The rising global incidence of myopia warrants urgent attention due to its role in predisposing individuals to vision-threatening ocular conditions, including but not limited to cataracts and glaucoma.This review seeks to delineate the current understanding of the complex relationship between myopia and cataracts, exploring both epidemiological and pathological perspectives.Notably, there is a recognized association between myopia and early-onset cataract.Persistent progression of myopia over a lifetime can induce chronic alterations in the lens, encompassing shifts in both its microenvironment and structural attributes.Moreover, managing cataracts in myopic eyes presents significant challenges due to increased surgical difficulty and a higher likelihood of perioperative complications.Consequently, it is crucial to facilitate early detection of complications, forge apt management strategies, and implement targeted interventions to mitigate the adverse effects of both cataract and cataract surgery-related visual impairments in individuals with myopia.The overarching goal remains to enhance the quality of life for those affected by myopia, especially during their most productive working years.

Abstract Background To compare the outcomes of sutured transscleral fixation and sutureless intrascleral fixation for the treatment of a dislocated intraocular lens (IOL). Methods Thirty-five eyes of 35 patients who required IOL repositioning surgery due to IOL dislocation were included in this retrospective study. Sixteen eyes underwent two-point sutured transscleral fixation, eight eyes underwent one-point sutured transscleral fixation, and 11 eyes underwent sutureless intrascleral IOL fixation. The patients were followed for ≥ 12 months after repositioning surgery, and their postoperative outcomes were recorded and analyzed. Results The major cause of IOL dislocation was ocular blunt trauma (19/35, 54.3%). The mean corrected distance visual acuity (CDVA) improved significantly after IOL repositioning (P = 0.022). The mean postoperative change in endothelial cell density (ECD) was − 4.5%. There were no significant differences in the changes in CDVA or ECD among the three groups with different repositioning techniques (both P > 0.1). The mean vertical tilt of the IOLs in all enrolled patients was significantly greater than the horizontal value (P = 0.001). The vertical tilt was greater in the two-point scleral fixation group than that in the sutureless intrascleral fixation group (P = 0.048). The mean decentration values in the one-point scleral fixation group in the horizontal and vertical directions were greater than those in the other two groups (all P < 0.01). Conclusion All three IOL repositioning techniques resulted in favorable ocular prognosis.

INTRODUCTION:To evaluate the characteristics of optic nerve head (ONH) in highly myopic eyes and its role in predicting intraocular pressure (IOP) spikes after cataract surgery. METHODS:Patients who are highly myopic and were scheduled for cataract surgery were enrolled in this prospective case series study. IOP was measured preoperatively and at 1 day and 3 days postoperatively. ONH characteristics including area, tilt ratio, lamina cribrosa (LC) thickness, and depth, and the presence of LC defects were evaluated with enhanced depth imaging optical coherence tomography. Factors influencing LC defects and early IOP spike were investigated using multivariate stepwise logistic regression. RESULTS:In total, 200 highly myopic eyes of 200 patients were analyzed: 35.00% had small ONH, 53.00% had ONH tilt, and 14.00% had LC defects. Multivariate analysis demonstrated female patients with larger ONH area and deeper LC tended to have LC defects (all P < 0.05). As to postoperative IOP, IOP change, and incidence of IOP spikes, eyes with small ONH, ONH tilt, and LC defects had similar (all P > 0.05), higher (all P < 0.05), and lower (all P < 0.05) outcomes compared with those without the corresponding characteristic, respectively. Multivariate analysis showed that presence of LC defects and thicker LC were protective factors for early IOP spikes, and axial length > 28 mm was a risk factor (all P < 0.05). CONCLUSION:Female patients with larger ONH area and deeper LC tend to have LC defects, which, together with thicker LC, was correlated with less IOP spikes in highly myopic eyes. TRIAL REGISTRATION:This study was conducted as part of a larger project, the Shanghai High Myopia Study, registered at www. CLINICALTRIALS:gov (accession number NCT03062085).

Cataract is the leading cause of visual impairment and blindness on a global scale. The pathogenesis of cataract is not completely understood. Circular RNAs (circRNAs) are a special kind of non-coding RNAs with high stability and conservation. They are widely involved in a variety of biological processes and diseases. Abnormal expression of circRNAs can participate in the development of cataract, affecting the function of lens epithelial cells through interacting with proteins and sponging microRNAs. They are possible targets for cataract prevention and treatment. This article reviews the research progress on the role of circRNAs in the occurrence and development of cataract.

