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    22 December 2025, Volume 49 Issue 6
    International consensuses and guidelines on diagnosing and managing cytomegalovirus retinitis
    Asia-Pacific Vitreo-retina Society, Asia-Pacific Professors of Ophthalmology, Asia-Pacific Society of Ocular Inflammation and Infection Translating author: Qian Zhuyun, Tao Yong
    2025, 49(6):  401-421.  doi:10. 3760/cma.j.cn115500-20251108-25601
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    With the paradigm changes in antiviral therapy, there are a myriad of emerging controversies in the management of cytomegalovirus retinitis (CMVR). A certain extent of variability exists in the management of CMVR among clinical practices worldwide. Hence, alignment in the management strategy is important towards optimizing the care of CMVR. An international panel of experts (IPE) formulated consensus statements for CMVR regarding to its 1) diagnosis, 2) screening, 3) treatment, 4) management in special populations and 5) emerging technologies. The clinical diagnosis of CMVR relies on patient’s susceptibility due to compromised immune function and characteristic fundus manifestations. Polymerase chain reaction (PCR) of intraocular fluid for detection of CMV is indicated when confirmation is necessary. Oral valganciclovir is the preferred first-line treatment, and intravitreal ganciclovir injection when CMVR threatens to involve the posterior pole. Cessation of maintenance treatment can be considered after 6 months when CMVR remains inactive with immune reconstitution. Immune recovery uveitis (IRU) must be distinguished from CMVR relapse. Screening is recommended for high-risk cases. Utilization of telemedicine and artificial intelligence-aided interpretation will help to alleviate the resources required for CMVR screening. Evidence for novel antiviral and immunotherapy have been appraised as second-line treatment options.
    Neuroinflammation in glaucomatous optic neuropathy
    Xie Junqing, Li Qian, Zhang Jingxue
    2025, 49(6):  422-431.  doi:10. 3760/cma.j.cn115500-20250822-25602
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    Glaucoma represents a group of neurodegenerative disorders characterized by progressive loss of retinal ganglion cells and optic nerve injury, though its precise pathogenesis remains incompletely understood. Recent studies have revealed significant activation of astrocytes and microglia in the retina and optic nerve head of glaucoma patients, manifested by morphological changes, migration, proliferation, and upregulation of injury-related molecular markers. Concurrently, elevated levels of inflammatory factors are observed in patient serum, suggesting that glial activation and neuroinflammation play a critical role in the pathophysiology of glaucoma. Importantly, modulating the homeostasis of astrocytes or microglia and suppressing neuroinflammatory responses exert protective effects against optic nerve injury. Therefore, further investigation into the mechanisms of glia-mediated neuroinflammation and potential regulatory strategies may offer novel therapeutic targets and interventions for optic nerve protection in glaucoma.
    Clinical application of bromonidine tartrate#br#
    Sun Yinuo, Zhang Shoukuan, Zhang Lei
    2025, 49(6):  432-437.  doi:10. 3760/cma.j.cn115500-20250623-25603
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    Brimonidine tartrate, a third-generation alpha-2 adrenergic receptor agonist, is widely used in the treatment of glaucoma and ocular hypertension. It lowers intraocular pressure (IOP) by reducing aqueous humor production and increasing uveoscleral outflow. Beyond its IOP-lowering effects, growing evidence suggests that brimonidine may also provide neuroprotection through IOP-independent mechanisms, such as enhancing retinal ganglion cell survival or inducing the expression of neuronal survival factors. Additionally, brimonidine induces miosis by activating presynaptic alpha-2 receptors, which reduces norepinephrine release, leading to relaxation of the iris dilator muscle and relative dominance of the sphincter muscle. This miotic effect offers clinical benefits in improving nighttime visual quality for patients following laser corneal refractive surgery and intraocular lens implantation.
    Binocular visual dysfunction associated with idiopathic epiretinal membrane
    Zhang Pei, Jia Liyun
    2025, 49(6):  437-441.  doi:10. 3760/cma.j.cn115500-20250701-25604
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    Patients with idiopathic epiretinal membrane (iERM) often experience binocular visual dysfunctions such as aniseikonia, diplopia, and impaired stereopsis. Conventional assessment using best-corrected visual acuity does not fully capture the subjective visual complaints in these individuals. Emerging clinical tools, including novel aniseikonia test and light on-off test, offer more precise evaluation of visual function. Mechanical traction caused by the epiretinal membrane induces pathological changes in retinal anatomy, where photoreceptor displacement and increased inner nuclear layer thickness are significantly correlated with binocular visual dysfunction. A deeper investigation into the dynamic effects of iERM on retinal structure and function, along with validation of their prognostic value, will provide a scientific foundation for personalized treatment and visual rehabilitation.
    Applications of artificial intelligence in the management of diabetic retinopathy
    Li Taoying, Zheng Yanshan
    2025, 49(6):  442-446.  doi:10. 3760/cma.j.cn115500-20250905-25605
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    In recent years, artificial intelligence (AI) has achieved significant advances in the management of diabetic retinopathy (DR). For screening, AI-based systems demonstrate a sensitivity of 95%-97% in detecting DR. In clinical assistance, deep learning models using preoperative fundus images can accurately predict visual acuity recovery at four weeks after surgery, while AI-assisted targeted photocoagulation has been shown to reduce risks of postoperative hemorrhage and corneal edema. In drug development, AI algorithms enable efficient screening of potential therapeutics and allow quantitative, objective assessment of treatment efficacy. However, clinical adoption still faces challenges such as limited model generalizability, insufficient interpretability, data privacy concerns, and the lack of robust regulatory frameworks. Moving forward, efforts should focus on deeper integration of data, algorithms, and clinical workflows, along with establishing standardized evaluation and regulatory systems, to foster reliable and sustainable implementation of AI in DR management.  

