Table of Content

22 August 2025, Volume 49 Issue 4

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Developments in diagnostic methods for ocular viral infections

Chen Kexin, Sui Wenjun, Liu Xiangyi

2025, 49(4):  241-246.  doi:10. 3760/cma.j.cn115500-20250304-25401

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The eye is a highly vulnerable site for viral infections, which can be attributed to a variety of viruses, including adenovirus, herpes simplex virus, cytomegalovirus, Epstein-Barr virus, and varicella-zoster virus. Presently, the detection of ocular viruses predominantly employs immunological and molecular biological techniques. Immunological methods include the detection of antigens and antibodies using enzyme-linked immunosorbent assay (ELISA), chemiluminescence immunoassay, and immunofluorescence. Enzyme detection is conducted through Western blotting and zymography methods, while immune effector molecules are analyzed using flow cytometry and mass spectrometry. Molecular biological approaches mainly utilize polymerase chain reaction (PCR) technologies, such as real-time fluorescence quantitative PCR, multiplex PCR, and digital PCR. Recently, next-generation sequencing (NGS) has been adopted for the identification of viruses causing ocular infections. In recent years, advancements in ocular virus detection technologies are increasingly focusing on high-throughput, automated, rapid, and non-invasive methodologies.

Research progress in optic nerve monitoring indicators for advanced glaucoma

Mo Xiang, Jin Aixia, Fan Ning

2025, 49(4):  247-252.  doi:10. 3760/cma.j.cn115500-20250506-25402

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Advanced glaucoma is characterized by severe visual field defects and deterioration of visual acuity. Precise dynamic monitoring of disease progression is crucial for delaying vision loss. Conventional diagnostic modalities, including optical coherence tomography and perimetry, exhibit reduced reliability in advanced-stage patients due to the "floor effect" and poor patient compliance.Recent advances in imaging technologies (e.g., optical coherence tomography angiography) and functional testing techniques (e.g., full-field electroretinography, microperimetry) have provided new approaches for monitoring advanced glaucoma. Particularly, the integration of artificial intelligence technologies (e.g., generative adversarial networks, convolutional neural networks) has significantly enhanced the accuracy and efficiency of detection.

Research on personalized astigmatism management in modern cataract surgery

Wang Zibo, Zhang Fengyan

2025, 49(4):  253-258.  doi:10. 3760/cma.j.cn115500-20241114-25403

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Approximately 40% of cataract patients have preoperative corneal astigmatism exceeding 1 diopter（D）. For correcting corneal astigmatism during cataract surgery, the methods include corneal incision correction and implantation of Toric intraocular lenses. Corneal incisional methods, such as clear corneal incisions, limbal relaxing incisions, and corneal relaxing incisions, which is effective for low to moderate astigmatism, offering advantages in ease of operation and cost-effectiveness. However, their long-term stability is somewhat limited due to factors such as age-related astigmatic changes, surgically induced astigmatism, and regression of the astigmatic correction. This makes precise calculation and personalized incision design essential for optimal outcomes. In contrast, Toric IOL provide reliable correction for various types and magnitudes of astigmatism but carry the risk of postoperative axis rotation. For patients with significant preoperative biometric errors (e.g. high myopia or keratoconus), the newer generation of light-adjustable intraocular lenses may be a preferable option.

Cataract surgery combined with curved corneal incision for correcting astigmatism

Zhang Qi, Wang Zhenyu, Song Xudong

2025, 49(4):  259-264.  doi:10. 3760/cma.j.cn115500-20250219-25404

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Arcuate keratotomy (AK) is an important method for correcting corneal astigmatism during cataract surgery. It is suitable for patients with normal corneal structure and preoperative regular corneal astigmatism of 1.0 to 1.5 diopters. The effectiveness of AK is influenced by factors such as incision length, incision depth, incision location, the type of preoperative astigmatism, and the degree of preoperative astigmatism. Compared to manual AK, femtosecond laser-assisted astigmatic keratotomy (FSAK) offers higher correction accuracy and long-term stability and can serve as an alternative to Toric intraocular lenses (Toric IOL) in certain cases. Based on the depth of the incision, FSAK is classified into penetrating and intrastromal FSAK, with the former providing greater corrective power and the latter offering higher safety. Studies have shown that its efficacy is influenced by incision location, corneal biomechanics, and postoperative wound healing. In the future, optimizing nomograms and integrating personalized planning may further enhance the corrective effectiveness of FSAK, making it a promising approach for managing astigmatism in cataract patients.

Abnormal cognitive and behavioral abilities of patients with strabismus and amblyopia

Li Shuzhen, Fu Tao

2025, 49(4):  264-268.  doi:10. 3760/cma.j.cn115500-20241214-25405

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Dyslexia is common in children with strabismus or amblyopia, resulting from the abnormal binocular function or cognitive behavioral ability. Cognitive behavior ability consists of perception, attention, memory, comprehension, language, intellection and study. Researches had shown that children with strabismus or amblyopia performed abnormal perceptual analytical ability, fine visual analytical ability, selective attention and visual working memory. And these deficiencies were considered to be correlated with abnormal visual input and abnormal development of cerebral visual pathway.