人工智能(AI)致力于在尽可能减少人为干预的情况下利用计算机技术模拟人类智能行为.鉴于其在多模态复杂数据处理和特征学习方面具备的独特优势,AI在医学诊断和治疗中被广泛研究和应用,眼科也不例外.眼科的检查结果多为图像和数字形式,具备应用AI的重要前提.本文对常见眼病的AI研究进展进行综述.

The ocular biometry characteristics are clinically significant for children with unilateral congenital cataracts, but there is a lack of data analysis concerning the preoperative measurements. The axial length (AL), mean keratometry (Km), corneal astigmatism (CA), and the anterior chamber depth (ACD) from both eyes before cataract surgery were obtained from 205 patients (410 eyes, 3–15 years of age) with unilateral congenital cataracts. In the congenital cataract eyes, shorter AL (22.44 ± 1.52 mm vs. 22.57 ± 1.04 mm, p = 0.036) and higher CA (– 1.89 ± 0.91 D vs. – 1.24 ± 0.67 D, p < 0.001) were found, and no significant difference was found in the Km and the ACD measurements compared to the contralateral normal eyes. Females had shorter AL and shallower ACD compared to males. However, the Km and CA in the females were significantly larger than that in males. Shorter AL, larger Km, higher CA, and shallower ACD were also found in females who had a binocular axial difference (the value obtained by subtraction of the contralateral normal eye from the congenital cataract eye) that less than zero. The preoperative ocular biometry of shorter AL, larger Km, higher CA, and shallower ACD should be considered in females with unilateral congenital cataracts. The age and the binocular axial differences had a statistically significant correlation (r = –0.192, p = 0.006). Therefore, changes in the binocular axial differences associated with aging may enhance the guidelines for intraocular lens selection and the management of congenital cataracts.

74岁男性,因"双眼视物模糊5年,加重1年"就诊.患者25年前曾行双眼高度近视放射状角膜切开术(RK).双眼最佳矫正视力:右眼0.4(﹣6.00/﹣4.00×65°),左眼0.3﹣2(﹣6.00/﹣4.00×70°).裂隙灯检查示双眼角膜不规则RK瘢痕,瞳孔圆,直径约2 mm,晶状体混浊.诊断为双眼并发性白内障,并行左眼白内障超声乳化联合人工晶状体(IOL)植入术,手术顺利,无并发症.术前根据IOLmaster 500的结果,使用Haigis公式计算出IOL度数为5.00 D,预计术后近视﹣1.50 D.术后第20天,左眼裸眼视力0.4,矫正视力+6.50/﹣1.50×5°→0.2,等效球镜+5.75 D,屈光误差超过7 D.讨论体会:对于RK术后的患者,特别是角膜存在不规则RK瘢痕的患者,我们要采用多种方法测量角膜曲率,特别是使用Pentacam角膜地形图测量,同时选择合适的IOL计算公式.对于角膜不规则的患者,使用以瞳孔为中心,实际瞳孔大小区域内的角膜曲率SimK参数,结合Barrett True K公式,计算的IOL度数最为准确.

51岁女性,因"左眼反复视力下降2年,加重1年"就诊.2年前因左眼反复视力下降,外院诊断为左眼玻璃体积血,予左眼玻璃体切除术,术后症状未见改善.此次就诊左眼裸眼视力0.1,矫正无助,眼压有波动,最高到32.4 mmHg(1 mmHg=0.133 kPa),症状在活动时更明显.裂隙灯检查见角膜色素性KP(+),前房Tyndall(+++),前房细胞(+++),颞上方虹膜基质萎缩伴透照缺损,瞳孔欠圆,直径约4 mm,对光反应迟钝,人工晶状体(IOL)倾斜,玻璃体混浊,眼底糊.5年前曾行双眼白内障摘除联合IOL植入术,双眼高度近视病史.诊断为葡萄膜炎-青光眼-前房积血综合征(UGH),需要与白内障术后的非感染性葡萄膜炎、迟发性感染性眼内炎相鉴别.给予巩膜层间缝线固定IOL置换术,术中房角镜下见前房角色素沉着,送检房水病原菌检测阴性,房水涂片见红细胞.术后1年内随访患者眼压稳定,玻璃体混浊消退,视力提高明显.讨论体会:白内障术后远期出现的反复视力下降伴眼压升高,反复前房炎症反应在考虑UGH时,应首先排除迟发性感染性炎症的可能性.无缝线巩膜固定三片式IOL(如Yamane方法)在高度近视患者中需谨慎使用.

