Background: Ocular hypertension (OHT) can lead to corneal transplant failure, yet no predictive model exists for OHT after femtosecond laser-assisted penetrating keratoplasty (Fs-PKP). This study aimed to develop and validate a predictive nomogram for OHT in Chinese patients undergoing Fs-PKP. Methods: A retrospective cohort study at Nanjing First Hospital included 238 patients who underwent Fs-PKP and were followed up for two years. OHT was defined as postoperative intraocular pressure exceeding 21 mmHg or an increase of more than 10 mmHg from baseline. Twenty-three variables related to recipient, donor, and surgical factors were evaluated. Key predictors were identified using the least absolute shrinkage and selection operator (LASSO) method and multivariate Cox regression, leading to nomogram development and validation via 500 bootstrap resamples. Results: The final nomogram included four independent predictors: prior PKP history, history of viral ocular disease, history of ocular trauma, and intraoperative plan. The model demonstrated good discrimination with a concordance index (C-index) of 0.705 (95% CI: 0.646-0.764), consistent after Bootstrap resampling (C-index: 0.705, 95% CI: 0.648-0.747). Time-dependent receiver operating characteristic analysis at 6, 12, and 24 months showed areas under the curve ranging from 0.677 to 0.756. Calibration curves indicated strong agreement between predicted and observed outcomes. Decision curve analysis demonstrated clinical usefulness across risk thresholds of 20%-70%. High-risk patients identified by the nomogram had significantly higher OHT rates than low-risk patients (P < 0.001). Conclusions: The nomogram accurately predicts OHT risk following Fs-PKP in Chinese patients, aiding clinical decision-making by preoperatively identifying high-risk individuals.

Purpose Aimed to create a nomogram using clinical and eye-specific metrics to predict the efficacy of intravenous glucocorticoid (IVGC) therapy in patients with active and moderate-to-severe Thyroid-Associated Ophthalmopathy (TAO). Methods This study was conducted on 84 eyes from 42 moderate-to-severe TAO patients who received systemic IVGC therapy, and 42 eyes from 21 controls. Data were collected retrospectively from June 2020 to December 2021. The least absolute shrinkage and selection operator (LASSO) method was used to identify predictive factors for "unresponsiveness" to IVGC therapy. These factors were then analyzed using logistic regression to create a nomogram. The model's discriminative ability was robustly assessed using a Bootstrap resampling method with 1000 iterations for receiver operating characteristic (ROC) curve analysis. Results The LASSO analysis identified six factors with non-zero coefficients as significant, including Schirmer I test values, Meibomian gland (MG) diameter, MG length, disease duration, whole capillary vessel density (VD) in the radial peripapillary capillary (RPC), and whole macular VD for the superficial retinal capillary plexus (SRCP). The subsequent logistic regression model highlighted MG length, whole macular VD for SRCP, and disease duration as independent predictors of IVGC therapy response. The constructed nomogram demonstrated an area under the curve (AUC) of 0.82 (95% CI: 0.73-0.91), affirming the model's consistent and reliable ability to distinguish between responsive and non-responsive TAO patients. Conclusion Our nomogram, combining MG length (<4.875 mm), SRCP VD (<50.25%), and disease duration (>5.5 months), reliably predicts lower IVGC therapy effectiveness in active, moderate-to-severe TAO patients.

Graft failure is a major challenge in femtosecond laser-assisted penetrating keratoplasty (Fs-PKP). This study focuses on the development and validation of a clinical predictive model aimed at identifying the risk of graft failure in individuals undergoing Fs-PKP in China, offering a tailored approach to improve surgical outcomes. This retrospective cohort study at Nanjing First Hospital involved 238 patients and followed the TRIPOD statement. The cohort was divided into a training set (n = 166) and a validation set (n = 72) in a 7:3 ratio. It analyzed 23 predictor variables related to recipient, donor, and surgical factors, defining graft failure as “visually significant and irreversible corneal stromal edema, haze, or scarring.” A comprehensive nomogram was created using univariate and multivariate Cox regression analyses and assessed by concordance index (C-index), time-dependent receiver operating characteristics (ROC) curve, calibration plots, and decision curve analysis (DCA). Five critical risk factors were identified: recipients’ history of systemic autoimmune disorders, ocular trauma, prior penetrating keratoplasty (PKP) history, donors’ diabetes history, and the endothelial cell density of the donor cornea. The nomogram showed a C-index of 0.72 (95

