PURPOSE:To investigate the factors influencing visual quality recovery after keratorefractive lenticule extraction (KLEx) and to establish a predictive model for postoperative visual quality using multimodal data integration. METHODS:A prospective, non-interventional single-center study was conducted on 210 eyes from 105 myopic patients undergoing KLEx surgery. Preoperative and postoperative visual quality was assessed using the Objective Scatter Index (OSI). High-precision segmentation of posterior lenticule scanning images was performed using a U-net-based deep learning model to extract radiomics features. These features, along with clinical data, surgical parameters, corneal topography, and biomechanics, were integrated into machine learning models for predicting OSI at 1 day and 1 week postoperatively. RESULTS:The study found that 30.95% (65/210) of eyes experienced poor early visual recovery. Significant differences in spherical equivalent, corneal curvature, and cutting depth were observed between good and poor visual quality groups. The ExtraTrees model demonstrated high efficacy in predicting OSI on the first postoperative day (area under the curve [AUC] = 0.96), whereas the AdaBoost model excelled at 1 week (AUC = 0.99). Regression models RidgeCV and LassoLarsIC performed best for predicting OSI values at 1 day and 1 week, respectively. Radiomics features such as original topology Gaussian Curvature Min and original gldm Dependence Variance were significantly correlated with the OSI. CONCLUSIONS:The study establishes a predictive framework that integrates intraoperative scanning image features, corneal biomechanics, and densitometry parameters, offering a quantitative basis for personalized surgical planning. The synergistic use of radiomics and clinical parameters can pre-identify high-risk patients, optimize surgical settings, and improve postoperative visual quality.

PURPOSE:We report a rare case of CMV-associated conjunctival atypical lymphoid hyperplasia (ALH). METHODS:A case report. RESULTS:A 34-year-old Chinese male with a 2-year history of recurrent bilateral redness, photophobia, and tearing, and no systemic or prior ocular illnesses, presented with severe bilateral conjunctival hyperemia, gelatinous limbal hyperplasia, and corneal opacities. Surgical excision was performed. Histopathology and immunohistochemistry revealed atypical lymphoid hyperplasia with a clonal B-cell population and CMV positivity within the lesional tissue. CONCLUSION:This case expands the clinical spectrum of ocular CMV disease and underscores the importance of considering CMV in the differential diagnosis of chronic, atypical conjunctival lesions. The relationship between CMV infection and ALH warrants further investigation. Long-term follow-up is needed to monitor for local recurrence or progression to overt lymphoma.

Anterior segment optical coherence tomography (AS-OCT) is essential for structural assessment of the anterior eye, yet automated landmark localization remains challenged by pervasive speckle noise, indistinct tissue interfaces, and labor-intensive manual annotation with notable inter-observer variability. This study presents NSE YOLO, an enhanced YOLOv11 framework for high-precision landmark localization in AS-OCT images after implantable collamer lens (ICL) implantation. It integrates a dual-branch NewConv module for multi-scale feature extraction, a dual-additive residual self-attention block (SABlock) to suppress background interference, and a Mamba-based EfficientViMBlock embedded in the C3k2 module to balance global contextual modeling and computational efficiency. Validated on 672 expert-annotated postoperative ICL images from 60 patients, NSE YOLO achieved an mAP@0.5 of 90.7% and mAP@0.5:0.95 of 85.1%, outperforming the YOLOv11 baseline by 5.2% and 6.6% with only 2.86 million parameters. Bland–Altman analysis showed negligible systematic bias and narrow limits of agreement for anterior chamber depth. For iridocorneal angle measurements, directional deviations and wider limits of agreement were observed, with performance approaching the level of inter-observer variability among human annotators. NSE YOLO enables automated quantification of anterior chamber depth and bilateral iridocorneal angles for post-ICL follow-up assessment, providing preliminary technical validation supporting further external and device-level evaluation.

