Table of Content

25 January 2026, Volume 35 Issue 1

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Reconsidering primary angle-closure glaucoma from the pathophysiological perspective of abnormal intraocular fluid circulation and imbalance of chamber pressure

Zhao Hanxue, Yu Xiaowei, Fan Zhigang, Shi Yan

2026, 35(1):  1-8.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.001

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Primary angle-closure glaucoma (PACG) is a vision-threatening eye disease that can lead to blindness, and its pathogenesis has long been debated. Traditionally, anatomical factors such as iris bombe, anterior lens displacement, and anterior rotation of the ciliary body have been considered the primary causes. However, the inconsistent therapeutic outcomes targeting these structural abnormalities suggest that they may represent concomitant changes during disease progression rather than the fundamental cause. Drawing from this insight, this article explores how intraocular chamber pressure imbalances, triggered by abnormal intraocular fluid circulation, affect different intraocular structures and functions, with the goal of clarifying the pathophysiological mechanisms underlying the development and progression of PACG. The proposed mechanisms mainly include: pathological choroidal expansion or abnormal suprachoroidal fluid transport leading to altered choroidal-vitreous pressure; abnormalities of the ciliary body-zonules-crystalline lens-hyaloid-anterior vitreous complex (CZLHV) resulting in changes in vitreous cavity-posterior chamber pressure; and forward displacement of the CZLHV complex compressing the iris, thereby creating a posterior-anterior chamber pressure gradient. This sequence ultimately causes iridotrabecular contact, angle closure, and obstruction of aqueous humor outflow through the trabecular meshwork. By systematically summarizing the roles of choroidal expansion, the vitreous buffering system, and the CZLHV complex in the pathogenesis and progression of PACG, this article aims to provide new insights for precision management and future pathogenesis research in PACG.

Diagnosis and management of microsporidial keratitis

Sun Xuguang

2026, 35(1):  9-17.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.002

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In recent years, the number of cases of microsporidial keratitis reported abroad has been increasing and many domestic ophthalmic institutions have also reported and diagnosed such cases. Microsporidia is a unicellular, intracellular parasitic protozoa, which mainly infects the cornea through contact contamination. Because its clinical manifestations are similar to common superficial punctate keratitis or fungal keratitis, its diagnosis mainly depends on laboratory examination of etiology. At present, the treatment of microsporidia cornea mainly depends on the combination of antifungal drugs such as voriconazole and antibiotics such as gatifloxacin, and patients with severe corneal stromitis need timely surgical treatment. The etiology, pathological mechanism, rapid diagnosis and treatment of microsporidia keratitis need further study.

Clinical features and etiological analysis of microsporidial keratoconjunctivitis

Huang Jiahe, Zhang Yang, Han Bing, Fu Ming, Zhu Huimin, Zhang Tianyi, Wang Wenying, Zou Jingling, Deng Shijing, He Yan

2026, 35(1):  18-26.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.003

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Objective To abserve the clinical features, etiological findings of a case series of patients with microsporidial keratoconjunctivitis (MKC). Design Retrospective case series. Participants Thirty-four patients with MKC at Beijing Tongren Hospital, between September 2024 and August 2025. Methods All patients were diagnosed through clinical feature evaluation, etiological examinations, and molecular biological methods. Diagnostic procedures included corneal scraping cytology, metagenomic next-generation sequencing (mNGS), nested PCR, and in vivo confocal microscopy (IVCM). Treatment consisted of isolating infected animals, administering oral albendazole, and applying topical polyhexamethylene biguanide or voriconazole eye drops. Treatment outcomes and recurrence were assessed. Therapeutic efficacy was defined as the disappearance of patient symptoms and improvement of slit-lamp findings, including resolution of conjunctival hyperemia, negative fluorescein staining of the corneal epithelium, disappearance of raised lesions, and absorption of stromal infiltrates. Main Outcome Measures Clinical symptoms, ocular signs, in vivo confocal microscopy findings, corneal scraping cytology, pathogen culture and PCR detection results, metagenomic sequencing findings, disease recurrence rate, and cure rate. Results The 34 patients had a mean age of 33.6±16.6 years (range: 7~67 years), and 91.1% had a clear history of animal contact. Clinically, most presented with epithelial keratitis and conjunctivitis; four patients progressed to subepithelial or stromal keratitis. Etiological examinations revealed microsporidia structures in corneal scraping samples from 28 cases. Among the 34 patients, 33 were infected with Encephalitozoon hellem (EH) and 1 with Enterocytozoon bieneusi (EB). Using a comprehensive treatment strategy(animal isolation, oral albendazole, and topical ophthalmic medications), all patients achieved complete symptom resolution, persistent negative fluorescein staining, and remission of inflammatory signs, resulting in effective cure. However, 7 patients who had previously used corticosteroids or immunosuppressants, or had repeated animal exposure, experienced symptom or sign exacerbation after initial improvement, or persistent inflammatory findings. These cases showed recurrent or prolonged disease, with a recurrence/prolongation rate of 20.59%. Conclusion MKC may have specific sources and routes of transmission in mainland China, closely related to animal contact.