1 病例资料及诊断 患儿男性,6岁,双眼视物模糊2年.既往有高度近视史.体格检查:左眼视力0.02,矫正无助,结膜无充血,角膜透明,KP(–),前房深,瞳孔直径3 mm,虹膜震颤,扩瞳见颞上方约200°晶状体不全脱位,视网膜平伏.眼压12.0 mmHg (1 mmHg=0.133 kPa).诊断:双眼先天性晶状体不全脱位.

Purpose: To evaluate the associations between anterior segment parameters and the rotational stability of a plate-haptic toric intraocular lens (IOL). Setting: Eye and Ear, Nose, Throat Hospital of Fudan University. Design: Retrospective case series. Methods: Patients who underwent uneventful phacoemulsification and plate-haptic toric IOL (AT TORBI 709M IOL) implantation were included. Preoperative axial length (AL) and anterior segment parameters, including the white-to-white (WTW) distance, anterior chamber depth (ACD), lens thickness (LT), and anterior segment length (ASL; the sum of ACD and LT) were recorded. IOL rotation, residual astigmatism (RAS), and visual acuity were evaluated 1 month postoperatively. The associations between the anterior segment parameters and IOL rotation were evaluated. Results: A total of 102 eyes of 102 patients were included. The mean AL was 26.43 +/- 2.65 mm (range 21.71-34.60 mm). The mean IOL rotation was 4.59 +/- 3.18 degrees, and RAS was 0.62 +/- 0.39 D postoperatively. No correlation was detected between AL, ACD, or LT and the rotation of the plate-haptic toric IOL (all P >.05). However, its rotation correlated positively with the WTW distance (r = 0.250, P =.011) and ASL (r = 0.214, P =.030). Backward stepwise multiple linear regression revealed that the WTW distance (beta = 2.142, P =.014) and ASL (beta = 2.060, P =.037) were independent predictors of plate-haptic toric IOL rotation. Conclusions: Plate-haptic toric IOLs rotate more in eyes with larger WTW distances and longer ASLs; therefore, toric IOL implantation should be performed with caution in eyes with these characteristics.

Purpose: To evaluate whether dry eye deteriorates after phacoemulsification cataract surgery, and to explore the influential factors. Methods: Studies published before February 2020 indexed on PubMed and the Cochrane Central Register of Controlled Trials were retrieved. A meta-analysis, including meta-regression, a sensitivity analysis, and a subgroup analysis, were performed. Results: Twenty studies with 2,247 eyes were included in the meta-analysis, dry eye-related parameters were investigated preoperatively and 1 month postoperatively. Patients with pre-existing meibomian gland dysfunction (MGD) had worsened subjective symptoms of dry eye (1.31, 95% confidence interval (CI) [0.66, 1.95], P < 0.0001), a reduced tear break-up time (BUT) (−2.27, 95% CI [−2.66, −1.88], P < 0.0001), and a worse corneal fluorescein staining (CFS) score (0.75, 95% CI [0.5, 1.0], P < 0.0001) after phacoemulsification cataract surgery, whereas in the general population, the subjective symptoms score and CFS remained unchanged and BUT decreased slightly after surgery. Patients without diabetes showed significantly reduced total tear secretion after phacoemulsification cataract surgery (−1.25, 95% CI [−1.62, −0.88], P < 0.0001). Conclusion: Dry eye generally remained unchanged 1 month after phacoemulsification cataract surgery. Notably, worsened symptoms and signs of dry eye were observed more frequently in patients with pre-existing MGD. Patients without diabetes were more susceptible to reduced tearing postoperatively. Clinical Trial Registration: Identifier: PERSPERO (2020: CRD42020203316).

In China where the incidence of myopia is particularly high, refractive surgery has experienced rapid acceptance during the past 20-30 years from radial keratotomy to small incision lenticule extraction and implantation of implantable collamer lenses, which have satisfied the demands for spectacle independence by a great many myopic patients. However, patients receiving early refractive surgery have gradually developed cataracts as time goes by, which implies that a post-refractive surgery era is approaching. In this era, Chinese cataract surgeons should pay attention to the challenges, which include an improvement in the accuracy of intraocular lens power calculation in post-corneal refractive surgery eyes, the explantation of implantable collamer lenses, and meeting patients' demands for spectacle independence to the greatest extent.