AIMS:Vascular endothelial growth factor (VEGF) drives corneal neovascularization (CorNV), yet no anti-VEGF eye drops are clinically available. We report phase I/IIa trials of KH906, a novel topical anti-VEGF agent. METHODS:Trial 1 was a phase I, open-label, dose-escalation study in healthy adults receiving KH906 at 0.1, 0.5, or 1.0 mg/mL. Trial 2 was a phase I, multicentre, open-label, dose-escalation study in patients with CorNV at the same doses. Trial 3 was a phase IIa, randomized, double-masked, placebo-controlled study assigning patients 1:1:1 to 0.5 mg/mL KH906, 1.0 mg/mL KH906, or placebo. Primary endpoints were safety, tolerability and pharmacokinetics (Trials 1 and 2) and safety, tolerability and efficacy (Trial 3). RESULTS:From 10 December 2018 to 16 June 2021, 18 healthy participants and 39 patients with CorNV were enrolled. One treatment-related adverse event occurred: a mild corneal epithelial defect in the 1.0-mg/mL group in Trial 3. No serious or other drug-related adverse events were observed. In Trial 2, KH906 reduced the CorNV area and vessel length. In Trial 3, at Day 28, mean changes in CorNV area were -1.2 (0.8), -1.6 (1.1) and -0.7 (1.1), and mean changes in CorNV length were -8.0 (7.3), -6.6 (5.9) and -1.7 (7.9), in the 0.5-mg/mL KH906, 1.0-mg/mL KH906 and placebo groups, respectively. The 1.0-mg/mL dose produced greater reduction of the CorNV area than lower doses, indicating a dose-response effect. CONCLUSIONS:KH906 appears safe and well tolerated and demonstrates preliminary efficacy in reducing CorNV, with higher doses showing greater effect, supporting further clinical development.

Implantable collamer lens (ICLs) surgery is increasingly used for myopia correction, yet postoperative narrowing of the iridocorneal angle (IA) has been associated with elevated intraocular pressure (IOP). Prior computational studies treated IA geometry and trabecular meshwork (TM) microstructure independently, leaving unresolved how IA narrowing alters TM pore structure and outflow resistance. Here, we combined optical coherence tomography with multi-scale computational fluid dynamics, coupling a macroscopic anterior-segment model with a TM representative volume element (RVE) to quantify the IA–porosity–IOP relationship. Modifying IA geometry alone produced negligible IOP changes (0.02–0.04 Pa posterior-chamber elevation), even at the narrowest angle of 16.6°. RVE simulations showed that angle-related TM deformation reduced porosity from 0.39 to 0.20. This porosity loss increased the mean pressure gradient by more than 1.5-fold and induced channelized flow near an RVE-derived transition porosity of 0.27. Larger IAs enhanced natural convection, increasing peak aqueous humour velocity by approximately 472%, while wall shear stress remained below endothelial detachment thresholds. These results identify TM pore deformation as a mechanical mechanism linking IA narrowing to increased aqueous outflow resistance and IOP. This mechanistic framework may guide precision ocular interventions, though patient-specific anatomical variability and time-dependent effects remain to be incorporated.

PURPOSE:To develop and validate a multimodal deep-learning model for predicting postoperative vault height and selecting implantable collamer lens (ICL) sizes using anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) images combined with clinical features. SETTING:West China Hospital, Sichuan University, Chengdu, Sichuan, China. DESIGN:Deep-learning study. METHODS:626 AS-OCT and 1309 UBM images from 209 eyes of 105 participants with ICL V4c implantation were used. Features were extracted using a convolutional neural network (ResNet50) and combined with clinical data for model training. Machine learning algorithms including Light Gradient Boosting Machine (LightGBM), Extreme Gradient Boosting (XGBoost), and Random Forest (RF) were used to develop models for postoperative vault height prediction and ICL size selection. Models were validated using metrics such as mean absolute error (MAE), root mean squared error (RMSE), R2 , accuracy, sensitivity, specificity, and precision. RESULTS:The LightGBM, XGBoost, and RF models showed RMSE values below 150 μm, MAE values below 120 μm, and R2 values around 0.4 in predicting postoperative vault height. The LightGBM model achieved the best performance in ICL size selection, with an accuracy of 0.904, sensitivity of 0.935, specificity of 0.907, and precision of 0.873, outperforming traditional methods and nearing the performance of senior doctors. CONCLUSIONS:The multimodal deep-learning model significantly improved the accuracy of predicting postoperative vault height and selecting ICL sizes for ICL V4c implantation, overcoming the limitations of single-modal data analysis. Future studies should expand sample sizes and conduct multicenter validations to enhance model generalizability and clinical applicability.