Abstract Background Thyroid-associated ophthalmopathy (TAO) is a potentially sight-threatening ocular disease that affects 50% of patients with Graves’ disease. N6-methyladenosine (m6A) modification is post-transcriptional RNA modification in mammalian mRNA. Exploring the role of m6A regulators and the immune infiltration characterization in TAO is essential to understand its pathogenesis. Methods We excavated differentially expressed m6A regulators from the TAO microarray data set (GSE58331) in the Gene Expression Omnibus (GEO). Based on R software (v4.2.2), we performed bioinformatics analyses including differential expression analysis, training models construction such as support vector machine (SVM), random forest (RF), and nomogram models for the evaluation of TAO occurrence, consensus clustering algorithm for the evaluation of clusters quantity, principal component analysis (PCA) for quantification of m6A modification level in individual patients, Gene Ontology (GO) functional annotation, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, and single sample gene set enrichment analysis (ssGSEA) for functional enrichment analysis, etc. Results Four significant m6A regulators (IGFBP2, IGFBP3, RBM15B, and FTO) were screened by differential expression analysis between the TAO group and the healthy group. RM identified that the four m6A regulators above were associated with the risk of TAO. Furthermore, a nomogram was conducted to provide benefits to patients. Based on filtered m6A regulators, we divided the TAO group into two m6A subtypes (cluster A/B) by consensus clustering. The PCA algorithm calculated the m6A score of each sample to quantify m6A patterns. GO functional annotation proved that m6A-related differentially expressed genes (DEGs) enriched in biological processes (BP), cellular components (CC), and molecular functions (MF). KEGG enrichment analysis showed m6A-related DEGs were particularly abundant in the endocytosis, protein processing in endoplasmic reticulum, ubiquitin mediated proteolysis, and protein export. ssGSEA presented the difference in immune infiltration between m6Acluster A/B and gene cluster A/B. In addition, we also analyzed the relationship between m6Aclusters or gene clusters and cytokines. Conclusions This article analyzed the effect of m6A modification in the pathogenesis of TAO, focusing on immune infiltration. These findings may be able to guide the future strategy of immunotherapy.

Purpose To explore the current research about the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in dysthyroid optic neuropathy (DON).Methods Studies in the literature that focused on OCT, OCTA and DON were retrieved by searching PubMed, EMBASE, Cochrane databases and Clinical Trial before 20 June 2023. The methodological quality was assessed using the Newcastle-Ottawa scale. The quantitative calculation was performed using Review Manager V.5.3.Results Twelve studies met the eligibility criteria and were included. DON group presented lower macular ganglion cell complex in the overall, superior and inferior hemifields compared with the non-DON group. Furthermore, the ganglion cell layer and inner plexiform layer in DON group was thinner in contrast to the non-DON group. The optic nerve head vessel density was lower in the DON group than that in the non-DON group. A reduction of radial peripapillary capillary vessel density could be seen in the DON group than the non-DON group in overall, inside disc, peripapillary, superior-hemifield, temporal and nasal. Besides, the macular superficial retinal capillary layer of non-DON and DON is lower than the healthy control group.Conclusions This study supported the potential value of OCT and OCTA metrics as novel biomarkers of DON. Ophthalmologists should comprehensively consider the retinal structure and microvasculature in dealing with DON.Ethics and dissemination This systematic review included data from published literature and was exempt from ethics approval. Results would be disseminated through peer-reviewed publication and presented at academic conferences engaging clinicians.PROSPERO registration number CRD42023414907.

