.22%) would have been labelled 'PACS Plus', while 38 patients (45.78%) would have been labelled 'PACS Minus'. On changing the PACS Plus criterion 'a family history of significant angle closure disease' to a modified criterion of 'a 1st degree relative with glaucoma', PACS Plus tool sensitivity was improved, with a significant increase in the number of labelled 'PACS Plus' (60 patients, 72.29%; p < 0.001, McNemar test with Edwards correction). The results found suggest that the PACS Plus tool could be amended to better identify high-risk PACS patients who go on to develop primary AACG. By broadening the family history criteria to 'a 1st degree relative with glaucoma', sensitivity might be significantly increased and better ascertain high-risk PACS patients for whom LPI would be beneficial.

To evaluate whether early postoperative corneal thickness is associated with 12-month endothelial cell and visual outcomes after Descemet membrane endothelial keratoplasty (DMEK). This retrospective multicentre study included eyes with central corneal thickness (CCT) data within 1 month and endothelial cell density (ECD) at 12 months. Early postoperative CCT was defined as the maximum value at 1 week or 1 month. Associations with ECD loss and visual acuity (VA) improvement were analysed using correlation and regression models. A total of 208 eyes were included. CCT decreased rapidly within the first postoperative month. Mean ECD decreased from 2690.7 ± 209.5 cells/mm2 at baseline to 1528.4 ± 494.0 cells/mm2 at 12 months, corresponding to a mean endothelial cell loss of 43.4%. No significant correlation was observed between early postoperative CCT reduction and 12-month ECD loss (r = 0.11, p = 0.075). In multivariable analysis, CCT reduction was not independently associated with ECD loss (p = 0.308) or VA improvement (p = 0.977), whereas baseline ECD (p = 0.039), baseline VA (p < 0.001) and country (p < 0.001) remained significant predictors. Early postoperative corneal thickness was not associated with endothelial or visual outcomes. These findings suggest that early CCT reflects short-term corneal recovery but has limited prognostic value after DMEK.

Purpose To evaluate the changes in aberrometry values on corneal topography and the function of the meibomian glands following therapeutic Botulinum toxin type A injections in patients with blepharospasm and hemifacial spasm. Materials and methods This retrospective interventional study included 24 eyes of 17 patients treated with Botulinum toxin type A for blepharospasm and hemifacial spasm. Corneal topography and meibography were performed before treatment and at 1 month. Results Botulinum toxin type A was injected bilaterally in seven patients and unilaterally in ten patients, totaling 24 treated eyes. There were no significant differences between pre- and post-injection measurements of flat keratometry (K1) (p = 0.585), steep keratometry (K2) (p = 1.000), mean keratometry (Kmean) (p = 0.809), corneal astigmatism (p = 0.641), astigmatism axis (p = 0.647), central corneal thickness (p = 0.631), anterior chamber depth (p = 0.127), and anterior chamber volume (p = 0.747). However, the root mean square of higher-order aberrations (RMS-HOA) (p = 0.018) and RMS-quadrafoil (Z4 4) (p = 0.012) significantly increased one month after the injection. Although increases were also observed in RMS-coma (Z3 1) (p = 0.225), RMS-trefoil (Z3³) (p = 0.147), secondary astigmatism (p = 0.433), and RMS-spherical aberration (Z4 0) (p = 0.150), these changes did not reach statistical significance. After the injection, there was a statistically significant reduction in tear break-up time (TBUT) (p = 0.041), Ocular Surface Disease Index (OSDI) score (p = 0.041), and the area of the meibomian glands (mm2) (p < 0.001). Conclusion Botulinum toxin A injection into the orbicularis oculi in both groups may decrease meibomian glands and tear function, increasing corneal aberrations and reducing visual quality after 1 month.

