Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has been increasingly implicated in selected ocular diseases, although its causal relevance varies across disease entities. The retina and retinal pigment epithelium are biologically susceptible to ferroptosis-related injury because of their high oxygen demand, abundant polyunsaturated lipids, mitochondrial activity, light exposure, and tightly regulated iron handling. This review summarizes core mechanisms of ocular ferroptosis, including iron uptake and export, glutathione–glutathione peroxidase 4 (GPX4)-dependent antioxidant defense, lipid peroxidation, mitochondrial dysfunction, neuroinflammation, and blood–retina barrier disruption. We discuss evidence from major degenerative, vascular, ischemic, hereditary, infectious, and immune-mediated retinal diseases, with particular attention to glaucoma, age-related macular degeneration, diabetic retinopathy, ocular toxoplasmosis, uveitis, retinal vasculitis, and inflammatory chorioretinopathy. We also evaluate ferroptosis-targeted therapeutic strategies, proposed operational criteria for defining ferroptosis in retinal disease, and candidate structural, functional, biochemical, and imaging endpoints for future translational studies. Current evidence supports ferroptosis as a context-dependent contributor to retinal injury rather than a uniform pathogenic mechanism. Future studies should integrate cell-type-resolved biomarkers, lipidomic and imaging readouts, functional rescue experiments, and clinically meaningful visual outcomes to clarify when ferroptosis modulation may support vision preservation.
AIM: To investigate the modulator action of resveratrol (RSV) through the suppression of transient receptor potential ankyrin 1 (TRPA1) on the hypoxia (HPO)-caused oxidative degeneration and apoptosis in human retinal pigment epithelial cells (ARPE19). METHODS: The control (CNT), RSV (50 µmol/L for 24h), HPO (200 µmol/L CoCl2 for 24h), and HPO+RSV groups were induced in the ARPE19. Apoptosis, caspases (caspases 3, 8, and 9), oxidants [lipid peroxidation, oxygen free radical (OFR), and dysfunction of mitochondrial membrane], antioxidants (glutathione and glutathione peroxidase), Ca2+, Zn2+ levels, live cell number and percentage were all measured in the cells of four groups. RESULTS: The HPO increased Ca2+ and Zn2+ fluorescence intensity in the cells. It also upregulated the apoptosis, caspases, and oxidant indicators while downregulating the antioxidants, and the count of live cells. TRPA1 agonist (cinnamonaldehyde) further upregulated these indicators (all P<0.05). When the HPO-induced increase in TRPA1 activation was treated with RSV and the TRPA1 antagonist (AP18), cell viability and antioxidants rose while the oxidant and apoptotic indicators decreased due to TRPA1 suppression (P<0.05). CONCLUSION: HPO exposure through TRPA1-mediated Ca2+ signaling, induces mitochondrial oxidative cell cytotoxicity and death, which may offer a treatment option for HPO-induced retinal disorders linked to increased OFR and Ca2+ influx.
AIM: To explore the feasibility of optical coherence tomography angiography (OCTA) in the early detection of syphilis and syphilitic chorioretinopathy. METHODS: Patients with newly diagnosed syphilis were enrolled from September 2022 to November 2023. All the participants underwent serological examinations including rapid plasma reagin (RPR) test and treponema pallidum particle agglutination (TPPA) test, as well as macular OCTA scanning. Quantitative indicators including macular vessel flow density (VFD), vessel length density (VLD), and foveal avascular zone (FAZ) were measured and analyzed. RESULTS: A total of 44 participants were recruited in this study, including 24 patients in the syphilis group (14 males, mean age: 30.83±9.59y) and 20 healthy individuals in the control group (6 males, mean age: 29.6±11.86y). Compared with the control group, the syphilis group presented significantly higher macular VLD and VFD (P<0.05), as well as an increased FAZ perimeter. Subgroup analysis was performed based on RPR titers, with patients divided into the low-titer subgroup (1:2–1:4) and high-titer subgroup (1:8–1:128). Both subgroups showed elevated VLD and VFD (excluding inner VFD) relative to controls (all P<0.05). Moreover, significant elevation of VFD was only observed in the high-titer subgroup. Receiver operating characteristic analysis identified outer VLD as the optimal indicator for distinguishing syphilis patients from controls, with an area under the curve of 0.802 (95%CI: 0.667–0.937). CONCLUSION: Syphilis patients with either low or high RPR titers show increased macular VLD and VFD in the absence of obvious visual impairment, indicating the potential of OCTA microvascular parameters for early auxiliary diagnosis of syphilitic ocular lesions.
