OBJECTIVE:To establish evidence-based guidance to standardize the clinical application of artificial iris implantation in patients with iris defects. METHODS:A systematic literature search was performed following evidence-based consensus development standards. Eighteen international experts participated in a Delphi process to define six core clinical issues. Evidence was screened, extracted, evaluated and integrated. Recommendations were formulated through iterative expert review. RESULTS:We established six key clinical issues related to artificial iris implantation and evidence-based recommendations to address critical gaps in clinical practice. Key outcomes included standardized criteria for indications, contraindications, and type of artificial iris selection, key aspects of surgeon-patient communication, surgical management principles and critical techniques, comprehensive perioperative care protocols, and strategies for managing long-term postoperative complications associated with artificial iris implantation. CONCLUSIONS:This consensus standardizes artificial iris implantation through six evidence-based recommendations. It provides a standardized protocol for safe clinical implementation to restore visual function and cosmetic integrity in patients with iris defect.

PurposeThis study sought to evaluate the differential impacts of two corneal incision sizes, 2.2 mm and 2.6 mm, on the utilization of intraoperative ultrasound energy and the subsequent postoperative corneal recovery in patients presenting with hard nuclear cataracts.MethodsA retrospective cohort study was undertaken, encompassing cataract patients classified with nuclear hardness grades III to V according to the Emery-Little classification. Participants were allocated into two groups based on the incision size: 2.2 mm and 2.6 mm. Key metrics, including endothelial cell density (ECD), central corneal thickness (CCT), incisional corneal thickness (ICT), and best-corrected visual acuity (BCVA), were assessed preoperatively and at intervals of 1 day, 1 week, 1 month, and 3 months postoperatively. Additionally, intraoperative phacoemulsification parameters and any complications were documented.ResultsThe study encompassed a total of 100 eyes, with 50 eyes in each group. No statistically significant differences were detected in cumulative dissipated energy (CDE) or ultrasound time (UST) between the two groups (P > 0.05). Both groups exhibited a significant postoperative decline in ECD (P < 0.05), yet no significant intergroup difference was observed in the magnitude of this reduction (P > 0.05). Central corneal thickness (CCT) and intraocular pressure (ICT) exhibited a statistically significant increase at both 1 day and 1 week postoperatively when compared to baseline measurements (P < 0.05). Notably, the increase in ICT was significantly more pronounced in the 2.2 mm incision group at both time points (P < 0.05). Best-corrected visual acuity (BCVA) showed significant improvement in both groups following surgery (P < 0.05), with no significant intergroup differences observed at any follow-up interval (P > 0.05). Additionally, no significant difference in central corneal edema was detected between the two groups (P > 0.05).ConclusionThe corneal incision size (2.2 mm versus 2.6 mm) did not influence the use of intraoperative ultrasound energy or result in differential corneal endothelial cell loss. However, smaller incisions (2.2 mm) were associated with increased short-term edema at the incision site, potentially impacting early wound healing.

Background: Age-related cataract (ARC) is the leading cause of global blindness in the elderly. An unbalanced metabolic state is known to contribute to lens epithelial cell dysfunction and ARC pathogenesis. However, the relationship between hyperlipidemia and ARC remains controversial. Methods: In this cross-sectional study based in the Eye and Ears, Nose, and Throat Hospital, Fudan University, a total of 384 ARC subjects were included, and stratified by cataract morphology (cortical, nuclear, and posterior subcapsular cataract [PSC]). Detailed ocular and systemic evaluations were performed. Ordinal univariate and multivariate logistic regression analyses were used to identify associations between serum biochemical indices and ARC severity. Results: After adjusting for potential confounders, multivariate analysis revealed that hyperlipidemia was independently associated with PSC severity. Specifically, elevated apolipoprotein B (APO-B; odds ratio [OR], 1.767; 95% confidence interval [CI], 1.297-2.408) and triglycerides (TG; OR, 1.311; 95% CI, 1.014-1.697) were significant risk factors, while high-density lipoprotein cholesterol (HDL-C; OR, 0.738; 95% CI, 0.572-0.952) demonstrated an inverse association. In contrast, cortical cataract severity was independently associated with female sex (OR, 1.829; 95% CI, 1.147-2.916), elevated APO-B (OR, 1.231; 95% CI, 1.012-1.498) and lactate dehydrogenase (LDH; OR, 1.264; 95% CI, 1.040-1.536). Nuclear cataract was primarily associated with older age (OR, 1.608; 95% CI, 1.301-1.987) and longer axial length (OR, 1.310; 95% CI, 1.064-1.611), with no independent links to serum lipids. Conclusion: These cross-sectional findings demonstrate a significant and subtype-specific association between hyperlipidemia and ARC, particularly regarding PSC severity. While these associative results are exploratory, lipid biomarkers may generate hypotheses for future risk stratification and preventive strategies.