ObjectiveTo investigate the ocular surface effects of different digital media experiences in Chinese elementary school students.DesignPopulation-based cross-sectional study was used.Setting14 randomly selected primary schools in Yuhuatai District, Nanjing, ChinaParticipants2,694 students between 7 and 8-year-old.Outcome MeasuresPrevalence of and risk factors for different types of dry eye disease,and different digital media experience with different ocular signs.ResultsThe prevalence of 'symptomatic DED' was 8.7% (95% CI 7.6% to 9.8%) and 'definite DED' prevalence rate was 5.5% (95% CI 4.7% to 6.4%). In multivariable logistic regression model, allergic conjunctivitis (OR=4.33, 95%CI (3.01 to 6.23), p<0.001), more than 1hour per day on outdoor activity (OR=0.69, 95%CI (0.49 to 0.99), p=0.043), smartphone (OR=2.73, 95%CI (1.51 to 4.91), p=0.001), tablet (OR=2.09, 95%CI (1.07 to 4.07), p=0.030) and homework (OR=1.86, 95%CI (1.22 to 2.83), p=0.004) were independently associated with 'definite DED', while allergic conjunctivitis (OR=5.58, 95%CI (4.12 to 7.55), p<0.001), more than 1hour per day on outdoor activity (OR=0.72, 95%CI (0.53 to 0.97), p=0.028), smartphone (OR=2.60, 95%CI (1.55 to 4.35), p<0.001), tablet (OR=1.84, 95%CI (1.02 to 3.34), p=0.044) and homework (OR=2.57, 95%CI (1.84 to 3.60), p<0.001) were independently associated with 'symptomatic DED'.ConclusionsUsing smartphones or tablets for an average of more than 1hour per day through the course of a year is independently associated with paediatric DED.

目的:观察系统性红斑狼疮(systemic lupus erythematosus,SLE)患者角膜神经纤维的表现,探讨SLE患者干眼和神经纤维病变的关系.方法:应用HRT3-CM角膜共聚焦显微镜检查比较30例(52只眼)SLE患者和33例(49只眼)健康对照者的角膜神经纤维密度(corneal nerve fiber density,CNFD)、角膜神经纤维分支密度(corneal nerve branch density,CNBD)、角膜神经纤维长度(corneal nerve fiber length,CNFL)和角膜神经纤维迂曲度(corneal nerve fiber tortuosity,CNFT),分析SLE患者干眼临床综合评分与系统性红斑狼疮疾病活动度(SLEDAI)评分的相关性.结果:SLE无干眼组、SLE干眼组、健康无干眼组和健康干眼组CNBD的差异有统计学意义(P＜0.05),SLE干眼组的CNBD明显小于健康干眼组和健康无干眼组,差异有统计学意义(P＜ 0.05);CNFL、CNFD、CNFT的差异在4组间均无统计学意义(P均＞0.05);SLE干眼组的SLEDAI评分与干眼临床综合评分的Pearson相关分析呈正相关(r=0.51,P=0.004),SLE干眼组的病程与干眼临床综合评分无相关性(r=0.34,P=0.069);SLE干眼组的角膜神经纤维参数与干眼临床综合评分均无相关性(P均＞ 0.05).结论:SLE发生干眼时,角膜神经结构异常可能为干眼的内在原因之一,角膜共聚焦显微镜可用于检查SLE角膜神经的病变情况;SLE病情严重程度与干眼严重程度呈正相关.

目的 探讨飞秒激光辅助深板层角膜移植(DALK)术后联合他克莫司治疗感染性角膜炎的疗效.方法 选择我院眼科2015年3月至2018年3月确诊的64例感染性角膜炎患者,按照手术方式分为2组,每组32例.2组患者在术前均给予抗感染药物规范治疗2周.观察组患者行飞秒激光辅助深板层角膜移植术,对照组患者行穿透性角膜移植术,术后2组患者均使用他克莫司滴眼液治疗.观察比较2组患者治疗有效率、最佳矫正视力、免疫排异反应、角膜表面曲率以及不良反应.结果 观察组患者治疗有效率(90.63％)高于对照组(65.63％),差异有统计学意义(P=0.016).通过对患者术后1个月、3个月、6个月的矫正视力对比观察,结果显示观察组患者均优于对照组;治疗后7d、14d观察组出现免疫排异反应的患者显著少于对照组;术后7d、1个月、3个月观察组患者眼压明显低于对照组,以上差异均具有统计学意义(P<0.05).术后6个月,2组患者眼压趋于稳定;治疗前后,2组患者的不同时点角膜表面曲率之间无显著差异.2组患者均未出现明显的不良反应.结论 飞秒激光辅助DALK术联合他克莫司可显著改善感染性角膜炎患者术后视力和球内压力,治疗效果显著,安全性较高.