Application of different staining methods in corneal scraping cytology and metagenomic next-generation sequencing in diagnosis of ocular microsporidiosis

Zhang Yang, Liang Qingfeng, Wang Zhiqun, He Yan, Xu Yingnan, Qu Hongnan, Chen Kexin, Deng Shijing, Han Bing

2026, 35(1):  27-32.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.004

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Objective To explore the diagnostic value of different corneal scraping cytology staining methods and metagenomic next-generation sequencing (mNGS) for ocular microsporidiosis. Design Retrospective study. Participants Thirty-three patients (40 eyes) with ocular microsporidiosis admitted to Beijing Tongren Hospital. Methods Corneal scraping cytology was performed with four staining methods (Giemsa, fungal fluorescence, Gram, acid-fast staining). Combined with mNGS, the detection rates of each method and the pathogenic spectrum of mNGS were analyzed. Main Outcome Measures Detection rates of different staining methods and mNGS. Results The overall detection rate of scraping cytology was 90.9%. The detection rates of Giemsa, fungal fluorescence, Gram, and acid-fast staining were 81.8%, 63.6%, 24.2%, and 9.1%, respectively. The combined Giemsa and fungal fluorescence staining achieved the highest detection rate (90.9%). Pearson's chi-square test showed significant differences in positive rates among the four staining methods (χ2=33.056, df=3, P<0.001). The detection rate of mNGS was 93.9%, with 5 microsporidia species identified. Conclusion Both corneal scraping cytology and mNGS are effective for diagnosing ocular microsporidiosis. Combination of Giemsa and fungal fluorescence staining is recommended.

Effect of recombinant human growth hormone on eye development in dwarfism children with myopia