Role of Caspase family proteins and oxidative stress damage in pathogenesis of cataracts and their clinical applications

Fan Meiqi, Li Xiaoxia, Jin Xiaohan, Zhao Yizhuo, Ma Lusheng

2025, 49(4):  269-275.  doi:10. 3760/cma.j.cn115500-20250316-25406

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The lens is a crucial structure for maintaining the transparency and refractive function of the eye. The regularly arranged lens fiber cells and uniformly distributed crystallins lay the foundation for excellent refractive imaging. Oxidative stress damage can disrupt the optical uniformity of the lens and is a significant contributor to the development of degenerative diseases such as age-relatedcataracts. Recent studies have found that Caspase family proteins are the core executors of apoptosis and are closely associated with the regulatory mechanisms of oxidative stress-induced damage in lens epithelial cells. The latest advancements in molecular biology and biochemistry have unveiled the intricate relationship among apoptosis pathways, oxidative damage, and lens transparency, highlighting key molecular mechanisms and potential therapeutic interventions.

Pathogenesis and therapeutic management of late-onset capsular block syndrome

Yang Yifan, Li Xintong, Han Yilin, Xu Su, Zhang Jingwen, Wang Zibo, Zhang Fengyan

2025, 49(4):  276-283.  doi:10. 3760/cma.j.cn115500-20250119-25407

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Late-onset capsular block syndrome (LCBS) is an ocular syndrome following cataract surgery characterized by capsular bag distension, intraocular lens (IOL) anterior displacement, and refractive shift, resulting from fluid accumulation within a sealed compartment formed by adhesions between the IOL and a small-diameter continuous curvilinear capsulorhexis (CCC) opening. Its pathogenesis involves three key mechanisms: (1) proliferation of lens epithelial cells secreting αB/βB crystallins and calcium ions to drive osmotic gradient formation; (2)latent Propionibacterium acnes infection inducing chylous opacity; and (3) inflammatory cytokines (TNF-α, IL-1β, BFGF, IL-8) mediating blood-aqueous barrier disruption. Diagnosis, beyond conventional ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT), now leverages multimodal imaging to enhance differential diagnostic accuracy. Therapeutic strategies primarily include laser therapy: Nd:YAG laser anterior capsulotomy is indicated for cases without posterior capsular opacification (PCO); posterior capsulotomy proves more effective for PCO-associated LCBS; combined capsulotomy reduces recurrence rates, and femtosecond laser treatment with intraoperative OCT overcomes traditional localization limitations; and surgical intervention involves anterior capsular release with fluid aspiration to preserve the posterior capsular barrier, and pars plana vitrectomy combined with posterior continuous curvilinear capsulorhexis (PCCC) for severe PCO or infected cases, with future efforts focused on individualized prevention and management.

New progress in visual prediction after idiopathic macular hole surgery

Chen Xin, Yang Na, Zheng Yan, Zhang Yueling

2025, 49(4):  284-289.  doi:10. 3760/cma.j.cn115500-20241214-25408

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Idiopathic macular holes (IMH) are the most common causes of central vision loss, with vitrectomy combined with intraretinal membrane detachment being the standard surgical approach. While postoperative closure rates remain high, visual function recovery varies significantly among patients due to multiple factors. Traditional methods involved optical coherence tomography (OCT) measurements of the hole's minimum diameter, height-to-base diameter ratio, and the integrity of the outer membrane and the elliptical beltand other parameters to predict postoperative vision recovery. Emerging techniques now incorporate preoperative assessments using micro-optometry and multifocal retinal electroretinography (mfERG) to measure average retinal sensitivity and central foveal amplitude values. Postoperative evaluations through fundus autofluorescence and adaptive optical laser scanning (AOLS) for detecting spontaneous fluorescence at the hole site and measuring cone cell density provide crucial clinical insights into visual recovery. The visual recovery process following IMH is influenced by multiple interacting factors, with accurate preoperative assessment of hole characteristics and long-term follow-up being key to evaluation the prognosis outcomes.

Roles of angiopoietin in pathogenesis of wet age-related macular degeneration

Mou Bo, Xiang Ying, Li Yuanyuan, Wang Gang, Song Xiusheng,

2025, 49(4):  290-297.  doi:10. 3760/cma.j.cn115500-20250223-25409

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As another pro-angiogenic factor, angiopoietin plays a key role in the development of Wet age-related macular degeneration (wAMD), and become a hot research topic at present. Studies have demonstrated that angiopoietins influence the pathogenesis and progression of wAMD by modulating vascular stability, endothelial cell proliferation, and neovascularization. Based on this mechanistic understanding, investigating angiopoietin-targeted antagonists has provided novel therapeutic avenues for wAMD treatment.

