Volume 61 · Issue 02 · 2025

This issue of Chinese Journal of Ophthalmology focuses on the research progress in the field of diagnosis and treatment of ocular surface diseases. The responsible editorial board of this issue is Professor Liu Guoguo. The content of this issue aims to provide cutting-edge information and practical guidance for the clinical and research of ocular surface diseases.

Ocular surface and tear diseases are among the most common and significant ocular conditions affecting eye health. In recent years, research and clinical diagnosis and treatment of ocular surface and tear diseases have rapidly developed in China, but numerous challenges remain. Breakthroughs in medical artificial intelligence (AI) offer new methods and approaches to address these difficulties. This article, based on the current state of AI applications for ocular surface and tear diseases in China and the major challenges, outlines future directions for progress. With the construction of shared multimodal databases, development of AI foundational models, improvement of AI evaluation systems, promotion of AI for comprehensive disease management throughout the entire lifecycle, and training of multidisciplinary talents, significant advances of the application of AI in the diagnosis and treatment of ocular surface and tear diseases would be achieved.

Varicella zoster virus keratitis (VZK) is a common infectious disease of the cornea. It has the clinical characteristics of multiple ocular tissue involvement, diverse corneal manifestations, and significant damage to corneal endothelial cells, and is prone to be misdiagnosed or missed. At present, a uniform diagnosis and treatment protocol of VZK is lacking at home and abroad. It is necessary to form consensus and guidance for accurate diagnosis and standardized treatment. The Ocular Infection Group of Chinese Ophthalmologist Association has facilitated relevant domestic experts, including corneal experts and dermatologists, to reach this consensus on the diagnosis, treatment, and prevention of VZK, on the basis of the previous publications, latest research progress, and expert clinical recommendations.

To explore the correlation between the nerve growth factor (NGF) in the corneal stroma and the corneal optical quality in high myopia patients wearing soft contact lenses (SCLs) for a long time before small incision lenticule extraction (SMILE).

A retrospective cohort study was conducted. Sixty high myopia patients (120 eyes) who underwent SMILE in Shanghai Tenth People′s Hospital from December 2020 to October 2022 were included, with an age of (30.75±4.37) years, including 26 males and 34 females. According to the duration of wearing SCLs before surgery, they were divided into three groups: group A (wearing time>10 years), group B (wearing time≤10 years), and group C (without wearing lenses). General examinations were carried out to collect medical histories and parameters, such as uncorrected visual acuity, intraocular pressure, and axial length of the eye. The Pentacam corneal topography system was used to measure corneal higher-order aberrations, including total higher-order aberrations and various coma aberrations, and to obtain the optical density of different parts and layers of the cornea. A part of the corneal stromal lenticule was used for immunofluorescence detection, and another part was used to detect the NGF level.

The expression level of NGF in the corneal stromal lenticules showed an upward trend with the prolongation of the wearing time of SCLs (P<0.05). The total higher-order aberration in group A was (0.39±0.10) μm, and the horizontal coma aberration was (0.17±0.12) μm, both higher than those in group C [(0.33±0.07) μm and (0.09±0.08) μm]. The full-thickness optical density of the central 6-mm annular region of the cornea in group A (13.64±2.08) and that of the central 2-mm circular region of the cornea in group B (13.58±1.28) were both higher than that in group C (12.74±0.85) (all P<0.05). The NGF level in the corneal stromal lenticules in group A was positively correlated with the optical density of the anterior layer and the full-thickness layer within the central 6-mm circular region of the cornea (both P<0.05). In group B, the NGF level in the corneal stromal lenticules was positively correlated with the optical density of the middle layer and the posterior layer within the central 6-mm circular region of the cornea, and also positively correlated with the optical density of the middle layer and the posterior layer of the 2-mm circular region (all P<0.05). The NGF level in the corneal stromal lenticules in group C was also positively correlated with the optical density of the middle layer and the posterior layer of the 0-to 6-mm annular region of the cornea (all P<0.05).

In high myopia patients who have worn SCLs for a long time, the expression of NGF in the corneal stromal lenticules increases, the corneal optical quality decreases, and the NGF level is closely related to the corneal optical density.

The aim of this study was to analyze the clinical and histopathological characters of inflammatory juvenile conjunctival nevus (IJCN).

Retrospective case series study. A total of 19 patients aged 18 years or younger with IJCN underwent conjunctival nevus excision surgery in Tianjin Eye Hospital from January 2015 to December 2023. The clinical signs (patient age, lesion location, and appearance, etc) as well as the hematoxylin-eosin staining and immunohistochemical staining appearances under an optical microscope were observed.

There were 10 males and 9 females. The age at surgery ranged from 5 to 18 years old, and the median age was 10 (6, 13) years old. All patients had a unilateral onset. The nevus was located at the temporal side of the bulbar conjunctiva in 13 eyes, at the nasal side in 5 eyes and at the inferior side in 1 eye. Nine lesions were adjacent to the limbus. The color of the lesions varied from yellowish-white to grayish-brown, with pigmentation in 15 eyes. The border was well circumscribed in 13 eyes. Follow-up data were available for 15 cases, with a median follow-up time of 51 (17, 54) months, ranging from 6 to 68 months, and no recurrence was found. Eighteen lesions were of the compound type, while one lesion was a junctional nevus. Lymphocytic and plasma cell infiltration was observed around the nevus cells. All nevus cells exhibited immunopositivity for S-100 and Melan-A proteins. HMB-45 was only positive within the superficial junctional zone, and the expression gradually decreased with the growth of nevus cells into the stroma. No nuclear PRAME expression was detected in any nevus cells. The ki-67 index ranged from 1% to 5%. The CK was positive in the conjunctival epithelium and epithelial inclusions (either solid or cystic). Cluster of differentiation (CD)20, CD3 and CD138 were expressed positively in inflammatory cells, which were mainly B cells in 13 eyes, plasma cells in 4 eyes, and T cells in 2 eyes.

