Table of Content

22 October 2024, Volume 48 Issue 5

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The progress of diagnosis and treatment of malignant glaucoma

Zheng Xuanli, Lin Haishuang, Li Jiaqian, Lei Changrong, Wan Rui, Ye Wenqing, Liang Yuanbo

2024, 48(5):  321-326.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.001

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Malignant glaucoma is one of the most severe complications of glaucoma surgery. It mainly includes three types: typical malignant glaucoma, malignant glaucoma after cataract surgery, and other secondary malignant glaucoma. Anatomical factors such as a shallow anterior chamber, short axial length, and thick lens, as well as being young, female, diagnosed with angle-closure glaucoma, having a history of external filtration surgery, and preoperative high intraocular pressure, are considered risk factors for the occurrence of malignant glaucoma. The hypothesis of trans-lens pressure differential provides a new perspective for rethinking and understanding the pathogenesis of malignant glaucoma, and may offer new strategies for its prevention and treatment. Relieving ciliary block and restoring the flow of aqueous humor between the anterior and posterior chambers of the eye are key in the treatment of malignant glaucoma.  (Int Rev Ophthalmol, 2024, 48: 321-326)


Changes on ocular structures and parameters after ultrasound cycloplasty

Liu Dongyue, Li Qiang, Zhao Jun

2024, 48(5):  327-332. 

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Ultrasound cycloplasty (UCP) is a new non-invasive glaucoma treatment technology based on high-intensity focused ultrasound. UCP can effectively reduce intraocular pressure (IOP) in the treatment of various types of glaucoma such as primary glaucoma, neovascular glaucoma, traumatic glaucoma and other refractory glaucoma. For increased IOP again after UCP, it is also effective to administer repeated UCP treatment 3~6 months later, when the anterior chamber inflammation is under control. Meanwhile, UCP treatment can cause the changes on ocular structures and parameters, as well as related complications. Most of the complications, changes of ocular structures and parameters such as keratometry, conjunctival and scleral thickness, anterior chamber flare and pupil diameter were transient, usually recovered to preoperative level or subsided within 3~6 months after UCP. The change in anterior chamber depth have not been definitely reported after UCP. However, the scleral ciliary process angle was increased, and the ciliary body area was decreased after UCP. At the same time, further research is needed to clarify the changes and complications in the ocular posterior segment caused by UCP.  (Int Rev Ophthalmol, 2024, 48:  327-332)


Recent progress in diagnosis, treatment and research of geographic atrophy

Liao Xingming, Yang Yuting, Ma Hongjie

2024, 48(5):  333-340.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.003

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Geographic atrophy (GA) is an advanced form of age-related macular degeneration, characterized by progressive and irreversible loss of photoreceptors, retinal pigment epithelium, and choriocapillaris. Ophthalmic imaging technologies, such as color fundus photography, fundus autofluorescence, and optical coherence tomography, are crucial tools for diagnosing and assessing disease progression in GA. Monitoring visual function is essential in the disease surveillance of GA, and a single visual function test may not fully reflect the patient's true visual experience. A comprehensive assessment should combine best corrected visual acuity, low luminance visual acuity, and microperimetry to provide a more complete evaluation. Currently, there is no effective treatment for GA, but emerging therapies such as complement inhibitors and gene therapy show promising prospects. (Int Rev Ophthalmol, 2024, 48:  333-340)


The roles of stromal cell-derived factor-1/C-X-C chemokine receptor type 4/C-X-C chemokine receptor type 7 signaling in choroidal neovascularization progression

Zou Rong, Yuan Fei

2024, 48(5):  341-348.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.004

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Choroidal neovascularization (CNV) is an important pathological mechanism of blinding neovascular age-related macular degeneration (NVAMD). Vascular endothelial growth factor (VEGFA), the key regulator of angiogenesis, not only mediates the localization and structural remodeling of the capillary plexus during normal eye development by binding to its tyrosine kinase receptor, but also promotes pathological angiogenesis and leakage. Recent studies has proved that stromal cell-derived factor-1 (SDF-1) mediates the chemotaxis of immune cells such as endothelial progenitor cells and macrophages by binding to its C-X-C chemokine receptor type (CXCR) 4 and CXCR7. It also directly activates signaling pathways such as PI3K/AKT/ERK in endothelial cells to promote endothelial cell proliferation, migration, and angiogenesis, thereby regulating the development of pathological choroidal neovascularization and induces endothelial-to-mesenchymal transition of endothelial cells (EndoMT) to promote subretinal fibrosis. (Int Rev Ophthalmol, 2024, 48:  341-348)

