Table of Content

22 April 2025, Volume 49 Issue 2

Previous Issue   

Anatomical characteristics and mechanisms of primary angle closure glaucoma in myopic eyes

Liu Yan, Cao Guofan, Zhu Junya, Zhang Linyu

2025, 49(2):  81-87.  doi:10.3760/cma.j.cn115500-20241019-25201

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Myopia is generally considered a protective factor for primary angle-closure glaucoma (PACG). However, with the change of environmental factors and the increase of near visual activity, the prevalence of myopia increased significantly, but the incidence of PACG did not decrease accordingly. Myopia, as a protective effect on PACG, actually refers to axial myopia rather than refractive myopia. The non pupillary block mechanism is more common in patients with high myopia and angle closure than in the general angle closure population. The angle closure in PACG patients with long axial length is mainly caused by non pupillary block mechanisms, especially the high pleated iris configuration. The increase in lens thickness and forward movement form a shallow anterior chamber, narrowing the width of the anterior chamber and flattening the corneal edge leading to angle narrower. Changes in iris area, thickness, curvature, as well as ciliary and neurovascular factors also play a certain promoting role in the process of angle closure in axial myopia. (Int Rev Ophthalmol, 2025, 49:  81-87)


Fixed combination medications for intraocular pressure reduction in glaucoma

Chen Yihao, Sun Xinghuai

2025, 49(2):  88-94.  doi:10.3760/cma.j.cn115500-20241108-25202

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The core treatment goal for glaucoma is reducing intraocular pressure. Traditional intraocular pressure -lowering medications are commonly administered as monotherapy or in combination. However, combination therapy often increases treatment complexity, leading to reduced patient adherence and diminished efficacy. Fixed-dose combinations (FDCs) simplify treatment regimens by integrating multiple intraocular pressure-lowering drugs into a single formulation. Studies have shown that FDCs significantly improve adherence compared to non-FDC regimens. Furthermore, the efficacy of FDCs in reducing intraocular pressure is at least non-inferior to non-FDC combinations. Additionally, preservative-free FDCs minimize ocular surface disease caused by preservatives, reducing conjunctival hyperemia rates, significantly improving tolerability. The adoption of FDCs not only optimizes therapeutic outcomes but also alleviates economic burdens, offering a superior treatment option for glaucoma patients. (Int Rev Ophthalmol, 2025, 49:  88-94)

Intraocular lens power calculation formulas based on artificial intelligence

Zhang Ran, Wang Zhenyu, Yang Yiquan, Wang Jinda

2025, 49(2):  95-100.  doi:10.3760/cma.j.cn115500-20241103-25203

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Currently, there are various intraocular lens (IOL) power calculation formulas available in clinical practice, but there is still room for improvement in their prediction accuracy, especially in cases of extreme axial lengths and complex ocular conditions. To enhance the accuracy of IOL power calculations, IOL power calculation formulas based on artificial intelligence (AI) have been developed and hold great promise. This article summarizes the newly developed AI-based IOL power calculation formulas in recent years, including pure data-driven IOL power calculation formulas (Hill RBF formula, Karmana formula, Nallasamy formula, etc.), optical theory combined with AI IOL power calculation formulas (Kane formula, PEARL-DGS formula, LISA-PPV formula, etc.), and other formulas (Hoffer QST formula, Ladas formula, Zhu Lu formula, etc.). These formulas demonstrate higher prediction accuracy when dealing with extreme eye axis and complex eye conditions, aiming to provide clinicians with more options and further improve the prediction accuracy of IOL power. (Int Rev Ophthalmol, 2025, 49:  95-100)