AIM: To characterize the distribution of persistent fetal vasculature (PFV) subtypes and to evaluate corneal astigmatism (CA) in children with unilateral PFV. METHODS: The medical records of patients diagnosed with PFV between January 2014 and August 2021 were retrospectively reviewed. Corneal keratometry parameters were measured using IOLMaster or a handheld keratometer. Differences in CA between the affected and fellow eyes were analyzed in 52 unilateral PFV patients with available examination data. RESULTS: Totally 133 patients diagnosed with PFV were retrospectively reviewed. The male-to-female ratio was 73/60. Median age at surgery was 38.03mo (interquartile range 58.27mo). Among the PFV patients, 32 (24.06%) had anterior PFV, 2 (1.50%) had posterior PFV, and 99 (74.44%) had combined anterior-posterior PFV. Mild combined PFV was the most common subtype. In unilateral PFV cases, the mean CA in the affected eye was 2.29±1.11 D, and 59.62% (31 eyes) had CA≥2.0 D. The mean CA in the affected eyes was significantly higher than in the fellow eyes (1.37±0.77 D; P<0.001). Among PFV-affected eyes with CA≥2.0 D, the steepest corneal meridian was vertically oriented in 30 cases (96.77%), while only 1 case (3.23%) had the steepest meridian oriented horizontally. CONCLUSION: In children with unilateral PFV, CA is significantly higher in the affected eyes than in the fellow eyes, and the steepest corneal meridian was predominantly oriented vertically.

Cataract is among the leading cause of vision impairment worldwide and it is essential to uncover molecule-level characteristics of different cataract subtypes for personalized treatment. Compared to existing diagnostic techniques, surface-enhanced Raman spectroscopy (SERS) shows advantages in sensitive molecular fingerprinting, tractability and compactness, making it highly suitable for clinical adoption. To further address the current lack of SERS-based techniques for cataract subtyping, this work presented an integrated methodology for robust and interpretable metabolic profiling of aqueous humor. A two-step sample pretreatment protocol has been therein developed to efficiently extract metabolites while ensuring compatibility with subsequent SERS detection. SERSome strategy was employed to enable rapid and robust metabolic profiling. Molecule-level SERSome interpretation was achieved by matching its positive intra-correlation network with metabolites' SERS barcode. Multiple analytical methods including statistical comparison, interpretable machine learning, and association analysis have been leveraged, evidencing key metabolite biomarkers such as ergothioneine, hypoxanthine and uric acid associated with cataract subtyping and diabetic retinopathy. In a word, this study has not only established a systematic methodology for metabolic analysis of aqueous humor but also provided a usable tool for both fundamental research and clinical applications in different diseases with high rapidness, cost efficiency and scalability.

This study aimed to explore the factors influencing corneal edema after phacoemulsification combined with intraocular lens implantation in elderly diabetic cataract (DC) patients and to establish a predictive model. A retrospective analysis was conducted on 300 DC patients who underwent phacoemulsification combined with intraocular lens implantation in our hospital between June 2022 and October 2023. Patients were randomly divided into a modeling group (n = 210) and a validation group (n = 90) in a 7:3 ratio. The modeling group was further divided into corneal-edema group (n = 57) and non-corneal-dema group (n = 153) based on the occurrence of postoperative corneal edema. Univariate and binary logistics regression analyses were employed to identify the influencing factors of postoperative corneal edema in DC patients. A predictive model was constructed using SPSS, and the model's application value was evaluated using receiver operating characteristic curve, calibration curve, and decision curve analysis in R language. There were no statistically significant differences in terms of general information between the modeling group and validation group (P > .05). Significant differences were observed in the comparison of diabetes duration, preoperative endothelial cell density, postoperative corneal endothelial cell loss, hypertension, surgery duration, and age between the corneal-edema group and non-corneal-edema group (P < .05). The results of binary logistics regression analysis showed that diabetes duration, preoperative endothelial cell density, postoperative corneal endothelial cell loss, hypertension, surgery duration, and age were influencing factors for postoperative corneal edema in DC patients (P < .05). The calibration curves of the model in the modeling group and validation group exhibited a slope close to 1, showing good consistency between predicted and actual risks. Receiver operating characteristic analysis results indicated an area under the curve of 0.96 and a standard error of 0.021 (95% confidence interval: 0.872-0.994) in the modeling group and an area under the curve of 0.94 and a standard error of 0.024 (95% confidence interval: 0.867-0.966) in the validation group. Decision curve analysis curve analysis demonstrated that the model had good application efficacy and clinical benefits in both groups. The predictive model based on influencing factors demonstrated good predictive performance and warrants further validation.

