Table of Content

25 January 2025, Volume 34 Issue 1

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Opportunities, challenges and prospects of minimally invasive glaucoma surgery

Xin Chen

2025, 34(1):  1-5.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.001

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Minimally invasive glaucoma surgery (MIGS) has quickly gained recognition and promotion among glaucoma specialists due to its effective intraocular pressure reduction, minimal surgical trauma, simple operation, fewer complications, and easy follow-up care. The new challengeshave arisen, such as inconsistent surgical classification, unclear criteria for MIGS selection and theintraocular pressure spike,which prompted clinicians and researchers to refocus on the aqueous humor drainage pathways, ushering glaucoma treatment into a new era characterized by the interaction and unity of theoretical breakthroughs and technological innovations. (Ophthalmol CHN, 2025, 34: 1-5)

Interpretation on US National Academies Myopia Report 2024

Li Yiman, Wang Yaxing

2025, 34(1):  5-9.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.002

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In recent years, the prevalence of myopia has continued to rise, becoming a significant challenge to global public health. In 2024, the guideline "Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease," published by the National Academies of Sciences, Engineering, and Medicine, formally reclassifies myopia as a disease for the first time and proposes targeted prevention and management strategies. This article will interpret the main updates of the guideline and explore how to apply these guiding principles in clinical practice. Through an in-depth understanding of the guideline, the aim is to provide a scientific basis for the prevention and control of myopia in children and adolescents, promote public awareness of myopia issues, and ultimately enhance vision health outcomes. (Ophthalmol CHN, 2025, 34: 6-9)

Rethinking cotton wool spots（Ⅱ）

Huang Houbin

2025, 34(1):  10-15.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.003

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This article is the contituation of “Rethinking cotton wool spots (I)” in the previous issue where it systemically illustrate the etiology, pathology and pathophysiology of cotton wool spots. The clinical manifestations, differential diagnoses and clinical significance would be explored herein. (Ophthalmol CHN, 2025, 34: 10-15)

Genotype and phenotype analysis of early-onset high myopia patients carrying pathogenic variants of LOXL3 gene

Xia Weiqiao, Xu Ke, Xie Yue, Yan Weiyu, Zhang Xin, Shi Jie, Li Nien, Li Yang

2025, 34(1):  18-24.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.004

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Objective To analyze the genotype and phenotype of patients with early-onset high myopia (eoHM) caused by pathogenic variants in LOXL3 gene. Design Retrospective case series. Participants A total of 17 patients with eoHM carrying pathogenic variants in LOXL3 gene, collected from Beijing Tongren Hospital (3 cases) and cases previously reported (14 cases). Methods Patients in Beijing Tongren Hospital underwent ophthalmic (BCVA, optometry, color fundus photography, retinal OCT) and systemic examinations (oral, facial, joint and hearing). Reported cases were recorded for the aforementioned information. Patients were diagnosed with Stickler syndrome (SS) or simple eoHM based on the presence of extra-ocular phenotypes. Main Outcome Measures Pathogenic gene variants, age of examination, spherical equivalent refraction (SER), extra-ocular phenotypes. Results Of the 17 patients, 11 were simple eoHM and 6 were SS. The median age at diagnosis was 4.0 years (simple eoHM) and 9.5 years (SS). The average SER was (-15.36±15.50) D (simple eoHM) and (-9.78±3.90) D (SS). The degree of myopia in simple eoHM patients was significantly greater than that in SS patients (P<0.001), and their myopia got worsens with age (P=0.0001), their visual impairment was obviously more severe than that in SS patients (P=0.026). SS patients exhibit extra-ocular manifestations in addition to ocular phenotypes, which were mainly midfacial hypoplasia. 16 pathogenic variants in LOXL3 gene were detected in this group of patients, including 9 missense variants, 6 truncation variants (5 frameshift and 1 nonsense), and 1 spliceing variant. All the simple eoHM patients carried at least one truncation variant, while the SS patients mainly carried missense variants. All patients in this group exhibited varying degrees of myopic fundus manifestations, but the parapapillary atrophy was narrow and thin. 3 simple eoHM patients had a history of retinal detachment. Conclusion This study expanded the variant spectrum of LOXL3 gene and found that patients carrying truncation variants of LOXL3 gene had severe high myopia and a high risk of retinal detachment, while patients carrying missense variants were prone to develop extra-ocular syndrome phenotypes. (Ophthalmol CHN, 2025, 34: 18-24)

PRSS56 gene mutations and clinical characteristics in Chinese patients with nanophthalmos#br#

