PURPOSE:To evaluate the effect of anterior capsule polishing (ACP) on postoperative formation of the capsule-intraocular lens (C-IOL) complex in patients with cataract who have normal axial length. METHODS:In this prospective randomized controlled trial, patients were assigned to either 360° ACP or no polishing. Primary outcomes (capsular bend index [CBI], adhesion index [AI], and continuous curvilinear capsulorhexis diameter [CCCD]) and secondary outcomes (IOL tilt and decentration) were quantitatively assessed at 1 week, 1 month, and 3 months postoperatively using 14-meridian swept-source optical coherence tomography (SS-OCT) (CASIA 2; Tomey). Additional secondary outcomes were root mean square (RMS), corrected distance visual acuity (CDVA), and spherical equivalent refraction (SER). RESULTS:Forty-five eyes were enrolled (23 ACP, 22 control), and 40 (20 per group) completed a 3-month follow-up. At 3 months, the ACP group showed lower CBI (3.16 vs 3.68; P = .001) and AI (0.00 vs 0.32; P = .023), larger CCCD (5.30 vs 5.04 mm; P = .025), and less CCCD contraction (0.11 vs 0.22 mm; P = .034). Between-visit changes in CBI and AI did not differ between groups. Vertical tilt and its RMS were greater with ACP (P = .012 and .009, respectively), whereas horizontal tilt, decentration, CDVA, and SER were comparable. CONCLUSIONS:ACP slows early C-IOL structural maturation (reduced capsular-bend kinetics and delayed capsule-IOL adhesion) without compromising early refractive stability and stabilizes the capsulorhexis, but increases vertical IOL tilt. These findings support selective use in eyes prone to contraction and caution when precise IOL alignment is required.

Purpose To identify risk factors associated with the development of high myopia following congenital cataract surgery and to establish a robust predictive model. Design Retrospective clinical cohort study. Subjects This retrospective study included 106 pediatric patients who underwent congenital cataract surgery with primary IOL implantation (mean follow-up 8.19 years). The model was externally validated in an independent cohort of 72 patients with a mean follow-up of 7.83 years. Methods Preoperative and postoperative ocular biometric parameters were collected. Risk factors for postoperative high myopia were analyzed using Cox proportional hazards regression, which served as the basis for model construction. The predictive performance of the model was rigorously evaluated for discrimination and calibration. Discriminative ability was quantified using Harrell’s C-index and the area under the receiver operating characteristic curve (AUC). Model calibration was assessed via calibration plots by comparing predicted probabilities with actual observed outcomes. Internal validation was performed using a bootstrapping method (500 iterations) to ensure model stability and adjust for potential overfitting. Results An initial postoperative refraction of <+0.75D, and a higher IOL Power to Axial length Ratio (IOL/AL ratio) were identified as significant risk factors for the development of postoperative high myopia. Shorter preoperative axial length was associated with a greater magnitude of postoperative myopic shift. The predictive model demonstrated robust performance, achieving a C-index of 0.711 (internal validation C-index: 0.713). The area under the receiver operating characteristic curve (AUC) values for predicting high myopia at 5 and 10 years were 0.858 and 0.745, respectively. Furthermore, calibration curves demonstrated excellent agreement between the predicted and observed outcomes throughout the follow-up period. In external validation, the model achieved a C-index of 0.825, 5-year AUC of 0.833, and 10-year AUC of 0.713. Conclusions Our analysis established that initial postoperative refraction <+0.75D, and an elevated IOL/AL ratio are key determinants of high myopia risk following surgery. Shorter preoperative axial length was associated with a greater magnitude of postoperative myopic shift. This predictive framework provides clinicians with a practical tool to optimize preoperative IOL selection and identify high-risk infants who require vigilant myopia prevention and balanced amblyopia management.

