Importance: Vision language models (VLMs) enable generalist multimodal reasoning, but their ability to resolve brief, low-contrast cues in surgical video without task-specific training is uncertain. Autonomous artificial intelligence (AI) agents offer an alternative paradigm by autonomously generating supervised classifiers tailored to specific visual tasks. Objective: To benchmark the performance of VLMs against supervised classifiers engineered by autonomous AI agents for detecting anterior capsular radial folds during continuous curvilinear capsulorhexis (CCC), and to compare both approaches with human graders. Design, Setting, and Participants: This retrospective diagnostic study utilized a multicenter dataset of 537 CCC videos collected from Beijing Tongren Hospital (China), National University Hospital (Singapore), and the OphNet-APTOS public dataset. Exposure: Presence or absence of anterior capsular radial folds during CCC, defined based on established expert consensus, was annotated at both clip and frame levels by senior glaucoma surgeons. Two analytic paradigms were evaluated: (1) direct zero-shot and few-shot inference using 11 generalist and medical-specific VLMs on single frames and frame sequences; and (2) autonomous code generation by 4 AI agents to construct supervised image classifiers from labeled frames. Human comparison included 7 graders with varying levels of ophthalmic experience. Main Outcomes and Measures: Discrimination of fold-positive versus fold-negative cases was assessed using macro-averaged precision, recall, and F1-score at the clip and frame levels. Secondary outcomes included comparisons with human graders. Results: Among 537 video clips (7.32 ± 3.35 seconds), 156 (29.1%) were fold-positive. VLM performance was limited; the top-performing model, Qwen2.5-VL, achieved a mean F1-score of 0.519. Few-shot prompting improved GPT-4.1 performance (mean F1-score from 0.177 to 0.480) but remained unstable. In contrast, an agent-engineered classifier achieved an F1-score of 0.869 and an area under the receiver operating characteristic curve of 0.958. In comparison with human graders, the top agent-generated model (F1-score, 0.835) matched junior specialists (mean F1-score, 0.829), whereas fine-tuned VLMs (maximum F1-score, 0.606) underperformed all human graders. Conclusions and Relevance: Generalist VLMs showed limited capacity to detect subtle intraoperative cues, whereas autonomous AI agents successfully constructed task-specific classifiers with near-clinical-level performance. These findings support agent-driven supervised modeling as a more effective strategy for fine-grained surgical video interpretation. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of Beijing Tongren Hospital gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The dataset is available at https://huggingface.co/datasets/leonChen/Tongren-Zonular-Video.

Objective:To investigate preoperative predictors for anterior and posterior capsule laxity during phacoemulsification combined with anti-glaucoma surgery in eyes with angle closure. Methods:Cross-sectional study. Patients aged ≥40 years diagnosed with angle closure who underwent phacoemulsification combined with anti-glaucoma surgery between May 2023 and May 2025 were enrolled. Eyes were classified into four groups based on intraoperative findings: anterior capsule laxity, posterior capsule laxity, combined capsule laxity, and normal capsule. Mixed-effects logistic regression analysis was employed to determine the independent predictors of anterior and posterior capsule laxity, respectively. Results:A total of 241 eyes of 203 patients were included. 36 eyes (14.9%) had anterior laxity, 51 eyes (21.2%) had posterior laxity, 73 eyes (30.3%) had combined capsule laxity, and 81 eyes (33.6%) had normal capsule. Eyes with anterior laxity had shallower anterior chamber depth (ACD) than normal capsule eyes (2.05 (1.82,2.29) mm vs. 2.33 (2.13, 2.52) mm, P<0.001) and were more frequently acute primary angle closure (APAC) (P=0.001). Posterior/combined laxity eyes showed higher vitreous zonule (VZ) absence (both P<0.001); combined laxity having thicker lens than normal eyes (5.16 ± 0.35mm vs. 4.95 ± 0.43mm, P=0.006). Regression analysis identified APAC diagnosis (odds ratio (OR) 3.04, 95% confidence interval (CI): 1.01-9.38, P=0.049) and shallower ACD (OR 0.05, 95% CI: 0.01-0.26, P=0.001) as independent predictors for anterior capsule laxity, while APAC diagnosis (OR 3.89, 95% CI: 1.20-13.50, P=0.026), VZ absence (OR 0.11, 95% CI: 0.04-0.27, P<0.001), and increased ciliary body maximum thickness (CBMT) (OR 1.92, 95% CI: 1.22-3.17, P=0.007) predicted posterior capsule laxity. The anterior and posterior capsule laxity prediction models achieved AUC values of 0.817 (95% CI: 0.739-0.896) and 0.781 (95% CI: 0.690-0.872), respectively. Conclusions:APAC diagnosis and shallow ACD predict anterior capsule laxity, whilst VZ absence, APAC diagnosis, and increased CBMT indicate posterior capsule laxity in eyes with angle closure. Identification of these biomarkers before surgery may help surgeons anticipate complications and optimize postoperative outcomes.

