Table of Content

25 August 2026, Volume 50 Issue 4

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Research progress on cardiovascular event complications associated with ophthalmic surgery

Zhou Hui, Wang Jing, Wang Jibin

2026, 50(4):  241-246.  doi:10.3760/cma.j.cn115500-20260326-26401

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With advancements in surgical techniques and improvements in anesthesia protocols, the incidence of ophthalmic surgery-related complications has significantly decreased. Although the probability of severe cardiovascular complications remains extremely low, they can still occur. Therefore, ophthalmologists must have a comprehensive understanding of these complications to implement proactive preventive measures, promptly recognize symptoms, and administer optimal treatment, thereby maximizing patient prognosis. Among the complications triggered by ophthalmic surgery, cardiovascular events are the most prevalent. These include the oculocardiac reflex, which can lead to hemodynamic instability and cardiac arrest; iatrogenic venous air embolism (such as ocular venous air embolism or perfluorocarbon syndrome), which may cause pulmonary circulation disturbances, respiratory distress, and cardiogenic shock; and postoperative venous thromboembolism. This review aims to provide a systematic overview of severe cardiovascular complications related to ophthalmic surgery by synthesizing the latest evidence-based medical findings. It will focus on their pathogenesis, high-risk factors, typical symptoms and signs, and briefly discuss clinical management strategies, offering a reference for ophthalmic clinical practice.


Relationship between the ciliary body and the pathogenesis of angle closure glaucoma

Chen Huan, Zheng Xuanli, Lin Haishuang, Wang Xiaojie, Zuo Jingjing, Liang Yuanbo

2026, 50(4):  247-252.  doi:10.3760/cma.j.cn115500-20260417-26402

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The ciliary body and its adjacent anatomical structures play a vital role in the pathogenesis of primary angle closure glaucoma (PACG). With the development of anterior segment imaging techniques such as ultrasound biomicroscopy, the key roles of pathogenic mechanisms including ciliary body rotation, narrow cilio-lenticular space, and zonular abnormalities in PACG have been gradually revealed. This article reviews the dynamic changes in ciliary body morphological parameters during the occurrence and progression of the disease. Based on the "trans-lens pressure differential" hypothesis, it proposes that morphological abnormalities of the ciliary body and zonules are downstream biomechanical outcomes of abnormally elevated trans-lens pressure differential: specifically, the pathological process progresses from initial ciliary block and the formation of trans-lens pressure differential to anterior lens displacement and forced stretching of the ciliary body, which further results in mechanical decompensation of the zonules. The above mechanisms contribute to a deeper understanding of the multifactorial pathogenic network of PACG and provide a new theoretical basis for fundamentally relieving ciliary block and improving patient prognosis by reshaping ciliary process morphology.


The role of ferroptosis in the pathogenesis and treatment of glaucoma

Wu Renyi, , Zhou Yongwei, Zheng Tan

2026, 50(4):  253-259.  doi:10.3760/cma.j.cn115500-20260326-26403

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Glaucoma is an ophthalmic disease characterized by optic nerve damage and visual field defects. Recent studies have revealed that ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, is extensively involved in the pathogenesis of glaucoma. This article provides a systematic review of the molecular mechanisms and research progress on ferroptosis in the development and progression of glaucoma. Ferroptosis induces retinal ganglion cell death and trabecular meshwork dysfunction through iron metabolism dysregulation, accumulation of lipid peroxides, and aberrant regulation of key molecules such as GPX4. Significant alterations in ferroptosis-related markers have been observed in both animal models of glaucoma and clinical samples. Intervention strategies targeting key nodes of ferroptosis (e.g., GPX4, ACSL4, NCOA4), including iron chelators, small-molecule inhibitors, and gene therapy, have demonstrated clear neuroprotective and intraocular pressure-lowering effects in preclinical models. Ferroptosis intertwines with other pathological processes such as oxidative stress, excitotoxicity, and neuroinflammation, collectively driving glaucoma progression. Targeting ferroptosis offers a novel strategy for glaucoma treatment that extends beyond simple intraocular pressure reduction and holds significant potential for clinical translation.However, current evidence is mainly derived from animal models and in vitro experiments, and whether ferroptosis is a driver or a consequence of glaucoma remains to be clarified. A systems biology perspective integrating multiple signaling pathways may facilitate a more comprehensive understanding of the disease mechanisms.


Applications of the finite element method in glaucoma research

Fu Chenyu, Fu Lin, Liang Yuanbo

2026, 50(4):  260-265.  doi:10.3760/cma.j.cn115500-20260326-26404

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Glaucoma is a leading cause of irreversible blindness worldwide, associated with elevated intraocular pressure, biomechanical injury of the optic nerve head and lamina cribrosa, and abnormal aqueous humor outflow. Conventional approaches fail to quantitatively reveal its mechanical pathogenesis. As a important computational approach, the finite element method (FEM) enables accurate simulation of ocular tissue stress, strain, and fluid dynamics. FEM quantifies lamina cribrosa displacement, stress concentration, and asymmetric distribution under high IOP, confirms increased outflow resistance caused by trabecular meshwork stiffening, and helps optimize IOP measurement, drug delivery, and surgical safety. This review summarizes advances of FEM in glaucoma research, discusses challenges in modeling, and explores the prospects of its integration with artificial intelligence and multiphysics coupling, providing reliable biomechanical evidence for precision management.