The mechanism and drug treatment of posterior capsular opacification

Ding Xuefei, Wang Zhenyu, Song Xudong

2025, 49(2):  101-108.  doi:10.3760/cma.j.cn115500-20241023-25204

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Posterior capsular opacification(PCO) is a condition in which lens epithelial cells (LEC) undergo inflammatory and epithelial-mesenchymal transition after cataract extraction surgery, leading to increased  proliferation, migration, and extracelluar matrix deposition of LEC, ultimately manifesting as the formation of surface deposits on the lens posterior capsule.  Although posterior capsulotomy with YAG laser is the  first-line treatment for PCO, but it still has certain limitations. Although research on the mechanism of PCO has gradually deepened, there are currently no approved drugs specifically for the prevention or treatment of PCO in clinical practice, and most of the drugs currently used for research are in the in vitro and in vivo experimental  practice. The drugs, such as nonsteroidal anti-inflammatory drugs, immunosuppressants, anti mitotic drugs, and traditional Chinese medicine extracts, applied to prevent PCO are mostly in the vitro and  vivo experimental stages and have not yet been widely used in clinic. In addition, the development of biomaterials and drug-sustained delivery systems also provide possible strategies for targeted pharmacological intervention. However, the main challenge currently faced is effectively inhibiting LEC proliferation while avoiding damage to other structures in the ocular. Therefore, future investigation should focus on drug safety and  the expansion of treatment windows. More precise and safer drug delivery systems should also be developed. (Int Rev Ophthalmol, 2025, 49:  101-108)


Comprehensive preoperative evaluation of patients undergoing cataract extraction

Zhou Hui, Chen Ling, Wang Jibin

2025, 49(2):  109-114.  doi:10.3760/cma.j.cn115500-20240910-25205

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A exhaustive perioperative evaluation and management strategy are overriding in cataract extraction. The primary goal of preoperative evaluation is to identify and reduce potential risks that threaten patient safety. Through comprehensive evaluation of medical history, eye examination, and other related examinations, clinical physicians can diagnose pre-existing diseases and identify risk factors that may affect the outcome of cataract surgery. A comprehensive evaluation should include detailed surgical plans and intraoperative decisions, assessing intraocular factors, which can provide key information for selecting appropriate surgical and anesthesia methods. Most of the patients receiving cataract surgery are elderly, and there may be systemic diseases (such as hypertension, diabetes or heart disease) that affect the safety of surgery at the same time. Evaluation and management of these diseases are essential to reduce perioperative complications. Multidisciplinary communication and collaboration between ophthalmologists, anesthesiologists, and other clinicians is key to executing evidence-based perioperative strategies.  This article reviewed the medical history related to cataract surgery, general examination, preoperative fasting, anesthesia precautions, and consideration of some specific diseases (such as hypertension, atrial fibrillation, chronic coronary syndrome, diabetes, lung disease, end-stage renal disease, claustrophobia syndrome, cognitive impairment).(Int Rev Ophthalmol, 2025, 49:  109-114)


Ocular toxicity related to novel targeted anti-cancer agents

Zhang Yongyi, Zhou Nan, Qi Yanhua

2025, 49(2):  115-118.  doi:10.3760/cma.j.cn115500-20240902-25206

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Targeted anti-cancer agents have now become one of the cutting-edge hotspots in the field of cancer therapy and have brought considerable therapeutic benefits to many patients. Ocular toxicity is one of the adverse events that may not be aware enough, affecting patients' living quality and treatment process. Common ocular toxicities include conjunctivitis, keratitis, dry eye, retinal hemorrhage, retinal detachment, etc. Ophthalmologists should fully acknowledge the feature of ocular toxicity caused by theses novel therapeutics, maximize the treating benefits to patients and improve life quality. (Int Rev Ophthalmol, 2025, 49:  115-118)


Macular buckle surgery for myopia traction maculopathy

Deng Jian, Pan Liduo, Li Yonghao

2025, 49(2):  119-123.  doi:10.3760/cma.j.cn115500-20241023-25207

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Macular buckle surgery involves implanting a buckle at the posterior pole of the sclera that corresponds to the macular area in order to shorten the axial length of the eye, prevent the advancement of posterior staphyloma, and relieve vitreous traction on the macula. This surgery can serve as an iatrogenic dome-shaped macula, with a high anatomical success rate and strong visual function recovery. It is especially beneficial for patients with myopic traction maculopathy complicated with a posterior staphyloma. Overcoming the shortcomings of early macular buckle surgery, the design of macular buckles has been continuously improved in recent years thanks to advancements in artificial intelligence, 3D printing, and buckle materials. Macular buckle surgery has shown special benefits in improving vision function and anatomical repositioning, whether it is done alone or in combination with vitrectomy. (Int Rev Ophthalmol, 2025, 49:  119-123)