Early intraoperative warning signs of zonular instability during cataract surgery, such as anterior capsular radial folds, are subtle and easily missed but are clinically important for preventing surgical complications. Whether current artificial intelligence (AI) systems can reliably detect such subtle warning signs in real-world surgical video remains unknown. Recently, automated AI model generators have become available, enabling the automatic construction of task-specific AI models for individual clinical tasks. To evaluate the diagnostic performance of general-purpose and automated task-specific artificial intelligence systems for detecting anterior capsular radial folds during cataract surgery and to compare their performance with human clinicians. This retrospective diagnostic study used 537 continuous curvilinear capsulorhexis (CCC) video clips collected from Beijing Tongren Hospital (China), National University Hospital (Singapore), and the OphNet-APTOS public dataset. Presence or absence of anterior capsular radial folds during CCC, annotated at both clip and frame levels by senior glaucoma surgeons based on expert consensus. Discrimination between fold-positive and fold-negative cases was assessed using macro-averaged precision, recall, and F1 score at the frame and clip levels. Performance was compared among general-purpose AI systems, task-specific models generated by an automated AI model generator, and human graders with different levels of clinical experience. Among 537 video clips (mean 7.32 seconds), 156 (29.1%) were fold-positive. General-purpose AI systems showed limited and inconsistent performance; the best-performing model achieved a mean F1 score of 0.519, and fine-tuned models remained inferior to human graders (maximum F1 score, 0.606). In contrast, task-specific models generated by an automated AI model generator achieved substantially higher performance (F1 score, 0.869; area under the receiver operating characteristic curve, 0.958). In head-to-head comparison with clinicians, the top automated task-specific model (F1 score, 0.835) matched the performance of junior specialists (mean F1 score, 0.829) but remained below that of senior specialists. General-purpose artificial intelligence systems do not reliably detect subtle intraoperative warning signs during cataract surgery and consistently underperform human clinicians. In contrast, recently available automated AI model generators enable the creation of task-specific models with near–junior specialist performance. These findings suggest that clinically reliable surgical AI is more likely to be achieved through automated generation of task-specific models rather than through general-purpose AI systems. Although evaluated in cataract surgery, these findings highlight a broader challenge for artificial intelligence in detecting brief, low-contrast intraoperative warning signs in surgical video. How reliably can general-purpose artificial intelligence (AI) systems and task-specific AI models generated by an automated AI model generator detect subtle intraoperative warning signs during cataract surgery compared with human clinicians? In this multicenter diagnostic study of 537 cataract surgery video clips, general-purpose AI systems were unreliable and consistently underperformed human clinicians in detecting anterior capsular radial folds. In contrast, task-specific AI models generated by an automated AI model generator—a technology that has only recently become available—achieved substantially higher diagnostic performance and matched the performance of junior specialists. General-purpose AI systems show limited reliability for detecting subtle intraoperative warning signs during cataract surgery. The recent availability of automated AI model generators enables a new paradigm of task-specific model development and represents a more clinically viable path for surgical decision support.