AIM:To investigate whether excessive glucocorticoid (GC) exposure disrupts retinal pigment epithelial (RPE) homeostasis through glucocorticoid receptor (GR)-dependent autophagy hyperactivation. METHODS:Human retinal pigment epithelial cell line (ARPE-19 cells) were exposed to GC (0-100 µmol/L, 48h). GR subcellular localization was analyzed via mitochondrial fractionation and immunofluorescence. Functional assessments included barrier integrity [zonula occludens-1 (ZO-1) immunostaining], phagocytic capacity (FluoSpheres™-labeled photoreceptor outer segment uptake), and ultrastructural analysis (transmission electron microscopy, TEM). Autophagic flux was quantified using mCherry-green fluorescent protein-microtubule-associated protein 1A/1B-light chain 3 (LC3) B reporters. Molecular mechanisms were probed through AMP-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) pathway activity and autophagic flux assessed by LC3-II levels. GR dependency was confirmed using the antagonist RU486, and cell-type specificity was assessed using mouse photoreceptor (661W) cells. RESULTS:GC induced GR upregulation and mitochondrial translocation in a dose- and time-dependent manner, correlating with pathological autophagy activation. Key findings included: 1) tight junction disruption, evidenced by ZO-1 fragmentation, 2) reduction in phagocytic uptake efficiency, 3) mitochondrial shrinkage and autolysosome accumulation (TEM), 4) altered AMPK/mTOR signaling (p-AMPK up, p-mTOR down) associated with autophagosome formation, 5) elevated LC3-II levels confirming excessive autophagic flux. Critically, all GC-induced effects, including GR upregulation, signaling changes, and increased autophagy, were abolished by GR antagonism with RU486. CONCLUSION:This study shows that GR-dependent GC exposure induces autophagic flux with ultrastructural evidence suggestive of mitochondria-targeted autophagy and alters AMPK/mTOR signaling, correlating with RPE barrier collapse and phagocytic failure, a possible link to steroid-associated central serous chorioretinopathy (CSC).
AIM: To evaluate the relationship between retinal nerve fibre layer (RNFL) thickness, suprasellar extension (SSE), tumour volume (TV) and visual outcome after pituitary adenoma surgery. METHODS: A prospective observational study was conducted in a tertiary teaching hospital which included patients with pituitary macroadenoma who required surgical resection between December 2015 to February 2020. Agreeable subjects underwent complete ocular examination, Humphrey visual field (HVF) and RNFL measurement using spectral domain optical coherence tomography preoperatively and 3-month postoperatively. Post-operative visual outcome was evaluated using both best-corrected visual acuity (BCVA, logMAR) and HVF mean deviation (MD). TV was estimated by multiplying the transverse, anteroposterior, and craniocaudal maximum diameter; and SSE by measuring tumour extension beyond the supraclinoid internal carotid artery from magnetic resonance imaging. RESULTS: Thirty-eight patients (18 males) were recruited. The mean age was 47.6±14.8y. The median and interquartile range (IQR) was 10.78 (6.45–16.94) cm3 and 14.05 (4.99–22.90) mm for TV and SSE, respectively. While postoperative RNFL significantly reduced in all sectors, significant improvement was seen in median BCVA in logMAR (from 0.301 to 0.176, P<0.001) and MD of HVF (from -10.04 to -3.91, P<0.001). Pre-operative global RNFL was significantly correlated with post-operative logMAR (r=-0.303, P=0.015) and MD (r=0.510, P<0.001). Only SSE showed significant negative correlations with all RNFL sectors. Each 10 µm thicker pre-operative global RNFL was associated with 0.13 lower (better) postoperative logMAR (β=-0.013, P<0.001) and 0.83 dB higher (better) MD (β=0.083, P=0.008). Patients with normal RNFL had better post-operative MD [median (IQR)=-2.35 (-1.45, -5.94)] than with thinned RNFL [median (IQR)=-6.63 (-2.80, -8.77), P=0.009]. CONCLUSION: SSE shows stronger association with RNFL thinning than TV, and thicker pre-operative RNFL predicted better post-operative visual outcomes.