PURPOSE:To describe the novel clinical phenotypes and develop a three-dimensional (3D) primary myofibroblast culture model to investigate morphological alterations associated with CPAMD8 deficiency. METHODS:We identified novel CPAMD8 variants by exome sequencing. Primary myofibroblasts from human ciliary muscle were cultured in a Matrigel-based 3D system, and CPAMD8 was knocked down by siRNA to assess effects on aggregate growth, morphology, and gene expression. RESULTS:Two novel nonsense variants of the CPAMD8 gene were identified within the pedigree. We identified megalocornea, lentis ectopia, and iris hypoplasia in patients with ASGD8, whereas glaucoma was not observed. Notable alterations in corneal biometry were observed in patients with ASGD8 for the first time. Additionally, as a preliminary observation based on the two affected individuals, reduced retinal vascular density was noted. Upon knockdown of CPAMD8 expression, three-dimensional cultured myofibroblasts demonstrated restricted proliferation, as observed under a microscope and confirmed by CCK-8 assay. Furthermore, ACTA2 expression was downregulated, and the expression of certain TGF-β receptors (TGFBR2 and TGFBR3) was altered, while TGFBR1 and SMAD2 remained unchanged, suggesting a partial rather than global disruption of TGF-β signaling. These findings are consistent with structural abnormalities of the anterior segment in ASGD8. CONCLUSIONS:ASGD8 can cause abnormalities in both the anterior and posterior eye segments. Our newly developed three-dimensional myofibroblast model offers a straightforward, efficient, and cost-effective approach for investigating genetic eye disorders.

Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai Key Laboratory of Visual Impairment and Restoration, No. 83 Fenyang Road, Shanghai 200031, China. e-mail: jiyh_eent@163.com Funding：This research was funded by National Natural Science Foundation of China, grant number 82070942 and Oriental Talents Program-Top-notch Talent project (BJWS2024015). AbstractPurpose: To describe the novel clinical phenotypes and develop a three-dimensional (3D) primary myofibroblast culture model to mimic the phenotypes of ciliary body observed in patients with Anterior segment dysgenesis 8 (ASGD8).Methods: We studied the family members and confirmed their genetic variants through exome sequencing. Next, we created CPAMD8 knockdown three-dimensional myofibroblast model to replicate and analyze the clinical features seen in the patients.Results: Two novel nonsense variants of the CPAMD8 gene were identified within the pedigree. We identified megalocornea, lentis ectopia, and iris hypoplasia in patients with ASGD8, whereas glaucoma was not observed. Notable alterations in corneal biometry and retinal vascular density were observed in patients with ASGD8 for the first time. Upon knockdown of CPAMD8 expression, three-dimensional cultured myofibroblasts demonstrated restricted proliferation, as observed under a microscope and confirmed by CCK-8 assay. Furthermore, the expression levels of key markers—such as TGF-β receptors and ACTA2 —were significantly altered in organoid models following CPAMD8 downregulation. These findings align with the abnormalities of the ciliary body and iris hypoplasia observed in ASGD8 patients.Conclusions: ASGD8 can cause abnormalities in both the anterior and posterior eye segments. Our newly developed three-dimensional myofibroblast model offers a straightforward, efficient, and cost-effective approach for investigating genetic eye disorders.