Objective:Primary angle closure disease (PACD) has long been the focus of screening, yet most cases are nonprogressive. In contrast, primary angle closure with or without glaucoma (PAC/G) poses greater risk and may deserve more attention. We aimed to compare screening indicator profiles for PACD and PAC/G, highlighting potential differences that may inform a shift in screening priorities. Design:A population-based cross-sectional study. Participants:Adults aged ≥35 years who completed standardized eye examinations. Only right eyes were analyzed; eyes with prior laser peripheral iridotomy were excluded. Methods:Participants underwent gonioscopy, anterior-segment OCT (AS-OCT), and A-scan ultrasound biometry. Univariable logistic regression and multivariable elastic-net models assessed the association and discriminative performance of AS-OCT parameters for detecting PACD and PAC/G. Main Outcome Measures:Odds ratios (ORs) and area under the receiver operator characteristic curve (AUROC) values of AS-OCT parameters for detecting PACD and PAC/G. Results:Of the 4546 eyes analyzed, 3831 had open angles and 715 had PACD, of which 53 had PAC/G. In the univariable logistic regression analysis, the angle opening distance (AOD) at 250 μm (AOD250) and the trabecular-iris space area (TISA) at 500 μm (TISA500) were more strongly associated with PAC/G than with PACD (P < 0.05, Wald test), whereas AOD500/750 and TISA750 were not significantly different in association. Additionally, TISA750 exhibited the highest AUROC value (0.88) for detecting PACD, whereas TISA500 had the highest AUROC value (0.91) for detecting PAC/G. Higher iris curvature was significantly associated with increased odds of PACD (OR: 1250.26; 95% confidence interval [CI]: 234.52-2265.99) but not with PAC/G (P < 0.05, Wald test). In the multivariable models for detecting PAC/G, a profile characterized by lower iris curvature (OR: 0.06; 95% CI: 0.05-0.08), narrower angle width (AOD500, TISA500, and TISA750), smaller anterior chamber area and volume, and smaller pupil diameter achieved an AUROC of 0.908 (95% CI: 0.858-0.959). Conclusions:Angle parameters closer to the scleral spur were underestimated, and curved irises were overestimated when screening for PAC/G versus PACD. Anterior-segment OCT-derived models for PAC/G screening have shown promising feasibility in population-based settings. Financial Disclosures:The authors have no proprietary or commercial interest in any materials discussed in this article.

P URPOSE . To elucidate the genetic basis of primary angle-closure glaucoma (PACG) by identifying pathogenic tissue and critical tissue-specific variants. M ETHODS . The correlations among PACG susceptibility, axial length (AL), and anterior chamber depth (ACD) were evaluated using meta-analyses. Propensity score matching was utilized on 2161 participants from the Handan Eye Study to determine the risk factors independent of ACD and AL for PACG. Subsequently, we employed the assay for transposase-accessible chromatin with sequencing (ATAC-seq) and allele-specific self-transcribing active regulatory region sequencing (STARR-seq) to screen 202 PACG genome-wide association study (GWAS) variants for chromatin accessibility and functional roles. R ESULTS . The meta-analysis found that PACG susceptibility loci are not associated with ACD or AL. However, abnormal iris phenotypes emerged as significant independent risk factors for primary angle-closure disease (PACD), unrelated to ACD and AL. Substantial enrichment of PACG heritability was observed in the open chromatin regions of the human iris. Within the iris-relevant cellular context, 22 out of the 202 PACG GWAS variants could influence enhancer activity. Two variants in the iris open chromatin regions were implicated in the modulation of PLEKHA7 and C10orf53 expression. The downregulation of these two genes affects cytoskeletal organization. C ONCLUSIONS . Our findings underscore the importance of the iris in the pathogenesis of PACG and identified iris-specific, enhancer-modulating variants that may influence disease risk. Our approach also provides a generalizable framework for studying ocular diseases from the perspective of enhancer-modulating variants.

Introduction: Bilateral acute iris transillumination (BAIT) is characterized by acute bilateral onset of intense pigment dispersion in the anterior chamber, diffuse iris transillumination, and mydriatic atonic pupils, accentuated pigment deposition in the angle of anterior chamber, and elevated intraocular pressure (IOP). Herein, we report an unusual case of a Chinese patient with BAIT presented to our hospital with no iris transillumination defect. Case Presentation: A 37-year-old male patient presented to our settings with bilateral photophobia, redness, and blurry vision. The symptoms began acutely following a respiratory illness, for which he was treated with moxifloxacin. The patient demonstrated a profound thick layer of pigment deposition on the anterior surface of the lens, corneal endothelial pigment dusting, and trabecular meshwork hyperpigmentation. He was previously diagnosed with acute anterior uveitis with accentuated IOP rise, and was subsequently treated with topical corticosteroids, cycloplegic, and IOP-lowering medications. Despite aggressive medical treatment, IOP remained refractory. The retinal nerve fiber layer severely restricted in both eyes (OU). He was then referred to our glaucoma consultant practice. Although low-energy Selective Laser Trabeculoplasty (SLT) (Quantel, USA) was then performed, it elicited no favorable response, a result that was different compared to previous reports on Caucasian patients. Finally, we performed binocular trabeculectomy combined with mitomycin application, resulting in the optimal IOP control. Conclusion: BAIT in Chinese patients has atypical characteristics, which can highly contribute to misdiagnosis and therapeutic delay with significant consequences. Simultaneously, it is essential to differentiate BAIT from iridocyclitis and pigment dispersion syndrome.

