Table of Content

22 February 2025, Volume 49 Issue 1

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Morphological changes of the Schlemm canal in glaucoma patients

Zhao Mian, Ye Wenqing, Liang Yuanbo

2025, 49(1):  1-7.  doi:10.3760/cma.j.cn115500-20241115-01001

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Schlemm canal is a circular tubular structure surrounding the trabecular meshwork around the limbus, which has a different morphological changes ( diameter and area ) in different states and different quadrants. For example, the study showed that the diameter and area of Schlemm canal decreased significantly with age, and the nasal side of Schlemm canal area was greater than the temporal side in normal adults. However, the diameter and area of Schlemm canal in high myopia were significantly larger than that of the normal control group, and the area of Schlemm canal in glaucoma patients was significantly smaller than that of normal subjects. As an important part of the aqueous drainage channel, the measurement of Schlemm canal morphological parameters has been paid great attention by researchers. The measurement methods have been developed from light microscope and electron microscope to ultrasound biological microscopy and optical coherence tomography. Previous studies have reported that the parameters of Schlemm canal in glaucoma patients was significantly smaller than that of normal subjects, as well as glaucoma treatment, such as medication, laser and surgical, can alter the microstructure of the Schlemm canal. (Int Rev Ophthalmol, 2025, 49:  1-7)

Progress in the application of different diagnostic instruments for preoperative assessment of lens zonule functionality

Tao Yufei, Pan Xiaohua, Jin Aixia, Fan Ning

2025, 49(1):  8-12.  doi:10.3760/cma.j.cn115500-20240902-01002

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The lens zonules play a crucial role in maintaining the normal position and shape of the lens. Laxity or rupture of the lens zonules can lead to adverse outcomes such as changes in anterior chamber depth,  increased intraocular pressure,  angle closure,  and partial dislocation of the lens. Abnormalities in lens zonule functionality are prevalent and often concealed in populations with high myopia and angle-closure glaucoma,  presenting significant challenges to cataract surgery. These abnormalities can lead to complications during surgery,  such as difficulty in capsulorhexis,  posterior capsule rupture,  and dropping of the lens into the vitreous cavity. Therefore,  preoperative assessment of lens zonule function is critically important. Currently,  clinical tools such as Ultrasound Biomicroscopy (UBM),  the new generation Swept-source anterior segment optical coherence tomography (SS-AS-OCT),  CASIA2,  and the Pentacam,  which is based on the principle of the Scheimpflug camera and analyzes the anterior segment in three dimensions,  are available for detecting and assessing the function of the lens zonules. UBM can directly detect ruptured lens zonules and assess the location of zonular ruptures but requires patient cooperation for eye movement during the examination. CASIA2,  a non-contact measurement device,  indirectly evaluates lens zonular function by measuring parameters such as anterior chamber depth,  anterior lens surface curvature radius,  lens thickness,  lens tilt,  and decentration,  but it cannot measure the posterior chamber and ciliary body morphology. Similar to CASIA2,  Pentacam assesses lens zonular function but has less comprehensive detection indicators and is prone to measurement errors influenced by factors such as ciliary body morphology. This article compares the advantages and disadvantages of these three instruments in assessing lens zonular function,  guiding clinicians to detect abnormalities in lens zonular function early,  particularly before cataract surgery,  thereby enhancing understanding of ocular pathologies.  (Int Rev Ophthalmol,  2025,  49:  8-12)

Postoperative complications of cataracts associated with high myopia

Zhang Ye, Qi Jiao, Zhu Xiangjia

2025, 49(1):  13-18.  doi:10.3760/cma.j.cn115500-20240917-01003

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Highly myopic cataract, as a complex cataract type associated with a high risk of blindness, significantly increases the incidence of postoperative complications, thereby posing a serious threat to the visual health of highly myopic individuals. The common postoperative complications associated with high myopia-related cataracts, include early intraocular pressure elevation, capsular contraction syndrome, posterior capsular opacification, and intraocular lens dislocation. Previous studies have shown that the pathological changes in highly myopic eyes, such as anatomical abnormalities caused by axial elongation, intraocular microinflammatory environments, and oxidative-antioxidative imbalances, contribute to structural and dynamic anomalies in aqueous humor outflow, epithelial-mesenchymal transition of lens epithelial cells, and loosening of the zonular fibers. These factors collectively increase the risk of postoperative complications. Clinically, measures such as meticulous polishing of the capsule during surgery, cautious use of capsular tension rings, and close postoperative monitoring with early intervention can help mitigate these complications to some extent.  (Int Rev Ophthalmol, 2025, 49:  13-18)

