Background The comparative efficacy of XEN gel stent implantation, either as a standalone procedure (XEN-only) or combined with phacoemulsification (Phaco-XEN), for the treatment of open-angle glaucoma (OAG) warrants further investigation. This systematic review and meta-analysis evaluated the efficacy of XEN-only and Phaco-XEN procedures compared to trabeculectomy (TB). Methods Five major electronic databases, including PubMed, ScienceDirect, and the Cochrane Library, were systematically searched from inception to September 1, 2025. We compared clinical outcomes among XEN-only, Phaco-XEN, and TB groups. Stratification analyses examined outcomes based on follow-up duration and geographic location. Efficacy endpoints included intraocular pressure (IOP), number of anti-glaucoma medications (NOAM), and bleb needling rates. Sensitivity analyses were performed to assess potential biases. Results A total of 56 eligible studies were included. (1) Both XEN-only and Phaco-XEN procedures achieved significant IOP reductions from baseline (P < 0.001). When comparing XEN-only versus Phaco-XEN, no statistically significant differences were observed in postoperative IOP (MD: −0.22; P = 0.06), NOAM (MD: 0.10; P = 0.06), or bleb needling rates (RR: 1.79; P = 0.06). (2) Compared with trabeculectomy (TB), there was no significant difference in postoperative NOAM for XEN-only (MD: −0.16; P = 0.16), but XEN-only had lower postoperative IOP (MD: −0.93; P = 0.0003). However, extremely high heterogeneity (I2 = 86%) suggests this finding should be interpreted with caution. Conversely, XEN-only surgery was associated with a significantly higher rate of bleb needling compared to TB surgery (RR: 3.09; P = 0.001). Hyphema and bleb needling were identified as the most frequent postoperative complications. Conclusion Both XEN-only and Phaco-XEN surgeries provide effective IOP reduction. There was no statistically significant difference in postoperative NOAM reduction between XEN-only and Phaco-XEN surgeries (P = 0.06). TB surgery remains superior regarding lower postoperative bleb needling rates compared to XEN-only surgery.

Advanced implantable medical devices often need to integrate multiple functions onto one surface to meet the complex needs in vivo. The construction of glycocalyx bionic coatings that mimic the natural multifunctional glycocalyx barrier of blood vessels, intestines, and ocular surfaces is an emerging strategy for function integration. However, in practical application scenarios such as corneal bandage lens (CBL) for corneal injury treatment, bio-enzymes from immune cells and bacteria can degrade the natural polymers constructing the glycocalyx bionic coating, such as hyaluronic acid, resulting in the loss of coating functionality. To address this issue, we propose an enzyme-resistant glycocalyx bionic coating (ER-GBC) strategy; by introducing baicalin as a hyaluronidase inhibitor into hyaluronic acid-based GBCs, the coating can be resistant to hyaluronidase's disruption. Meanwhile, by the free radical scavenging and bacteriostatic properties of baicalin and the bactericidal properties of silver nanoparticles embedded into the coating, the multiple functional ER-GBC of hydrophilic, anti-bacterial, and anti-inflammatory were realized. As a result, the ER-GBC-modified CBL achieved good therapeutic results in the rabbit model of bacterial keratitis. This ER-GBC strategy, constructed by combining glycocalyx active ingredients with corresponding enzyme inhibitors, is expected to provide new methods for developing bionic coatings for medical devices and clinical translation.

Retinopathy of prematurity (ROP) remains the leading cause of blindness in premature infants owing to abnormal retinal blood vessels development,but molecular mechanisms are still not fully elucidated. Oxygen-induced retinopathy (OIR) mouse is the extensively used angiogenesis model for the study of ROP pathogenesis. In this study, we investigated five cell types that composed the microenvironment of retinal vessels in OIR mice by single-cell RNA sequencing (scRNA-seq) and revealed a complex and time-dependent regulation of vascular arrest and angiogenesis in the OIR microenvironment. Importantly, we also observe that Müller glia exhibit robust expression of CST3 (cysteine protease inhibitor cystatin C) during the early phase of hypoxic adaptation, leading to capillary morphogenesis in the hyaloid, disrupting physiological vascular patterning and contributing to OIR development. Altogether, our study reveals pivotal roles of the retinal microenvironment in both normal vascularization and ROP progression,suggesting that CST3 is a potential therapeutic target for ROP.