Purpose: To investigate the proportion of zonulopathy in patients with age-related cataract, and further explore demographics and ocular characteristics, as well as potential risk factors. Methods: Hospital-based, observational, cross-sectional study. We enrolled consecutive patients who were 45 years or older and diagnosed with age-related cataract and underwent surgery between October 2022 and April 2023 at the Division of Cataract, Beijing Tongren Hospital. Zonulopathy was diagnosed based on intraoperative signs. We calculated the total proportion, age, and gender specific proportions of zonulopathy. We compared the demographic and ocular characteristics between the cases with and without zonulopathy. Univariate and multivariate logistic regression analyses were employed to determine the risk factors associated with the presence of zonulopathy in patients with age-related cataract. Results: A total of 640 age-related cataract patients with a median age of 70.0 (64.0–77.0) were enrolled. Zonulopathy was diagnosed intraoperatively in 70 patients (10.9%). Compared with the patients having no zonulopathy, those with zonulopathy were likely to be older (P < 0.001), have a shallower central ACD (P < 0.001), a thicker lens (P < 0.001) and a shorter AL (P = 0.010). Logistic regression analyses showed that the risk predictors associated with the presence of zonulopathy in patients with age-related cataract were older age (OR, 1.042; P = 0.035) and shallower central ACD (OR, 0.834; P < 0.001). Conclusion: Zonulopathy in age-related cataract patients is not an uncommon finding. Clinicians should be mindful of zonulopathy in patient population with advanced age and shallower ACD.

男性，47岁。因视物有光晕伴雾感而就诊。右眼矫正视力0.3，眼压23 mmHg，裂隙灯检查应用宽裂隙光的切向照明法，可见右眼晶状体前表面的中央盘状脱屑及中间透明带，瞳孔缘处灰白色碎屑物质沉着(左图)。房角开放，小梁网色素增加、色素颗粒粗大且分布不均(右图)。盘沿及视网膜神经纤维层尚可。

Précis: The proportion, clinical characteristics, and risk factors of zonulopathy in primary angle closure disease (PACD) were analyzed. Zonulopathy is an underrecognized common finding in PACD, especially in patients with acute angle closure (AAC). Purpose: To examine the proportion and risk factors associated with intraoperative zonulopathy in PACD. Patients and Methods: This is a retrospective analysis of 88 consecutive patients with PACD who underwent bilateral cataract extraction at Beijing Tongren Hospital from August 1, 2020 to August 1, 2022. Zonulopathy was diagnosed based on intraoperative findings including the presence of a lens equator, radial folds of the anterior capsule while making capsulorhexis, and other signs of the unstable capsular bag. The subjects were grouped based on their PACD subtype diagnoses: AAC, primary angle closure glaucoma (PACG), primary angle closure (PAC), or primary angle closure suspect (PACS). Multivariate logistic regression was performed to identify risk factors associated with zonulopathy. The proportion and the risk factors of zonulopathy were estimated in patients with PACD and in PACD subtypes. Results: Of 88 patients with PACD (67.3 ± 6.9 y old, 19 males and 69 females), the overall proportion of zonulopathy was 45.5% of patients (40/88) and 30.1% of eyes (53/176). Among the PACD subtypes, the proportion of zonulopathy was highest (69.0%) in AAC, followed by 39.1% in PACG, and 15.3% in PAC and PACS combined. AAC was an independent risk factor associated with zonulopathy ( P = 0.015, AAC vs PACG, PAC, and PACS combined; odds ratio: 0.340, CI: 0.142–0.814). Shallower anterior chamber depth ( P = 0.031) and greater lens thickness ( P = 0.036), but not laser iridotomy, were associated with an increased proportion of zonulopathy. Conclusions: Zonulopathy is common in PACD, especially in patients with AAC. Shallow anterior chamber depth and thick lens thickness were associated with an increased proportion of zonulopathy.