Treatment status of diabetic macular edema after par plana vitrectomy

Sui Jiajia, Lu Guihong, Zhu Rongrong

2025, 49(2):  124-128.  doi:10.3760/cma.j.cn115500-20240921-25208

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Diabetic macular edema (DME) is the leading cause of vision loss in patients with diabetic retinopathy (DR) and can occur at any stage of DR. The treatment of DME remains a challenge due to its complex pathogenesis. When DR progresses to vitreous hemorrhage or retinal detachment, vitrectomy (par plana vitrectomy (PPV)) is often required, after which the inflammatory factors and pharmacokinetics in the vitreous cavity are altered, and adjustment of the dose and injection interval of anti-vascular endothelial growth factor (VEGF) may be required for DME after PPV.  Intravitreal injections of anti-inflammatory drugs or anti-VEGF combined with anti-inflammatory drug therapy should be the first choice of treatment for DME after PPV. Currently, there are fewer reports in the literature and studies on the treatment options for DME after PPV, and there is a lack of relevant treatment consensus. (Int Rev Ophthalmol, 2025, 49:  124-128)


Pathogenesis and treatment of choroidal neovascularization secondary to pathological myopia

Ye Hongli, Gao Yunan, Yu Shengbin

2025, 49(2):  129-134.  doi:10.3760/cma.j.cn115500-20241010-25209

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Pathological myopia-induced choroidal neovascularization (PM-CNV) can severely lead to irreversible central vision loss, affecting the quality of life of patients. Its onset is related to the combined effects of mechanical traction on the retina and choroid caused by excessive axial length, abnormal hemodynamics, and genetic factors. Currently, anti-VEGF drugs have become the standard first-line treatment for PM-CNV, but their long-term efficacy is not satisfactory, and repeated administration poses a risk of retinal and choroidal atrophy and thinning. Currently, some new drugs with stronger and more lasting effects for PM-CNV are undergoing basic research and clinical trials.(Int Rev Ophthalmol, 2025, 49:  129-134)


Common pathophysiological mechanism and gene correlation between high myopia and diabetes retinopathy

Ding Guoxin, Wang Jing, Wang Xian, Li Yingqi

2025, 49(2):  135-140.  doi:10.3760/cma.j.cn115500-20241013-25210

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Recent studies have identified potential shared pathological mechanisms between high myopia (HM) and diabetic retinopathy (DR). The application of technologies such as genome-wide association studies (GWAS) has gradually revealed overlaps in genetic susceptibility, gene expression regulation, and signaling pathway remodeling between the two conditions. This review summarizes the shared pathological mechanisms of HM and DR, including oxidative stress, inflammatory responses, and extracellular matrix remodeling, and explores their genetic associations. Genomic studies have highlighted the critical roles of genes such as VEGF, TGFB2, COL1A1, insulin pathway-related genes, KCNQ5, and CNTN2 in HM and DR. These findings enhance our understanding of the shared genetic architecture of HM and DR and provide a foundation for the development of personalized treatment strategies. (Int Rev Ophthalmol, 2025, 49:  135-140)


Application of metabolomics in the analysis of biomarkers associated with corneal diseases

Lan Chenghong, Wang Feng

2025, 49(2):  141-146.  doi:10.3760/cma.j.cn115500-20240902-25211

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Early identification of diagnostic biomarkers is essential to reduce the risk of cornea-related visual impairment. Metabolomics is the study of metabolites in the fluids or tissues of organisms resulting from genome-wide or proteomic interactions. Mass spectrometry and nuclear magnetic resonance are now used in corneal, tear and atrial fluid analysis to identify biomarkers associated with corneal diseases. Infectious keratitis-associated metabolites, such as RVD3, 18-HEPE, and 11(12)-EET, reveal mediators associated with the pathogenic phase of the infection. Inflammatory factors (e.g., arachidonic acid and linoleic acid), and upregulation of short-chain organic acids (e.g., citric acid, pyruvic acid, succinic acid, oxaloacetic acid and glutamate), revealed metabolic mechanisms of ocular discomfort and related disorders after soft contact lens wear. Post-corneal refractive surgery-related metabolites such as ascorbic acid, taurine, spermidine,  histidine and arachidonic acid, suggested metabolites primarily associated with inflammation, oxidation, neuroprotection, and regeneration. Upregulated prostaglandin F2α, Prostaglandin A2, 16,16-dimethylprostaglandin E2, and 5-hydroxy eicosatetraenoic acid could help to identify patients with at-risk cone corneas. Upregulation of metabolites such as collagen subtype III, sphingomyelin, and inositol had the potential to be used as a biomarker for diabetic keratopathy. (Int Rev Ophthalmol, 2025, 49:  141-146)