Postoperative reocclusion remains a major challenge in lacrimal duct stent implantation, primarily driven by persistent inflammation and fibrosis. To address this issue, we developed a coating system that integrates drug release with interfacial bioactivity regulation. A polydopamine-hybridized zeolitic imidazolate framework (pZIF-8) was synthesized via a one-pot method and co-loaded with mometasone furoate (Elocon Cream) and verteporfin (anti-fibrotic) to construct a reactive oxygen species (ROS)/pH responsive nanocarrier. A trilayered coating consisting of a polydopamine (PDA) adhesive layer, a drug-loaded pZIF-8 middle layer, and an outermost hyaluronic acid (HA) antifouling layer was assembled on a silicone stent using a layer-by-layer approach. In vitro, the coating exhibited significantly reduced protein adsorption and bacterial adhesion compared to Control, supported >75% viability of epithelial cells (RPMI 2650) while reducing macrophage (RAW 264.7) viability to approximately 2% and fibroblast (L929) viability to below 50% of Control, and achieved sustained drug release under inflammatory conditions (pH 6.0 + 0.1 mM H₂O₂). In a rabbit lacrimal duct model, the coated stent attenuated acute inflammation, reduced collagen deposition, and downregulated YAP1 expression compared to bare stents. Immunofluorescence analysis showed that bare stents promoted M2a macrophage polarization, whereas the coated stent promoted M2b polarization, as indicated by negative CD68/CD206 colocalization. These findings demonstrate a coating system that combines a ROS/pH-responsive nanocarrier with an antifouling surface to target inflammation and fibrosis. This approach may offer a strategy for preventing stent restenosis and could be adapted for other implantable luminal devices. STATEMENT OF SIGNIFICANCE: Lacrimal stent implantation is frequently complicated by restenosis due to postoperative inflammation and fibrosis. Current stents serve as passive mechanical supports and do not actively intervene in this pathological process. Here we report a metal-organic framework (MOF)-based trilayer coating designed to address both inflammation and fibrosis. The coating consists of a polydopamine adhesive layer, a pZIF-8 MOF layer co-loaded with mometasone furoate (Elocon Cream) and verteporfin (anti-fibrotic), and an outermost hyaluronic acid antifouling layer. The pZIF-8 nanocarrier exhibits ROS/pH-responsive degradation, while the HA outer layer provides sustained release and antifouling properties. This design may offer a strategy to prevent restenosis and could inform the design of other implantable luminal devices.

To compare the efficacy and safety of five femtosecond laser platforms (FLPs) in femtosecond laser-assisted cataract surgery (FLACS) and guide clinical selection. Systematic searches (PubMed, Cochrane Library, Web of Science, Embase, ClinicalTrials.gov, Chinese databases) identified randomized controlled trials and cohort studies (from January 2009 to May 2024) on FLACS for age-related cataracts. Outcomes included cumulative dissipated energy (CDE), effective phacoemulsification time (EPT), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal endothelial density (CED), central corneal thickness (CCT), overall complications (OCs), capsular complications (CapCs), corneal complications (CorCs), and conjunctival complications (ConCs). Continuous outcomes were expressed as weighted mean differences (WMDs) with 95

Dry eye, a common eye disease globally, poses significant challenges to clinical diagnosis and management due to its complex pathogenesis and high incidence rate. The development of artificial intelligence (AI) technology has provided new opportunities for the analysis and auxiliary diagnosis of dry eye imaging. This expert consensus focuses on the classification and annotation methods of dry eye imaging, in line with the application needs of AI technology. It summarizes the scope and tasks of research on the classification and annotation of dry eye imaging and provides detailed standards for the principles and methods of classification and annotation of major imaging modalities, including lipid layer of the tear film, tear meniscus height, tear film breakup time, corneal fluorescein staining, and meibomian gland images. It also clarifies the tools and processes for classification and annotation. The consensus proposes systematic quality control requirements, including annotation consistency assessment, multi-round review, and data cleaning methods. Finally, the consensus summarizes the current challenges and proposes targeted solutions. The launch of this consensus aims to provide high-quality data support for the development of AI in dry eye, enhance the application effects of AI in dry eye diagnosis, disease monitoring, and personalized treatment, and offer scientific references and technical support for clinical and research applications of AI in the field of dry eye.