女性20岁患者双眼开角型青光眼,右眼小梁切除术后2个月眼球按摩,术后25个月视力下降,诊断为圆锥角膜.减少按摩频次和力量,随访9个月,眼压正常,圆锥角膜无进展.

PURPOSE:To analyze the trends of glaucoma surgery procedures over the past 5 years among hospitals across major provinces in China.MATERIALS AND METHODS:This was a retrospective observational study based on medical records. We obtained the annual numbers of commonly performed glaucoma incisional surgeries from 57 hospitals of 30 provincial regions in the Chinese Glaucoma Study Consortium (CGSC) from January 2015 to September 2019. The trend of glaucoma surgery was analyzed by Cochrane-Armitage trend test.RESULTS:Trabeculectomy, cataract extraction combined with goniosynechialysis, cataract extraction combined with trabeculectomy, and surgical peripheral iridotomy (SPI) were the top 4 surgical procedures percentages of which have the most substantial change over the course of 2015 to 2019 (all Ptrend <0.001). Numbers of trabeculectomies decreased significantly from 47.59% in 2015 to 31.21% in 2019; cataract extraction combined with goniosynechialysis increased from 12.12% to 28.48%; cataract extraction combined with trabeculectomy increased from 13.11% to 15.97%; and SPI decreased from 9.03% to 6.34%. The proportion of internal drainage surgery increased from 24.31% in 2015 to 39.29% in 2019 while external drainage surgery decreased from 69.20% to 54.64% (All Ptrend <0.001). The microinvasive glaucoma surgeries including AB-interno Canaloplasty, gonioscopy-assisted transluminal trabeculotomy, and Trabectome, increased from 0.62% to 1.40% (Ptrend<0.001). Across all study hospitals, the trends were similar, except for the Tibet Autonomous Region Eye Center, where SPI and trabeculectomy remained the most common anti-glaucoma surgeries.CONCLUSION:In the past 5 years, we observed substantial reduction in trabeculectomy, and increase in combination cataract-glaucoma procedures across major hospitals in China. The proportion of internal drainage surgery increased, while external drainage surgery decreased significantly. Detailed understanding of shifting trends in glaucoma surgeries can facilitate better health care resource allocation and training of glaucoma subspecialists in China.

目的 调查2020年新冠疫情严格管控初期（1月23日～2月23日）及缓解期（10月1～31日）眼科急诊疾病谱特征。设计横断面调查。研究对象新冠疫情严格管控初期及缓解期北京同仁医院（崇文门及亦庄院区）眼科急诊连续就诊的病例7741例。方法 通过医院信息系统收集与分析患者人口学信息、疾病诊断、就诊时间。主要指标疾病构成比。结果 缓解期接诊5704例,是初期的2.8倍。30～39岁就诊者最多,占21.8%（初期占22.6%,缓解期占21.5%）。初期与缓解期患者平均年龄分别为（43.0±20.1）岁、（39.6±21.2）岁（P＜0.001）,18岁以下者初期与缓解期分别占12.3%、19.7%（P＜0.001）。7741例中眼表疾病占43.0%,（初期41.4%、缓解期43.6%）,眼外伤占29.5%（初期28.9%、缓解期29.7%,其中初期及缓解期电光性眼炎分别占3.5%、0.7%,P＜0.001;眼球穿通伤分别占2.7%、1.7%,P＜0.05;眼异物伤分别占2.7%、6.2%,P＜0.05）,眼睑泪器疾病占10.3%（初期9.0%、缓解期10.9%）、青光眼占5.8%（初期7.8%、缓解期5.0%,P＜0.001）、玻璃体视网膜疾病占4.0%（初期4.9%、缓解期3.6%）、自身免疫性疾病占3.0%（初期4.1%、缓解期2.6%）。结论 新冠疫情造成眼科急诊就诊人数减少尤其是18岁以下患者。疫情期间电光性眼炎明显增多,眼异物伤明显减少。（眼科,2022,31:45-50）

男性,68岁.2021年4月因慢性闭角型青光眼右眼急性发作行小梁切除术联合丝裂霉素C.9月行右眼白内障超声乳化摘除IOL植入联合房角分离术.术前查体裂隙灯检查发现晶状体前囊呈波浪状(上图、中图).进一步检查发现波浪状前囊为急性高眼压下小梁切除术术后产生的瞳孔区渗出膜,紧密贴附于晶状体前囊膜表面(下图),术中轻巧撕除晶状体前囊渗出膜,完成连续环形撕囊.术后视力0.8,IOL位置正,眼压11～16 mmHg.