Surgical treatment of cataract after implantable collamer lens implantation

Xi Yue, Wang Zhenyu, Zhang Ran, Wang Jinda

2026, 50(4):  266-272.  doi:10.3760/cma.j.cn115500-20251208-26405

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Cataract formation after posterior chamber phakic intraocular lens (Implantable Collamer Lens, ICL) implantation involves complex mechanisms, and subsequent cataract surgery presents unique challenges in preoperative evaluation, intraocular lens (IOL) power calculation, surgical strategy selection, and perioperative management. This article reviews the evolution of ICL technology and the mechanisms underlying cataract development after ICL implantation, and summarizes recent advances in the surgical management of post-ICL cataracts. Particular emphasis is placed on preoperative structural and functional ocular assessment, IOL power calculation strategies, combined ICL explantation with phacoemulsification and IOL implantation, femtosecond laser-assisted cataract surgery (FLACS), and the clinical application of other related adjunctive technologies , as well as a summary of prevention and management measures for perioperative complications, aiming to provide a reference for clinical diagnosis and treatment.Overall, comprehensive preoperative evaluation, optimized IOL calculation, and individualized surgical strategies may improve surgical safety, refractive predictability, and visual outcomes in cataract surgery after ICL implantation.


Artificial intelligence-enabled paradigm shift in the whole-process management of cataract

Li Zhiwei, Chen Xiaofeng

2026, 50(4):  273-277.  doi:10.3760/cma.j.cn115500-20260308-26406

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Cataract stands as the leading ocular disorder responsible for blindness worldwide. Conventional diagnosis and treatment paradigms for cataract are plagued by a series of dilemmas across the entire care continuum, including subjectivity in clinical decision-making, inconsistent standardized operational protocols, and inequitable distribution of medical resources throughout screening, definitive diagnosis, surgical intervention and postoperative management. The emergence of artificial intelligence (AI) technology has given a novel solution to address these challenges in cataract care. This article systematically reviews the cutting-edge application progress of artificial intelligence technologies in the full-cycle diagnosis and treatment of cataract, with an intensive focus on five core critical segments: cataract screening and grading, preoperative biometric measurement and intraocular lens power calculation, intraoperative surgical operation assistance, postoperative management, as well as integrated full-process care delivery. This paper further conducts an in-depth analysis of how AI drives the paradigm shift in cataract diagnosis and treatment.


Progress in intraocular lens power calculation formulas for pediatric cataract

Zhao Yitong, Zhou Haiyan, Yan Hong

2026, 50(4):  278-283.  doi:10.3760/cma.j.cn115500-20260402-26407

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Refractive shift following pediatric cataract surgery is a significant clinical challenge, and intraocular lens (IOL) power calculation formulas play a crucial role in influencing the postoperative refractive shift. Direct application of adult IOL power calculation formulas results in considerable inaccuracy, making the selection of pediatric-specific formulas particularly important. This article systematically reviews the current status of traditional formulas, modern optimized formulas, and novel predictive models. Studies indicate that when performing primary IOL implantation, using at least two formulas to calculate IOL power based on axial length and the method of IOL optic capture in the posterior capsule helps reduce postoperative refractive shift. For secondary in-the-bag IOL implantation, the Barrett Universal II (BUII) formula demonstrates unique advantages in predictive accuracy and stability, whereas for secondary sulcus IOL implantation, targeted adjustments to IOL power or optimization of formula constants are required to improve calculation accuracy. The choice of IOL calculation formula for pediatric eyes should be individualized according to age, axial length, implantation site, and surgical technique, with emphasis on optimizing IOL power formulas to achieve more stable refractive outcomes.


elationship between intermittent exotropia and myopia progression in children

Chen Yuxin, Shi Xuefeng

2026, 50(4):  284-290.  doi:10.3760/cma.j.cn115500-20251208-26408

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Intermittent exotropia (IXT) is a common type of strabismus in children in China, and the relationship between IXT and myopia progression has received widespread attention in recent years. Existing studies suggest that children with IXT may experience imbalanced accommodation-convergence, abnormal fusion function, and unstable visual input, which could biologically influence axial elongation and thereby contribute to the onset and progression of myopia. However, clinical findings on whether IXT affects myopia progression remain inconsistent. Some evidence indicates that IXT may accelerate myopia progression, while other studies suggest its effects are not significant. Overall, the development and progression of myopia in the context of IXT result from multifactorial interactions. This article aims to provide a systematic review of the impact of IXT on myopia progression in children and the underlying mechanisms.