Primary open-angle glaucoma (POAG), a leading cause of irreversible blindness, involves complex neurodegeneration in which the contribution of systemic immunity remains enigmatic. Here, we dissect the circulating immune landscape in POAG patients via high-resolution single-cell RNA sequencing of ~1.4 million peripheral blood mononuclear cells (PBMCs) from 110 patients and 110 controls of Chinese ancestry. We revealed significant immune remodeling in POAG, characterized by increased CD4+ T lymphocytes and myeloid cells and impaired cytolytic potential, as evidenced by reduced cell proportions of terminally differentiated CD8+ GZMK+ T cells and NK cells. Transcriptomic analysis revealed a sophisticated dual transcriptional landscape in which both proinflammatory and neuroprotective signaling pathways coexist across multiple immune cell lineages. While TNF and IFNG pathway genes were broadly downregulated, specific inflammatory activation components and neuroprotective genes were upregulated in distinct cell populations, suggesting that POAG represents a complex immunometabolic syndrome characterized by a dysregulated balance between inflammatory and neuroprotective signaling. Cell type-specific eQTL mapping and SMR analysis revealed that POAG genetic risk loci exert their effects through immune gene regulation in specific PBMC subsets. Functional validation using Ifng-/- and Tnf+/- mice in an LPS/NMDA-induced retinal injury model, which mirrored the immune alterations observed in human POAG, demonstrated that genetic deficiency in these pathways markedly exacerbated retinal ganglion cell loss and visual pathway deficits. Our study establishes a crucial link between systemic immune dysregulation—specifically the disrupted balance between inflammatory and neuroprotective signaling—and retinal health, highlighting the importance of restoring this balance for future POAG therapeutic strategies.

Objective: To investigate the anti-inflammatory, antioxidant, and goblet cell-stimulating effects of a suspension of Ophiopogon japonicus (L. f.) Ker Gawl. (O. japonicus, Mai Dong) extract combined with hyaluronic acid (HA) in the mouse model with dry eye disease (DED). Methods: A DED mouse model was induced using benzalkonium chloride (BAK), followed by treatment with O. japonicus extract-containing eye drops at varying concentrations. Experimental groups included a normal control, a DED model control, a positive control, and an O. japonicus extract-treated group. Corneal fluorescein staining and tear break-up time (TBUT) were used to assess tear film stability and ocular surface integrity. Enzyme-linked immunosorbent assay (ELISA) measured inflammatory factor levels in corneal and conjunctival tissues, whereas Western blot (WB) analyzed key antioxidant and inflammatory markers, including nuclear factor erythroid 2-related factor (2Nrf2) and heme oxygenase 1 (HO-1). Periodic acid-schiff (PAS) staining and immunofluorescence were used to evaluate goblet cell density and mucin secretion. Results: O. japonicus extract significantly improved corneal damage, reduced fluorescein staining scores, prolonged TBUT, and increased tear secretion. It downregulated inflammatory markers, including interleukin-8 (IL-8), interleukin-1β (IL-1β), and interferon-γ (IFN-γ) while upregulating Nrf2, HO-1, and the interleukin-13 (IL-13)/IFN-γ ratio, alleviating oxidative stress and inflammation. PAS staining showed increased conjunctival goblet cell density and restored mucin secretion, enhancing tear film stability. Conclusion: O. japonicus extract demonstrated significant anti-inflammatory, antioxidant, and goblet cell-stimulating effects in a DED model, with good biocompatibility and promising therapeutic potential. Future research should optimize extraction processes and validate their efficacy and safety in clinical settings.