Tao Jing, Hao Jie, Shen Renjuan, Fu Yuxiao, Li Jiao, Wang Xuwen

2025, 34(1):  27-33.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.005

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Objective To explore the genetic and clinical characteristics of PRSS56 gene mutations in Chinese patients with nanophthalmos and to reveal correlations between genotypes and phenotypes. Design Retrospective case series. Participants Forty unrelated Chinese families with nanophthalmos, diagnosed and followed up at Beijing Tongren Hospital from 2003 to 2023. Methods Comprehensive ophthalmic examinations were performed on the patients and their family members. Peripheral venous blood was collected from 51 patients and 42 family members with normal ocular phenotypes. DNA was extracted, and the coding region and adjacent intron regions of the PRSS56 gene were analyzed by whole-exome sequencing (WES), followed by bioinformatics analysis and pathogenicity prediction. Statistical analysis of genotypes and phenotypes was conducted using SPSS 27.0 and R 4.4.1 software. Main Outcome Measures Ophthalmic examination results, mutant genotypes, and the proportion of complications such as angle-closure glaucoma (ACG) and uveal effusion syndrome (UES). Results PRSS56 gene mutations were identified in 15 of 40 unrelated Chinese nanophthalmos families (15 probands and 5 affected family members ), with a detection rate of 37.50%. A total of 16 PRSS56 gene mutations were discovered, including 3 novel mutations [c.494dupG (p.Glu167Gly), c.340dupG (p.Ala115Gly), c.407C>T (p.Ala136Val)] and 13 previously reported mutations. Among these, the mutation frequency of c.1066dupC was 53.33% (8/15), making it the most common mutation in this cohort. Nanophthalmos patients with PRSS56 gene mutations exhibited typical clinical features of poor vision, short axial length, and shallow anterior chamber, accompanied by optic disc crowding, tortuous and dilated retinal vessels, and retinal folds in the macular area. Patients first diagnosed after the age of 40 years had a thicker average scleral thickness, a shallower average central anterior chamber depth, and higher proportion of ACG and UES( all P<0.05). The group carrying the high-frequency mutation of c.1066dupC showed a tendency of having a shorter anterior segment. Conclusion This study elucidates the PRSS56 gene mutations and clinical characteristics in Chinese patients with nanophthalmos and their correlations, expands the mutation spectrum of the PRSS56 gene, deepens the understanding of genotype-phenotype correlations in nanophthalmos, and lays a more comprehensive theoretical foundation for the accurate diagnosis, treatment, and prognostic management of this disease. (Ophthalmol CHN, 2025, 34: 27-33)

Diagnostic value of axial length to corneal radius ratio in myopia assessment of preschool children

Hou Jin, Zhang Wanxia, Jiao Yonghong, Mi Xuejing, Chen Wei, Pu Jianing, Ma Zhangfang

2025, 34(1):  36-39.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.006

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Objective To investigate the diagnostic value of the axial length-to- corneal radius (AL/CR) ratio for assessing myopia in preschool children aged 3 to 6 years. Design A cross-sectional study. Participants Cluster sampling was used to select 1878 children aged 3 to 6 years from 27 kindergartens in Haidian District, Beijing from December 2020 to August 2021. Methods After cycloplegia, refraction was measured in both eyes to determine the spherical equivalent (SE). Axial length (AL) and corneal curvature (K) were measured using optical biometry, with the corneal radius (CR) and the axial length-to-corneal radius ratio (AL/CR) calculated. Myopia was defined as SE≤-0.50 D, and AL/CR>3 was considered indicative of suspected myopia. Data were analyzed using normality tests, rank correlation analysis, and receiver operating characteristic (ROC) curves to evaluate the predictive value of AL/CR for myopia in children aged 3 to 6 years. Main Outcome Measures SE, AL/CR , sensitivity, specificity , and the area under the ROC curve. Results Both SE and AL/CR values followed a normal distribution, with average SE at (1.15±0.94) D and average AL/CR at (2.86±0.07). Correlation analysis revealed a negative association between SE and AL/CR (r=-0.324, P＜0.01). Compared with the results from cycloplegic refraction(SE≤-0.50 D), the sensitivity of the AL/CR ratio >3 for diagnosing myopia was 0.375, with a specificity of 0.985, an accuracy of 95.7%, and a Kappa coefficient of 0.956. The area under the ROC curve was 0.862. At an AL/CR cutoff of 2.928, the Youden index was maximized, yielding a sensitivity of 73.90% and a specificity of 85.30% for diagnosing myopia. Conclusion The AL/CR ratio demonstrates high specificity and accuracy in diagnosing myopia in preschool children, indicating its significant clinical value for predicting the onset of myopia. (Ophthalmol CHN, 2025, 34: 36-39)

