Table of Content

22 October 2025, Volume 49 Issue 5

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The relationship between intrinsically photosensitive retinal ganglion cell, non-imaging visual functions, and glaucoma

Xu Ke, Pang Yulian, Zhang Xu

2025, 49(5):  321-326.  doi:10.3760/cma.i.cn115500-20250714-25501

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Intrinsically photosensitive retinal ganglion cells (ipRGC), the third class of photoreceptors discovered in recent years, play a key role in non-image-forming visual functions such as the pupillary light reflex and circadian rhythm regulation. Glaucoma, characterized by the progressive loss of retinal ganglion cells, is often associated with impairment of these non-image-forming visual functions. Studies have shown that ipRGC exhibit relative resistance to glaucomatous damage; however, as the disease progresses, their function gradually declines, leading to abnormalities in the pupillary light response and disruptions in circadian rhythms. These characteristics of ipRGC offer new perspectives on the diagnosis and treatment of glaucoma:  on one hand, chromatic pupillometry can be used to assess ipRGC function, providing insight into the extent of disease progression; on the other hand, interventions such as optimizing light exposure and melatonin supplementation may help stabilize circadian rhythms, potentially offering effective strategies to improve patients' quality of life.

Distribution and roles of integrins in the aqueous humor outflow pathway

Wu Jiayi, Xu Lijuan, Zhou Tao, Han Jialing, Liang Yuanbo

2025, 49(5):  327-333.  doi:10.3760/cma.i.cn115500-20250725-25502

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Glaucoma, an irreversible blinding eye disease characterized by optic nerve damage and visual field defects, has a pathogenesis closely linked to structural and functional alterations in the trabecular meshwork (TM) and Schlemm’s canal (SC). Integrins, serving as crucial transmembrane receptors on the cell surface, act as vital bridges connecting the extracellular matrix (ECM) to the cytoskeleton. Within the TM and SC, integrins exhibit subtype-specific distribution patterns. Through their modulation of cell-ECM adhesion, cytoskeletal reorganization, and cellular contractility, integrins critically influence TM tissue stiffness and the morphology/function of the aqueous humor outflow pathway. These roles suggest that targeting specific integrin subtypes—particularly αvβ3 and β1 subunits—may offer a promising strategy for modulating the pathological microenvironment in glaucoma.

Artificial intelligence assisted calculation of cup-to-disc ratio in glaucoma

Zhang Linyi, Wang Sheng, Wang Weiwei, Zhao Lei

2025, 49(5):  334-340.  doi:10.3760/cma.i.cn115500-20250422-25503

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Glaucoma, the leading cause of irreversible blinding worldwide, is characterized by its subtle and progressive nature. Early detection and surveillance of its progression are crucial for effective management. The cup-to-disc ratio (CDR) is one of the important indicators in this regard.Artificial intelligence (AI), through deep learning algorithms, enables efficient image analysis. When combined with existing diagnostic methods, AI significantly improves the CDR calculation in glaucoma, while greatly reducing screening costs and the rate of missed diagnoses in the early stages. However, challenges remain, including limited model generalizability due to the high reuse of public datasets, dependence on image quality, limited availability of glaucoma disease databases for AI model development, the “black-box” nature of AI algorithms, and the lack of legal and regulatory frameworks related to AI. Nevertheless, AI offers substantial advantages in medical image interpretation and holds great promise for advancing glaucoma diagnosis and treatment toward greater precision and convenience.

Bidirectional regulation of body mass index on eye diseases related to trans-lamina cribrosa pressure difference: mechanisms, evidence, and clinical implications