Primary open-angle glaucoma (POAG) is the leading cause of irreversible blindness worldwide, primarily due to the degeneration of retinal ganglion cells (RGCs). In this study, we reported vav guanine nucleotide exchange factor 2 (VAV2) as a POAG-associated gene. Through whole exome sequencing (WES) of 398 Han Chinese POAG patients and 2,010 controls, we discovered nine rare VAV2 variants linked to POAG (P_burden=1.40×l0−6). Functional analyses revealed that these variants disrupted normal VAV2 protein function, leading to compromised cytoskeletal organization in human trabecular meshwork cells and impaired axonal growth in the 661W cell line. In vivo, Vav2 knockout mice exhibited key POAG features, including increased intraocular pressure (IOP), abnormal trabecular meshwork structure, reduced visual sensitivity, and RGC loss. This study also implicated VAV2 in the modulation of the Rho signaling pathway, which is essential for maintaining trabecular meshwork integrity and neuronal function. Taken together, this research identified VAV2 as a candidate gene for POAG and suggests VAV2 as a potential target for genetic screening of POAG diagnostics.

Phacoemulsification with intraocular lens (IOL) implantation is a widely used effective treatment for cataracts. However, the surgical outcome relies heavily on precise operations with marked eye location and orientation, which ideally require a high-precision navigation system for complete guidance of surgical procedure. However, both research and current commercial surgical microscopes still face substantial challenges in handling various complex clinical scenarios. Here we propose a neural network-powered surgical microscopic system that can benefit from big data to address the unmet clinical need. In this system, we designed an end-to-end navigation network for real-time positioning and alignment of IOL and then built a computer-assisted surgical microscope with a complete imaging and display platform integrating the control software and algorithms for surgical planning and navigation. The network used an attention-based encoder-decoder architecture with an edge padding mechanism and an MLP layer for eye center localization, and combined siamese network, correlation filter, and spatial transformation network to track eye rotation. Using computer-aided annotation, we collected and labeled 100 clinical surgery videos from 100 patients, and proposed a data augmentation method to enhance the diversity of training. We further evaluated the navigation performance of the microscopic system on a human eye model.

Marfan syndrome (MFS) is a hereditary connective tissue disorder that is primarily caused by mutations in the fibrillin-1 (FBN1) gene. This disease predominantly affects the eyes, bones, and cardiovascular system, with cardiovascular complications posing the most significant threat to life. Currently, conventional treatments, which are based on pharmacological management and surgical interventions, aim to slow disease progression and manage life-threatening cardiovascular complications. Emerging technologies such as CRISPR-Cas9 gene editing and induced pluripotent stem cell (iPSC) have advanced the understanding of FBN1 mutation heterogeneity and disease mechanisms beyond TGF-β signaling, providing novel platforms for drug discovery and personalized therapeutic exploration. This review explores recent progress in MFS therapies, focusing on surgical innovations, emerging medicine and therapeutic targets, while discussing the potential future applications of gene therapy.

PURPOSE:To characterize the ultrastructural features of lens epithelial cells (LECs) in intumescent white cataracts and investigate their potential role in capsular bag behavior following cataract surgery. DESIGN:Pathological analysis and case-control study. METHODS:For pathological analysis, anterior lens capsules (including basement membrane and LECs) were obtained during continuous curvilinear capsulorrhexis from patients with intumescent white cataracts and age- and sex-matched controls with nuclear cataracts. These samples were evaluated using hematoxylin and eosin (H&E) staining, transmission electron microscopy (TEM), and immunohistochemistry. For clinical assessment, 22 patients with intumescent white cataracts and 22 age- and sex-matched controls with nuclear cataracts were followed for at least one year postoperatively to assess the capsular bag behavior (including capsular fibrosis and intraocular lens [IOL] stability). RESULTS:In nuclear cataracts, H&E staining showed homogeneous and continuous LECs. In contrast, intumescent white cataracts exhibited uneven, swollen, and discontinuous LECs, accompanied by prominent capsular splitting. TEM revealed pleomorphic and degenerative LECs with compressed nuclei, intracellular vacuoles, and swollen mitochondria. Immunohistochemistry revealed decreased Na⁺/K⁺-ATPase, integrin β1, and COX IV expression in intumescent white cataracts. Clinically, patients with intumescent white cataracts had lower anterior and posterior capsule opacification (ACO and PCO) scores (all P < .05), and greater IOL decentration (P < .05) compared to control patients. CONCLUSIONS:LECs in intumescent white cataracts exhibited significant ultrastructural damage. These cellular alterations might correlate with less capsular fibrosis and greater IOL decentration following cataract surgery. This study provides a novel clinicopathologic perspective that LECs may influence postoperative capsular bag behavior. These findings suggest that in intumescent white cataracts with abnormal LECs, refining surgical practice and individualizing postoperative follow-up strategies are warranted to ensure long-term IOL stability.