Glaucoma is a leading cause of irreversible blindness globally, with its incidence continuing to rise. Anxiety and depression are highly prevalent psychological comorbidities among patients with glaucoma. This narrative review summarizes the latest domestic and international research regarding anxiety and depression in glaucoma populations, focusing on their epidemiology, risk factors, bidirectional interactions with glaucoma, and relevant intervention strategies. This review aims to provide theoretical evidence for optimizing clinical psychosomatic comprehensive management regimens, so as to improve therapeutic outcomes and quality of life in glaucoma patients.
AIM: To propose a novel Bian-stone and moxibustion (BSM) therapy for meibomian gland dysfunction (MGD) treatment, and to evaluate its clinical efficacy and safety based on objective ocular surface parameters. METHODS: A total of 140 patients with MGD were enrolled in this randomized controlled study and equally allocated (1:1 ratio) into the BSM group and the intense pulsed light (IPL) group. Patients in the BSM group received 30-minute BSM treatment every other day. Subjects in the IPL group completed four independent treatment sessions. The evaluated outcomes included the Ocular Surface Disease Index (OSDI), eyelid margin morphology, meibomian gland (MG) morphology and function, tear film breakup time (TBUT), ocular surface staining (OSS) score, Schirmer's test (ST), and tear meniscus height (TMH). All assessments were performed at baseline, as well as at 1- and 3-month follow-ups after treatment. RESULTS: The BSM group consisted of 24 males and 47 females with a mean age of 59.04±16.50y, while the IPL group included 27 males and 42 females with a mean age of 60.39±15.90y. No significant differences in age, sex distribution, and clinical history were observed between the two groups. At 1 and 3mo post-treatment, the BSM group exhibited significant improvements in OSDI scores, eyelid margin hyperemia and neovascularization, MG expression, secretion status and gland loss, conjunctival hyperemia, and TBUT. Notably, the BSM group achieved superior improvements in OSDI scores and eyelid neovascularization compared with the IPL group at the 3-month follow-up. Additionally, significant reductions in eyelid margin edema and irregularity were only observed in the BSM group at 3mo after intervention. CONCLUSION: BSM therapy can effectively relieve clinical symptoms and restore tear film homeostasis in patients with MGD, serving as a promising and viable therapeutic approach for MGD management.
Artificial intelligence (AI) has shown remarkable accuracy in the diagnosis of common ocular diseases such as diabetic retinopathy (DR), glaucoma, retinopathy of prematurity (ROP), and age-related macular degeneration (AMD), often matching or even outperforming expert clinicians. Despite these advancements, AI adoption in clinical settings remains limited due to key barriers. This systematic review evaluates 34 studies (2018–2025) highlighting AI's diagnostic performance (often >90% accuracy) while pointing out significant gaps in real-world deployment. We identify these persistent challenges through comprehensive analysis of current literature and propose actionable pathways to bridge the “last-mile gap” between research and clinical practice. This review pointed out three significant gaps in real-world deployment. These include 1) disjointed integration into clinical workflows, 2) lack of transparency in AI decision-making, and 3) poor generalizability across diverse populations. Our findings provide a framework for advancing AI implementation in ocular diagnostics to achieve equitable, scalable, and trustworthy solutions for global vision care.