Current status and progress of idiopathic intracranial hypertension

Zhang Qi, Wu Jie, Sun Mingming, Zhou Huanfen, Xu Quangang, Wei Shihui

2024, 48(5):  349-356.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.005

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Idiopathic intracranial hypertension (IIH) is clinically characterized by elevated intracranial pressure, headaches, papilledema, and vision loss, predominantly affecting obese women of childbearing age. IIH poses a significant threat to patients' vision and quality of life. However, the underlying pathophysiological mechanisms driving the increase in intracranial pressure remain unclear. Previously, theories primarily focused on abnormalities in cerebrospinal fluid circulation，but in recent years, it has been gradually recognized that abnormal glymphatic system, obesity-related metabolic dysfunction, androgen and glucocorticoid disorders are involved in the occurrence of this disease. OCT examination and telemetry intracranial pressure monitor can monitor the fluctuation of intracranial pressure in patients, which provides help for the prevention and delay of complications of idiopathic intracranial hypertension. Furthermore, novel targeted drugs, such as 11β-HSD1 inhibitors and glucagon-like peptide-1 receptor agonists, offer new therapeutic options for managing IIH. (Int Rev Ophthalmol, 2024, 48:  349-356)


Application of intraoperative optical coherence tomography in corneal transplantation surgery

Zhan Xin, Liu Hongshan

2024, 48(5):  357-363.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.006

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Intraoperative optical coherence tomography (iOCT) is an intraoperative navigation microscope system that can be used not only for surgeries such as vitreoretinal, ICL implantation, cataracts, glaucoma, but also for corneal transplantation surgery. In penetrating keratoplasty, the real-time visualization of iOCT helps the surgeon understand the intraocular situation, define the implant bed range, and handle angle adhesions. In lamellar keratoplasty, the depth and uniformity of corneal stroma detachment can be observed to prevent perforation of the posterior elastic layer, timely treatment of interlayer fluid accumulation, and avoid the formation of double anterior chambers. In addition, in corneal endothelial transplantation, iOCT can reveal the position of the graft and its adhesion to the corneal stroma, observe whether the graft is unfolded or inverted, and help the surgeon handle it in a timely manner to improve the success rate of the surgery. (Int Rev Ophthalmol, 2024, 48:  357-363)

Research progress of anterior chamber-associated deviation

Li Qian, Qing Guoping

2024, 48(5):  364-370.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.007

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Anterior chamber-associated immune deviation (ACAID) is the primary manifestation of ocular immune privilege. It mainly involves the roles of antigen-presenting cells and regulatory T cells to inhibit systemic immune responses against intraocular antigens. The underlying mechanisms are complex, relying not only on the normal anatomical structure and physiological functions of the eye but also involving dynamic immune regulatory processes and humoral balance. Recent research has revealed more molecular mechanisms related to ACAID, such as the roles of immune checkpoint molecules and their impact on immune tolerance. Moreover, studies of ACAID mechanisms have demonstrated its potential applications in preventing graft rejection and treating autoimmune eye diseases. These research findings provide new perspectives on understanding the process of ocular immune privilege and are of significant importance in developing novel anti-inflammatory and immunotherapeutic approaches.  (Int Rev Ophthalmol, 2024, 48: 364-370)