IntroductionCongenital cataract is a major cause of blindness and severe visual impairment in children. It may occur as an isolated ocular abnormality or in combination with microcornea, microphthalmia, aniridia, or glaucoma. It can also be part of syndromic conditions. Whole-exome sequencing (WES) is now recognized as an appropriate first-line approach for genetic testing in patients with congenital cataract. In this study, we use WES to characterize the genotype spectrum in a pediatric cataract cohort from southern China.MethodsIn this study, we aimed to clarify the genetic basis of congenital cataract in 40 families from southern China by WES. All candidate variants were confirmed by Sanger sequencing. After bioinformatic analysis, we prioritized rare or novel variants predicted to have moderate to damaging effects and assessed their segregation within each family.ResultsIn this cohort of 40 probands with congenital cataract, pathogenic/likely pathogenic variants were identified in 15 (37.5%) individuals, including 6 sporadic cases and 9 familial cases. The identified variants involved 12 genes (CRYBB3, CRYBB2, CRYGS, CRYAA, GJA8, MIP, NHS, BCOR, COL11A1, PAX6, FTL, and FYCO1). In total, 15 pathogenic/likely pathogenic variants were detected, of which 7 were novel. Among genotype-positive patients, seven presented with syndromic cataract, whereas eight had non-syndromic cataract.DiscussionThis study performed WES in 40 probands with congenital cataracts from southern China and achieved a molecular diagnostic yield of 37.5%. Pathogenic/likely pathogenic variants were predominantly identified in crystallin genes, genes encoding lens membrane proteins, and genes implicated in syndromic forms of disease. Notably, a substantial proportion of apparently sporadic cases harbored variants suggestive of a de novo origin. These findings support the clinical utility of WES in clarifying the genetic basis of genetically heterogeneous congenital cataract. They also underscore the limitations of WES compared with whole-genome sequencing (WGS) and highlight the need for larger cohorts and functional validation of candidate variants.

BackgroundWe investigated the metabolic profiles of aqueous humor (AH) among patients with high-myopia complicated nuclear cataract (HMnC), age-related nuclear cataract (NC), cortical cataract (CC), and high myopia (HM); we sought to identify possible metabolic mediators for these conditions.MethodsThe metabolic data of AH from 29 patients (nine with HMnC, nine with CC, seven with NC, and four with high myopia) were analyzed by liquid chromatography-tandem mass spectrometry. Principal component analysis, sample correlation analysis, and orthogonal partial least squares discriminant analysis modeling were conducted. Univariate and multivariate analyses were performed to identify differential metabolites with potential biological significance.ResultsFor HMnC patients, the level of glutathione was decreased, whereas arginine, tyrosine, and tryptophan were more abundant in AH. Dihomomethionine and 8-methylthiooctanaldoxime located in the methionine metabolic pathways were downregulated in NC samples compared with HMnC samples. Additionally, the levels of D-alanyl-D-alanine, 1-methylpyrrolinium, L-phenylalanine, ecgonine methyl ester, ecgonine, tropinone, and azacyclohexane, NNK-N-oxide, 3-succinoylpyridine, and N-nitrosodimethylamine were all upregulated in HM samples compared with HMnC samples.ConclusionThis work identified valuable metabolic biomarkers and pathways that may improve understanding HMnC pathogenesis. Here, we found that a decrease in glutathione might promote the occurrence of HMnC. Arginine, tyrosine, and tryptophan were more abundant in AH from HMnC patients and tended to prevent HMnC progression. These findings have translational value in terms of developing new therapeutic measures for HMnC-related complications.

Benign Metastasizing Leiomyoma (BML) and Intravenous Leiomyomatosis (IVL) are rare uterine-derived smooth muscle tumors. Although both exhibit histologically benign and similar features, they demonstrate aggressive biological behaviors. Currently, molecular genetic studies on BML and IVL are limited, and no comparative research on their genetic variations has been reported. To investigate the genetic basis underlying their shared aggressive phenotypes, this study employs whole-exome sequencing (WES) to conduct a molecular genetic comparison between the two entities. The aim is to explore potential genetic variations that may reveal common pathological pathways shared by these diseases, thereby enhancing our understanding of the molecular mechanisms driving their invasiveness. A pulmonary BML case and an IVL case underwent analysis, with paraffin-embedded tumor tissues subjected to WES. Mutant genes were screened and comparatively analyzed between the two cases. WES revealed 15 single nucleotide polymorphism (SNP) genetic mutations in the BML case: HFM1, SCN10A, HEXA, SLC7A14, TEP1, KCNJ12, KCNJ18, DNAJB12, ACOX3, ABCC2, RASA1, ALOX15B, TCIRG1, COL5A3, and MCCC2. In the IVL case, 18 mutant genes were observed: CADPS2, GPSM2, REEP4, KCNJ12, KCNJ18, DUSP15, PDE11A, TCIRG1, KLHL33, PAH, MYO18A, FBLN7, ATP7B, MYO7A, MLKL, LRP10, KRT15, and HEPH. The mutations were consistent across both samples in this case. Shared mutations in BML and IVL cases included TCIRG1, KCNJ12, and KCNJ18. BML and IVL exhibit distinct gene mutations in tumor development, with certain shared mutations.