AIM: To evaluate the predictive value of urinary albumin creatinine ratio (UACR), albumin excretion rate (AER), and estimated glomerular filtration rate (eGFR) for vision-threatening diabetic retinopathy (VTDR) in individuals with diabetes. METHODS: A comprehensive literature search across PubMed, Embase, Web of Science, Scopus, and the Cochrane Library from their inception to February 2024 were performed. The diagnostic accuracy of microalbuminuria (MA; including UACR and AER) and eGFR in predicting VTDR using sensitivity, specificity, positive likelihood ratio and negative likelihood ratio, diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (ROC) curve were assessed. Analyses incorporated both bivariate generalized linear mixed models and random-effects models to ensure a robust and unbiased interpretation of the data. RESULTS: The review included 14 studies with a total of 87 223 patients. The pooled sensitivity and specificity of MA and eGFR for predicting VTDR were 0.77 [95% confidence interval (CI), 0.57–0.89] and 0.51 (95%CI, 0.31–0.72), respectively. The DOR was 3.47 (95%CI, 1.94–6.18), with the area under the summary ROC curve at 0.70 (95%CI, 0.66–0.74). Notably, UACR as a predictor showed a sensitivity of 0.88 (95%CI, 0.43–0.99) and specificity of 0.55 (95%CI, 0.22–0.84), with an area under the curve of 0.78 (95%CI, 0.74–0.82). Despite significant heterogeneity among the studies (P<0.01), no publication bias was detected. CONCLUSION: UACR is a highly sensitive but moderately specific indicator for early detection and management strategies in this high-risk population.
AIM: To investigate the key role of the mitochondrial outer membrane protein FUN14 domain-containing 2 (FUNDC2) in retinal pigment epithelium (RPE) ferroptosis during retinitis pigmentosa (RP) progression. METHODS: Unbiased label-free proteomics was employed to identify differentially expressed proteins in the RPE of a sodium iodate (SI)-induced rat model. In vitro experiments were conducted using human retinal pigment epithelial (ARPE)-19 cells. The effects of SI treatment and FUNDC2 knockdown on cell viability and the expression of ferroptosis-protective molecules, including glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), ferritin heavy chain 1 (FTH1), and solute carrier family 25 member 11 (SLC25A11) were evaluated. RESULTS: Proteomic analysis revealed that FUNDC2 was significantly upregulated in the RPE of SI-induced rats. In ARPE-19 cells, SI treatment significantly increased FUNDC2 expression while decreasing the levels of ferroptosis-protective molecules. Functional experiments demonstrated that knocking down FUNDC2 effectively rescued SI-induced loss of cell viability and restored GPX4 expression. CONCLUSION: These findings provide the first evidence that FUNDC2 acts as a potential upstream regulator of RPE ferroptosis in RP, at least partially by negatively regulating GPX4. Consequently, FUNDC2 is a potential therapeutic target for the future treatment of RP.
AIM: To evaluate changes in visual acuity and accommodation function following femtosecond laser-assisted in situ keratomileusis (FS-LASIK) combined with monovision in patients aged over 40y. METHODS: This prospective, non-randomized cohort study included patients who were divided into an FS-LASIK binocular group (full correction) and an FS-LASIK monovision group. The binocular group consisted of Group 1 (15 patients) with simple myopia and Group 2 (12 patients) with myopia and presbyopia. The monovision group (Group 3) included 13 patients with myopia and presbyopia. Parameters assessed included the uncorrected distance visual acuity (UCVA), the uncorrected near visual acuity (UNVA), contrast sensitivity (CS), binocular cross-cylinder (BCC), accommodative amplitude (AMP), positive relative accommodation (PRA), negative relative accommodation (NRA), and accommodative facility (AF). Patient satisfaction was evaluated at 3mo postoperatively. RESULTS: A total of 40 patients (80 eyes) were enrolled (mean age 43.63±3.666y; 12 males). At 3mo after FS-LASIK, UCVA improved significantly in all patients (P<0.001), while UNVA remained comparable to preoperative levels (P>0.05). BCC in Group 3 decreased by 0.30±0.43 compared to preoperative levels, showing a statistically significant difference (P=0.037). The AMP in Group 3 showed an increasing trend with greater improvement in the nondominant eye than in the dominant eye (P>0.05). Patient satisfaction was high in all groups. CONCLUSION: FS-LASIK combined with monovision is an effective treatment for patients aged over 40y with myopia and presbyopia, which not only improves visual acuity but also achieves high patient satisfaction and improves postoperative BCC.