AIM: To describe a technique of managing intraocular lens (IOL) with deep dislocation in the vitreous cavity by performing pars plana vitrectomy (PPV) with only one pars plana incision under the direct illumination of the surgical microscope. METHODS: Patients who had in-the-bag or out-of-the-bag (spontaneous) IOL dislocation after uneventful phacoemulsification cataract extractions, with the dislocated IOL or IOL-capsular bag complex dropping completely into the vitreous since 2013 were included in our studies. The postoperative patients were followed up for 6mo. Detailed description of technique and retrospective description of eight typical cases were demonstrated in this study. RESULTS: A total of 40 surgeries were conducted using this technique. The main possible predisposing conditions included: post-vitrectomy, posterior capsule rupture or broken zonules, a history of ocular trauma, long axial length, secondary IOL implantation, chronic uveitis, retinitis pigmentosa and post-glaucoma surgery. In all eyes, the IOLs were successfully removed. No intraoperative or postoperative complications related to the procedures occurred. The preoperative corrected distance visual acuity (CDVA) ranged from 20/133 to 20/25, and at 6mo postoperatively, the CDVA was similar or the same. The intraocular pressure was all within the normal range. CONCLUSION: One-port PPV under direct vision with microscope illumination is a simple and safe surgical technique to managing IOL dislocation, which shortens the surgical time, and largely avoids surgical complications.

新型冠状病毒肺炎(COVID-19)疫情作为国际关注的突发公共卫生事件,威胁着全球公共卫生健康.虽然我国已度过至暗时刻,但该病毒迄今已造成3000多名医护人员感染,并导致至少35人牺牲,包括3名眼科医师.2019新型冠状病毒(2019-nCoV),即严重急性呼吸综合征冠状病毒2(SARS-CoV-2)主要通过呼吸道传染,该病毒是否会通过眼部传播?会引起哪些眼部表现?作为眼科医师,应该注重哪些防护措施?本文结合国内外最新文献和相关研究,从2019-nCoV的眼部发病机制以及眼部表现入手,分析是否存在眼部传染途径,并指出目前眼科必要的防控措施,希望为病毒性眼病的基础研究以及眼科医务人员的防控提供参考.

医护人员与患者接触的频率比普通民众高,更容易受到2019新型冠状病毒(2019-nCoV)感染的威胁.本文根据2019-nCoV感染的临床及流行病学特征,从眼科患者就诊的不同阶段提出系统的防护建议,包括患者流行病学筛查,医护人员一般性防护、专科防护,眼科仪器消毒等,以便相关人员做好预防措施.

在无晶状体囊膜支撑下植入人工晶状体是临床手术的难点之一，手术操作技巧要求高，尽管有多种手术方法可供选择，但手术并发症仍不少见。本文介绍临床传统的以及近年发展的几种无晶状体囊膜支撑人工晶状体固定术，重点阐述手术指征、手术特点和要点，为临床开展相关工作提供参考。（中华眼科杂志， 2020， 56： 393- 397）

1 病例资料及诊断 患者女性,58岁,左眼白内障超声乳化联合人工晶状体(intraocular lens,IOL)植入术后5年,眼部羽毛球击伤后视物模糊3个月.体格检查:左眼视力0.15,角膜透明,前房中深,tyn(-),IOL复合体嵌顿于瞳孔,颞侧襻进入前房.扩瞳后见IOL复合体向鼻上方不全脱位,玻璃体轻度混浊,视网膜平伏.眼压18.5 mmHg(1 mmHg =0.133 kPa).诊断:左眼外伤性IOL复合体不全脱位,左眼白内障超声乳化联合IOL植入术后.