Glaucoma is a leading cause of irreversible blindness worldwide. A substantial proportion of patients experience disease progression despite adequate IOP control, which is the most significant modifiable risk factor. This indicates the involvement of additional pathogenic mechanisms. One such mechanism is neuroinflammation within the retina and optic nerve head, spearheaded by resident glial cells. These activated glial cells initiate a cascade of proinflammatory cytokines that drives oxidative stress, excitotoxic injury, and ultimately apoptosis in retinal ganglion cells (RGCs), the cells that are responsible for vision. Given the central role of cytokines in mediating this neuroinflammatory damage, several genetic association studies have checked whether functional variants in the cytokine genes modify disease susceptibility to primary glaucoma. In this review, we critically compare and assess the strength of these associations in both open-angle and angle-closure glaucoma, highlighting the inconsistencies and population-specific variability, while also evaluating the limitations of current association studies and how to overcome these challenges. Second, we address a critical mechanistic gap-how cytokine gene variants may influence glial activation, and contribute to the inflammatory ocular microenvironment that may drive disease progression. Finally, we discuss if oxidative stress-driven epigenetic modifications may modulate cytokine gene expression and amplify inflammatory responses in individuals who might be genetically predisposed to develop primary glaucoma.

Objective measurement of tonic and dynamic accommodative behavior in Duane retraction syndrome.

The diagnostic significance of lncRNA BANCR in Glaucoma.

Prospective Evaluation of Iridocorneal Angle and Anterior Segment Changes Following Lower Eyelid Blepharoplasty: Evidence of Transient, Reversible Ocular Biomechanical Alterations.

The study aimed to compare the efficacy and safety of netarsudil (NET), alone or in fixed-dose combinations (FDC), in comparison with prostaglandin analogues (PGAs: bimatoprost [BIM], latanoprost [LAT], travoprost [TRA], and tafluprost [TAF]) for the treatment of primary open-angle glaucoma (POAG) or ocular hypertension. Literature search in PubMed, Embase, Cochrane Library, Web of Science (inception to July 2025). Identified 26 randomized controlled trials (RCTs) (5,390 patients). The primary outcome was the mean difference in intraocular pressure (IOP) reduction at 3months; the secondary outcome was the incidence of conjunctival hyperemia. Pair-wise meta-analysis used Cochrane Review Manager 5.4, Bayesian network meta-analysis via Aggregate Data Drug Information System (ADDIS) with Markov Chain Monte Carlo (MCMC) simulations. Inconsistency assessed via node-splitting, convergence evaluated via Brooks-Gelman-Rubin method. Network meta-analysis showed 3-month IOP -lowering hierarchy: FDC > BIM > TRA > LAT > TAF > NET. Conjunctival hyperemia incidence (highest to lowest): TAF > FDC > NET > BIM > TRA > LAT. Node-splitting confirmed consistency (P ≥ 0.05), convergence was satisfactory. Funnel plots indicated no publication bias for IOP outcomes but potential bias for conjunctival hyperemia. Although NET ranked lower in IOP-lowering efficacy compared to most PGAs and FDC, it demonstrated a favorable safety profile, particularly with a relatively lower incidence of conjunctival hyperemia than TAF and FDC. These findings suggest that NET may serve as a valuable alternative in patients who are intolerant to PGAs or require adjunctive therapy, warranting further investigation in targeted populations.