AIM: To investigate the protective effects of deferoxamine (DFO) on high glucose (HG)-induced ferroptosis and inflammatory responses in retinal Müller glial cells (MGCs) and offer potential therapeutic targets for early intervention in diabetic retinopathy (DR). METHODS: Primary MGCs were cultured from C57BL/6J mouse retinas and exposed to normal glucose (NG, 5 mmol/L) or HG (25 mmol/L) conditions for various durations. Ferroptosis-related markers, including intracellular Fe2+ levels, glutathione (GSH), reactive oxygen species (ROS), malondialdehyde (MDA), and key proteins glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), ferritin heavy chain 1 (FTH1), were examined using multiple assays such as immunoblotting, enzyme-linked immunosorbent assay (ELISA), immunofluorescence (IF), and fluorometric detection. The role of DFO was evaluated through cell viability assessment and analysis of inflammatory cytokines interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α). RESULTS: HG exposure significantly increased intracellular Fe2+ content, decreased GSH levels, elevated ROS and MDA concentrations, and altered expression profiles of ferroptosis regulators GPX4 and SLC7A11. Immunoblot and IF analyses confirmed downregulation of GPX4 and SLC7A11 alongside accumulation of FTH1 under prolonged HG treatment. DFO administration markedly attenuated these ferroptotic changes while reducing inflammatory cytokine secretion, demonstrating its protective effect against HG-induced damage in MGCs by modulating the nuclear factor erythroid 2-related factor 2 (Nrf2)/thioredoxin reductase 1 (TXNRD1) pathway. CONCLUSION: Low-dose DFO effectively mitigates HG-induced ferroptosis and inflammatory responses in MGCs through the Nrf2/TXNRD1 signaling axis, providing a theoretical framework for developing novel therapeutic strategies in DR management.
AIM: To describe a modified technique using multiple-layer amniotic membrane (AM) to manage corneal perforations in graft-versus-host disease (GVHD). METHODS: This case series included three eyes from 3 patients with GVHD and corneal perforation who underwent AM transplantation between 2019 and 2020. AM was collected from human placenta shortly after the cesarean section. During surgery, the AM was folded and sutured into the wound to create an “AM pocket” into which small AM debris was placed. The pocket was then closed using a 10-0 nylon suture and covered with an AM seal. After re-epithelization and AM scarring, sutures were removed. RESULTS: All 3 patients achieved successful wound closure with a single surgery, and corneal thickness remained >300 μm at the 6-month follow-up. Visual acuity improved in patients with peripheral perforation. CONCLUSION: The “Pocket” AM transplantation technique is an effective option and recommend for treating acute corneal perforations in patients with GVHD. Our modified AM transplantation method provided definitive wound closure and successfully repaired wounds of various sizes without recurrent corneal melting or perforations.
AIM: To compare the fluctuating characteristics, mean value and peak value of intraocular pressure (IOP) between medically and surgically controlled eyes in patients with primary open angle glaucoma (POAG) based on a 12-hour daytime diurnal curve (12-DDC) and water drinking test (WDT). Additionally, this study evaluated the consistency of 12-DDC outcomes measured on two separate days. METHODS: This was a cross-sectional observational study. Eligible POAG patients with unilateral medically and contralateral surgically controlled IOP via functional augmented trabeculectomy bleb were enrolled. Diurnal IOP was detected every 3h from 8:00 a.m. to 8:00 p.m. over two consecutive days to establish the 12-DDC. The WDT was performed subsequent to the completion of diurnal IOP measurement. RESULTS: A total of 21 POAG patients were included, with a mean age of 65.5±7.3y, predominantly male (n=17, 81.0%), and of Malay ethnicity (n=13, 61.9%). The medically controlled eyes exhibited significantly greater diurnal IOP fluctuation (4.6±1.7 mm Hg) compared with surgically controlled eyes (3.0±1.5 mm Hg, P=0.005). Similarly, the peak IOP derived from WDT was significantly higher in medically controlled eyes (19.6±4.1 mm Hg) than in surgical counterparts (11.2±3.4 mm Hg, P<0.001). A strong and significant positive correlation was identified between peak IOP values of 12-DDC and WDT. For surgically controlled eyes, 12-DDC measurements obtained on two different days showed excellent consistency at all corresponding time points, with Kappa values ranging from 0.88 to 0.95. CONCLUSION: Under the condition of consistent physiological background affecting IOP circadian variation in the same individual, surgically controlled eyes demonstrate a superior IOP profile with lower fluctuation and peak IOP compared with medically controlled eyes in POAG patients.