The significance and contributions of corneal biomechanics in the study of chronic elevated intraocular pressure are multifaceted. Not only does it enhance our understanding of how chronic elevated intraocular pressure affects corneal structure and function, but it also offers new perspectives for the early diagnosis of glaucoma. Analysis of the cornea’s biomechanical properties enables earlier identification of high-risk glaucoma patients and potential development of personalized treatment plans, thereby improving treatment outcomes. Moreover, changes in corneal biomechanics can serve as a new metric for assessing glaucoma treatment effectiveness, providing precise clinical feedback. Continued research on the role of corneal biomechanics in chronic elevated intraocular pressure and glaucoma is crucial for improving the diagnosis, treatment, and prognosis. Understanding associations between these biomechanical changes and glaucoma development can elucidate disease mechanisms, enabling more effective treatment strategies and preventive measures. This review explores the latest research developments on corneal biomechanical changes associated with chronic elevated intraocular pressure and their impact on glaucoma management, highlighting the importance of these changes in clinical practice.

PurposeUveal melanoma (UVM) is the most common primary intraocular malignancy in adults, characterized by high mortality despite its relatively low incidence. This study aimed to utilize unsupervised learning techniques to identify a high immune infiltration subtype of UVM and improve patient stratification based on mortality risk.MethodsA total of 70 hematoxylin and eosin (H&E) stained whole-slide images (WSIs) of UVM were collected from the Genomic Data Commons (GDC) data portal, along with genomic and clinical data. An additional validation cohort of 68 UVM patients from West China Hospital was included. Pathomic features were extracted using CellProfiler software, and deep learning models were constructed for classification and survival prediction. Unsupervised clustering was performed to identify critical regions for prognosis prediction and patient classification. The relationship between histopathological features and genomics was explored.ResultsThe study achieved accurate prediction and classification of UVM patients using deep learning models and machine learning techniques. A high immune infiltration subtype of UVM was identified, which showed prognostic relevance. Unsupervised clustering categorized UVM patients into three distinct subgroups. The developed deep learning model based on the Inception-V3 architecture demonstrated promising results in survival prediction.ConclusionThis study demonstrates the potential of unsupervised learning and deep learning techniques in identifying a high immune infiltration subtype of UVM and improving patient stratification based on mortality risk. This research contributes to the field of computational pathology and highlights the potential of utilizing histopathological images, genomic data, and deep learning models in enhancing the management of UVM patients.

Purpose:The study aimed to assess the impact of VISULYZE nomogram software on refractive outcomes after lenticule extraction for myopia and myopic astigmatism correction. Methods:This ambispective, single-site, matched case-control study was conducted at West China Hospital in Chengdu, China. Treatments using the VISULYZE nomogram were compared to a control group without it. The main outcome was refractive accuracy at 3 months, measured by the proportion of eyes achieving a spherical equivalent (SEQ) within ±0.50 D of the target and astigmatism ≤0.50 D. Results:The study involved 180 eyes, with 90 treated using VISULYZE and 90 matched controls analyzed retrospectively. In the VISULYZE group, 98.9% achieved SEQ within ±0.50 D versus 85.6% in the control group (P<0.001). Astigmatism ≤0.50 D was achieved in 100% of VISULYZE-treated eyes compared to 93.3% in controls (P=0.006). Both groups had similar safety indices. VISULYZE showed higher correlations between attempted and achieved SEQ (R²=0.9799) and astigmatism (R²=0.8996) compared to the control group (SEQ: R²=0.9590; Astig: R²=0.5992). Standard efficacy and safety measures showed no difference between groups. Conclusion:The VISULYZE-generated nomogram demonstrated improved predictability and accuracy in refractive outcomes. It may enhance results for surgeons compared to those using no nomogram or a standard offset nomogram.