Treatment of keratoconus combined with adolescent vernal keratoconjunctivitis      

Yin Xiaofan, Ge Jinling

2025, 49(2):  147-152.  doi:10.3760/cma.j.cn115500-20241116-25212

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Vernal keratoconjunctivitis occurs in children and adolescents due to chronic inflammation prone to complications such as keratoconus. The treatment of ordinary keratoconus focuses more on mechanical correction (such as corneal cross-linking, rigid breathable contact lenses) or corneal transplantation surgery, and postoperative management is relatively simple. The treatment methods for vernal keratoconjunctivitis combined with keratoconus are similar to those for ordinary keratoconus, which include early keratoconus wearing contact lenses for visual correction, the inner ring of corneal stroma for improving the visual acuity of patients, corneal cross-linking for preventing the progression of keratoconus, penetrating keratoplasty and deep anterior lamellar keratoplasty for provide some patients with good visual effects and high graft survival rate. However, the treatment of vernal keratoconjunctivitis combined with keratoconus is complex, mainly due to the chronic inflammation and allergic reactions in the eyes that may affect surgical outcomes and postoperative recovery. Priority should be given to controlling inflammation, surgical selection should be more cautious, and postoperative management should be stricter. Early intervention and personalized treatment for vernal keratoconjunctivitis combined with keratoconus are key. (Int Rev Ophthalmol, 2025, 49:  147-152)


Effective optical zone of corneal refractive surgery

Yang Liangjin, Wang Xiaoxuan, Lei Yulin

2025, 49(2):  153-157.  doi:10.3760/cma.j.cn115500-20250106-25213

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The effective optical zone (EOZ), a critical indicator for evaluating corneal refractive surgery outcomes, directly affects postoperative visual quality and complications. This review summarizes the definition of EOZ, measurement methods, and its variations under different surgical techniques (including LASIK, SMILE, PRK, and lenticule implantation) and refractive errors (myopia, hyperopia, and astigmatism). Studies indicate that SMILE achieves a larger EOZ compared to LASIK and PRK, while high refractive corrections (myopia >6.00 D or hyperopia >3.00 D) may lead to significant EOZ reduction. Corneal topography (e.g., axial curvature difference method) is widely used for EOZ measurement in clinical practice, yet standardization remains challenging. Furthermore, EOZ correlates with postoperative higher-order aberrations, glare, and subjective visual quality, though minor EOZ deviations may not compromise patient satisfaction. Future directions include focusing on dynamic EOZ changes in low-to-moderate refractive corrections and establishing standardized measurement protocols. (Int Rev Ophthalmol, 2025, 49:  153-157)


Refraction changes of anisometropia

Xing Xiaoying, Zhu Qiujian

2025, 49(2):  158-160.  doi:10.3760/cma.j.cn115500-20241125-25214

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The development and transformation of anisometropia is a complex process that is often affected by many factors. Hyperopia induced anisometropia is relatively stable, while myopic anisometropia has more complex changes. Amblyopia has a significant impact on the development of anisometropia. Before the age of 6, myopic anisometropia tends to decrease, and then stabilizes or slowly increases. Single focus frame glasses stabilize the degree of refractive error, but increase myopia in both eyes. Functional frame glasses stabilize the degree of anisometropia and achieve good myopia control. Orthokeratology has a better effect on controlling myopia in high myopia degree eyes, increasing myopia in the contralateral eye and reducing the degree of unevenness. The impact of atropine preparations on the development and outcome of anisometropia remains to be studied. (Int Rev Ophthalmol, 2025, 49:  158-160，Cover III)