Background:Moderate-to-severe lens subluxation poses surgical challenges due to extensive zonular weakness and the need to maintain stable intraocular lens (IOL) positioning while preserving the capsular bag. Objectives:To evaluate the outcomes and safety of a modified technique using intrascleral suture fixation of a standard capsular tension ring (CTR) to preserve the capsular bag in moderate-to-severe lens subluxation. Design:Retrospective, single-center case series. Methods:Consecutive eyes with 120°-300° zonular dialysis underwent phacoemulsification via a 2.4 mm clear corneal incision and a 0.8 mm lateral incision. Capsular bag stabilization was achieved by intrascleral fixation of a standard CTR using a knotless Z-suture with double-strand 8-0/9-0 polypropylene, followed by in-the-bag IOL implantation. Primary outcomes were postoperative IOL centration and corrected-distance visual acuity (CDVA); secondary outcomes included refractive error and complications. Follow-up was scheduled at 1, 3, 6 months (some at 12 months) and annually thereafter. Results:Sixteen eyes of nine patients were included. Median follow-up was 328.0 days (interquartile range (IQR) 256.5, 443.0). Median logMAR CDVA improved from 0.35 (IQR 0.30, 0.57) preoperatively to 0.19 postoperatively. Mean absolute spherical equivalent decreased from 9.82 ± 1.02 D to 1.16 ± 0.25 D. IOLs were well‑centered in 13 eyes (81.3%); a slight, clinically insignificant tilt was observed in 3 eyes (18.7%). One intraoperative posterior capsule rupture did not preclude in-the-bag IOL implantation. Two eyes had transient postoperative intraocular pressure elevation managed medically. No other significant complications occurred. Conclusion:Intrascleral fixation of a standard CTR is a simple, accessible, and effective bag-preserving technique for moderate-to-severe lens subluxation, enabling stable in-the-bag IOL implantation with favorable visual and refractive outcomes. Registration:ClinicalTrials.gov: NCT06627062.

Accurate segmentation and quantification of the eyeball and lens from MRI images are crucial for clinical diagnosis and treatment planning of ocular diseases. Traditional methods for analyzing eye structures in MRI have drawbacks including low segmentation accuracy and reliance on laborious, time-consuming manual processes. To solve these problems, we propose a SEDP-SegResnet model for segmentation of the eyeball and lens structures from 3D MRI images. The framework takes SegResnet as its backbone network and incorporates a 3D-SE layer to handle deep features from decoder, 3D-SE layer assigns different weight information to the feature map channels through squeeze and excitation mechanism. Moreover, skip connections in the U-shaped architecture model are replaced with Dynamic Deep Feature Prefusion (DDFP) modules. The DDFP can achieve in-depth fusion of encoder and decoder features based on global information, thereby enhancing 3D image context comprehension of the model. The performance of SEDP-SegResnet is evaluated through a series of experiments using a proprietary dataset of orbital MRI scans. The results show that SEDP-SegResnet outperforms current mainstream 3D deep-learning-based segmentation models across multiple evaluation metrics including the Dice Similarity Coefficient (DSC) and Intersection over Union (IoU). The model achieves robust performances in segmenting margin of eyeballs and blur-edge lenses. SEDP-SegResnet achieves a DSC of 96.81% for eyeball segmentation and 90.57% for lens segmentation, superior than a variety of commonly used segmentation models. It provides a more accurate, automated and robust method for the segmentation and quantification of eyeball and lens in MRI, offering an advanced computer-aided diagnosis tool.

Purpose:To evaluate the hard nuclear cataract surgery outcomes by comparing the combined burst mode and continuous torsional mode conducted of Centurion Vision System. Methods:Prospective comparative cohort study. Based on the Emery-Little classification, this study assigned cataract patients with nuclear density grade III to V into two groups: the combined mode group (Group A) and the torsional mode group (Group B). Endothelial cell density (ECD), central corneal thickness (CCT), and best-corrected distance visual acuity (BCVA) were evaluated at different time intervals, including 1 day, 1 week, 1 month, and 3 months. Results:207 patients: 100 in the group A and 107 in the group B. Patients in group A with severe nuclei experienced lower cumulative dissipated energy (p = 0.007) and shorter ultrasound time (p < 0.001). Both groups exhibited a decrease in ECD after surgery, but the decrease was comparatively lower among group A patients with severe nuclei (p < 0.05). There was a notable increase in the CCT in both groups at the 1-day and 1-week time points compared to the baseline values (p < 0.001). Changes in CCT were significantly greater in group B at 1-day (p < 0.001), 1-week (p = 0.002), and 1-month (p = 0.004) intervals among patients with severe nuclei. Conclusion:Burst torsional combined with longitudinal ultrasound can be more effective for harder nuclei phacoemulsification than the continuous torsional ultrasound. Trial Registration:This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Fudan University's Eye & ENT Hospital. This study was registered as a clinical trial (number: NCT06991374).