Brown-McLean Syndrome is a rare clinical condition typically presenting as localized edema involving a 2–3 mm peripheral area of the cornea, which often has undergone intraocular surgery. We present a unique case of unilateral Brown-McLean Syndrome (BMS) with concurrent keratoconus in an 18-year-old male patient. The individual sought medical attention due to poor vision in the right eye, which had been unnoticed for a month. Notably, there was no history of ocular surgery or trauma, and the patient did not suffer from any systemic diseases. Clinical examination revealed peripheral corneal edema, extending 2–4 mm from the limbus, exclusively affecting the right eye. Corneal topography indicated the presence of keratoconus, which was an incidental finding during the investigation. This case underscores the importance of considering BMS in the differential diagnosis of peripheral corneal edema even in the absence of ocular surgery or trauma. The potential relationship between BMS and keratoconus is explored, suggesting that long-term edema and degeneration of the peripheral cornea could alter its biomechanical properties, leading to deformation and keratoconus. Thorough clinical evaluation and long-term follow-up are crucial in managing such patients.

AIM: To explore the mechanical indices used for differential diagnosis and to investigate the relationship between ocular biomechanics and glaucoma severity within each group. METHODS: This cross-sectional study included 185 eyes from 185 subjects: 62 normal controls, 91 high-tension glaucoma (HTG), and 32 normal-tension glaucoma (NTG) patients. All participants underwent a comprehensive ophthalmic examination that involved ocular biomechanical measurements. Glaucoma severity was assessed using visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD) and retinal nerve fiber layer (RNFL) thickness. Multivariable models were used to compare fifteen biomechanical parameters among the three groups adjusting for age, gender, intraocular pressure (IOP), central corneal thickness (CCT), and axial length (AL). The generalized linear model was utilized for multifactor comparison. RESULTS: Significant differences in first applanation time (AT1), highest concavity time (HC time), stress strain index (SSI), and HC deflection were found among the three groups (P<0.05). AT1 was significantly higher in the HTG group compared to controls (P<0.05), and SSI was higher in HTG than NTG (P<0.05). HC deflection in the HTG group was significantly smaller than in NTG (P<0.05). Furthermore, AT1 levels were observed to be significantly higher in primary open angle glaucoma (POAG) patients compared to controls (P<0.05). Receiver operating charactristic (ROC) analysis showed HC deflection had an area under the curve (AUC) of 0.802 between HTG and NTG. A negatively significant correlation was observed between SSI and VFI in POAG patients. CONCLUSION: Biomechanical analysis reveals that corneas in POAG patients are stiffer than normal controls, with increased corneal stiffness correlating with more severe glaucomatous damage. Interestingly, stiffer corneas in NTG patients appeares protective. In addition, HC deflection may be useful for differentiating HTG and NTG.