Li Tao, Tang Juan, Zhang Qinqin, Dai Chuanqiang

2026, 35(1):  40-47.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.007

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Objective To explore the effect of recombinant human growth hormone (rhGH) on eye development in children with myopia and dwarfism under the background of secondary sexual characteristics. Design Case-control study. Participants Sixty children (120 eyes) with dwarfism in the age stage of secondary sexual characteristics admitted to Ziyang Central Hospital from February 2021 to May 2024, while 60 children with normal development were set as the normal control group. Methods Sixty children (120 eyes) with dwarfism were randomly divided into treatment group and observed group. The treatment group received rhGH intervention for growth and development. The changes in height, growth hormone (GH), serum insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), and ocular biological indicators [including corneal curvature(CC), spherical equivalent (SE), astigmatism (AST), axial length (AL), anterior chamber depth (AD), vitreous thickness (VT)] were compared and analyzed before and after treatment for 1 and 2 years. Main Measure Outcomes Height, GH, IGF-1, IGFBP-3, and ocular biological indicators. Results Before treatment, the average height, IGF-1, GH, and IGFBP-3 of children in the dwarfism group were significantly lower than those in the normal control group (all P<0.05); Pearson correlation analysis and linear regression analysis showed that CC (r=0.681, 0.375; P=0.001, 0.003), SE (r=0.474, 0.427; P=0.007, 0.003), AST (r=0.392, 0.394; P=0.002, 0.001), AL (r=0.369, 0.369; P=0.003, 0.001), AD (r=0.385, 0.275; P=0.017, 0.001), and VT (r=0.175, 0.258; P=0.003, 0.021) were positively correlated with height in both the dwarfism group and the normal control group of children. After 1 and 2 years of treatment with rhGH, the height, IGF-1, GH, and IGFBP-3 of the treatment group significantly increased (all P<0.05). The increase in height after 2 years was (27.53±3.02) cm, which was significantly higher than that of the non treatment group (17.14±1.95 cm) (P=0.001). Compared with baseline, the CC, SE, AL, AD and VT of children in the treatment group, non treatment group, and normal control group increased at 1-year and 2-year follow-up, and the differences were statistically significant (all P<0.05). The SE increases in the treatment group, non treatment group, and normal control group at 1-year follow-up were (0.87±0.13) D, (0.33±0.07) D and (0.32±0.09) D, respectively, and at 2-year follow-up were (1.72±0.49) D, (0.54±0.12) D and (0.79±18) D, respectively. The annual increase in AL was (0.64±0.12) cm, (0.22±0.06) cm and (0.33±0.09) cm, respectively. The two-year increase in AL was (1.17±0.28) cm, (0.51±0.13) cm, and (0.56±0.15) cm, respectively (all P<0.05). In addition, at the 1-year and 2-year follow-up time points, compared with the non treatment group, the increase in CC, AST, AD, and VT in the treatment group was consistent with the trend of SE and AL changes, and the differences were statistically significant (all P<0.05). Conclusion rhGH therapy can accelerate the progression of myopia in dwarfism children under the background of secondary sexual characteristics. For such patients, close monitoring of ocular biological indicators is essential to prevent excessive axial length growth and to implement timely myopia prevention measures.

Observation on hemostatic effect of new-type precision temperature-controlled disposable electrocautery pen in pterygium surgery

Tang Jiayang, Li Shang, Wu Qianru, Jie Ying

2026, 35(1):  48-53.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.008

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Objective To explore the clinical application effect of the new-type precision temperature-controlled disposable electrocautery pen in hemostasis during pterygium surgery under local anesthesia. Design Case-control study. Participants A total of 400 patients with primary pterygium who underwent surgery at Beijing Tongren Hospital from February 2024 to April 2025. Methods The patients were randomly divided into the electrocoagulation group and the control group, with 200 cases in each group. The electrocoagulation group used a new type precision temperature-controlled disposable electrocoagulation pen for hemostasis, while the control group used an integrated spherical ophthalmic cautery for hemostasis. Intraoperative hemostasis time, operation time, presence of crusting after hemostasis, postoperative subjective symptoms, subconjunctival hemorrhage, and postoperative recurrence rate in the two groups were recorded, compared, and statistically analyzed. Main Outcome Measures Intraoperative hemostasis time, operation time, presence of crusting after hemostasis, postoperative subjective symptoms, subconjunctival hemorrhage, and postoperative recurrence rate. Results The mean hemostasis time in the electrocautery group (33.96±4.56 s) was significantly shorter than that in the control group (116.36±12.49 s) (t=-87.634, P<0.001). The total operative time in the electrocautery group (36.60±5.10 min) was also shorter than that in the control group (39.91±3.63 min) (t=-7.450, P<0.001). Regarding intraoperative eschar formation, the incidence in the electrocautery group (2.00%) was significantly lower than that in the control group (10.50%) (χ2=12.331, P<0.001). Both groups provided satisfactory surgical field clarity, with a clear visual field rate of 97.50% in the electrocautery group and 95.00% in the control group. On the first postoperative day, there were no statistically significant differences between the two groups in terms of subjective symptoms (pain, foreign body sensation, irritation, epiphora), subconjunctival hemorrhage, or the one-year postoperative recurrence rate (all P>0.05). Conclusion The novel precise temperature-controlled disposable electrocautery pen demonstrated reliable hemostatic efficacy in pterygium surgery, effectively reducing both hemostasis time and operative time while minimizing intraoperative eschar formation, without increasing postoperative complications.