Age-related cataract (ARC) represents a major global cause of visual impairment, with ultraviolet B (UVB) radiation recognized as a primary contributor to oxidative damage in the lens. FOXO3, a key regulator of aging, apoptosis, and oxidative stress-induced cell death, was investigated for its role and regulatory mechanisms in UVB-induced oxidative stress using human lens epithelial cells (HLECs). A progressive decrease in FOXO3 protein expression was observed in the lens capsules across various stages of cataract progression, as well as in UVB-exposed animal models and UVB-treated HLECs. Functional assays demonstrated that FOXO3 overexpression protected HLECs against UVB-induced damage by increasing cell viability, reducing reactive oxygen species (ROS) generation, and suppressing apoptosis. Furthermore, we demonstrated that the AMPK/FOXO3 signaling pathway is involved in this protective mechanism, as AMPK inhibition restored FOXO3 expression and mitigated UVB-induced cellular damage. Additionally, lncRNA SNHG12 was identified as a potential candidate regulated by FOXO3. Overexpressing FOXO3 in HLECs resulted in reduced lncRNA SNHG12 expression, whereas FOXO3 knockdown elevated lncRNA SNHG12 levels. Further luciferase reporter assays validated their interaction, revealing FOXO3 as a negative regulator of SNHG12 expression. Moreover, the knockdown of SNHG12 significantly attenuated apoptosis and oxidative stress induced by UVB in HLECs. In conclusion, these findings suggest that FOXO3 alleviates UVB-induced oxidative stress in lens epithelial cells through the AMPK/FOXO3 pathway and regulation of SNHG12, providing a potential therapeutic target for ARC.

PURPOSE:Age-related cataract (ARC) is the leading cause of visual impairment worldwide, with ultraviolet B (UVB) radiation recognized as a major risk factor. This study aimed to investigate whether UVB induces ferroptosis in human lens epithelial cells (HLECs) and to explore the role of TRIM69 in modulating this process through the p53 signaling pathway. METHODS:HLECs were exposed to UVB irradiation, and ferroptosis was assessed by measuring cell viability, reactive oxygen species (ROS) accumulation, glutathione peroxidase 4 (GPX4) expression, and glutathione (GSH) levels. Ferroptosis inhibition was examined using ferrostatin-1 (Fer-1). TRIM69 expression was modulated by overexpression and knockdown, while the interaction with p53 signaling was evaluated through p53 overexpression assays. Western blotting was performed to analyze GPX4 and SLC7A11 expression. RESULTS:UVB exposure induced ferroptosis in HLECs, evidenced by reduced GPX4 and GSH, elevated ROS, and decreased viability. Fer-1 treatment significantly improved cell viability and suppressed ROS accumulation. TRIM69 overexpression significantly mitigated the effects of UVB irradiation on cell viability, GSH levels and ROS production, whereas knocking down TRIM69 expression exacerbated these effects. Importantly, p53 overexpression reversed the protective effects of TRIM69 and downregulated GPX4 and SLC7A11, implicating p53-dependent signaling in ferroptosis regulation. CONCLUSION:These findings demonstrate that TRIM69 protects HLECs against UVB-induced ferroptosis by inhibiting p53-mediated suppression of GPX4 and SLC7A11. TRIM69 may represent a promising therapeutic target for preventing oxidative damage and delaying the onset of ARC.