BACKGROUND:Congenital cataracts (CC) are one of the leading causes of impaired vision or blindness in children, with approximately 8.3-25% being inherited. The aim of this study is to investigate the mutation spectrum and frequency of 9 cataract-associated genes in 19 Chinese families with congenital cataracts. PURPOSE:To identify the gene variants associated with congenital cataracts. METHODS:This study included a total of 58 patients from 19 pedigrees with congenital cataracts. All probands were initially screened by whole-exome sequencing(WES), and then validated by co-segregation analysis using Sanger sequencing. RESULTS:Likely pathogenic variants were detected in 8 families, with a positivity rate of 42.1%. Variants in various genes were identified, including GJA3, CRYGD, CRYBA4, BFSP2, IARS2, CRYAA, CRYBA1, ARL2 and CRYBB3. Importantly, this study identified compound heterozygous variants of IARS2 in one family. CONCLUSIONS:Our research findings have revealed multiple gene variants associated with cataracts, providing clinical guidance for improved molecular diagnosis of congenital cataracts in the era of precision medicine.

Purpose To investigate the effect of capsular tension rings (CTRs) on the accuracy of nine new-generation intraocular lens (IOL) formulas in long eyes. Methods A total of 106 eyes (106 patients) with CTR (CTR group) and another 106 eyes (106 patients) without CTR (NCTR group) were analyzed. The differences in mean prediction error, standard deviation, mean absolute prediction error (MAE), median absolute prediction error (MedAE), root mean square absolute prediction error (RMSAE), and percentage of eyes within ±0.25, ±0.50, ±0.75, ±1.00, and greater than ±1.00 diopter (D) were compared. Results In the CTR group, only the Hoffer QST and VRF-G formulas showed significantly lower MedAE compared to the NCTR group. There was no statistically significant difference found among other formulas. The VRF-G and Hoffer QST formulas had lower MAE (0.351 to 0.367) than the Kane (0.469) ( P < .05). The K6 and Pearl-DGS formulas had higher MAE (0.441 to 0.452) than the Zhu-Lu (0.351) and Emmetropia Verifying Optical (EVO) 2.0 (0.377) ( P < .05). In the NCTR group, the Zhu-Lu and RBF 3.0 formulas had lower MAE (0.340 to 0.411) compared to the Kane (0.477) ( P < .05). The Zhu-Lu and EVO 2.0 formulas also had lower MAE (0.340 to 0.363) than Pearl-DGS (0.429) ( P < .05), and the EVO 2.0 had lower MedAE (0.273) than the Kane (0.433) ( P < .05). The percentage of eyes within ±0.50 D (76 to 85, 71.70% to 80.19%) of the RBF3.0, K6, EVO 2.0, and Zhu-Lu formulas were higher than Kane (53.77%) ( P < .02). Conclusions CTR implantation does not improve the refractive prediction accuracy of the most new generation IOL formula. The Zhu-Lu formula is recommended for use in long eyes, regardless of CTR implantation. [ J Refract Surg . 2025;41(2):e114–e119.]

Excessive accumulation of reactive oxygen species in the retina is the predominant pathogenic mechanism underlying dry age-related macular degeneration (dAMD). Although antioxidant chemicals have been shown to be effective in reducing ROS levels, their bioavailability and therapeutic efficacy are restricted by ocular barriers. Herein, we developed a tetrahedral framework nucleic acid (tFNA)-based antioxidant drug for the treatment of retinal oxidative stress diseases. By exploiting their penetration capability, these tFNAs penetrated multiple ocular tissues and cellular barriers. These tFNAs protected retinal pigment epithelium cells from glyoxal-induced oxidative stress damage by exerting their intrinsic antioxidant properties through the JNK and AKT pathways upon entering the cells. The subconjunctival administration of tFNAs alleviated structural damage and reduced retinal cell apoptosis in a retinal oxidative stress rat model. These results indicated that tFNAs are a promising therapeutic drug for the treatment of retinal oxidative stress diseases, which sheds light on the development of dAMD therapy.