Purpose:To evaluate the efficacy, safety, and predictability of Keratorefractive Lenticule Extraction (KLEx) surgery guided by a VISULYZE-generated nomogram for myopia and astigmatism correction. Methods:This prospective cohort study included 130 consecutive patients (260 eyes) undergoing KLEx surgery using a VISULYZE-generated nomogram. Patients were followed for 3 months postoperatively. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent (SE). "Nine Standard Graphs" were generated using VISULYZE software and analyzed according to international standards for evaluating the quality of corneal refractive surgery. Subgroup analyses based on age (≤30 years vs >30 years) and preoperative SE (≤-6.00 D vs >-6.00 D) were performed. Results:At 3 months postoperatively, 96% of eyes achieved UDVA of 20/20 or better, and 96.2% maintained or improved CDVA compared to preoperatively. No eyes lost 1 or more lines of CDVA. The correlation coefficient (R²) between attempted and achieved SE was 0.9732. 98.1% of eyes were within ±0.50 D of the attempted SE. 99.2% of eyes achieved a postoperative cylinder ≤0.50 D. Subgroup analysis revealed that older patients (>30 years) had slightly lower UDVA compared to younger patients, while high myopes (≤-6.00 D) showed a trend towards slight under-correction and lower efficacy compared to moderate and low myopes. However, astigmatism correction was comparable between subgroups. Conclusion:KLEx surgery guided by a VISULYZE-generated nomogram demonstrates excellent efficacy, safety, and predictability for myopia and astigmatism correction. While age and preoperative myopia degree may subtly influence efficacy, the nomogram provides a valuable tool for personalized surgical planning. Further research is warranted to refine nomogram development, particularly for older and highly myopic patients.

To analyze corneal topographic and biomechanical parameters in keratoconus patients before undergoing accelerated corneal collagen cross-linking (A-CXL) surgery and use machine learning models to identify prognostic factors for disease progression after treatment. This was a retrospective, single-center study on 95 eyes from 69 keratoconus patients (mean age 21.46 ± 7.07 years) undergoing A-CXL, with 3–22 months follow-up. Corneal tomography (Pentacam) and biomechanical measurements (Corvis ST) were performed at baseline and follow-up visits. Changes in the E-stage were used to define progression. LASSO, XGBoost, and random forest machine learning models were applied to identify prognostic factors. A nomogram was developed to predict progression probabilities. 42.1

Background This study aims to assess the long term effectiveness, safety, predictability and stability of V4c implantable collamer lenses (ICL) for correction of moderate to extreme high myopia. Methods We reviewed 125 eyes from 64 patients who implanted V4c ICL at the Refractive Surgery Center of West China Hospital in Chengdu, China, between May 2015 and January 2017. The median spherical equivalent was −11.50 D (interquartile range [IQR]: −13.00 to −9.00 D). We followed up with the patients over five years and evaluated several parameters, including uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), axial length, refractive error, endothelial cell density (ECD), intraocular pressure (IOP), white-to-white distance (WTW), and vault. We performed a correlation analysis to explore the potential impacts on vault following implantation. Results The median safety index (postoperative CDVA/preoperative CDVA) during the last follow-up was 1.00 (interquartile range [IQR]: 1.00–1.20), and the efficacy indices (postoperative UDVA/preoperative CDVA) were 1.20 (IQR: 1.00–1.25), 1.20 (IQR: 1.00–1.33), and 0.8 (IQR: 0.65–1.00) at postoperative 1 week, 1 month, and 5 years, respectively. At the five-year mark, 16% of the eyes were within ±0.50 D of expected correction, and 73% were within ±2.00 D. No significant difference in ECD was observed between pre-operative and post-operative measurements. Compared to baseline, we observed a significant increase in IOP at the one-week follow-up, which decreased significantly at the one-month visit. Furthermore, we identified ICL size and spherical equivalent (SE) as independent variables in a multiple linear regression model that accurately predicted the five-year vault after surgery. Conclusion In conclusion, V4c ICL implantation is an effective and safe treatment for moderate to extreme high myopia with good predictability and stability over the long-term.