Objective We compared the protein structure and pathogenicity of clinically relevant variants of the COG4 gene with AlphaFold2 (AF2), Alpha Missense (AM), and ThermoMPNN for the first time.Methods and analysis The sequences of clinically relevant Cog4 missense variants (one novel identified p.Y714F and three pre-existing p.G512R, p.R729W and p.L769R from Uniprot Q9H9E3) were imported into AF2 for protein structural prediction, and the pathogenicity was estimated using AM and ThermoMPNN. Different pathogenicity metrics were aggregated with principal component analysis (PCA) and further analysed at three levels (amino acid position, substitution and post-translation) based on all possible Cog4 missense variants (n=14 915).Results Localised protein structural impact including change of conformation and amino acid polarity, breakage of hydrogen bond and salt-bridge, and formation of alpha-helix were identified among clinically relevant Cog4 variants. The global structural comparison with multidimensional scaling demonstrated variants with similar protein structures (AF2) tended to exhibit similar clinical and biological phenotypes. The Cog4 p.Y714F variant exhibited greater protein structural similarity to mutated Cog4 found in Saul‒Wilson syndrome (p.G512R) and shared similar clinical phenotype (congenital cataract and psychomotor retardation). PCA of included pathogenic metrics demonstrated p.Y714F occurred at a critical position in Cog4 amino acid sequence with disrupted post-translational phosphorylation.Conclusion Deep learning algorithms, including AF2, AM and ThermoMPNN, can be useful for evaluating variant of uncertain significance (VUS) by structural and pathogenicity prediction. Despite classified as VUS (American College of Medical Genetics and Genomics criteria: PM1, PP4), the pathogenicity in this Cog4 variant cannot be ruled out and warrants further investigation.

To compare the precision of the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) in estimating SIA when predicting the power and axis of toric IOLs under different circumstances. 120 eyes of 99 patients undergoing toric IOL replacement in a simple cataract surgery were included in the retrospective study. The predicted position of toric IOL was calculated by Z Calc online calculator and Barrett Toric Calculator with M-SIA (0.4D) or C-SIA (0.1D). Position prediction error (PPE, the difference between the predicted position of toric IOL and the ideal position of toric IOL), its absolute value (PPE-Abs) and △PPE (the difference between absolute value of PPE calculated by C-SIA and by M-SIA using the same toric calculator) were used to evaluate the precision in estimate of SIA. Statistical significance in mean PPE and mean PPE-Abs was found in the group M-Barrett. The orientation of corneal astigmatism and eye laterality were influential to mean PPE while gender was not. △PPE was below 0 in both toric calculators. Significant difference in △PPE was seen between groups with different corneal astigmatism when all eyes were OS, as well as between groups with different eye laterality when all eyes were with WTR astigmatism. We did not find a significant difference between M-SIA and C-SIA in estimating the SIA of the patients undergoing small-incision cataract surgery combined with toric IOL implantation. M-SIA was not recommended in Barrett Toric Calculator. The orientation of corneal astigmatism and the incision on the cornea should be considered when choosing between M-SIA and C-SIA.

This study aims to investigate the hypothesis that Yes-associated protein (YAP) significantly regulates antioxidant potential and anti-apoptosis in UVB-induced cataract by exploring the underlying molecular mechanisms. To investigate the association between YAP and cataract, various experimental techniques were employed, including cell viability assessment, Annexin V FITC/PI assay, measurement of ROS production, RT-PCR, Western blot assay, and Immunoprecipitation. UVB exposure on human lens epithelium cells (HLECs) reduced total and nuclear YAP protein expression, increased cleaved/pro-caspase 3 ratios, decreased cell viability, and elevated ROS levels compared to controls. Similar Western blot results were observed in in vivo experiments involving UVB-treated mice. YAP knockdown in vitro demonstrated a decrease in the protein expression of FOXM1, Nrf2, and HO-1, which correlated with the mRNA expression, accompanied by an increase in cell apoptosis, caspase 3 activation, and the release of ROS. Conversely, YAP overexpression mitigated these effects induced by UVB irradiation. Immunoprecipitation revealed a FOXM1-YAP interaction. Notably, inhibiting FOXM1 decreased Nrf2 and HO-1, activating caspase 3. Additionally, administering the ROS inhibitor N-acetyl-L-cysteine (NAC) effectively mitigated the apoptotic effects induced by oxidative stress from UVB irradiation, rescuing the protein expression levels of YAP, FOXM1, Nrf2, and HO-1. The initial findings of our study demonstrate the existence of a feedback loop involving YAP, FOXM1, Nrf2, and ROS that significantly influences the cell apoptosis in HLECs under UVB-induced oxidative stress.