Distribution characteristics of angle Alpha and angle Kappa and their association with ocular biometric parmeters

Liu Shuaishuai, Ren Qianwen, Ding Xiaochen, Liu Yong

2026, 35(1):  54-60.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.009

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Objective To observe and describe the distribution characteristics of angle Alpha and angle Kappa in adults with normal axial length, as well as their correlations with age and ocular biological parameters.Design Retrospective study. Participants A total of 9,272 cases (18,544 eyes), with an age range of 6~95 years (33.27±25.70 years), who underwent Lenstar 900 examination at Hefei Aier Eye Hospital from January 2018 to December 2022 were included. All participants had an axial length of 21~26 mm and no history of refractive surgery, contact lens wear, ocular trauma, or other ocular surgeries. Methods Participants were divided into 10 groups by age (≤10 group, >10~20 group, >20~30 group, >30~40 group, >40~50 group, >50~60 group, >60~70 group, >70~80 group, >80~90 group, >90 group). Each eye was measured consecutively 3 times using the Lenstar 900, and the average value was taken for analysis. The Lenstar 900 expresses the angle Kappa as the distance between the pupil center and the corneal vertex. The angle Alpha is represented by the distance between the corneal center and the corneal vertex. The Kolmogorov-Smirnov test was used to verify the data distribution; non-normally distributed data were expressed as median (P25, P75). The Wilcoxon signed-rank test was applied to compare differences in angle Alpha and angle Kappa between the left and right eyes, as well as between genders. Spearman correlation analysis was used to explore the relationships between angle Alpha/angle Kappa and ocular parameters. A linear mixed-effects model was used to control the correlation between the two eyes of the same subject, and nonlinear regression was used to fit the age-related change curves of angle Alpha and angle Kappa. Main Outcome Measures The distribution of angle Alpha and angle Kappa, and their correlations with age and ocular biological parameters. Results Both angle Alpha and angle Kappa showed a non-normal skewed distribution. For angle Alpha, 71.70% of eyes had a value <0.5 mm, and 93.97% had a value <0.8 mm. For angle Kappa, 94.86% of eyes had a value <0.5 mm, and 99.39% had a value <0.8 mm. Angle Alpha in both eyes was mostly distributed in the superotemporal quadrant, with the largest value in the superotemporal quadrant; angle Kappa in both eyes was mostly distributed in the inferotemporal quadrant with the largest value in the inferotemporal quadrant. The median angle Alpha was 0.42 (0.26, 0.53) mm for the right eye and 0.41 (0.26, 0.52) mm for the left eye (P=0.004); it was 0.41 (0.26, 0.53) mm in males and 0.40 (0.25, 0.52) mm in females (P=0.001). The median angle Kappa was 0.24 (0.14, 0.31) mm for the right eye and 0.23 (0.13, 0.30) mm for the left eye (P＜0.001); it was 0.23 (0.13, 0.30) mm in males and 0.24 (0.13, 0.31) mm in females (P=0.825). There was a moderate positive correlation between angle Alpha and angle Kappa (r=0.352, P<0.001). Neither angle Alpha nor angle Kappa showed a significant linear correlation with age; instead, they exhibited a non-linear relationship of first decreasing and then increasing. The regression equations were as follows: angle Alpha=0.5076-0.0101Age+0.0001Age2 and angle Kappa=0.2139-0.0014Age+0.00003Age2. The smallest values of both angles were observed in the 20~30 years age group. Additionally, angle Alpha and angle Kappa were positively correlated with lens thickness (r=0.166， P＜0.001； r=0.215， P＜0.001), negatively correlated with anterior chamber depth (r=-0.223， P＜0.001； r=-0.234， P＜0.001), axial length (r=-0.295， P＜0.001； r=-0.162， P＜0.001), and white-to-white distance (r=-0.079， P＜0.001； r=-0.119， P＜0.001), and showed no correlation with central corneal thickness and corneal curvature radius. Conclusion Alpha and Kappa angles are primarily distributed on the temporal side of the visual axis, both exhibiting a trend of initially decreasing and then increasing with age. Alpha and Kappa angles measured by Lenstar 900 both show non-normal distribution, Alpha angles are greater individual variation compared with Kappa angles. Alpha and Kappa angles exhibit significant correlations with the ocular structural parameters.