We report a rare case of cytomegalovirus (CMV) iridocyclitis and vitreoretinal lymphoma (VRL) that developed sequentially in the same eye during long-term infliximab (IFX) therapy for ulcerative colitis. This case highlights both the risk of opportunistic ocular infections and lymphoproliferative disorders coexisting in the same eye and the diagnostic challenges associated with prolonged immunosuppression. A 65-year-old man presented to the ocular inflammatory service at Nippon Medical School Tama-Nagayama Hospital with deteriorating vision in the left eye. His medical history included IFX therapy for 11 years for ulcerative colitis, a 7-year history of bilateral primary open-angle glaucoma, and recurrent iridocyclitis in the left eye. Slit-lamp examination revealed mutton-fat keratic precipitates and dense vitreous opacities. Multiplex PCR of the aqueous humor detected CMV and Epstein-Barr virus (EBV). The cytological grading of the vitreous fluid was class IIIb. Cytokine analysis revealed an interleukin (IL)-10/IL-6 ratio of > 1.0, and immunoglobulin heavy chain gene rearrangement revealed monoclonality. Based on these findings, the patient was diagnosed with concurrent CMV iridocyclitis and VRL in the same eye. EBV positivity in the aqueous humor may have been associated with VRL development under prolonged immunosuppression. Topical ganciclovir was initiated for CMV iridocyclitis. The patient underwent bilateral ocular radiotherapy (40Gy) and systemic chemotherapy with rituximab, methotrexate, procarbazine, and vincristine after IFX cessation. Although inflammatory and infiltrative lesions resolved, his final visual acuity was 20/200 due to glaucomatous visual field loss. The present case highlights both the risk of opportunistic ocular infections and lymphoproliferative disorders associated with prolonged immunosuppression and the diagnostic challenge when both conditions coexist in the same eye. Careful monitoring and close collaboration between ophthalmologists and internists are essential for the early diagnosis and appropriate management of such patients.

To compare anterior scleral thickness (AST) and aqueous outflow structure metrics Schlemm's canal area (SCA), trabecular meshwork thickness (TMT), and scleral spur length (SSL) among primary open-angle glaucoma (POAG), ocular hypertension (OHT), and healthy eyes using spectral-domain OCT (SD-OCT), and to evaluate their inter-relationships. In this prospective study, we included 126 participants (56 POAG, 24 OHT, 46 controls) from a tertiary glaucoma clinic (January-May 2025). One eye per subject was analysed. SD-OCT (REVO 60, Optopol, Poland) was used to obtain horizontal anterior-segment scans in nasal and temporal quadrants. AST was measured at 0-3 mm from the scleral spur (AST0-AST3); SCA, TMT, and SSL were quantified on exported images using Fiji/ImageJ with pixel-to-micron calibration. Group comparisons employed ANOVA/Kruskal-Wallis with post-hoc tests. Correlations and multiple linear regression assessed determinants of nasal AST0. Inter-observer repeatability was evaluated with ICC. Mean age was 67.9 ± 10.0 (POAG), 62.7 ± 10.4 (OHT), and 62.9 ± 6.6 years (controls). AST0 was significantly lower in POAG and OHT compared with controls in both nasal and temporal quadrants (all p < 0.001). For AST3, temporal values were lower in POAG and OHT compared with controls (p < 0.001), while nasal AST3 showed no significant group difference. SCA and SSL were significantly lower in POAG and OHT compared with controls in both quadrants (all p < 0.001). TMT tended to be lower in patient groups but often did not reach significance. In multivariable analysis, nasal SCA and nasal SSL were independent positive predictors of nasal AST0 (both p < 0.001; model R² = 0.356). Inter-observer ICCs ranged 0.78-0.93 (highest for nasal SCA = 0.93), indicating good repeatability. POAG and OHT are characterised by a thinner anterior sclera and smaller Schlemm's canal area and scleral spur length compared with controls. The independent association of SCA and SSL with AST supports a biomechanical coupling between the perilimbal sclera and outflow structures. These metrics warrant further longitudinal study for diagnostic/prognostic utility.