Association of alterations in choroidal thickness and hemodynamics with the development and progression of juvenile myopia

Wang Huimin, Bian Hongjun

2026, 50(4):  291-296.  doi:10.3760/cma.j.cn115500-20260128-26409

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Children's choroidal thickness (ChT) increases with age but decreases with axial elongation. During ocular development, axial length growth is strongly correlated with refractive status, and a relatively longer axial length significantly increases the risk of myopia onset. This review focuses on the patterns of change, molecular mechanisms, and clinical thresholds of choroidal thickness (ChT) and choroidal vascularity index (CVI) in myopic adolescents. It is observed that during myopia progression in adolescents, ChT diminishes alongside a reduction in CVI. These parameters may therefore serve as specific biomarkers for targeted prevention and control of myopia in children and adolescents.


Evolutionary characteristics of optic disc and retinal structure and microcirculation in the progression of myopia in children and adolescents

Yang Yatong, Li Siyu, Zhang Xiangrong

2026, 50(4):  297-301.  doi:10.3760/cma.j.cn115500-20260212-26410

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Myopia progression involves more than just axial elongation. It is accompanied by specific remodeling of the optic disc, retinal anatomy, and microcirculation. As myopia worsens, the optic disc ovality index and tilt ratio increase significantly. The measurement of optic disc area must account for the influence of ocular magnification effects. The peripapillary atrophy zone widens as the axial length increases, serving as an early monitoring indicator for pathological myopia. Regarding the retina, the foveal thickness is significantly greater in highly myopic individuals, while the outer retinal thickness is thinner. In terms of microcirculation, blood perfusion in the optic disc and parapapillary areas decreases as myopia progresses. However, the specific patterns of blood flow density changes in the retinal and choroidal microcirculation require further confirmation. Integrating these features is essential for building a precise monitoring system for myopia prevention and control in youth.


Retinal sensitivity on microperimetry in macular edema of various etiologies

Li Si, Yang Na, Zhang Haijiang, Wang Liying, Zhang Yueling

2026, 50(4):  302-308.  doi:10.3760/cma.j.cn115500-20251217-26411

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The review discusses changes in macular retinal sensitivity during microperimetry for conditions such as retinal vein occlusion, diabetic retinopathy, and uveitis leading to macular edema. In these cases, macular central retinal thickness, retinal structural integrity, the extent of non-perfusion in the macular region, and vascular density are closely related to macular retinal sensitivity. Additionally, there are notable differences in the impact of laser therapy and various drug treatments on macular retinal sensitivity. This implies that measuring the macular retinal sensitivity by microperimatry can provide more precise treatment for patients.


Research progress on the assessment of orientation and mobility in visually impaired patients

Zhao Yu, Zhao Weiqi, Yang Xiaohui

2026, 50(4):  309-313.  doi:10.3760/cma.j.cn115500-20251223-26412

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At present, the main indicators for assessing the orientation and mobility (O&M) ability of visually impaired patients include percentage of preferred walking speed, number of contacts with obstacles, number of directional deviations, other efficiency indicators, self-assessment, safety indicators, and the assessment environment. The application of O&M ability assessment includes understanding the prognosis of different visually impaired patients and evaluating the effectiveness of various assistive devices. The O&M ability of patients with severe visual impairment can be assessed using the orientation and mobility for very low vision test battery (O&M-VLV), while patients with inherited retinal dystrophies require the multi-luminance mobility test (MLMT). The assessment of O&M ability in visually impaired patients can also be used to evaluate the effectiveness of assistive tools such as three-dimensional tactile maps and different navigation systems.


Radiation-induced optic neuropathy after radiotherapy for head and neck tumors

Han Yuying, Wei Shihui, Fu Tao

2026, 50(4):  314-320.  doi:10.3760/cma.j.cn115500-20251217-26413

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Tumors of the head and neck are often located adjacent to visual pathways. Radiotherapy is an indispensable treatment for these tumors, but it also carries a significant risk of severe delayed visual impairment. Radiation-induced optic neuropathy (RION) is a delayed, radiation-induced ischemic injury of the optic nerve and optic chiasm, characterized by acute or subacute painless vision loss that can lead to irreversible visual impairment. The latency period ranges from several months to years. The incidence of RION is closely associated with radiotherapy techniques and doses, varying among different tumor types. The pathogenesis of RION remains incompletely elucidated but is thought to involve vascular endothelial damage-induced ischemia and edema, as well as axoplasmic transport disruption in the optic nerve fibers. Diagnosis of RION is primarily one of exclusion, requiring the exclusion of other causes of vision loss, such as tumor recurrence, followed by a comprehensive analysis of medical history, clinical manifestations, and imaging findings. Current treatments for RION are mainly symptomatic, as no definitive cure exists. Options include corticosteroid therapy, hyperbaric oxygen therapy, and anti-vascular endothelial growth factor (anti-VEGF) therapy. This review aims to systematically elaborate on the concept, epidemiological characteristics, influencing factors, clinical manifestations, diagnosis, and treatment of RION, providing a reference for clinical decision-making in radiotherapy for head and neck tumors and the prevention and management of RION.