Nance–Horan syndrome (NHS) is a rare X-linked dominant disorder caused by pathogenic variants in the NHS gene on chromosome Xp22.2-Xp22.13. Clinical manifestations consist of congenital cataracts, along with dysmorphic facial features and dental anomalies and, in certain instances, intellectual disability. This study aimed to identify the genetic cause responsible for NHS in a Chinese family with four individuals primarily presenting with congenital cataracts. Genomic DNA was collected from six family members, including four affected individuals (three females and one male) from a two-generation family. The family history and clinical data were documented. Whole-exome sequencing was performed on the proband, and candidate pathogenic variants were filtered through a series of screening steps and validated by Sanger sequencing. Co-segregation analysis was conducted to confirm the pathogenicity of the identified variant. Genetic analysis revealed a novel frameshift pathogenic variant in NHS gene (c.1735delA: p.R579Gfs*91) present in all four affected members. All affected members exhibited congenital cataracts, congenital ptosis, strabismus, high myopia as well as dental and facial anomalies, and more severe characteristic features observed in the male patient. These clinical manifestations were consistent with the phenotype of NHS. This study identified a novel NHS pathogenic variant in a Chinese family, expanding the mutational spectrum of NHS. Contrary to previous reports of female carriers exhibiting mild symptoms, we demonstrated severe ocular phenotypes in three affected females. These findings will assist in providing genetic counseling for NHS patients.

Triple-negative breast cancer (TNBC) is an aggressive subtype lacking effective targeted therapies, with circular RNAs (circRNAs) emerging as key regulators in cancer progression through competitive endogenous RNA (ceRNA) networks. Although circRNAs function as miRNA sponges in TNBC, the specific role of circDUSP1 in the miR-429/DLC1 pathway remains unknown. In this study, a circular RNA, circDUSP1, was identified as differentially expressed in TNBC using an online database. Using TNBC patient tissues and cell lines (MDA-MB-231/MDA-MB-468), we quantified circDUSP1 expression via qRT-PCR. The molecular characteristics of circDUSP1 were identified through methods such as nuclear-cytoplasmic separation, RNase R digestion, and FISH. Assessed the impact of circDUSP1 on TNBC cell proliferation/migration/invasion through functional assays (CCK-8, colony formation, Transwell, etc.). The circDUSP1/miR-429/DLC1 regulatory network's role in TNBC was validated using dual-luciferase reporter gene, RNA pull-down, and rescue assays. circDUSP1 was significantly downregulated in TNBC tissues and cell lines. circDUSP1 overexpression suppressed TNBC cell proliferation, migration, invasion, and tumor growth in vivo circDUSP1 directly bound miR-429 to relieve its repression of tumor suppressor DLC1 miR-429 mimics attenuated circDUSP1-mediated tumor suppression. circDUSP1 inhibits TNBC progression by acting as a molecular sponge for miR-429 to upregulate DLC1. This regulatory network represents a novel therapeutic target for TNBC.

Background This study evaluates the impact of corneal power on the accuracy of 14 newer intraocular lens (IOL) calculation formulas in cataract surgery. The aim is to assess how these formulas perform across different corneal curvature ranges, thereby guiding more precise IOL selection. Methods In this retrospective case series, 336 eyes from 336 patients who underwent cataract surgery were studied. The cohort was divided into three groups according to preoperative corneal power. Key metrics analyzed included mean prediction error (PE), standard deviation of PE (SD), mean absolute prediction error (MAE), median absolute error (MedAE), and the percentage of eyes with PE within ± 0.25 D, 0.50 D, ± 0.75 D, ± 1.00 D and ± 2.00 D. Results In the flat K group (Km < 43 D), VRF-G, Emmetropia Verifying Optical Version 2.0 (EVO2.0), Kane, and Hoffer QST demonstrated lower SDs (± 0.373D, ± 0.379D, ± 0.380D, ± 0.418D, respectively) compared to the VRF formula (all P < 0.05). EVO2.0 and K6 showed significantly different SDs compared to Barrett Universal II (BUII) (all P < 0.02). In the medium K group (43 D ≤ Km < 46 D), VRF-G, BUII, Karmona, K6, EVO2.0, Kane, and Pearl-DGS recorded lower MAEs (0.307D to 0.320D) than Olsen (OLCR) and Castrop (all P < 0.03), with RBF3.0 having the second lowest MAE (0.309D), significantly lower than VRF and Olsen (OLCR) (all P < 0.05). In the steep K group (Km ≥ 46D), RBF3.0, K6, and Kane achieved significantly lower MAEs (0.279D, 0.290D, 0.291D, respectively) than Castrop (all P < 0.001). Conclusions The study highlights the varying accuracy of newer IOL formulas based on corneal power. VRF-G, EVO2.0, Kane, K6, and Hoffer QST are highly accurate for flat corneas, while VRF-G, RBF3.0, BUII, Karmona, K6, EVO2.0, Kane, and Pearl-DGS are recommended for medium K corneas. In steep corneas, RBF3.0, K6, and Kane show superior performance.