AIM: To evaluate the efficacy and safety of micropulse transscleral laser therapy (MP-TLT) in lowering intraocular pressure (IOP) in eyes with primary glaucoma at different stages. METHODS: In this retrospective longitudinal cohort study, data were collected from the charts of patients who undergo MP-TLT. Information regarding medication burden (including oral carbonic anhydrase inhibitor use), IOP, and visual acuity, were gathered prior to the procedure and at day 1, week 1 and at 1, 3, 6, 12, 18, and 24mo follow-up. Glaucoma severity staging was performed according to the Hodapp-Parrish-Anderson classification system based on visual field parameters assessed with standardized automated perimetry. Early glaucoma was defined as mean deviation (MD) better than -6 dB, moderate glaucoma as MD between -6 and -12 dB, and advanced glaucoma as MD worse than -12 dB. RESULTS: Totally 84 eyes of 53 patients (22 females), with a mean age of 67.14±11.39y affected by progressive primary open angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) were included. Before treatment, mean best corrected visual acuity was 0.26±0.36 logMAR, mean IOP was 22.32±6.64 mm Hg and patients took a mean of 2.96±0.75 topical IOP lowering molecules; moreover, 18 patients also required acetazolamide tablets. At 1mo follow-up, a significant (P<0.001) reduction of mean IOP was detected both in POAG (-7.16±2.92 mm Hg) and PACG (-6.89±3.12 mm Hg) eyes, remaining stable during the further follow-up. A significant (P<0.01) reduction in the number of drugs taken was observed at 3-month follow-up both in POAG (-0.59±0.32) and PACG (-1.06±0.73) eyes. These effects persisted over time during the further follow-up. Furthermore, marked decreases in IOP and IOP-lowering drugs were seen in patients with early, moderate, and advanced glaucoma, and these results closely matched the findings from the entire study cohort. CONCLUSION: The results obtained suggest that MP-TLT may be an effective and safe option for managing patients with POAG and PACG at every stage of the disease.
AIM: To systematically characterize the clinical features, correlations, and therapeutic implications of participants with moyamoya disease (MMD)-related retinal artery occlusion (RAO) through a case series and pooled descriptive analysis. METHODS: A total of 9 participants with MMD-RAO (2020–2025) and 9 cases retrieved from published literature (1981–2025) were retrospectively reviewed to descriptively explore the association between MMD and RAO. Mean difference (MD) was adopted as the effect size for continuous variables, while odds ratio (OR) was used for categorical variables. Heterogeneity was evaluated using the Q statistic and I2 index. Publication bias was assessed via funnel plots, and sensitivity analysis was performed using the leave-one-out method. RESULTS: Eighteen participants were enrolled in the final analysis, with a male predominance (male:female=1.25:1). Limited improvement in best-corrected visual acuity (BCVA) was observed after treatment (logMAR range: 0.22–3.0). Central retinal artery occlusion (CRAO) was the predominant subtype (83.3%), followed by branch retinal artery occlusion (BRAO, 11.1%) and cilioretinal artery occlusion (CLRAO, 5.6%). Participants in our institutional cohort were significantly older than those reported in literature (52.89±9.53 vs 25.56±12.58y, P<0.001). Our cohort presented slightly worse initial BCVA (2.04±0.9 vs 1.90±0.68; MD=0.14, 95%CI: -0.60–0.88, P=0.711, I2=78.3%) and inferior visual recovery (1.99±0.9 vs 1.22±1.14; MD=0.77, 95%CI: -0.19–1.73, P=0.132, I2=82.5%), whereas complete visual recovery (logMAR=0.1) was documented in one BRAO case from published reports. The efficacy of intra-arterial thrombolysis (IAT) reached 60% (3/5) in our cohort, and the overall rate of visual improvement was 41.2%. Mild publication bias was detected; however, sensitivity analysis verified the robustness of primary results. CONCLUSION: Participants with MMD-related RAO exhibit unique clinical characteristics differing from those with isolated RAO or uncomplicated MMD. This study identifies an “older MMD phenotype” complicated by RAO, and highlights the necessity of comprehensive vascular screening in elderly participants presenting with RAO to facilitate timely combined ophthalmological and neurological intervention.