北京同仁医院积累了几十年的眼科进修医生的教学经验,近年来在进修医生教学实践中应用"以问题为导向"(Problem-Based Learning,PBL)教学法,逐步总结出独特的"辩误施教"教学法.这种教学方法有利于加深进修医生对基础知识理论的理解,提高进修医生发现问题、解决问题的能力及独立的临床思维能力.每月定期召开进修医生沙龙,进行必要的考核、多种形式的总结和交流有利于促进交流,提高教学效果.

OBJECTIVE:To analyze the rates of blindness with the demographics and clinical characteristics of patients with primary angle-closure disease (PACD) to provide a comprehensive epidemiologic reference in China.METHODS:A retrospective analysis was conducted in the Chinese Glaucoma Study Consortium database, which is a national multicenter glaucoma research alliance of 111 hospitals participating between December 21, 2015 and September 9, 2018. The diagnosis of PACD was made by qualified physicians through examination. Comparison of sex, age, family history, subtypes of PACD, and blindness were analyzed.RESULTS:A total of 5762 glaucoma patients were included, of which 4588 (79.6%) had PACD. Of PACD patients, 72.1% were female with the sex ratio (F/M) of 2.6, and the average age of patients was 63.8±9.3 years with the majority between 60 and 70 years. Additionally, 30% of these patients had low vision in one eye, 8.8% had low vision in both eyes, 1.7% had blindness in one eye, and 0.3% had blindness in both eyes. There were statistical differences with regards to age between male and female patients with PACD, with male patients being older on average. Primary angle-closure glaucoma was more commonly diagnosed in males (60%) compared to females (35.9%), whereas acute primary angle closure (APAC) was more commonly diagnosed in females (54.3%) compared to males (37.7%). The visual acuity in APAC patients was lower and the rate of low vision and blindness was higher than other subtypes.CONCLUSION:PACD was the major type of glaucoma in Chinese hospitals. There were more female patients with PACD, mostly between 60 and 70 years old, with higher rates of APAC in women. APAC resulted in the worst visual outcomes of all PACD subtypes.

BackgroundTo explore the outcomes and mechanisms of intraocular pressure (IOP) control using low-dose transscleral cyclophotocoagulation (LDTSCP) followed by phacoemulsification in patients with prolonged acute primary angle closure (APAC).MethodsPatients with prolonged APAC refractory to all other treatment modalities were prospectively recruited, and underwent LDTSCP (10 shots, 2 s duration, 120° treatment with the energy starting at 1500 mW and titrated to the level with audible burst but not exceeding 2000 mW) and anterior chamber paracentesis 1 week prior to phacoemulsification with intraocular lens implantation and viscogoniosynechiolysis. Postoperative IOP, vision, anatomic changes on anterior segment optical coherence tomography and complications were recorded.ResultsTwenty eyes with prolonged APAC were recruited. Median follow-up was 12 months (range 9–18), at which point the vision in all eyes had improved and IOP was ≤17 mm Hg on no antiglaucoma medications. Following LDTSCP at postoperative day (POD) 1, IOP decreased in all eyes to a median 15 mm Hg (range: 6–28 mm Hg). Post-LDTSCP supraciliary effusion (SCE) occurred in 90% of eyes on POD1 or POD7 and ciliary body defect (CBD) was detected in 30% of eyes and resolved in all cases by postoperative month 1. Lower post-LDTSCP IOP was associated with more number of bursts (r=−0.558, p=0.011) and higher grade of SCE (r=−0.877, p<0.001), but not with total energy (p=0.240). Eyes with CBD (p=0.018) and a higher number of bursts (r=0.657, p=0.002) had higher grade SCE.ConclusionsLDTSCP-induced SCE may explain the post-LDTSCP IOP reduction seen in eyes with prolonged APAC. LDTSCP instead of traditional more extensive treatment, was sufficient to provide a relatively safe and effective bridge therapy prior to phacoemulsification.Trial registration numberChinese Clinical Trials Registry (ChiCTR1900023567).