BackgroundMalignant mesothelioma (MM) is a rare and aggressive tumor that is found in the pleura and peritoneum. A few cases of MM in the pericardium and tunica vaginalis testis have been reported. Moreover, primary occurrence in the atrium is extremely rare. The visual appearance of this tumor is similar to that of a common atrial myxoma, which makes it challenging for clinicians and radiologists to diagnose and treat this disease.Case demonstrationAn 18-year-old woman presented with symptoms of chest pain, shortness of breath, cough, and expectoration for 7 days. Echocardiography was performed on the patient, which revealed an atrial mass. Myxoma was one of the differential diagnoses. The tumor was an elliptical mass with tips, and the cut surface was jelly-like, similar to myxoma. After surgery, a pathologic examination of the biopsied tumor confirmed epithelial-type MM. During postoperative follow-up, no recurrence of the tumor was observed.ConclusionsMM originating in the atrium is considered to be extremely rare. Consequently, clinicians can easily misdiagnose atrial MM as a myxoma. Moreover, to confirm the diagnosis, histopathologic biopsy, histomorphological characterization, immunohistochemistry, and molecular genetic testing are required. Therefore, clinical diagnosis and treatment of MM are challenging.

This study aimed to explore the cardioprotective mechanism of irisin in the context of cardiac injury. Utilizing a myocardial infarction (MI) mouse model, we investigated the therapeutic potential of recombinant human irisin (rhIrisin) administered for 28 days post-infarction. The efficacy of irisin treatment was evaluated through echocardiographic assessment of cardiac function and serum analysis of myocardial injury markers. Our research provided novel insights into the impacts of irisin on the NLR Family Pyrin Domain Containing 3 (NLRP3) inflammasome activation and pyroptosis, assessed both in vivo in MI mice and in vitro in hypoxia/reoxygenationtreated H9C2 cells. Remarkably, irisin treatment significantly reduced levels of lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), and troponin I, indicating reduced myocardial injury. Echocardiography highlighted substantial improvements in left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and dimensions (LVIDd and LVIDs) in irisin-treated mice, underscoring enhanced cardiac function. Moreover, irisin was shown to significantly suppress the mRNA and protein expressions of key components involved in NLRP3 inflammasome pathway (NLRP3, ASC, caspase-1 (p20), and interleukin-18 (IL -18)) both in MI-induced mice and hypoxia/reoxygenation-treated cells. This study firstly reveals that the cardioprotective effect of irisin is mediated through the attenuation of NLRP3 inflammasome activation and pyroptosis, positioning irisin as a promising therapeutic agent for cardiac injury.

Purpose: To quantify the presence of early structural alterations in the outer retinal layer and choroid among healthy subjects and diabetic patients with no or mild diabetic retinopathy, and to establish the correlation between the measured structural parameters and retinal sensitivity. Methods: In total, 31 eyes from subjects with type 2 diabetes and 29 eyes from healthy subjects were enrolled. Optical coherence tomography was used to measure outer retina layers and choroid, while microperimetry was used to characterize the changes of visual function in a 6-mm diameter area at macula. Quantitative analysis of structural and functional changes was performed between groups and the structure-function correlations were determined. Results: The thickness of myoid and ellipsoid zone, choroid and the mean retinal sensitivity were significantly smaller in diabetic group than that in controls (all P values < 0.05). Besides, thinner choroid and outer retina was associated with the decreased retinal sensitivity, especially in diabetic patients (r = 0.377, P = 0.048; r = 0.401, P = 0.034; respectively). Final multiple regression models showed the outer retinal thickness (ORT) (P = 0.033), choroidal thickness (P = 0.003) and the interaction between ORT and choroidal thickness (P = 0.001) were significant predictors to retinal sensitivity. Conclusions: Thinning of choroid and outer retina were significantly correlated with reduced retinal sensitivity, which indicate outer retina and choroid might be potential imaging markers for evaluation of visual function related to neural impairment in type 2 diabetic patients without or in the early stage of diabetic retinopathy.