Observation of structural and vascular features of retina and choroid in young myopic anisometropia

Yang Yuxin, Xu Mengyao, Zhang Fengju, Xu Yushan, Zhang Linlu, Wen Jie

2025, 34(1):  40-46.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.007

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Objective To investigate the interocular differences in retinal and choroidal morphology and vascularity in patients with anisometropic myopia, and to further explore the relationship with myopia. Design Cross-sectional study. Participants 110 young patients with myopic anisometropia. Methods Using OCTA, measurements were obtained for retinal and choroidal thickness, retinal vessel length density (RVLD), choroidal vessel volume (CVV), choroidal stroma volume (CSV), and choroidal vessel index (CVI). Mean vessel width and branch points were derived from OCTA retinal images using custom Python scripts based on OpenCV. The interocular differences of the retinal and choroidal thickness, RVLD, CVV, CSV, CVI, mean vessel width and branch points were compared. Main Outcome Measures Retinal and choroidal thickness, RVLD, CVV, CSV, CVI, mean vessel width and branch points. Results In most regions, the retinal and choroidal thicknesses, as well as CVV and CSV, were lower in the more myopic eye compared to the less myopic eye. These measurements were correlated with spherical equivalent (SE) and axial length (AL) (all P＜0.05). Logistic regression analysis indicated that mean vessel width may be a significant factor influencing the refractive differences between the eyes in individuals（β=-0.157, P=0.019）. Restricted cubic spline analysis revealed that in the parafoveal zone, the CVI increased with SE when SE was less than -2.112 D, and decreased when SE was greater (P for nonlinear＜0.05). Conclusion In young anisometropic individuals, higher degrees of myopia were associated with thinner retinal and choroidal thicknesses, as well as reduced CVV and CSV, significantly linked to AL and SE. The threshold of the CVI parafoveal was identified at -2.112 D. Variations in mean vessel width suggest potential contributions to individual refractive anisometropia. (Ophthalmol CHN, 2025, 34: 40-46)

Efficacy of low-degree astigmatism correction of bifocal toric intraocular lenses

Yao Jinglei, Li Luxi, Li Tian, Jiang Zhaocai, Xu Zhengjie

2025, 34(1):  49-53.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.008

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Objective To observe the refractive correction effect of bifocal Toric IOL implantation on cataract patients with low-degree of corneal astigmatism. Design Retrospective case series. Participants Forty cataract patients with low-degree corneal astigmatism (0.75~1.25 D) were enrolled. Twenty patients underwent phacoemulsification combined with bifocal Toric IOL implantation (Toric group), and 20 patients underwent phacoemulsification combined with bifocal IOL implantation (control group). Methods The patients' medical records were reviewed, and the uncorrected distance visual acuity (UDVA) , the best corrected far vision acuity (BCVA) , the uncorrected near visual acuity (UNVA), and the best corrected near vision (BCNV), astigmatism, and visual quality of life score were recorded and compared between the two groups. Main Outcome Measures UDVA, BCVA, UNVA, BCNV, astigmatism and visual quality of life score. Results UDVA and UNVA in Toric group were better than those in control group (all P<0.05). There was no significant difference in BCVA and BCNV between the two groups (all P>0.05). There was no significant difference in astigmatism between the two groups before surgery (P>0.05). At 3 months after surgery, the mean astigmatism was (0.31±0.12) D in the Toric group and (0.83±0.28) D in the control group (t=-7.634，P<0.001). The total score of subjective visual quality questionnaire (QoV) was good in both groups, and the total score of the Toric group (88.12±0.142) was better than that of the control group (81.77±1.15) (t=15.558, P<0.001). The light interference score of Toric group (23.7±0.97) was significantly better than that of control group (18.09±0.52) (t=22.756, P<0.001). There was no significant difference in medium and near distance living ability between the two groups. But the night driving ability score of the Toric group (4.15±0.16) was significantly better than that of the control group (2.26±0.22)(t=31.168, P<0.001). Conclusion Bifocal Toric IOL implantation can improve corneal astigmatism, uncorrected distance and near visual acuity, reduce the optical interference of bifocal IOL, and improve the visual quality after cataract surgery. (Ophthalmol CHN, 2025, 34: 49-53)

