Abstract Background This study aimed to observe the safety and effectiveness of combined phacoemulsification and goniosynechialysis (PEI-GSL) in patients with primary angle-closure glaucoma (PACG) and coexisting cataracts. Methods This multicenter prospective study enrolled 289 consecutive patients with PACG and cataracts who were treated using PEI-GSL between November 1, 2022 and March 12, 2024. All patients underwent comprehensive ocular evaluations at baseline, at 1 week, and at 1, 3, 6, and 12 months postoperatively. Complete success was defined as achieving an intraocular pressure (IOP) of 6–18 mmHg without antiglaucoma medications or reoperation. Qualified success was similarly defined but allowed antiglaucoma medications. Results Among patients with PACG, 237 (82.0%) of 289 completed a 12-month follow-up. The baseline IOP decreased from 22.9 ± 10.2 to 14.0 ± 3.1 mmHg at 12 months, and the number of antiglaucoma medications declined from 2.08 ± 1.23 to 0.14 ± 0.52. The complete and qualified success rates were 80.6% and 88.3%, respectively. Postoperative complications occurred in 49 (17.0%) patients; while 3 (1.0%) patients underwent yttrium-aluminum-garnet (YAG) laser capsulotomy and 6 (2.1%) required glaucoma surgery. Multivariate Cox regression analysis revealed that the anterior chamber depth ( P = 0.044) and axial length ( P = 0.050) were positively associated with qualified success. The complete and qualified success rates among patients with advanced PACG were 78.2% and 87.9%, respectively. Conclusion We demonstrated that PEI-GSL is an effective and safe treatment for patients with PACG and coexisting cataracts, even in advanced stages.
To compare the axial length (AL) elongation between orthokeratology (OK) and highly aspherical lenslets (HAL) in children with myopia. This retrospective study included children with spherical equivalent refraction (SER) ranging from − 0.50 to − 9.00 D who were treated with OK lenses or HAL spectacles. Propensity score matching (PSM) was performed to balance baseline characteristics, including age, SER, sex, and baseline AL. The primary outcome was the 12-month AL elongation. Subgroup analyses were conducted according to age (8–9, 10–11, and 12–14 years) and refractive error categories (mild: − 0.50 to − 3.00 D; moderate: − 3.00 to − 5.00 D; high: − 5.00 to − 9.00 D). After PSM, 3,122 matched pairs (n = 6,244) with balanced baseline characteristics were included. Overall, OK group had greater AL elongation over 12 months than the HAL group (0.20 ± 0.18 mm vs. 0.15 ± 0.17 mm; P < 0.001). In age-stratified analyses, the OK group demonstrated greater AL elongation than the HAL group among younger children, including those aged 8–9 years (0.26 ± 0.18 mm vs. 0.19 ± 0.18 mm; P < 0.001) and 10–11 years (0.17 ± 0.17 mm vs. 0.12 ± 0.17 mm; P < 0.001). By contrast, no significant between-group difference was observed in children aged 12–14 years (P = 0.305). SER-stratified analyses revealed a refractive-error-dependent pattern. In children with mild myopia (− 0.50 to − 3.00 D), the OK group demonstrated greater AL elongation than the HAL group (P < 0.001). By contrast, among children with high myopia (− 5.00 to − 9.00 D), the OK group had lower AL elongation than the HAL group (P < 0.001), while no significant difference was observed for moderate myopia (P = 0.950). Subgroup analyses were performed using a propensity score-matched cohort. HAL were associated with less AL elongation in younger children and those with mild myopia, whereas OK lenses were associated with less AL elongation in children with high myopia. No significant differences between treatment modalities were observed in children with moderate myopia or in older children.