AIM: To evaluate the effect of low-degree astigmatism on objective visual quality through the Optical Quality Analysis System (OQAS). METHODS: This study enrolled 46 participants (aged 23 to 30y, 90 eyes) with normal or corrected-to-normal vision. The cylindrical lenses (0, 0.5, 0.75, 1.0, and 1.25 D) were placed at the axial direction (180°, 45°, 90°, and 135°) in front of the eyes with the best correction to form 16 types of regular low-degree astigmatism. OQAS was used to detect the objective visual quality, recorded as the objective scattering index (OSI), OQAS values at contrasts of 100%, 20%, and 9% predictive visual acuity (OV100%, OV20%, and OV9%), modulation transfer function cut-off (MTFcut-off) and Strehl ratio (SR). The mixed effect linear model was used to compare objective visual quality differences between groups and examine associations between astigmatic magnitude and objective visual quality parameters. RESULTS: Apparent negative relationships between the magnitude of low astigmatism and objective visual quality were observed. The increase of OSI per degree of astigmatism at 180°, 45°, 90°, and 135° axis were 0.38 (95%CI: 0.35, 0.42), 0.50 (95%CI: 0.46, 0.53), 0.49 (95%CI: 0.45, 0.54) and 0.37 (95%CI: 0.34, 0.41), respectively. The decrease of MTFcut-off per degree of astigmatism at 180°, 45°, 90°, and 135° axis were -10.30 (95%CI: -11.43, -9.16), -12.73 (95%CI: -13.62, -11.86), -12.75 (95%CI: -13.79, -11.70), and -9.97 (95%CI: -10.92, -9.03), respectively. At the same astigmatism degree, OSI at 45° and 90° axis were higher than that at 0° and 135° axis, while MTFcut-off were lower. CONCLUSION: Low astigmatism of only 0.50 D can significantly reduce the objective visual quality.

AIM: To investigate the molecular diagnosis of a three-generation Chinese family affected with aniridia, and further to identify clinically a PAX6 missense mutation in members with atypical aniridia. METHODS: Eleven family members with and without atypical aniridia were recruited. All family members underwent comprehensive ophthalmic examinations. A combination of whole exome sequencing (WES) and direct Sanger sequencing were performed to uncover the causative mutation. RESULTS: Among the 11 family members, 8 were clinically diagnosed with congenital aniridia (atypical aniridia phenotype). A rare heterozygous mutation c.622C>T (p.Arg208Trp) in exon 8 of PAX6 was identified in all affected family members but not in the unaffected members or in healthy control subjects. CONCLUSION: A rare missense mutation in the PAX6 gene is found in members of a three-generation Chinese family with congenital atypical aniridia. This result contributes to an increase in the phenotypic spectrum caused by PAX6 missense heterozygous variants and provides useful information for the clinical diagnosis of atypical aniridia, which may also contribute to genetic counselling and family planning.

BACKGROUND:The human lens is a highly organized tissue, and it is constructed of delicate inner architectures that ensure its transparency. However, the pattern of cell distribution in the intact lens has rarely been observed or traced in a three-dimensional (3D) perspective. METHODS:Here, we modified and compared three different kinds of tissue transparency methods to investigate the cellular and molecular changes in the human lens at different ages from a 3D perspective. RESULTS:First, we analyzed the general 3D parameters of cleared human lenses from 6 months to 72 years of age and found that the equator proportion remained constant with age (23.05% ± 0.36). Next, we visualized the cellular distribution patterns in the anterior capsule and equator, as well as the distribution of cortical fiber cells. Interestingly, we observed the accumulation of equatorial epithelium in adolescents and the asymmetrical denucleation of cortical fiber cells in the elderly. Zonula occludens-1 and tropomyosin receptor kinase A were also identified in the pre-equatorial germinative zone, and its presence decreased when comparing lenses of a 17-year-old to those of a 49-year-old. CONCLUSION:We present a 3D cellular and molecular reconstruction of the human lens, illustrating the observed alterations in human lens epithelial cells across different ages.