Objective::To compare the stability of two-haptic and four-haptic intraocular lenses (IOL) in high myopic eyes.Methods::In this retrospective case-control study, 148 high myopic patients who received uneventful phacoemulsification with the implantation of a two-haptic IOL (Tecnis ZCB00, AMO) or four-haptic IOL (MC X11 ASP, HumanOptics) during October 2016 to June 2017 at the Eye & ENT Hospital of Fudan University were selected. Of these, 54 were in the two-haptic IOL group, and 94 in the four-haptic IOL group. Follow-up was planned for six months after surgery, including routine postoperative examinations. An OPD-Scan III aberrometer was used to evaluate the decentration and tilt of the IOL, higher-order aberrations, and modulation transfer function. Comparisons of IOL decentration and tilt, and visual qualities were conducted between the two groups. An independent-sample t-test, Mann-Whitney U-test, χ2 test, and Spearman correlation test were used in statistical analyses. Results::No statistically significant difference in terms of age, gender, or best-corrected visual acuity was seen between the two groups. However, significant differences were seen between the decentration of the two-haptic IOL group and the four-haptic IOL group when they were divided into subgroups of axial lengths between 26 mm and <28 mm, and between 28 mm and <30 mm [0.26(0.15, 0.33)mm vs. 0.18(0.10, 0.24)mm, Z=-2.81, P=0.005; (0.42±0.28)mm vs. (0.18±0.07)mm, t=2.96, P=0.01]. Meanwhile, significant correlations were found between decentration and axial length in both the two-haptic IOL group ( r=0.304, P=0.027) and four-haptic IOL group ( r=0.366, P<0.001). Under conditions of a pupil size of 7 mm, better ocular and intraocular higher-order aberrations and coma were seen in the four-haptic IOL group (all P<0.05). Conclusions::For high myopic eyes, the four-haptic IOL seems to be better than the two-haptic IOL in terms of long-term IOL stability and visual quality, especially in low-light conditions.

目的通过对白内障患者术后视觉质量和并发症的临床随访,评价国产AQBHL型预装式人工晶状体（intraocular lens,IOL）系统治疗白内障的有效性和安全性。方法多中心、随机、开放、阳性产品、平行对照临床试验。120例（120眼）受试者随机分为试验组（61例）和对照组（59例）,试验组采用国产全预装系统（型号:AQBHL）植入IOL（型号:AQBH）,对照组采用传统植入器和导入头植入IOL（型号:A1-UV）。术后1 d、1周、1个月、3个月、6个月和1 a进行随访,每次随访均对患眼进行视力、等效球镜度数、眼压、裂隙灯检查;术后3个月、6个月进行对比敏感度检查;术后1 a进行眼底检查和角膜内皮检查。结果术后各随访时间点,两组受试者裸眼远视力、裸眼近视力、最佳矫正远视力、最佳矫正近视力、等效球镜度数、对比敏感度、眼压的差异均无统计学意义（均为P＞0.05）;两组受试者的视力、屈光度数均在术后1个月达到稳定状态;术后各随访时间点两组受试者的视力相对术前均有显著提高（均为P＜0.01）;两组手术推注过程均顺畅,均未发生术中并发症;术后早期的炎性反应,组间比较差异无统计学意义（P＞0.05）;术后1 a,两组受试者角膜内皮细胞计数和角膜内皮多形性变化比较差异均无统计学意义（均为P＞0.05）;随访期间未发现IOL变色、混浊、钙化等异常情况,无一例受试者进行二次手术。结论国产AQBHL型预装式IOL系统可提供安全、可靠、可控的IOL植入过程,临床应用的安全性与非预装式推注系统相当;AQBH型IOL与A1-UV型IOL均可有效矫正白内障患者术后视力,矫正效果稳定,视觉质量优秀,生物相容性良好,术后并发症少,临床应用的有效性和安全性较高,可作为治疗白内障患者的有效手段。

目的 建立一个稳定、高效检测眼内液中铜绿假单胞菌的体系.方法 采用环介导等温扩增(LAMP)技术,由0.1～0.2 mL眼内平衡盐溶液(BSS)模拟眼内房水或玻璃体,利用铜绿假单胞菌gbca基因,特异性设计5组LAMP引物,并对扩增方法进行关键试剂的优化,检测眼内液中铜绿假单胞菌.结果 该扩增方法经过优化后,最低可以检出100 fg/μL纯基因组DNA,接近荧光定量灵敏度,具有很好的重现性.此外该方法在检测眼内液中混合的菌落时呈现出良好的检测效果,可以检测出2.1×102 CFU/mL,极具应用价值.结论 建立了一个稳定、高效、灵敏的恒温扩增体系,可以应用于眼内液中铜绿假单胞菌的检测.