Purpose The aim of this study was to evaluate the efficacy and safety of the Ahmed glaucoma valve in pediatric patients with refractory glaucoma. Methods A comprehensive literature search was conducted across multiple major databases, including PubMed, Embase, the Cochrane Library of Systematic Reviews, Science Direct, China's National Knowledge Infrastructure, and the Wanfang database. We retrieved studies published before December 2022 that met the inclusion criteria, including clinical controlled trials (randomized controlled trials) and clinical noncontrolled trials (non-randomized controlled trials) on the use of Ahmed glaucoma valve in pediatric patients with refractory glaucoma. We performed a meta-analysis and systematic review. The efficacy measures included intraocular pressure, number of anti-glaucoma medications, visual acuity, and success rate. The safety measures were complications. Statistical analysis was performed using RevMan 5.0 software. Results We identified 46 eligible studies: Compared with geographic location and study type, the Ahmed glaucoma valve showed a decrease in postoperative intraocular pressure and number of anti-glaucoma medications compared to preoperative levels in children with refractory glaucoma ( P < 0.001). Compared with etiological, the Ahmed glaucoma valve showed a decrease in intraocular pressure after surgery compared to preoperative levels in children with refractory glaucoma (SMD: 14.57, 95% CI: 14.05–15.08, P < 0.00 1), and a decrease in postoperative number of anti-glaucoma medications compared to preoperative number of anti-glaucoma medications (SMD: 1.45, 95% CI: 1.37–1.54, P < 0.001). Compared with trabeculectomy revision surgery, there was no significant difference in the complete success rate between the two groups (SMD: 0.86, 95% CI: 0.52–1.39; P = 0.37). Overall, the postoperative intraocular pressure at the time of Ahmed glaucoma valve implantation was lower than that at the time of trabeculectomy revision surgery (SMD: 1.01, 95% CI: 0.71–1.31, I2 = 99%, P < 0.001). Subgroup analyses based on whether mitomycin C was use d or not. There was a statistically significant difference in intraocular pressure between Ahmed's glaucoma valve surgery and preoperative (SMD: 14.13, 95% CI: 13.47–14.80, P = 0.007). Comparison of cumulative complete success rates of Ahmed S2, S3, and Ahmed FP7, FP8 in Ahmed glaucoma valve surgery (SMD: 0.74, 95% CI: 0.38–1.45, I2 = 85%, P = 0.38). There is no statistical difference between the two groups. Choroidal effusion and anterior chamber hemorrhage are the two most common adverse events after Ahmed's glaucoma valve surgery. Conclusions The Ahmed glaucoma valve implantation has some effectiveness in reducing intraocular pressure in children with refractory glaucoma, but there are still many complications. Valve model may not be the key factor affecting the postoperative effectiveness and adverse reactions of refractory glaucoma in children.