Purpose: This study aimed to determine the influence of decentration, rotation, and tilt on objective optical quality of plate haptic toric intraocular lenses (tIOLs). Methods: The area ratio of modulation transfer function (MTF), strehl ratio of point spread function (PSF), and higher order aberrations (HOAs) for 3 mm and 5 mm pupil diameter (PD) were evaluated at postoperative 1 month. The retroillumination images pictured by OPD-scan III were used to quantify the degree of decentration and rotation, whereas the tIOL tilt was directly obtained by the tilt aberration. Patients were separated into two subgroups based on tIOL misalignment cutoff values. Results: There were 29 eyes (24 patients) in the study. The decentration of more than 0.25 mm did not substantially differ from those less than or equal to 0.25 mm. PSF of 3 mm PD and MTF, intraocular HOAs, and trefoil aberration for 3 mm and 5 mm PD significantly deteriorated with a rotation of more than 3 degrees, whereas only intraocular HOAs for 5 mm PD and coma for 3 mm and 5 mm PD were significantly severe with a tilt of more than 0.1 mu m and 0.25 mu m in corresponding PD. Furthermore, tIOL rotation and tilt were highly correlated with intraocular trefoil aberration and coma, respectively. Conclusions: The decentration of the monofocal bitoric IOLs is more tolerant to optical quality degradation after 1 month of surgery but more sensitive to intraocular trefoil aberration caused by rotation and coma aberration induced by tilt. Translational Relevance: As far as we know, this is the first study to investigate the relationship between the plate haptic bitoric IOL misalignment and objective optical quality measured by OPD-scan III in the real world, which may provide reference information for IOL selection to improve surgical outcomes.

The study aimed to compare and rank the accuracy of formulas for calculating intraocular lens (IOL) power in paediatric eyes in a systematic way. A literature search was conducted in Pubmed, Web of Science, Cochrane Library, and EMBASE by December 2021. Combined with traditional and network meta-analysis, we analysed the percentages of paediatric eyes with prediction error (PE) within ±0.50 dioptres (D) and ±1.00 D as the outcome measurements among different formulas. Subgroup analyses stratified by age were also undertaken. Thirteen studies with 1781 eyes comparing 8 calculation formulas were included. For the traditional meta-analysis results, Sanders-Retzlaff-Kraff theoretical (SRK/T) (risk ratios (RR), 1.15; 95% confidence intervals (CI), 1.03–1.30) performed significantly better than the SRKII formula for the percentage of eyes with PE within ±0.50 D. In addition, SRK/T (RR, 1.10; 95% CI, 1.02–1.18) and Holladay 1(RR, 1.15; 95% CI, 1.01–1.30) both performed significantly better than the SRKII formula for the percentage of eyes with PE within ±1.00 D. Considering the ranking based on the surface under the cumulative ranking curve (SUCRA) by Bayesian method, the top four formulas were Barrett Universal II (UII), Haigis, Holladay 1, and SRK/T on the percentage of PE within ±0.50 D, whereas the top four formulas were Barrett UII, Holladay 1, SRK/T, and Hoffer Q formulas on the percentage of PE within ±1.00D. Concerning both outcome measurements of rank probabilities, the top three Barrett UII, SRK/T, and Holladay 1 formulas were considered to provide more accuracy for IOL power calculation in paediatric cataract eyes, and Barrett UII tends to perform better in older children.

Background The aim of this study is to investigate the genetic and epigenetic mechanisms involved in the pathogenesis of age-related cataract (ARC). Methods We obtained the transcriptome datafile of th ree ARC samples and three healthy, age-matched samples and used differential expression analyses to identify the differentially expressed genes (DEGs). The differential lncRNA-associated competing endogenous (ceRNA) network, and the protein-protein network (PPI) were constructed using Cytoscape and STRING. Cluster analyses were performed to identify the underlying molecular mechanisms of the hub genes affecting ARC progression. To verify the immune status of the ARC patients, immune-associated analyses were also conducted. Results The PPI network identified the FOXO1 gene as the hub gene with the highest score, as calculated by the Maximal Clique Centrality (MCC) algorithm. The ceRNA network identified lncRNAs H19, XIST, TTTY14, and MEG3 and hub genes FOXO1, NOTCH3, CDK6, SPRY2, and CA2 as playing key roles in regulating the pathogenesis of ARC. Additionally, the identified hub genes showed no significant correlation with an immune response but were highly correlated with cell metabolism, including cysteine, methionine, and galactose. Discussion The findings of this study may provide clues toward ARC pathogenic mechanisms and may be of significance for future therapeutic research.