目的:了解儿童罹患青光眼的疾病类型、特点,更好地做到早期发现早期治疗.方法:收集北京同仁医院2014—2019年度834例0～18周岁住院接受抗青光眼手术的患者,回顾性分析患者的人群特点与疾病构成特点.结果:834例患者中,原发青光眼397例(47.6％),继发青光眼429例(51.4％).另有8例无法明确诊断青光眼类型.原发青光眼中以原发先天性青光眼最常见,继发青光眼中以白内障术后继发青光眼为主,两种类型的青光眼占总患者数的50％.结论:儿童罹患青光眼的疾病种类繁多,其中原发先天青光眼与白内障术后继发青光眼最常见,重视婴幼儿先天青光眼的筛查,监测儿童白内障术后眼压有助于早期发现青光眼,并给予治疗,延缓儿童青光眼患者视功能的损害.

目的:调查内蒙古包头地区原发性闭角型青光眼(PACG)患者视功能相关生活质量以及焦虑抑郁状况并分析其影响因素。方法:采用横断面研究设计，连续收集2018年9月至2020年1月于包头朝聚眼科医院就诊的治疗后双眼随机3次非接触眼压值≤20 mmHg(1 mmHg＝0.133 kPa)的PACG患者182例364眼，记录患者性别、年龄、婚姻状况、教育水平、月收入、治疗花费总额、青光眼治疗时间、手术及药物治疗史、最佳矫正视力(BCVA)、Humphrey视野指标以及美国国立眼科研究所视功能相关生活质量量表-25(NEI-VFQ-25)和医院焦虑抑郁量表(HADS)评分。年龄与VFQ-25评分的相关性采用Pearson相关分析；其他数据资料之间的相关性采用Spearman秩相关分析。采用多元逐步线性回归分析方法分别分析VFQ-25评分、HADS评分与上述分析中有统计学意义的影响因素之间的相关性。结果:纳入患者的平均年龄为(59.75±8.43)岁。VFQ-25综合得分为68.59±14.43，HADS、焦虑亚量表(HADS-A)和抑郁亚量表(HADS-D)得分分别为16.00(12.00，20.00)、8.00(6.00，10.00)、8.00(6.00，10.00)。焦虑或抑郁状态(HADS-A或HADS-D评分>10分)患者占比分别为18.1%(33/182)和13.7%(25/182)。受试者年龄与视功能较好眼BCVA和视功能较差眼BCVA均呈正相关( rs＝0.36、0.29，均 P<0.01)，与损害较轻眼Humphrey视野平均缺损(MD)、损害较重眼MD、损害较轻眼VFI、损害较重眼VFI均呈负相关( rs＝-0.21、-0.23、-0.30、-0.23，均 P<0.01)。VFQ-25评分与年龄、视功能较好眼BCVA、视功能较差眼BCVA均呈负相关( rs＝-0.32、-0.34、-0.48，均 P<0.01)，与损害较轻眼MD、损害较重眼MD、损害较轻眼VFI、损害较重眼VFI均呈正相关( rs＝0.37、0.45、0.38、0.46，均 P<0.01)。HADS-A评分与损害较轻眼MD呈负相关( rs＝-0.20， P<0.01)；HADS-D评分与视功能较差眼BCVA呈正相关( rs＝0.26， P<0.01)，与损害较轻眼MD、损害较重眼MD、损害较重眼VFI均呈负相关( rs＝-0.21、-0.22、-0.22，均 P<0.01)；HADS评分与视功能较差眼BCVA呈正相关( rs＝0.22， P<0.01)，与损害较轻眼MD、损害较重眼MD、损害较重眼VFI均呈负相关( rs＝-0.20、-0.20、-0.21，均 P<0.01)；VFQ-25评分与HADS-A评分、HADS-D评分、HADS评分均呈负相关( rs＝-0.41、-0.41、-0.45，均 P<0.01)。经多因素分析，影响VFQ-25评分的因素包括年龄( P<0.01)、教育水平( P<0.01)、治疗花费总额( P<0.05)、视功能较好眼BCVA( P<0.05)和损害较重眼MD( P<0.01)；影响HADS评分的因素包括性别( P<0.05)和VFQ-25评分( P<0.01)。 结论:内蒙古包头地区PACG患者视功能相关生活质量和焦虑或抑郁状态患者占比均较低。随着年龄增加，PACG患者视功能下降，视野损害程度加重，视功能相关生活质量下降，焦虑和抑郁程度加重。教育水平低、治疗花费总额高的患者视功能相关生活质量较差；女性患者更易出现焦虑和抑郁状态。