PURPOSE:To evaluate the corneal biomechanical characteristics of eyes with Sturge-Weber syndrome (SWS) secondary glaucoma (SSG) by analyzing corneal biomechanical parameters obtained using the Corneal Visualization Scheimpflug Technology instrument (Corvis ST). METHODS:In patients with SWS, eyes affected by SSG were designated as the SSG group while the contralateral eyes were designated as the SWS contralateral group (SC group). Patients from the myopia clinic served as the control group. Dynamic corneal response parameters (DCRs) including the stress-strain index (SSI)-a critical material stiffness parameter that excludes interference from IOP and central corneal thickness (CCT)-were analyzed. RESULTS:For CCT, no significant difference was observed between the SSG and SC groups. However, significant differences were found between the SSG and control groups and between the SC and control groups. Parameters such as HC Time, A1 Deformation Amp., A2 Deformation Amp., length of Whole Eye Movement (WEM), DA Ratio Max (2 mm), PachySlope, DA Ratio Max (1 mm), and ARTh showed significant differences between the SSG group and control group. In the SSG group, 4 of night eyes had an SSI of less than 0.85. CONCLUSIONS:Some DCRs indicated a stiffer cornea in the SSG group, possibly due to a thicker cornea in this group. On analyzing SSI, it was found that corneal material properties change, becoming less stiff in some of the patients with SSG. In conclusion, our study provides a preliminary exploration of the biomechanical properties of SWS secondary glaucoma.

Background: Uveal melanoma (UVM) is a prevalent intraocular malignancy with a high mortality rate. This study aimed to utilize unsupervised learning techniques to identify a high immune infiltration subtype of UVM and improve patient stratification based on mortality risk.Methods: A total of 70 hematoxylin and eosin (H&E) stained whole-slide images (WSIs) of UVM were collected from the Genomic Data Commons (GDC) data portal, along with genomic and clinical data. An additional validation cohort of 68 UVM patients from West China Hospital was included. Pathomic features were extracted using CellProfiler software, and deep learning models were constructed for classification and survival prediction. Unsupervised clustering was performed to identify critical regions for prognosis prediction and patient classification. The relationship between histopathological features and genomics was explored.Findings: The study achieved accurate prediction and classification of UVM patients using deep learning models and machine language learning techniques. Above 95% accuracy to identify the high immune infiltration subtype of UVM which showed prognostic relevance. Unsupervised clustering categorized UVM patients into three distinct subgroups. The developed deep learning model based on the Inception-V3 architecture demonstrated promising results in survival and gene mutant prediction.Interpretation: This study demonstrates the potential of unsupervised learning and deep learning techniques in identifying a high immune infiltration subtype of UVM and improving patient stratification based on mortality risk. This research contributes to the field of computational pathology and highlights the potential of utilizing histopathological images, genomic data, and deep learning models in enhancing the management of UVM patients.Funding: Not applicable.Declaration of Interest: Every author states that they have no conflicting interests.Ethical Approval: Whole slide images (WSIs) of patients with uveal melanoma receiving radical enucleation were obtained with their agreement for the WCH-UVM cohort. The West China Hospital Ethics Committee gave its approval to the study, which adhered to the principles of the Helsinki Declaration.

Purpose To explore whether implantable collamer lens implantation has any effect on the postoperative objective indicators of dry eye and to determine the severity of its influence on each indicator. Methods This prospective observational trial was performed in the Department of Ophthalmology of West China Hospital and was approved by the Biomedical Ethics Sub-Committee of the West China Hospital of Sichuan University. A total of 89 non-dry eye patients (178 eyes in total) who received ICL implantation surgery at West China Hospital of Sichuan University were enrolled. The noninvasive keratograph tear film breakup time (NIKBUT), noninvasive keratograph tear meniscus height (NIKTMH), score of lipid layer, score of meibomian gland function, and hyperemia index were obtained via the OCULUS Keratograph for all subjects before surgery and at 1 week, 1 month, and 3 months after surgery. The fluorescein tear film breakup time (FBUT), corneal fluorescein staining score (CFS), and Schirmer test I were also measured at the same time. Results A total of 178 eyes completed the 1-week and 1-month follow-up, and 40 eyes completed the 3-month follow-up. Compared with the preoperative baseline, there was no significant difference in the NIKBUT or the corneal fluorescein staining score at each follow-up time point ( P > 0.05, P > 0.05, P > 0.05). The FBUT and Schirmer test I at 1 week, 1 month, and 3 months after surgery were significantly higher than the preoperative baseline ( P < 0.01, P < 0.01, P < 0.01). The NIKTMH and the score of lipid layer were significantly lower than the preoperative baseline at 1 week, 1 month, and 3 months after surgery ( P < 0.01, P < 0.01, P < 0.05). The score of meibomian gland function and hyperemia index were significantly lower than the preoperative baseline 1 week after surgery ( P < 0.01). Conclusion ICL implantation has no adverse effect on the occurrence of postoperative dry eye, but it reduces the basal tear secretion of patients after surgery and has adverse effects on the indices of meibomian gland function in the short term postoperatively.