Li Yilin, Fu Yingdi, Wang Ningli, Hu Jianping,

2025, 49(5):  341-347.  doi:10.3760/cma.i.cn115500-20250911-25504

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Body mass index (BMI) can influence intraocular pressure (IOP) and cerebrospinal fluid pressure (CSFP), modulating the trans-laminar cribrosa pressure difference (TLCPD), and thereby contributing to the development of pressure-related neuro-ophthalmic diseases. High BMI elevates both IOP and CSFP. BMI is inversely correlated with TLCPD. Low BMI primarily lowers CSFP, leading to a compensatory increase in TLCPD, making it an independent risk factor for primary open-angle glaucoma, especially normal-tension glaucoma. Increasing BMI to within the normal range may be protective against glaucoma. However, the revesed cranio-ocular pressure gradient caused by high BMI underlies the core pathophysiology of idiopathic intracranial hypertension and spaceflight-associated neuro-ocular syndrome.Based on the evidence and possible mechanisms of the impact of BMI on intraocular pressure, CSFP, and TLCPD, clinical management should shift from a single intraocular pressure or CSFP indicator to a TLCPD perspective to achieve more accurate risk prediction and clinical management. At the same time, elucidating how adipokines and inflammatory molecules influence TLCPD, particularly in populations with low BMI, is a worthwhile direction for future research.

Application of perceptual learning training based on intelligent devices in visual rehabilitation of peripheral visual field defects

Li Qiuying, Xu Zixuan, Li Jinrong

2025, 49(5):  348-355.  doi:10.3760/cma.i.cn115500-20250620-25505

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Peripheral visual field defects, as a common manifestation of various ophthalmic and neurological disorders, significantly impair patients' visual function and quality of life. In recent years, perceptual learning based on visual cortical plasticity has demonstrated the potential to activate residual visual function, improve visual sensitivity, spatial integration, and visual search ability, thereby promoting visual field recovery and functional enhancement. Moreover, intelligent devices have enabled diversified training modalities. Specifically, computer-based training enhances fine visual discrimination, oculomotor control, and spatial perception through tasks involving stimulus recognition, eye movement, and visual attention with spatial cueing; virtual reality-based training improves binocular visual field perception; and multimodal training with auditory and neurofeedback further strengthens overall sensitivity and multisensory integration. These training modalities collectively provide novel theoretical foundations and application pathways for visual rehabilitation in peripheral visual field defects.

Capsular tension ring implantation: techniques and complications

Zhao Yuyang, Qing Guoping

2025, 49(5):  356-362.  doi:10.3760/cma.i.cn115500-20250725-25506

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Capsular tension ring (CTR) is widely used in complex cataract surgeries or angle-closure glaucoma surgeries with zonular weakness. It serves to stabilize the intraocular lens (IOL) and the capsular bag, improve postoperative visual outcomes, and prevent further damage to the weak zonule. However, CTR implantation also carries potential risks. Common intraoperative complications include injury to residual zonules, displacement or even luxation of the capsular bag, capsular tear, vitreous prolapse, residual pieces of lens nudear or cortex, corneal endothelial damage, and IOL displacement or drop into the vitreous cavity. Postoperative complications may consist of posterior capsular opacification, anterior capsular contraction syndrome, dislocation of the capsular bag-CTR-IOL complex, elevated intraocular pressure, secondary glaucoma, retinal detachment, and cystoid macular edema. For unpreloaded CTR, the safe and practical method is to import it gentlely with forceps along the inside of the capsular equator. For preloaded CTR, Fish Tail method has been proved to be safe and efficient. 

Clinical application of monofocal extended depth of focus IOL based on wavefront-shaping technology

Chen Ting, Wang Zhenyu, Liu Zhaochuan, Song Xudong

2025, 49(5):  363-370.  doi:10.3760/cma.i.cn115500-20250226-25507

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With the increasing demand for full-range postoperative vision in cataract patients, the extended depth of focus (EDOF) intraocular lens (IOL), represented by the Acrysof IQ Vivity DFT015 based on aspheric wavefront-shaping technology, addresses the compromise between depth-of-field extension and visual disturbances inherent in traditional monofocal and multifocal IOLs. The vivity IOL provides a broader depth-of-field range compared to conventional monofocal IOLs. Through micromonovision design, it enhances near vision in some patients, improves contrast sensitivity, and significantly reduces postoperative photic phenomena such as glare, halos, and starbursts, thereby delivering superior visual quality. Additionally, the Vivity IOL demonstrates broad applicability, showing favorable adaptability and efficacy in patients with comorbid ocular conditions such as glaucoma and epiretinal membranes.