Objective To evaluate the clinical efficacy of intravitreal injection of Compaq combined with trabeculectomy and total retinal photocoagulation in the treatment of neovascular glaucoma.Methods A total of 37 cases(37 eyes)neovascular glaucoma were selected as the research subjects.Comparescept was injected into the cavity of the vitreous body,after the neovascularization subsided,composite trabeculectomy was per-formed and retinal photocoagulation was performed at the right time according to the corneal condition.The follow-up period was 6 months.The visual acuity,intraocular pressure changes and complications were ob-served before and after operation.Results After 6 months of follow-up,visual acuity of 27 eyes improved,eye-sight of 7 eyes unchanged,and vision of 3 eyes decreased.There was a significant difference in visual acuity be-tween the patients before and after operation(P＜ 0.05);there was no significant difference in intraocular pressure(P＞0.05),before and 1 week after the injection(P＞0.05).The difference was statistically signifi-cant at 1 week,1,3 and 6 months after the operation(P＜0.05).No active bleeding occurred during the opera-tion.1 d after operation,4 eyes had a small amount of blood in the anterior chamber and vitreous hemorrhage occurred in 2 eyes.Conclusion Compaq combined with compound trabeculectomy and retinal photocoagulation for the treatment of neovascular glaucoma can effectively improve visual acuity and control intraocular pres-sure.The effect is obvious,and safe,which is worthy of clinical application.

AIM To design, optimize and validate a rapid, internally controlled real-time polymerase chain reaction (RT-PCR) test for herpes simplex virus (HSV) in the diagnosis of necrotizing herpes stromal keratitis. METHODS Tears alone or together with corneal epithelium scrapings from 30 patients (30 eyes) suspected of necrotizing herpes stromal keratitis were tested for HSV DNA by RT-PCR. The samples were collected during the first visit and then on the subsequent 7, 14, 28, 42, and 56d. The symptoms of the patients were scored before treatment to determine the correlation between HSV concentration in the corneal epithelium scrapings and clinical scores. RESULTS The positive rate (46.4%) in the corneal epithelium group before the therapy was significantly higher than that (13.3%) in the tears group (P=0.006). There were 13 positive HSV patients before the therapy, the concentration of HSV DNA in corneal epithelium scrapings group was significantly higher than that in the tears group (paired t-test, P=0.0397). Multilevel mixed-effects model analysis showed that the difference between the corneal epithelium scrapings group and the tears group was statistically significant (P=0.0049). The Spearman rank correlation analysis indicated a positive correlation between the HSV concentration in the corneal epithelium scrapings and clinical scores before the treatment (r=0.844, P<0.0001). CONCLUSION RT-PCR appears to be a powerful molecular tool for the diagnosis of necrotizing herpes stromal keratitis.