An ideal adhesive hydrogel must possess high adhesion to the native tissue, biocompatibility, eligible biodegradability, and good mechanical compliance with the substrate tissues. We constructed an interpenetrating double-network hydrogel containing polysaccharides (alginate and dextran) and nanosized spherical dendrimer by both physical and chemical crosslinking, thus endowing the hydrogel with a broad range of mechanical properties, adhesive properties, and biological functions. The double-network hydrogel has moderate pore sizes and swelling properties. The chelation of calcium ions significantly enhances the tensile and compressive properties. The incorporation of dendrimer improves both the mechanical and adhesive properties. This multicomponent interpenetrating network hydrogel has excellent biocompatibility, tunable mechanical and adhesive properties, and satisfied multi-functions to meet the complex requirements of wound healing and tissue engineering. The hydrogel exhibits promising corneal adhesion capabilities in vitro, potentially supplanting the need for sutures in corneal stromal surgery and mitigating the risks associated with donor corneal damage and graft rejection during corneal transplantation. This novel polysaccharide and dendrimer hydrogel also shows good results in sutureless keratoplasty, with high efficiency and reliability. Based on the clinical requirements for tissue bonding and wound closure, the hydrogel provides insight into solving the mechanical properties and adhesive strength of tissue adhesives.

In the conventional technique, viscoelastic agents are typically rinsed away with balanced salt solution (BSS), but it may lead to a series of complications such as viscoelastic residue, anterior chamber instability and intraoperative TICL rotation. The utilization of irrigation and aspiration (I/A) has been shown to be effective in maintaining anterior chamber stability, reducing the incidence of postoperative high intraocular pressure, and minimizing postoperative fundus complications. However, there is a lack of previous studies investigating the impact of I/A on corneal endothelial cells during ICL implantation. The objective of this study was to examine the effect of I/A on corneal endothelial cells in patients undergoing myopia correction through implantation of Implantable Collamer Lens with a central hole (V4c ICL). A retrospective selection was made of 344 eyes from 172 patients who underwent V4c ICL implantation and I/A to remove viscoelastic agent from the anterior chamber between 2021 and 2022. The intraocular pressure (IOP) was measured at 1 h, 2 h and 3 h after surgery. Corneal endothelial cell density (ECD), coefficient of variation in cell size (CV), standard deviation of cell area (SD), and percentage of hexagonal cells (HEX) were evaluated at 1 week postoperatively to assess corneal endothelial cells. The first two represent polymegethism or morphological variation, while the third parameter represents the degree of polymorphism of the corneal endothelial cells. Electronic medical records were utilized for data collection purpose. All surgeries proceeded without complications. The IOP was 16.50 ± 3.42 mmHg (range: 11.5–22.3 mmHg) prior to surgery and increased to 21.25 ± 5.61 mmHg (range: 9.5–34.8 mmHg), 19.85 ± 5.18 mmHg (range: 11.4–36.2 mmHg) and finally settled at an average of 18.81 ± 4.57 mmHg (range: 10.1–38.8 mmHg) at the respective time points of 1 h, 2 h and 3 h after surgery. The preoperative ECD was recorded as being approximately 3004 ± 295 cell/mm2, which exhibited a marginal decreased of 1.17