Astigmatism correction in cataract surgery

Zheng Huicong, Wan Xiuhua

2025, 49(5):  371-377.  doi:10.3760/cma.j.cn115500-20250102-25508

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Preoperative astigmatism is a key determinant of postoperative visual quality in cataract surgery. Accurate ocular biometry and individualized surgical planning are essential for effective astigmatism correction. For patients with conditions such as dry eye, tear film stabilization prior to measurement is necessary to ensure reliable data acquisition. Currently, four main approaches are commonly employed to correct astigmatism during cataract surgery: (1) Clear corneal incision at the steep meridian, suitable for astigmatism <1.00 D; (2) Peripheral corneal relaxing incision, which provides 1.00-3.00 D of correction and serves as a practical alternative when toric intraocular lens (IOL) is unavailable; (3) Toric IOL implantation, regarded as the most effective method, capable of correcting 0.75-4.00 D of astigmatism; and (4) Femtosecond laser-assisted arcuate keratotomy, offering precise and controllable correction of corneal astigmatism.These techniques may be applied individually or in combination to achieve optimal refractive outcomes.

Factors influencing the postoperative outcomes of phakic intraocular lens implantation

Yang Chuci, Gao Mengman, Guo Xiujin

2025, 49(5):  378-386.  doi:10.3760/cma.i.cn115500-20250404-25509

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Phakic intraocular lens (implantable collamer lens, ICL) implantation is suitable for patients who are not ideal candidates for corneal refractive surgery, such as those with thin corneas or extreme myopia. Although ICL implantation is generally safe and effective, individual differences in postoperative corrective outcomes exist. Key factors influencing the surgical outcomes of ICL include: (1) Patient-related factors, such as ocular anatomical parameters (e.g., anterior chamber depth, corneal endothelial cell density, pupil diameter), refractive status (particularly the personalized correction of extreme myopia and astigmatism), systemic and other ocular diseases, patient age, and accommodative function; (2) Surgical factors, including ICL power calculation and selection (e.g., characteristics of V4c and V5 ICLs and the evolution of calculation formulas), surgical techniques (e.g., micro-incision design), and postoperative management (e.g., use of corticosteroids, vault monitoring, and ICL position stability). With the application of new designs such as the V5 ICL, the development of artificial intelligence-assisted calculation models, and the refinement of surgical techniques, the precision and safety of ICL implantation have significantly improved. Preoperative accurate evaluation, personalized treatment planning, and standardized postoperative follow-up are crucial for optimizing visual outcomes.

Role of fibroblast growth factor 21 in the pathogenesis of diabetic retinopathy

Tian Ye, Dou Guorui, Wang Xin, Zhang Guoheng, Chen Yuan

2025, 49(5):  386-392.  doi:10.3760/cma.j.cn115500-20250520-25510

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Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus, which is a serious threat to patients' visual function, and its occurrence is closely related to the imbalance of glucose and lipid metabolism, hypertension and insulin resistance. Fibroblast growth factor 21 (FGF21), as a key metabolic regulator, not only enhances insulin resistance and improves glucose-lipid metabolism, but also directly regulates the function of retinal vascular endothelial cells through specific activation of the FGF receptor/β-Klotho complex. Notably, despite significantly elevated plasma levels of FGF21 in patients with clinical DR, its pathophysiologic significance remains controversial and may involve compensatory protective mechanisms or FGF21-resistant states.The role and possible mechanisms of FGF21 in the progression of DR may be mainly through the activation of signaling pathways such as AKT/ERK and Nrf2, which inhibit oxidative stress, attenuate the inflammatory response, block pathologic angiogenesis, vascular leakage, and improve neural retinal function.

Biomarkers of refractory diabetic macular edema

Zhao Bowen, Zhang Rui, Wang Wei

2025, 49(5):  394-400.  doi:10.3760/cma.i.cn115500-20250526-25511

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The pathological manifestation of diabetic macular edema (DME) is the accumulation of fluid between the outer plexiform layer and the inner nuclear layer of the retina, resulting in visual impairment. Systemic factors such as high-sensitivity c-reactive protein, homocysteine and creatinine can identify refractory dme early; Intraocular inflammatory mediators and cytokines, such as interleukin and monocyte chemoattractant factor, provide new ideas for the treatment of refractory DME As well as OCT, OCTA and other imaging markers can provide a reference for the judgment of prognosis.