Influence of implantable collamer lens implantation on higher-order aberrations

Liu Jianying, Liu Zhenyu, Wan Xiuhua, Li Jing

2025, 34(1):  53-57.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.009

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Objective To evaluate the changes in higher-order aberrations (HOAs) under a 4.00 mm pupil diameter after implantation of implantable collamer lens (ICL V4c). Design Retrospective case series. Participants From August to December 2022, 42 patients (84 eyes) aged 19 to 45 years with myopia underwent implantation of ICL V4c at Beijing Tongren Hospital. Methods HOAs were measured in a dark room environment with a 4.00 mm natural pupil diameter, both preoperatively and one month postoperatively using the iTrace visual analyzer. The changes of the intraocular and total high-order aberrations of the cornea were observed and compared between before and after the surgery. Main Outcome Measures The root mean square (RMS) values of total HOAs, spherical aberration, coma, trefoil, and secondary astigmatism for the corneal. Results The intraocular HOAs preoperatively and postoperatively were 0.291±0.214 μm and 0.169 ± 0.145 μm, respectively (t=4.223, P<0.001), and the total HOAs were 0.299±0.213 μm and 0.188±0.149 μm, respectively(t=3.963, P<0.001). The postoperative intraocular spherical aberration increased towards to the negative direction compared to preoperatively (t=3.191, P=0.002), and the corneal trefoil aberration also increased (t=-2.305, P=0.024). There were no significant changes in the total corneal HOAs, coma, and secondary astigmatism compared to preoperatively (all P>0.05). Conclusion ICL V4c implantation corrects refractive errors and also reduces the total HOAs and the intraocular HOAs, with the exception of spherical aberration. The negative spherical aberration of the ICL led to an increase in intraocular spherical aberration, and the corneal trefoil aberration increased due to the creation of corneal incisions, while other corneal HOAs remained unchanged. (Ophthalmol CHN, 2025, 34: 53-57)

Application of intelligent pushing technology in pre hospital preparation for ophthalmic general anesthesia day surgery

Ma Zhangfang, Yang Xiaoxiao, Wang Ying, Zhang Yan, Yang Jie, Zhang Zijing, Li Yue, Zhang Wanxia

2025, 34(1):  58-62.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.010

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Objective Exploring the application effect of intelligently pushing technology on the pre-hospital preparation of ophthalmic general anesthesia day surgery patients based on a health education precision connection system. Design Non synchronous controlled study. Paticipants 84 patients with day surgery under general anesthesia were admitted to the ophthalmic day ward of Beijing Tongren Hospital from March to June 2023. In which, 42 patients admitted from March to April were the control group; Forty-two patients admitted from May to June were included in the observation group. Methods 42 patients in the control group were provided with pre-hospital nursing by telephone visit (traditional form). For 42 patients in the observation group, the intelligent push technology of the health education precision connection system was used to accurately push audio nursing guidance materials at different time nodes for health education and psychological nursing of pre-hospital patients. After the patient is admitted, the same nurse asks the patient if he/she has completed the pre-hospital routine preparations according to the doctor's advice, and recorded the number of completed cases. Another nurse who has undergone scale measurement training will distribute Self-Rating Anxiety Scales (SAS) to patients during the time period from appointment for surgery, admission to the hospital, and before surgery. The SAS were filled by the patients and the scales were calculated. The number of patients who completed routine preparation before admission and the scores of SAS were compared between the two groups. Main Outcome Measures The number of completed cases, scores of SAS. Results 40 cases (95.2%) in the observation group who completed all routine preparations according to medical advice was significantly higher than the 33 cases (78.6%) in the control group (χ2=5.126，P=0.024); The number of cases with sufficient sleep preparation on the night before surgery was significantly higher in the observation group (41 cases, 97.6%) than in the control group (35 cases, 83.3%)(χ2=4.974，P=0.026); The score of SAS in the control group (43.64±5.64) was significantly higher than that in the observation group (40.26 ± 4.31) (t=3.088, P=0.003). Conclusion The intelligent pushing technology based on the health education precise connection system for pre-hospital preparation nursing can reduce preoperative anxiety of ophthalmic general anesthesia day surgery patients, promote the completion of pre-hospital preparation, and thus promote the efficient, safe, and high-quality operation of ophthalmic general anesthesia day surgery. (Ophthalmol CHN, 2025, 34: 58-62)

Application of multi-platform situational teaching method in ophthalmology clerkship instruction