The progress of selenium-induced cataract 

Wu Xijin, Wang Zhenyu, Fang Rui, Song Xudong

2025, 49(1):  19-24.  doi:10.3760/cma.j.cn115500-20241017-01004

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The selenium-induced cataract animal model is extensively utilized in investigating age-related cataracts due to its convenience and high reproducibility. In vivo models can be established by subcutaneous or intraperitoneal injection of sodium selenite solution into rats, while in vitro models can be created by incubating isolated rat lenses in a medium containing a high concentration of sodium selenite. Sodium selenite arrests lens epithelial cells in the cell cycle, accelerating apoptosis. Furthermore, it induces oxidative stress within the lens, reducing catalase and superoxide dismutase activities, increasing malondialdehyde levels, and decreasing nicotinamide adenine dinucleotide phosphate concentrations. These changes alter the metabolic state of lens cells, disrupt calcium ion homeostasis, and activate calpains, leading to proteolysis, phase transition of the lens, and loss of cytoskeletal proteins, ultimately resulting in lens opacification. Previous studies have confirmed that vitamin C and the calpain inhibitor E64 could delay the progression of selenium-induced cataracts; however, the effects of sodium selenite on oxidative stress in liver and kidney tissues should also be considered. (Int Rev Ophthalmol, 2025, 49:  19-24)

Pathogenesis and potential drug  of cataract

Ma Lin, Huang Lintao, Shi Hang, Wang Wanhe, Wu Li'an

2025, 49(1):  25-31.  doi:10.3760/cma.j.cn115500-20240722-01005

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The pathogenesis of cataracts is linked to multiple factors, with oxidative stress, excessive quinone substances, aldose reductase activity, and lens protein aggregation being the main mechanisms. Recently, many drugs and compounds have been identified through basic and animal studies as having potential anti-cataract effects. These include polyphenolic compounds extracted from plants, Ginkgo biloba leaves, ginger, and drugs like pirenoxine eye drops for excessive quinone substances. Aldose reductase inhibitors such as diosgenin and L-lysine and anti-lens protein aggregation agents like lanosterol and 25-hydroxycholesterol also show promise, indicating a shift towards molecular approaches in anti-cataract therapy. Despite the therapeutic potential seen in research, limitations such as the extrapolation of animal study results and individual variability currently hinder their clinical application. With further research, these drugs may be used in clinical settings in the future. (Int Rev Ophthalmol, 2025, 49:  25-31)

Effects of pregnancy on the choroid

Hao Junsheng, Li Zhongen

2025, 49(1):  32-38.  doi:10.3760/cma.j.cn115500-20240904-01006

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Pregnancy is a complex physiological process,  changes in blood volume,  peripheral vascular resistance,  hormones,  and other factors cause changes in choroidal thickness,  choroidal vascular index,  and other markers,  and these choroidal changes are noninvasive biomarkers for monitoring normal pregnancy and predicting the prognosis of pregnancy complications and comorbidities.The morphology and physiological-pathological changes of the choroid have been verified by OCT,  indocyanine green angiography(ICGA),  ultrasound Doppler and other techniques. Clinical biochemical tests reveal the association of the changes in the internal environment of pregnancy affecting the choroid. Pregnancy is one of the factors that increase the incidence and recurrence of choroidal diseases. Controversial issues remain in understanding the effects of pregnancy on the choroid,  basic research is lacking,  and further studies are needed to fully reveal the choroidal changes during pregnancy. (Int Rev Ophthalmol,  2025,  49:  32-38)

Immunological mechanisms underlying the pathogenesis and treatment of choroidal neovascularization