PURPOSE:To evaluate the predictive accuracy of modern intraocular lens (IOL) formulas and axial length (AL) adjusted traditional IOL formulas, including Wang-Koch and Cooke-modified AL (CMAL) method, in long eyes with plate-haptic IOLs, and to compare refractive prediction error variances with C-loop IOLs. DESIGN:Retrospective consecutive case series study. METHODS:Data from 391 eyes with Zeiss 509 M and 302 eyes with Alcon SN6CWS implants in highly myopic patients, following cataract surgery from January 2019 to November 2023, were collected. One eye per patient was selected. Predictive outcomes of 15 modern formulas (Barrett Universal II (BU II), Cooke K6 (K6), Emmetropia Verifying Optical (EVO) 2.0, Hoffer-QST, Kane, Karmona, Ladas AI, Naeser 2, Olsen, Pearl-DGS, Radial Basis Function (RBF) 3.0, T2, VRF-G, Zhu-Lu, and Z-Calc) and 4 traditional IOL formulas (Haigis, Hoffer Q, Holladay 1, and SRK/T) with AL adjusted methods, were evaluated. The mean prediction error, mean absolute prediction error (MAE), root-mean-square absolute prediction error (RMSAE) and the proportions of eyes with PEs within ±0.25 Diopter (D), ±0.50 D, ±0.75 D, and ±1.00 D were analyzed. Top 10 RMSAE-ranked formulas underwent further subgroup analysis based on AL, anterior chamber depth (ACD), and keratometry (K). RESULTS:For the 509 M group, RMSAE ranking for the top 10 IOL formulas were the RBF 3.0 (0.432), Zhu-Lu (0.436), Olsen (0.436), EVO 2.0 (0.437), Pearl-DGS (0.447), K6 (0.452), VRF-G (0.454), Naeser 2 (0.464), Haigis-CMAL (0.465) and Karmona (0.477). Karmona and Naeser 2 showed poorer performance in the extremely long AL and steep K subgroups, respectively (p ≤ 0.042). Haigis-CMAL accuracy was significantly lower in shallow ACD and flat K subgroups (P ≤ .045). The SN6CWS group showed significantly lower MAE and RMSAE compared to the 509 M group for the BU II, EVO 2.0, Hoffer-QST, Kane, Pearl-DGS, and Zhu-Lu formulas (P ≤ .024). CONCLUSIONS:In long eyes with plate-haptic IOLs, RBF 3.0 performed best, closely followed by Zhu-Lu, Olsen, and EVO 2.0; Karmona and Naeser 2 are discouraged for extreme AL and steep K conditions, respectively; Haigis-CMAL is not suggested for shallow ACD and flat K cases. Refractive outcomes in eyes implanted with a C-loop design IOL were more accurate than for those implanted with a plate-haptic design, for most tested formulas.

AIMS:A three-dimensional electroanatomic mapping system-guided transseptal puncture (3D-TSP), without fluoroscopy or echocardiography, has been only minimally reported. Indications for 3D-TSP remain unclear. Against this background, this study aims to establish a precise technique and create a workflow for validating and selecting eligible patients for fluoroless 3D-TSP. METHODS AND RESULTS:We developed a new methodology for 3D-TSP based on a unipolar electrogram derived from a transseptal needle tip (UEGM tip) in 102 patients (the derivation cohort) with intracardiac echocardiography (ICE) from March 2018 to February 2019. The apparent current of injury (COI) was recorded at the muscular limbus of the foramen ovalis (FO) on the UEGM tip (sinus rhythm: 2.57 ± 0.95 mV, atrial fibrillation: 1.92 ± 0.77 mV), which then disappeared or significantly reduced at the central FO. Changes in the COI, serving as a major criterion to establish a 3D-TSP workflow, proved to be the most valuable indicator for identifying the FO in 99% (101/102) of patients compared with three previous techniques (three minor criteria) of reduction in atrial unipolar or bipolar potential and FO protrusion. A total of 99.9% (1042/1043) patients in the validation cohort underwent successful 3D-TSP through the workflow from March 2019 to July 2023. Intracardiac echocardiography guidance was required for 6.6% (69/1042) of patients. All four criteria were met in 740 patients, resulting in a 100% pure fluoroless 3D-TSP success rate. CONCLUSION:In most patients, fluoroless 3D-TSP was successfully achieved using changes in the COI on the UEGM tip. Patients who met all four criteria were considered suitable for 3D-TSP, while those who met none required ICE guidance.