To assess the correlation between optical coherence tomography (OCT) and ultrasound pachymetry (USP) as methods for analysing central corneal thickness (CCT) and to evaluate ophthalmic factors affecting CCT. The eyes of 3070 subjects of the Northern Finland Birth Cohort (NFBC) were examined at the age of 45-49 years. CCT was measured using OCT and USP. The optic nerve head (ONH) and retinal nerve fibre layer (RNFL) parameters were assessed with OCT and Heidelberg Retina Tomograph (HRT). Visual acuity and refraction were evaluated with an autorefractometer and intraocular pressure (IOP) with rebound tonometry (iCare) and Goldmann applanation tonometry (GAT). The evaluation of glaucomatous damage was based on the ONH, RNFL and visual fields. The mean CCT was 540.0 ± 34.8 μm with OCT and 540.7 ± 39.6 μm with USP. There was a strong correlation (r = 0.927, p < 0.001) between the devices, and the inter-method agreement increased with better visual acuity (r = 0.086, p = 0.003). The CCT measured with OCT correlated with IOP (r = 0.400 (iCare), r = 0.314 (GAT), p < 0.001), rim area (r = 0.048, p = 0.011), cup volume (r = -0.046, p = 0.014) and RNFL (r = 0.041, p = 0.027). We found no correlation between CCT and glaucoma. The results indicate that OCT and USP may be used interchangeably when measuring CCT. As expected, CCT had a substantial correlation with IOP, but was also positively associated with ocular neural tissue (rim and RNFL) and negatively with the optic cup.

PurposeTo characterize the genetic landscape of congenital ectopia lentis (EL) and assess genotype–phenotype correlations with implications for surgical decision-making.MethodsThis retrospective study enrolled patients with congenital EL who presented to Fudan University Eye and ENT Hospital between 2017 and 2025. We performed targeted next-generation sequencing for probands, with candidate variants confirmed by Sanger sequencing. Patients were categorized into FBN1 and non-FBN1 groups. The ocular features and surgical options were compared across genotypes.ResultsA total of 497 probands were enrolled. The molecular diagnostic yield was 93.36%, with FBN1 variants accounting for 82.93% and non-FBN1 variants for 10.44%. Compared with FBN1 cases, non-FBN1 patients exhibited higher EL severity (P < 0.001), lower corneal curvature radius (CCR) (P < 0.001), and higher incidence of ocular comorbidities (P < 0.01). Surgically, non-FBN1 patients more often required robust intraocular lens fixation methods than did FBN1 patients (P < 0.001). Within the FBN1 cohort, the DN(Cys+CaB)+HI subgroup exhibited longer axial length (AL) (P < 0.001), thinner central corneal thickness (CCT) (P = 0.015), and a higher proportion of clinically diagnosed Marfan syndrome (P < 0.001) compared with the DN(Others) subgroup. In contrast, the FBN1 DN(Others) subgroup showed comparable AL, CCT, and CCR to the non-FBN1 group (all P > 0.05). No significant difference of ocular biometrics or surgical options were observed within the non-FBN1 group, except for the highest CCR in patients harboring CPAMD8 variants (P = 0.004).ConclusionsGenetic characterization of congenital EL extends beyond diagnosis to inform ocular phenotype variability and surgical decision-making.

To investigate the effects of laparoscopic sleeve gastrectomy (LSG), a common subtype of metabolic and bariatric surgery (MBS), on corneal densitometry (CD) and lens densitometry (LD). This prospective, single-center study included 58 eyes of 58 obese participants. Preoperative and 6-month postoperative CD, LD, and anterior segment parameters were evaluated using Pentacam topography. The primary outcomes were changes in CD and LD six months after surgery. A total of 58 eyes from 58 participants, with a mean age of 36.76 ± 10.79 years, were evaluated. Six months following LSG, the average body mass index (BMI) decreased from 43.4 ± 6.6kg/m2 to 31.54 ± 5.13kg/m2 (p < 0.001). Central corneal thickness (CCT), intraocular pressure (IOP), CD, and LD decreased significantly six months after LSG (p < 0.001). The anterior chamber depth (ACD) and angle (ACA) significantly increased six months after LSG (p < 0.001 for all parameters). Correlation analyses showed a moderate positive association between changes in CD and LD, whereas only weak correlations were observed between changes in ocular and metabolic parameters. LSG was associated with significant changes in CD, LD, and anterior segment parameters, suggesting a positive effect on ocular tissue transparency. Not applicable.