Ji Chunyi, Ji Jing

2025, 49(1):  38-44.  doi:10.3760/cma.j.cn115500-20240920-01007

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The core pathological feature of neovascular age-related macular degeneration (NVAMD) is the formation of choroidal neovascularization (CNV). The mechanisms underlying CNV formation are complex and not yet fully understood. Currently, vascular endothelial growth factor (VEGF) inhibitors are the first-line treatment for NVAMD and have achieved preliminary success. However, the inability of patients to benefit from long-term outcomes has become increasingly apparent. Recent studies have identified multiple critical immune factors that play significant roles in CNV formation. The recruitment and polarization of macrophages (M) are central to this process, with M2 polarization promoting CNV progression. Additionally, complement cascade activation, inflammasome activation, and the secretion of pro-inflammatory cytokines further drive macrophage recruitment and polarization, exacerbating CNV lesions. Based on these findings, combining complement inhibitors, anti-inflammatory cytokines, and macrophage polarization modulators with anti-VEGF therapy holds potential not only to slow or reverse CNV progression but also to reduce the occurrence of therapeutic resistance, offering new hope for NVAMD patients. (Int Rev Ophthalmol, 2025, 49:  38-44)

The role of pyroptosis in the pathogenesis of diabetes retinopathy

Cheng Quan, Zha Xu, Zhou Liqiong, Zhang Yuanping

2025, 49(1):  45-50.  doi:10.3760/cma.j.cn115500-20240828-01008

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Diabetic retinopathy (DR) is a common and serious complication in people with diabetes, severely affecting vision and even leading to blindness. However, the pathogenesis of DR has not been thoroughly elucidated. Recent studies have found that pyroptosis, as a novel form of programmed cell death, has played a key role in the pathogenesis of DR. The molecular pathways of pyroptosis in the pathogenesis of DR, covering multiple levels such as inflammatory response, oxidative stress, and cell signaling, and identify multiple key pathways, such as mitochondrial dysfunction, ROS accumulation, and Fas/FasL signaling axis, which lead to retinal cell degeneration. Therapeutic strategies focus on targeting pyrotosis modulators, including caspase inhibitors, mitochondrial stabilizers, and Bcl-2 family proteins, to prevent retinal cell death. Additionally,moduating oxidative stress, inflammatory response, and autophagy are potential therapeutic approaches, The developing targeted therapies that specifically modulate these pathways, as well as gene therapies and small molecule inhibitors, could provide promising therapies to prevent the progression of diabetic retinopathy. (Int Rev Ophthalmol, 2025, 49:  45-50)

Global prevalence study of uncorrected refractive errors

Zhou Fangyue, Li Kehan, Hu Yishan, Zhang Yongming

2025, 49(1):  51-56.  doi:10.3760/cma.j.cn115500-20240920-01009

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Uncorrected refractive error (URE) is the most prevalent cause of visual impairment, particularly among moderate to severe cases. Despite its relatively simple treatment, URE poses a significant social burden without insufficient attention and early intervention.  URE in children is a widely concerned issue, while URE in the elderly is still in a blind spot that urgently needs attention. Beyond age, factors such as gender and economic status are also closely related to URE. The social impact of URE is extensive. Across all demographic groups, URE may lead to a decrease in quality of life and psychological health issues. For specific populations, such as children, URE can result in amblyopia, while for the elderly it can increase the risk of falls and other accidental injuries. To improve the current situation of URE, the provision of refractive services and spectacles needs to be enhanced. The burden of primary vision screening can be reduced through a variety of optometric methods such as self-correction of refractive error and the application of photorefraction technology. Telemedicine can improve refractive services in areas with poor medical resources. Options to enhance spectacles provision include the provision of ready-made spectacles and the use of self-adjustable glasses. (Int Rev Ophthalmol, 2025, 49:  51-56)

The value of axial length measurement in  myopia prevention and control   among children and adolescents

Li Ruofan, Xian Haocheng, Li Xuemin, Zhang Chun, Pan Zhe

2025, 49(1):  56-61.  doi:10.3760/cma.j.cn115500-20241009-01010

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Axial length (AL) is a crucial parameter for assessing eye development in children and adolescents,  as its growth is closely associated with the progression of myopia. In this age group,  AL exhibits a consistent growth trend with age,  making dynamic monitoring of its changes particularly significant. However,  several factors—including genetics,  baseline refractive status,  pathological myopia,  and anthropometric measurements—can influence AL changes. The presence of individual variability adds complexity to predicting refractive properties based on ocular axis length alone. Despite these challenges,  AL remains a vital indicator for forecasting the onset and progression of myopia. Research indicates that when AL is considered alongside other parameters such as corneal curvature radius,  corneal refractive power,  and uncorrected distant visual acuity,  it holds significant clinical value for myopia diagnosis. Interventions such as orthokeratology lenses,  low-concentration atropine,  low-energy red light therapy,  and increased outdoor activity have all been associated with delayed axial growth. It is essential to consider the specific circumstances of each individual patient when applying these treatments. Currently,  AL measurement primarily depends on optical biometry; however,  attention must be given to patient cooperation and the selection of appropriate equipment.  (Int Rev Ophthalmol, 2025, 49:  56-61)