Safety and early biological response of plastic graft and xenogeneic sclera for posterior scleral reinforcement in New Zealand white rabbits

Huang Weilin, Wang Xuefei, Duan Anli

2026, 35(1):  61-66.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.010

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Objective To compare the safety and early biological responses between xenogeneic sclera and a titanium-silicone composite plastic scleral reinforcement graft in posterior scleral reinforcement (PSR) surgery in New Zealand white rabbits. Design Experimental study. Participants Twenty-four clean-grade healthy adult rabbits (weight: 2.0~3.5 kg). Methods The rabbits were randomly assigned to two groups with sex matching Group A received xenogeneic sclera, and Group B received a moldable plastic graft; all underwent PSR in the right eye. External ocular inflammation was assessed using a modified Efron grading scale, intraocular pressure (IOP) and tear secretion (Schirmer’s test) were measured at postoperative day 3, week 4 and 12. Flash electroretinography (ERG) and graft-sclera integration were evaluated at week 12. Main Outcome Measures Total ocular inflammation score, IOP, Schirmer test results, ERG a- and b-wave amplitudes, and graft integration status. Results On day 3, Group A showed significantly higher inflammation scores than Group B [median (IQR): 9.0 (9.0-10.0) vs. 4.0 (4.0-5.0), P=0.002], with greater reduction in schirmer test [（-7.83±1.11）mm vs. （-5.25±0.89）mm at day 3; （-5.25±0.87）mm vs. （-3.13±0.83）mm at week 4 ] (all P<0.05). At week 4 and 12, inflammation resolved in both groups, and tear production returned to baseline (all P>0.05). No significant differences were observed in IOP at any time point or ERG a-/b-wave at week 12 amplitudes between groups (all P>0.05). At week 12, grafts in Group A exhibited blurred margins and tight fusion with the host sclera, whereas those in Group B remained clearly demarcated and slightly mobile; both were encapsulated by dense fibrous tissue. Conclusion The plastic reinforcement graft demonstrated comparable safety to xenogeneic sclera. It induced milder early inflammation due to minimally invasive surgery, while xenogeneic sclera promoted better biological integration, potentially offering superior posterior pole perfusion benefits. The two materials are complementary, and selection should be individualized based on therapeutic goals.

Insights for the training mode of cataract microsurgery in Xizang（Tibet） Autonomous Region through the "Group-based" Medical Aid Program

Cen Yujie, Han Liang, Ciren Qiongda, Fan Xiang

2026, 35(1):  70-75.  doi:10.13281/j.cnki.issn.1004-4469.2026.01.012

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Objective To explore training patterns for cataract microsurgery in Xizang（Tibet） through the Group-based Medical Aid Program, aiming to enhance the microsurgical skills of ophthalmologists in the Xizang Autonomous Region（XAR）. Design Survey research. Participants 51 ophthalmologists working in Xizang and 5 aid experts. Methods All subjects underwent interviews, and questionnaires were distributed to ophthalmologists in XAR. Participants were grouped based on their ability to independently perform cataract microsurgery, with comparative analysis of training pathways between groups. Main Outcome Measures Learning pathways for cataract microsurgery among XAR ophthalmologists; characteristics of cataract microsurgery in XAR and differences from mainland practices; current status and challenges in cataract microsurgery training in XAR. Results The primary training model for cataract microsurgery in XAR is the traditional “master-apprentice” approach, supplemented by Xizang doctors undergoing training in mainland China and medical experts from other regions providing on-site instruction in XAR. The average learning period for Xizang doctors to independently perform cataract microsurgery was (3.4±0.4) years. Training in mainland China significantly improved surgical skills among Xizang ophthalmologists, the proportion of surgeons in the group capable of performing independent surgeries who underwent training in mainland China (51.9%) was significantly higher than that in the group not yet capable of performing independent surgeries (25.0%) (P=0.05). 63.0% of Xizang ophthalmologists reported feeling most confident in performing small-incision extracapsular cataract extraction, while mastery of phacoemulsification techniques lagged. Conclusion The current cataract microsurgery training model in Tibet is limited and inefficient, requiring urgent improvement.