Li Zheqing, Song Tingting, Wei Wenbin

2025, 34(1):  63-67.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.011

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Objective To evaluate the teaching effect of multi-platform situational teaching on the learning experience and clinical application ability training of ophthalmic interns. Design Teaching research. Participants A total of 72 interns of fifth-year clinical medical students from the Shijingshan Teaching Hospital of Capital Medical University were enrolled. Methods Students were divided into two groups of 36 each using the random number table method. The teaching was assigned to two groups: the traditional instruction group and the multi-platform situational teaching group. The multi-platform situational teaching group adopts the group system, which adopts the clinical teaching of classic case inquiry, real-time clinical physical examination of multi-mode slit lamp, group discussion and formulation of diagnosis and treatment plan, formation of group summary report and summary evaluation of instructors to complete the internship teaching. After teaching, the teaching effect (scores of clinical application ability, clinical critical thinking ability and doctor-patient communication ability) of the two groups were tested by the improved ophthalmology probation test form. The students' experience to teaching was scored by using Likert five-level scoring method (Likert-type Scale). Compare the difference of teaching effect and teaching experience between the two groups. Main Outcome Measures The score of the assessment form after the internship, Likert score. Results Before the internship, the assessment score of the multi-platform situational teaching group and the traditional instruction group was (78.74±6.17) points and (76.59±5.71) points respectively (t=1.53, P=0.06). After the internship, the scores of all items and the total score of the clinical ability assessment in the multi-platform situational teaching group were higher than those in the traditional instruction group (all P<0.001). According to the results of the Likert-type Scale, the score of the multi-platform instruction teaching group and the traditional instruction group in terms of the ease of understanding theoretical knowledge was (4.18±0.65) points and (3.93±0.84) points respectively (P=0.08); the multi-platform situation teaching group (4.34±0.43 points) felt a heavier post-class learning burden than the traditional instruction group (4.10±0.45 points) (P=0.004); in terms of mastering disease diagnostic criteria, classroom interest, and post-class active knowledge expansion, the scores of the multi-platform situation teaching group were significantly higher than those of the traditional instruction group (all P<0.001). Conclusion The multi-platform situationa teaching method is obviously superior to the traditional instruction method in improving students' clinical ability and teaching experience. (Ophthalmol CHN, 2025, 34: 63-67)

Preliminary result of accompanying service by medical social workers for elderly ophthalmic patients

Chen Weizhen, Wei Wenbin, Chen Jiyan, Han Shuangxue

2025, 34(1):  68-71.  doi:10.13281/j.cnki.issn.1004-4469.2025.01.012

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Objective To study the application effectiveness of medical social workers in accompanying elderly patients in ophthalmology departments of public hospitals. Design Retrospective comparative case series. Participants 37 elderly ophthalmic patients receiving escort services and treceived the telephone satisfaction visits from the cataract center of Beijing Tongren Hospital as the observed group, 62 patients of the same date, doctor, and age through the hospital information system，who was traditional visiting a doctor, as the controlled group. Methods Accompanying services were provided by the medical social workers and volunteers for the elderly ophthalmic patients in the observed group; the patients in the controlled group saw a doctor by themselves. Artificial intelligence (AI) robots were used to process the telephone follow-up to assess the satisfaction of the patients in the two groups. Likert scale was used to conduct a questionnaire survey. The questionnaire involves 4 dimensions (six questions): medical procedures, medical ethics, medical quality and service time. Each dimension was rated on a scale of 1 to 5. Satisfied 5 points, more satisfied 4 points, generally 3 points, less satisfied 2 points, dissatisfied 1 point. Main Outcome Measures Satisfaction score. Results The score of the process smoothness of the observed group was 4.94±0.19, which significantly increased compared with that of the controlled group (4.43±0.88) (t=-4.431，P<0.01); the score of satisfaction with waiting time was 4.74±0.58, which significantly increased compared with that of the controlled group (4.05±1.19) (t=-3.916，P<0.01); and the score of overall satisfaction with the medical visit was 4.84±0.13, which significantly increased compared with that of the controlled group (4.57±0.41) (t=-4.789，P<0.01). There were no significant differences in the scores of doctors' treatment level satisfaction, doctors' attitude satisfaction, nurses' service satisfaction and other personnel satisfaction between the two groups (all P>0.05). The linear regression results showed that observed group patients had a medical procedures satisfaction score of 0.513 points higher compared to those in the controlled group（r2=0.112，P=0.001）; a waiting time satisfaction score of 0.762 points higher compared to those in the controlled group（r2=0.192，P＜0.001）; and a overall satisfaction score of 0.290 points compared to those in the controlled group (r2=0.200，P＜0.001). Conclusion The intervention of medical social workers in the companion consultation service for elderly ophthalmic patients in the ophthalmology department can reduce the medical treatment difficulties of the elderly, shorten the medical treatment time, alleviate adverse emotions, effectively enhance the convenience and satisfaction of elderly patients in seeking medical treatment. (Ophthalmol CHN, 2025, 34: 68-71)