Treatment of allergic conjunctivitis

Yang Yinghui, Zhang Yue, Yu Xiaobing

2025, 49(1):  62-68.  doi:10.3760/cma.j.cn115500-20240825-01011

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Allergic conjunctivitis (AC) is a common benign ocular surface disease. Numerous drugs are available for the clinical treatment of allergic conjunctivitis, but limitations such as slow onset of action, prolonged duration of administration, combination of drugs, prolonged duration of administration, and systemic adverse effects urgently call for the exploration of new and effective therapies for allergic conjunctivitis. In recent years, more and more new target drugs (Th2 inhibitors, anti-IgE antibodies, PDE4 inhibitors, receptor antagonists, glucocorticoid receptor agonists) as well as new modes of drug delivery (drug-eluting ophthalmoscopes, immunotherapy) have emerged. The efficacy and mechanism of action of the new target drugs are currently being studied in experimental animals. The marketed drug-eluting ophthalmoscopes are effective in relieving allergic symptoms, but the potential drug toxicity associated with the use of nanoparticles still needs further study. Immunotherapy has not yet been applied in the treatment of allergic conjunctivitis. Currently, there is no effective treatment option for allergic conjunctivitis, but the emergence of new target drugs and different modes of drug delivery has brought new hope for the treatment of allergic conjunctivitis.  (Int Rev Ophthalmol, 2025, 49:  62-68)

Research advancement of mesenchymal stem cells in the treatment of ocular diseases

Ren Shuting, Xie Xiaodong

2025, 49(1):  68-74.  doi:10.3760/cma.j.cn115500-20240518-01012

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Mesenchymal stem cells (MSCs) are multipotent stem cells with anti-inflammatory, immunomodulatory, damage repair, and tissue regeneration properties, and they have the capability to produce extracellular vesicles. These vesicles derived from MSCs retain similar therapeutic characteristics as the stem cells themselves and offer advantages such as easier storage and transport, as well as a lower risk of carcinogenesis. In  models of ocular surface disease, mesenchymal stem cells can alleviate the symptoms of hydration-deficient dry eye by modulating the immune response and inhibiting the progression of inflammation, promoting corneal tissue regeneration, and increasing the number of lacrimal acinars. For pterygium, MSCs reduce tissue invasiveness by inhibiting fibroblast migration. Additionally, they relieve ocular discomfort in patients with graft-versus-host disease by reprogramming macrophages to suppress inflammation. Furthermore, MSCs help in alleviating symptoms of allergic conjunctivitis and improving the prognosis of chemical eye injuries. Although clinical trials are underway to validate the efficacy of mesenchymal stem cells in ocular surface diseases, the evidence is still insufficient. (Int Rev Ophthalmol, 2025, 49:  68-74)

The correlation between matrix metalloproteinase 2 and ophthalmic diseases

Abudou Sataer Aishan, Zhou Ying, Wang Xiaokang, Li Xia

2025, 49(1):  75-80.  doi:10.3760/cma.j.cn115500-20241113-01013

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Matrix metalloproteinase (MMP) has a class of protein hydrolases that degrade the extracellular matrix. In corneal diseases, matrix metalloproteinase 2 (MMP-2) is associated with migration and infiltration of inflammatory cells, thereby exacerbating the inflammatory response and tissue damage in corneal alkali burns. In glaucoma, MMP-2 maintains normal aqueous humor dynamic balance by regulating the extracellular matrix. However, after glaucoma filtration surgery, MMP-2 can promote bleb fibrosis, increase bleb resistance, and hinder the outflow of aqueous humor, thus affecting the surgical effect. (Int Rev Ophthalmol, 2025, 49:  75-80)