AIM:To evaluate three-month visual and refractive outcomes after small incision lenticule extraction (SMILE) Pro with the VISUMAX 800 femtosecond laser for myopic astigmatism correction and to compare results with previously reported VISUMAX 800 and VisuMax 500 outcomes. METHODS:Retrospective, observational clinical study. Records of 64 patients (128 eyes) who underwent SMILE Pro using the VISUMAX 800 laser (Carl Zeiss Meditec AG, Jena, Germany) between June and November 2024 were reviewed. Preoperative and 3-month postoperative data were analyzed in eyes with corrected distance visual acuity (CDVA) of 1.0 or better, including spherical equivalent (SE), refractive astigmatism, and vector analysis. Patients were classified into low (≤1.50 D) and high (>1.50 D) astigmatism subgroups. RESULTS:The mean age of 64 patients (128 eyes) was 26.10±4.25y (19-36y). Attempted and achieved SE were strongly correlated (r=0.97, P<0.001). At 3mo, 36.7% and 87.5% of eyes were within ±0.50 and ±1.00 D of target refraction, respectively. Mean residual astigmatism was -0.56±0.27 D, lower in the low-astigmatism group (-0.39±0.23 D) than in the high group (-0.72±0.21 D; P<0.001). The mean absolute astigmatic angle of error was 4.47°±4.68°, with 97.6% ≤15°. No intraoperative or postoperative complications occurred. CONCLUSION:SMILE Pro using the VISUMAX 800 femtosecond laser provides safe and predictable correction of myopic astigmatism with good axis alignment. However, the observed undercorrection in higher cylinders suggests that further optimization of astigmatic nomograms may improve refractive accuracy.
AIM:To compare the educational benefits of three-dimensional (3D) surgical videos compared with two-dimensional (2D) surgical videos as a training tool for trainees in pediatric persistent fetal vasculature (PFV). METHODS:Trainees were stratified into three tiers by retinal surgery exposure and independent operating experience: Level 1 (≤5y, no independent cases), Level 2 (5-10y, ≤5 independent years), Level 3 (>10y, >5 independent years). Trainees viewed 3D and 2D surgical videos of pediatric PFV in a randomized order and immediately completed a questionnaire to provide educational assessments. RESULTS:Twelve trainees viewed 9 paired 3D and 2D surgical videos from 9 pediatric PFV patients (9 3D videos and 9 2D videos), resulting in 216 completed questionnaires. For pediatric PFV cases, trainees demonstrated a higher accuracy rate when watching 3D surgical videos compared to 2D surgical videos in discerning the depth of the anterior chamber (85.2% vs 70.4%, χ²=6.857, P=0.009), the location of lens opacity (86.1% vs 69.4%, χ²=8.679, P=0.003), and vitreous strips (89.8% vs 78.7%, χ²=5.027, P=0.025). Trainees believed that, compared to 2D surgical videos, 3D surgical videos significantly improved their ability to discriminate shallow anterior chambers (5.70±1.58 vs 3.92±1.14, P<0.001), the location of lens opacity (6.80±1.60 vs 4.36±1.35, P<0.001), vitreous strips (9.06±2.02 vs 7.16±2.42, P<0.001), complicated tractional retinal detachment (9.31±2.13 vs 7.99±2.63, P<0.001), and macular involvement (8.47±2.62 vs 6.91±2.84, P<0.001) in pediatric PFV cases. Trainees found 3D surgical videos to be significantly more satisfactory than 2D surgical videos in terms of image magnification (8.90±1.61 vs 7.17±1.65, P<0.001), clarity (9.21±2.11 vs 7.42±2.27, P<0.001), and depth of field (8.31±2.38 vs 6.78±2.79, P<0.001). Trainees regarded 3D surgical videos as significantly more suitable for ophthalmic surgical teaching (9.23±0.83 vs 5.75±0.93, P<0.001) and implementation (8.83±2.69 vs 6.15±2.83, P<0.001) compared to 2D surgical videos. CONCLUSION:3D-display surgical videos offer superior educational benefits for trainees earning pediatric PFV vitrectomy surgery compared to 2D videos.