Background Herpes stromal keratitis (HSK) is a common infectious ocular surface disease,with a higher recurrent rate,especially in necrotizing HSK.The diagnosis of HSK primarily depends on signs and symptoms,and specific laboratory diagnostic is lack.Objective This study was to clarify the expression of herpes simplex virus (HSV) in the corneal epithelium scrapings and tears of necrotizing HSK patients.Methods Thirty eyes of 30 patients with necrotizing HSK were enrolled in Nanjing Hospital of Nanjing Medical Hospital from September 2012 to September 2013 under the patient's informed consent.The eyes were examined by slit lamp microscope and scored.HSK patients received local and systemic therapy for 8 weeks and then an oral maintenance dose for 6 months.Corneal epithelial scrapings and tears samples were collected for HSV DNA detection by real-time PCR before and the 1 st,2nd,4th,6th and 8th week after therapy respectively.The difference of HSV positive rate was compared between corneal epithelium scrapings and tears samples using Chi-square test.Multilevel mixed effective model was employed to evaluate HSV concentration change in the samples at various time points in the HSV-positive patients of initial visit.The correlation between HSV concentration and clinical score was analyzed by Spearman rank correlation.Results HSV-positive rate was 46.4％ (13/30) in the corneal epithelial scrapings and 13.3％(4/30) in the tear samples,showing a significant difference between them (P =0.006).HSV-positive rate was significantly lower in the corneal epithelial scrapings 1 week,2 weeks and 4 weeks after treatment than before (P =0.001,0.003,0.004),and no HSV was detected 6 weeks and 8 weeks after treatment.No significant change in HSV-positive rate in tear samples in 1 week and 2 weeks after treatment in comparison with before treatment (P =1.000,0.583),and no HSV was detected after 4 weeks following treatment.The HSV concentration was 2460 (2 165-636500)/ml in initial 13 HSV-positive eyes of corneal epithelial scrapings and 0 (0-1150)/ml in initial 13 HSV-positive eyes of tear samples.Multilevel mixed effective model determined that HSV concentration was significantly lower in corneal epithelial scraping than that in tear (P =0.005),and HSV concentration was reduced with the lapse of time (P =0.001),with the faster rate of decline in the corneal epithelial scrapings (P =0.049).A positive correlation was found between initial HSV concentration and clinical scores (rs =0.844,P =0.000).Conclusiors Real-time PCR appears to be a powerful molecular tool for the detection of HSV in the HSK,especially in corneal epithelial scrapings of lesion.The initial positive outcome of viral DNA in corneal epithelial scrapings predicts a severe clinical procedure.

Femtosecond laser has the characteristic of high precision cutting, so it has great application potential in keratoplasty.It can replace the mechanical microkeratome used for penetrating keratoplasty, lamellar keratoplasty and endothelial keratoplasty according to the clinical need to produce different shapes of corneal graft and the graft bed. Femtosecond laser provides a new way for improving and optimizing the operation of various keratoplasty. In this paper, we reviewed the use of femtosecond Iaser in keratoplasty.

Objective The purpose of this study was to determine whether the platelet-rich plasma–agarose gel scaffold could be a bioactive scaffold capable of growth factors release for cartilage repair. Methods Porcine chondrocytes were seeded in agarose gel and platelet-rich plasma–agarose gel. During the 28-days culture, microstructure of hydrogels and morphologies of chondrocytes seeded in the hydrogels were observed using scanning electron microscope; viability of chondrocytes in gels was examined by live/dead assay; qualitative and quantitative analysis of glycosaminoglycan, collagen and DNA were assessed by histological, immunohistochemcial staining and biochemical assay; gene expression was measured by real-time polymerase chain reaction. In vitro cartilage ring models were used to evaluate the integration of the scaffolds, and the integration strength was analyzed by mechanical push-out tests. Results Scanning electron microscope revealed both scaffolds had highly uniform porous structure. Live/dead scaffolds showed 100% cells alive in both groups. After 28-days culture, glycosaminoglycan, collagen, DNA content and chondrocyte-related genes expression in platelet-rich plasma–agarose gel were significantly higher than pure agarose gel. Integration strength in platelet-rich plasma–agarose gel was also higher compared to pure agarose gel. Conclusion Platelet-rich plasma showed a positive effect on chondrocytes proliferation, differentiation and integration between native cartilage and engineered tissue when combined with agarose gel. Our findings suggest that platelet-rich plasma–agarose gel scaffold is a promising bioactive scaffold for future cartilage tissue engineering and future clinical works.

Herpes simplex keratitis( HSK) is the leading cause of infectious blindness. In general, diagnosis of HSK is based on clinical findings, which often are not confirmatory. With the development of molecular biology,a variety of laboratory methods that helped in achieving a diagnosis including in vivo confocal microscopy( IVCM),loop- mediated isothermal amplification( LAMP),real-time polymerase chain reaction( rt- PCR),nested PCR and multiplex PCR. They are considered as accurate and fast diagnostic techniques,thus characteristics of these are reviewed in this paper.