BACKGROUND:Age-related macular degeneration (AMD) is a leading cause of visual impairment; however, robust drug targets for primary prevention remain elusive. This study aimed to identify candidate genetic loci and putative genetically supported proteins for AMD through integrative genomics and proteomics. METHODS:A genome-wide association study (GWAS) meta-analysis (28,543 cases and 1,072,092 controls) was performed to identify risk loci, followed by proteome-wide Mendelian randomization (MR), colocalization, and multi-omics summary-data-based MR with heterogeneity in dependent instruments (SMR-HEIDI) analyses to infer genetically supported proteins. Functional characterization included gene enrichment, single-cell RNA sequencing, mediation across 731 immunophenotypes, and a mouse knockout assessment. Druggability was evaluated using the Drug-Gene Interaction Database. RESULTS:The GWAS meta-analysis identified 10 candidate genetic loci for AMD (including three previously reported and seven newly identified loci). Proteome-wide MR and colocalization analyses uncovered 23 genetically supported plasma proteins (11 risk and 12 protective factors). Multi-omics SMR-HEIDI analysis prioritized LAMC2 and PLTP as first-tier risk genes, which was consistently supported across protein, expression, and methylation levels. Single-cell RNA sequencing revealed cell-type-specific enrichment of key genes in monocytes and stromal/progenitor-like cells within AMD retinas, and subsequent mediation analysis identified specific immune traits, most notably regulatory T-cell subsets, as potential partial mediators of AMD risk. Druggability assessment identified 15 target genes, and bioinformatic enrichment nominated cyclophosphamide. Given the toxicity profile of cyclophosphamide, this computational finding serves strictly as a pathway indicator, reinforcing the broader therapeutic relevance of modulating the identified immune-related targets. CONCLUSION:Our integrative analyses identified candidate genetic loci and genetically supported proteins for AMD, providing a foundation for translating genomic findings toward primary prevention. The exploratory nature of this study highlights the need to experimentally validate the proposed targets and underlying mechanisms.
This study aimed to explore the risk factors associated with bilateral involvement and to develop a predictive model for visual prognosis in Chinese patients with non-arteritic anterior ischemic optic neuropathy (NAION). In this retrospective database-related meta-analysis, we retrospectively identified patients with NAION from the Chinese Neuro-Ophthalmic Diseases project database between September 2020 and December 2024. The clinical characteristics of the patients were summarized. Logistic and stepwise regression analyses were performed to identify the factors associated with bilateral involvement. Patients were randomly divided into training (75
Abstract Background The purpose of this study was to characterize the longitudinal refractive outcomes of orbital decompression in thyroid eye disease (TED), compare refractive trajectories across decompression strategies, and identify the anatomical correlates and baseline predictors of postoperative refractive changes. Methods This retrospective longitudinal study included 57 eyes of 46 patients with moderate-to-severe TED who underwent orbital decompression. Comprehensive ophthalmic evaluations including eyelid position parameters, refractive and axial measurements, and corneal biomechanical and tomographic assessments were performed preoperatively and during postoperative follow-up. Postoperative observations were analyzed using generalized estimating equations (GEE) models with restricted cubic splines, with time treated as a continuous variable to allow flexible modeling of temporal patterns. Multivariate GEE models were used to compare decompression strategies, evaluate associations between postoperative ocular biometric changes and postoperative refractive changes, and identify baseline predictors of clinically significant postoperative myopic drift. Results Orbital decompression was associated with a biphasic pattern of refractive change characterized by an initial myopic shift, followed by partial hyperopic recovery over time ( P < 0.001), with the greatest myopic shift occurring at approximately 2–3 months postoperatively. The refractive trajectories differed significantly across decompression strategies. Compared with one-wall decompression, two-wall decompression demonstrated a greater magnitude and more rapid progression of refractive change, as well as an increased risk of clinically significant myopic drift, independent of decompression extent. Standardized GEE analyses identified postoperative changes in measured axial length as the strongest correlate of postoperative refractive change ( P < 0.001). Additional associations were observed for changes in exophthalmos, eyelid position, corneal biomechanics, and corneal tomographic parameters. Several baseline ocular biometric parameters were independently associated with susceptibility to clinically significant postoperative myopic drift. Conclusions Orbital decompression induces dynamic postoperative refractive changes that vary according to decompression strategy and individual ocular characteristics. Postoperative refractive changes appeared to peak at approximately 2–3 months and partially recovered thereafter, with refractive status gradually approaching relative stabilization over time, suggesting that definitive refractive correction may be better deferred until postoperative stabilization. These findings provide clinically relevant insights into postoperative refractive behavior and may support individualized surgical planning and perioperative management for TED.