    Research progress on the role of pyroptosis in the occurrence and development of diabetes-related eye diseases #br#
    Zhang Xiaoguang, Li Yuanbin
    2025, 49(6):  447-454.  doi:10. 3760/cma.j.cn115500-20250620-25606
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    Diabetes-related ocular complications—such as diabetic retinopathy, diabetic keratopathy, and diabetic cataracts—can severely impair patients' vision. Pyroptosis, an inflammatory type of programmed cell death, plays a critical role in the onset and progression of these disorders. The activation of the NLRP3 (NOD-like receptor pyrin domain 3) inflammasome is central to the pyroptotic process. Through inflammasome activation and the release of pro-inflammatory cytokines, pyroptosis contributes to damage in ocular tissues including the retina, cornea, and lens, thereby accelerating the progression of diabetes-related eye diseases. Inhibitors of pyroptosis, such as MCC950, calcitriol, oridonin, and disulfiram, have been shown to alleviate ocular inflammation by suppressing inflammasome activation, offering potential for improved clinical outcomes.
    Research advances in the diagnosis and treatment of endogenous endophthalmitis
    Zhang Deng, Gu Feng, Zhang Xifan, Zhang Xiaoyu, Zhang Xin
    2025, 49(6):  455-461.  doi:10. 3760/cma.j.cn115500-20250725-25607
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    Endogenous endophthalmitis is a severe, sight-threatening infectious ocular condition. In East Asia, hypervirulent Klebsiella pneumoniae represents the predominant pathogen, and infected individuals often present with concurrent invasive infections in systemic sites such as the liver, lungs, and urinary tract. The disease predominantly affects patients with underlying conditions such as diabetes, immunosuppression, or renal impairment, and may occur across all age groups. Diagnosis is primarily based on clinical presentation and ophthalmological examination, rather than relying exclusively on microbiological culture results. Current management mainly consists of systemic antimicrobial therapy combined with local treatments. In recent years, several novel antibacterial strategies have emerged, demonstrating considerable potential for future clinical application.
    Research progress on drug delivery routes for the treatment of fundus diseases#br#
    Wang Zhen, Liu Ruiling, Wu Peipei, Wang Guimei, Zheng Shijun, Ruan Qingguo
    2025, 49(6):  462-469.  doi:10. 3760/cma.j.cn115500-20250725-25608
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    Traditional approaches for treating fundus diseases, such as topical eyedrops and oral administration, are minimally invasive but often yield suboptimal therapeutic outcomes due to poor intraocular penetration caused by physiological ocular barriers. In contrast, intravitreal, subretinal, and periocular injections achieve better efficacy but carry risks of ocular trauma and infection. In recent years, considerable progress has been made in the development of non-invasive drug delivery strategies for fundus diseases. For instance, cell-penetrating peptides—used either in direct drug conjugation or as part of drug carrier systems—significantly enhance the ability of therapeutics to cross ocular barriers and reach the posterior segment. Similarly, drug carriers such as hydrogels, novel nanoliposomes, and contact lenses can prolong ocular surface retention time, thereby indirectly improving drug delivery to the fundus. More recently, an integrated wearable system with an electrically driven switch has been developed, which uses electrical stimulation to enhance ocular barrier penetration, enabling efficient non-invasive delivery of macromolecular drugs to the posterior eye.
    Impact of epidermal growth factor receptor inhibitors on the ocular surface#br#
    Gong Xueqin, Zhang Jinyu, Zheng Zhewen, Zhou Shiyou
    2025, 49(6):  469-473.  doi:10. 3760/cma.j.cn115500-20240403-25609
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    Targeted drugs represent an effective class of anticancer agents for treating cancer patients with related gene mutations. In individuals with epidermal growth factor receptor (EGFR)-related molecular mutations, EGFR inhibitors can bind specifically to the receptor, thereby inhibiting tumor cell growth. With the increasing use of targeted therapies, their side effects—including those significantly affecting quality of life—have become more evident, particularly on the ocular surface. The administration of EGFR inhibitors has been associated with reversible eyelid ectropion and edema. Other reported ocular manifestations include trichomegaly (elongation and darkening of eyelashes), conjunctivitis, corneal epithelial damage, stromal thinning, corneal ulceration, and tear film instability. The mechanisms underlying these adverse ocular changes, however, require further investigation.
    The new methods for in vivo corneal biomechanical measurement
    Hu Bi, Jie Ying, Tian Lei
    2025, 49(6):  474-480.  doi:10. 3760/cma.j.cn115500-20250102-25610
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    Corneal biomechanics plays a critical role in the screening, differential diagnosis, diagnosis, and treatment of ocular disorders such as corneal ectatic diseases. In vivo corneal biomechanics testing techniques  primarily assess the biomechanical properties of cornea  through air-puff technique, optical imaging, and finite element modeling. Currently, four types of instruments are widely used in clinical practice to extract corneal biomechanical parameters:the Ocular Response Analyzer (ORA), the Corneal Visualization Scheimpflug Technology (Corvis ST), Brillouin microscopy, and optical coherence elastography (OCE).  Advances in these technologies have enabled a shift from global corneal biomechanical assessment toward localized and precise measurements. Such progress has not only improved the accuracy of evaluating corneal biomechanical properties, but also significantly enhanced early screening and precise staging of keratoconus. Furthermore, these tools offer reliable support for assessing the safety of corneal refractive surgery and monitoring the efficacy of corneal cross-linking procedures.