AIM:PAX6 is a transcription factor involved in embryonic development of many organs, including the eyes and the pancreas. Mutations of PAX6 gene is the main cause of a rare disease, congenital aniridia (CA). This case-control study aims to investigate the effects of PAX6 mutations on glucose metabolism and insulin secretion in families with CA. METHODS:In all, 21 families with CA were screened by Sanger sequencing. Patients with PAX6 mutations and CA (cases) and age-matched healthy family members (controls) were enrolled. Oral glucose tolerance test (OGTT) was performed to detect diabetes or impaired glucose tolerance (IGT). Insulin and proinsulin secretion were evaluated. RESULTS:Among 21 CA families, heterozygous PAX6 mutations were detected in five families. Among cases (n = 10) from the five families, two were diagnosed with newly identified diabetes and another two were diagnosed with IGT. Among controls (n = 12), two had IGT. The levels of haemoglobin A1c were 36 ± 4 mmol/mol (5.57 ± 0.46%) and 32 ± 5 mmol/L (5.21 ± 0.54%) in the cases and the controls, respectively (p = 0.049). More importantly, levels of proinsulin in the cases were significantly higher than that of the controls, despite similar levels of total insulin. The areas under the curve of proinsulin in the cases (6425 ± 4390) were significantly higher than that of the controls (3709 ± 1769) (p = 0.032). CONCLUSION:PAX6 may participate in the production of proinsulin to insulin and heterozygous PAX6 mutations may be associated with glucose metabolism in CA patients.

目的 分析新型冠状病毒肺炎疫情期间眼科急诊眼外伤疾病谱变化趋势及流行病学特点.设计回顾性比较性病例系列.研究对象以2020年1月23日至3月31日北京同仁医院眼科急诊就诊的1209例眼外伤患者作为研究组,以2019年同期就诊的2444例眼外伤患者作为对照组.方法 通过医院信息系统调取数据,登记并整理患者的年龄、性别、就诊时间、眼外伤类别、致伤部位、就诊数量等情况,对眼外伤急诊疾病谱变化及流行病学特点进行分析.主要指标年龄、性别、就诊时间、急诊诊断、患者数量.结果 疫情期间眼科急诊患者总数5978例,眼外伤患者1209例,占20.2％;2019年同期眼科急诊患者总数12776例,眼外伤患者2444例,占19.1％(x2=3.111,P=0.078).研究组男性患者835例(69.1％),对照组男性患者1743例(71.3％)(x2=1.976,P=0.160).研究组患者年龄37.0(26.5,52.0)岁,对照组患者年龄35.0(22.0,50.0)岁(U=1369248.50,P＜0.001).两组间各年龄组的就诊患者均以青年组(18～44岁)占比最高(研究组561例,46.4％;对照组1090例,44.6％)(x2=1.062,P=0.303);未成年组(0～17岁)患者就诊例数及比例的差异有统计学意义(研究组199例,16.5％;对照组548例,22.4％)(x2=17.854,P＜0.001).疫情期间非机械性眼外伤患者例数增多,其中电光性眼炎患者较去年同期明显增多(研究组141例,81.0％;对照组53例,46.9％)(x2=36.437,P＜0.001).机械性眼外伤患者较去年同期明显下降(研究组1035例,85.6％;对照组2331例,95.4％)(x2=106.619,P＜0.001).机械性眼外伤最常累及眼睑(研究组599例,57.9％;对照组1351例,58.0％)(x2=0.002,P=0.964);研究组的结膜损伤较对照组增多(研究组213例,20.6％;对照组336例,14.4％)(x2=19.959,P＜0.001);葡萄膜损伤较去年同期减少(研究组39例,3.8％;对照组131例,5.6％)(x2=5.125,P=0.024);开放性眼外伤所占比例的差异无统计学意义(研究组101例,9.8％;对照组193例,8.3％)(x2=1.966,P=0.161).结论 新型冠状病毒肺炎疫情期间眼科急诊总量及眼外伤急诊量明显下降.男性、青年、未成年人仍是急诊眼外伤的高发人群,未成年人发病率较去年同期下降.电光性眼炎患者明显增多,机械性眼外伤患者明显下降.