Aldosterone and ocular diseases

Xu Tianyi , Liang Yuanbo, Zhang Shaodan

2024, 48(5):  371-377.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.008

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Aldosterone, as an important mineralocorticoid secreted by the adrenal gland, is involved in various pathological and physiological processes such as systemic water and electrolyte balance, inflammation, and immunity. Inflammation, immune, and vascular related abnormalities in water and electrolyte balance are closely related to the occurrence and development of various eye diseases. Extensive research on cardiovascular diseases has confirmed that aldosterone can activate mineralocorticoid receptors and play a pro-inflammatory role in systemic diseases. Previous studies have suggested that aldosterone plays a beneficial anti-inflammatory role in inflammatory diseases such as uveitis, and its mechanism may be not only due to its activation of mineralocorticoid receptors, but also due to the disruption of corticosteroid receptor homeostasis under aldosterone application. Meanwhile, aldosterone plays a role in the ocular water and electrolyte balance, promoting exudative changes in diseases such as central serous retinopathy and wet age-related macular degeneration. Aldosterone also participates in aqueous humor homeostasis and nerve damage, and may play a key role in the pathological process of glaucoma. By further clarifying the regulatory mechanisms of systemic and local aldosterone on the physiological and pathological processes of the eye, new evidence may be provided for exploring the pathogenesis of related eye diseases, while also providing new diagnostic and therapeutic ideas for the development of new disease diagnosis and treatment methods. (Int Rev Ophthalmol, 2024, 48: 371-377)

Research progress on eye ultraviolet radiation injury and protection

Cui Minghui Chen Jiliang Yu Haobing Liu Xiaoyu Ning Zhe Hu Bo

2024, 48(5):  378-384.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.009

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In recent years, the destruction of the ozone layer has led to the enhancement of ultraviolet-B (UV-B) radiation, especially in plateaus, oceans and polar regions, due to the extremely high reflectivity of UV-B, which makes special occupational groups such as welders and ultraviolet disinfection workers face a higher risk of ultraviolet eye disease. To reduce the occurrence of eye diseases, physical protection can include using protective eyewear that meets the UV400 standard. In clinical treatment, options may include anti-inflammatory, anti-infection, surface anesthesia, and wound healing-promoting medications. In addition, natural active substances such as flavonoids, saponins, peptides and phenolic compounds have a good protection effect against UV-B radiation and can also be potential candidates for the research and development of related drugs.(Int Rev Ophthalmol, 2024, 48: 378-384)

The development history of photorefraction technology and its application in screening for refractive errors in children

Huang Yan, Gao Jie, Zhen Yi

2024, 48(5):  385-392.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.010

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Photorefraction technology determines the refractive status of children by analyzing images of light reflected from the retina. This method is suitable for younger children who have difficulty cooperating for extended periods, significantly enhancing the feasibility of early screening for myopia, hyperopia, astigmatism, and strabismus, making large-scale screenings possible. Photorefraction technology has evolved from film imaging to digitalization, miniaturization, and intelligence. In particular, the integration of artificial intelligence technology has significantly improved diagnostic accuracy and adaptability. Deep learning algorithms automatically analyze and extract features from eye images, enabling photorefractors to maintain high stability and accuracy in complex environments. The application of digital simulation technology also provides a scientific basis for further optimization of photorefraction technology, simulating imaging effects under different ocular conditions and providing strong support for improving device performance. With the commercialization of technology, various models of photorefractors have been developed, such as MTI, iScreen, PowerRefractor, Plusoptix, Spot, GoCheckKids, etc. These devices continue to improve in portability, ease of operation, and diagnostic accuracy, providing diverse options for screening refractive errors in children. Photorefraction technology is increasingly widely used in screening for refractive errors in children, with notable progress. Diagnostic accuracy and efficiency have been significantly improved, providing important technical support for early intervention and protection of global children's visual health. (Int Rev Ophthalmol, 2024, 48:  385-392)

The application of artificial intelligence in ophthalmic surgery

Wang Feng, Lan Chenghong, Peng Jing, Shao Yi

2024, 48(5):  393-399.  doi:10.3760/ cma.j.issn.1673-5803.2024.05.011

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Ophthalmic surgery is one of the most delicate microsurgical procedures, and the huge demand for artificial intelligence (AI) assisted ophthalmic surgery will become an important factor in accelerating precision medicine. It has been applied to refractive surgery, corneal transplantation, oculoplastic surgery, cataract surgery, and vitreoretinal surgery, etc. For example, the analysis of clinical data can help to make effective preoperative planning, robotic-guided surgical methods can improve intraoperative safety and accuracy, and the prediction of surgical timing and postoperative complications can help surgeons to make better clinical decisions. However, AI in ophthalmic surgery still requires optimization of deep learning algorithms and the development of systems that allow for real-time evaluation.  AI has the potential to become an important aid in ophthalmic surgery to improve patient outcomes. (Int Rev Ophthalmol, 2024, 48:  393-399)