Advanced research on psychological impact factors of macular diseases

Zhang Jinrong, Zhang Yue, Wang Jianing, Yu Xiaobing

2025, 49(4):  297-303.  doi:10. 3760/cma.j.cn115500-20250304-25410

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Macular diseases, including central serous chorioretinopathy (CSCR), age-related macular degeneration (AMD), diabetic macular edema, and macular hole, could lead to varying degrees of visual impairment and are also closely associated with a range of psychological disorders. Anxiety, depression, and stress-related conditions are found at a higher prevalence among affected individuals. Type A personality traits and elevated psychological stress may increase the risk of CSCR onset and influence its progression and recurrence. The underlying mechanisms are thought to involve dysregulation of the hypothalamic-pituitary-adrenal axis, elevated levels of cortisol and catecholamines, abnormal activation of the mineralocorticoid receptor pathway, and autonomic nervous system dysfunction, among other pathological processes. Therapeutically, while anti-vascular endothelial growth factor (VEGF) therapy has shown significant efficacy in improving visual outcomes in AMD, the psychological burden of repeated intravitreal injections may contribute to increased stress and reduced treatment adherence. Clinical observational studies suggest that treatment-related anxiety and depressive symptoms may adversely affect patients' quality of life and visual prognosis. The critical role of psychological impact factors was highlighted in the management of the macular diseases.

Role of Dickkopf-1 in occurrence and development of diabetic retinopathy

Li Yuanwei, Huang Xionggao,

2025, 49(4):  304-308.  doi:10. 3760/cma.j.cn115500-20241214-25411

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The Dickkopf (DKK) protein family plays a crucial role in biological development and cellular signal transduction. It mainly affects cell proliferation, apoptosis, and migration by regulating the Wnt/β-catenin signaling pathway, and plays a role in many diseases. DKK-1 inhibits the proliferation and migration of retinal pigment epithelium and retinal microvascular endothelial cells by suppressing the Wnt/β-catenin signaling pathway, which is important for maintaining the stability of the blood-retinal barrier, reducing neovascularization, and has a significant impact on the occurrence and development of fundus diseases such as diabetic retinopathy. This may provide new strategies for the diagnosis and treatment of retinal diseases such as diabetic retinopathy. In the future, it may be possible to develop safer specific small-molecule drugs or biological agents targeting DKK-1, or combine them with new gene therapy technologies to attempt new treatment methods for retinal diseases.

Research progress of diabetic choroidopathy

Ren Lanxin, Huang Dingguo

2025, 49(4):  309-314.  doi:10. 3760/cma.j.cn115500-20250415-25412

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Diabetic choroidopathy (DC), as an important co-factor of diabetic retinopathy (DR), may accelerate the process of retinal ischemia and hypoxia due to early microcirculation disorders.The characteristics of DC include: (1) Structural alterations: Choroidal thickness (CT) exhibits significant thinning during the preclinical stages of DR, while paradoxical thickening may manifest in the proliferative phase, attributable to compensatory vasodilation mechanisms. (2) Microcirculatory abnormalities: Choriocapillaris (CC) flow deficit percentage (FD%) demonstrates significant elevation in diabetes mellitus patients without DR, and exhibits a positive correlation with DR severity progression. (3) Macrovascular and medium vessel impairment: Choroidal Vascularity Index (CVI) reduction precedes the onset of clinically detectable retinal vasculopathy, with particular predilection for the Haller's layer within the macular region. CC FD% and CVI can be used as quantitative indicatorsfor early detection of subclinical DR, while the divergent impacts of anti-vascular endothelial growth factor therapy versus panretinal laser photocoagulation on choroidal perfusion dynamics provide a basis for the formulation of individualized treatment strategies.

Understanding of myelin oligodendrocyte glycoprotein antibody associated optic neuritis

Wang Xi, Li Xiaoming

2025, 49(4):  315-320.  doi:10. 3760/cma.j.cn115500-20250316-25413

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In recent years, myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-associated optic neuritis (MOG-ON) has gradually become a research focus in neuro-ophthalmology. The bilateral incidence of MOG-ON is relatively high, accompanied by obvious optic disc edema, and the enhancement of the optic nerve sheath and adjacent tissues can be seen on MRI. The likelihood of recurrence is high, but the prognosis of MOG-ON is usually better than that of aquaporin-4 antibody (AQP4-IgG) associated optic neuritis. At present, the optimal treatment plan for MOG-ON is still in the exploratory stage. Hormone shock is effective in the acute phase, and long-term immunotherapy was usually required for the relapsing patients. Targeted therapy such as rituximab and tocilizumab has gradually become a research hotspot to reduce the recurrence rate.