Purpose:To report the one-year follow-up outcomes of a surgical technique designed to rescue severely subluxated cataracts and stabilize the intraocular lens (IOL)-capsular bag complex using permanent polypropylene capsular hooks. Methods:Four patients (four eyes) with severely subluxated cataracts underwent surgery. A spatula was used to elevate and stabilize the dislocated lens in the retropupillary space to facilitate capsulorhexis. Phacoemulsification and aspiration were performed using capsular retractors and a capsular tension ring. Permanent polypropylene capsular hooks were implanted to stabilize the IOL-capsular bag complex. Postoperative outcomes were assessed over a follow-up period of at least 1 year. Descriptive analyses were performed to summarize and report the outcomes of this limited case series. Results:The follow-up period ranged from 13 to 20 months. All patients demonstrated improved and stable subjective refraction and best-corrected visual acuity (BCVA). At the final follow-up, the mean postoperative prediction error was -0.17 ± 0.29 D. Slit-lamp examinations showed that the IOL-capsular bag complex and the permanent polypropylene capsular hooks remained stable. Anterior segment optical coherence tomography (AS-OCT) revealed minimal IOL tilt of 1.52 ± 1.20. No intraoperative or postoperative complications were reported. Conclusion:The technique offers a viable approach for managing severely subluxated cataracts, providing stable support for the IOL-capsular bag complex and yielding favorable clinical outcomes. However, as this novel technique was evaluated in a small sample size, further studies with larger cohorts and longer follow-up periods are needed to confirm its long-term safety and efficacy.

Age-related macular degeneration (AMD), particularly its atrophic (dry) form, is a leading cause of irreversible blindness in the elderly. Limited treatment efficacy stems from its complex pathogenesis, highlighting an urgent need for novel therapeutic targets. This study investigates the contribution of the choroidal immune microenvironment, focusing on intercellular communication involving resident fibroblasts-a cell type whose role in AMD remains poorly defined. By analyzing single-cell RNA sequencing data from human choroid, we interrogated crosstalk between fibroblasts, macrophages, and NK/T cells, identifying interferon-gamma (IFNγ) and tumor necrosis factor-alpha (TNFα) signaling pathways as central mediators. We demonstrate that activated choroidal fibroblasts release key inflammatory mediators, including IL6, CCL2, CSF1, CXCL9, and CXCL10, which functionally recruit macrophages and CD8+ T cells, thereby shaping the local immune landscape. Critically, targeting these pathways in vivo using TAPI-1 (inhibiting TNFα processing) and Tofacitinib (inhibiting IFNγ signaling) significantly ameliorated retinal, RPE, and choroidal pathology in a NaIO3-induced murine model of dry AMD. Our findings underscore the pathogenic role of fibroblast-mediated choroidal inflammation driven by TNFα and IFNγ signaling in dry AMD, presenting these pathways as promising therapeutic targets.

Superhydrophilic surfaces play an important role in nature. Inspired by this, scientists have designed various superhydrophilic materials that are widely used in the field of biomaterials, such as PEG molecular brushes and zwitterionic materials. However, superhydrophilic coatings with only anti-fouling properties do not satisfy the requirements for rapid reendothelialization of cardiovascular stent surfaces. Herein, a novel polyphenol superhydrophilic surface with passivated protein-adsorption properties was developed using two-electron oxidation of dopamine and polyphenols. This coating has a multiscale effects: 1) macroscopically: anti-fouling properties of superhydrophilic; 2) microscopically: protein adhesion properties of active groups (quinone-, amino-, hydroxyphenyl groups and aromatic ring). Polyphenols not only enhance the ability of coating to passivate protein-adsorption, but also make the coating have polyphenol-related biological functions. Therefore, the polyphenol and passivated protein-adsorption platform together maintain the stability of the scaffold microenvironment. This, in turn, provides favorable conditions for the growth of endothelial cells on the scaffold surface. In vivo implantation of the coated stents into the abdominal aorta resulted in uniform and dense endothelial cells covering the surface of the neointima. Moreover, new endothelial cells secreted large amounts of functional endothelial nitric oxide synthase like healthy endothelial cells. These results indicate that the polyphenol superhydrophilic coating potentially resists intra-stent restenosis and promotes surface reendothelialization. Hence, polyphenol superhydrophilic coatings with passivated protein-adsorption properties constructed by two-electron-assisted oxidation are a highly effective and versatile surface-modification strategy for implantable cardiovascular devices.

A new kind of superhydrophilic drug-carrying coating was synthesized from dopamine and rapamycin to prevent nasolacrimal duct from obstructing through anti-inflammation, anti-infection and anti-fibrosis regulation. This research provides a versatile surface bioengineering strategy.