The IJCN primarily occurs in children and adolescents. It presents with a yellowish-white to grayish-brown flat mass on the bulbar conjunctiva. Most cases are compound nevi with prominent lymphocytic infiltration and conjunctival epithelial ingrowth between nevus cells.

To investigate the prevalence of blindness and visual impairment in adults and the related causes in China.

A population-based cross-sectional survey was conducted during 2021 and 2022 among 13 provinces, municipalities, and autonomous regions, including Beijing, Hebei, Jiangsu, Shanghai, Guangdong, Henan, Shanxi, Ningxia Hui Autonomous Region, Chongqing, Yunnan, Sichuan, Heilongjiang, and Liaoning. Respondents were adults aged 18 years and above, and were classified into groups of young adults (18 to 39 years), middle-age adults (40 to 59 years), and the elderly (≥60 years). The examinations included visual acuity measurement, non-contact tonometry, slit-lamp examination, fundus photography, automatic refraction (non-mydriasis), and demographics (questionnaire). The diagnosis and distribution of eye diseases were analyzed. The Cochran-Armitage test was used for statistical processing.

A total of 93 123 adults with a mean age of 48.8 years (range, 18 to 101 years) completed the survey, and the response rate was 76.2% (93 123/122 191). There were 37 725 males (40.5%) and 55 398 females (59.5%), while 32 357 (34.75%) were aged 18 to 39, 29 127 (31.28%) were aged 40 to 59, and 31 639 (33.97%) were aged≥60. According to the best-corrected visual acuity (BCVA) in the better eye of 93 123 adults, the blindness, moderate to severe visual impairment (low vision), and mild visual impairment were found in 280, 2 270, and 4 679 patients, respectively. Based on BCVA of the worse eye, the top three causes of blindness and low vision were cataract (1 271/2 982, 42.62%), uncorrected refractive error (433/2 982, 14.52%), and pathological myopia (90/2 982, 3.02%), without considering trauma or other undefined fundus diseases.

From 2021 to 2022, the prevalence rates of blindness and low vision in Chinese adults were 0.30% and 2.44%, respectively. Cataract was the primary eye disease leading to blindness and low vision, and pathological myopia became the major cause of irreversible blindness in the population.

To investigate the impact of eyeliner tattooing on the ocular surface, the morphology and function of meibomian glands, and to explore its potential influence on ocular surface health.

A retrospective cohort study was conducted. A total of 31 female subjects (62 eyes) with eyeliner tattoos who visited the outpatient department of Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from April to September 2022 due to visual fatigue and other reasons were included as the eyeliner group, and 28 age-matched female subjects (56 eyes) without eyeliner tattoos were included as the control group. Questionnaires, tear meniscus height measurement, evaluation of the distance between meibomian gland imaging and the eyeliner, detection of the thickness of the lipid layer of the tear film and blink parameters, tear secretion test and tear film break-up time(BUT) measurement, meibomian gland function score and other examinations were carried out for all subjects. The main indicators included the Ocular Surface Disease Index (OSDI) score, tear meniscus height (TMH), lipid layer thickness of the tear film, tear secretion test, and BUT, etc.

The OSDI score of the eyeliner group was (43.05±19.00) points, which was significantly higher than that of the control group [(20.70±12.42) points] (P<0.05). The TMH of the eyeliner group was (0.19±0.06) mm, and the BUT was (4.19±1.28) s, both of which were lower than those of the control group [(0.31±0.16) mm and (5.64±2.16) s], and the differences were statistically significant (both P<0.05). The scores of meibomian gland loss degree, meibomian gland secretion, and meibomian gland excretion ability in the eyeliner group were all significantly higher than those in the control group (all P<0.05). In addition, the proportion of incomplete blinks in the eyeliner group was significantly higher than that in the control group (P<0.05). The distance between the eyeliner and the opening of the meibomian gland was positively correlated with the scores of meibomian gland loss degree and meibomian gland excretion ability (r=0.432, 0.539; both P<0.05).

Eyeliner tattooing has a significant impact on the ocular surface and the morphology and function of meibomian glands, resulting in an increase in the OSDI score, a decrease in the TMH and BUT, a decline in meibomian gland function, and an increase in the proportion of incomplete blinks, which may increase the risks of ocular discomfort and dry eye.

To explore the clinical effectiveness of glucocorticoids combined with amniotic membrane transplantation in the treatment of severe marginal ulcerative keratitis.

A retrospective case series study was conducted. Data from 10 patients (10 eyes) with marginal ulcerative keratitis who received glucocorticoid administration combined with amniotic membrane transplantation at the Eye Hospital of Shandong First Medical University from October 2017 to May 2022 were collected. There were 6 males and 4 females with an average age of 61.3 years. All patients underwent corneal scraping, bacterial culture, fungal culture, and confocal microscopy examination to exclude bacterial, fungal, and Acanthamoeba infections. The main indicators included visual acuity, intraocular pressure, corneal ulcer healing, and resolution of stromal edema.

The follow-up after surgery ranged from 1 to 18 months. Postoperative visual acuity in all patients was significantly improved compared to preoperative levels. Among the 10 patients, 5 had partial abnormalities in blood immune indicators. For patients with purulent exudates attaching to the endothelial surface as shown on anterior segment optical coherence tomography, anterior chamber irrigation was performed to remove the exudates during surgery. Corneal ulcers healed within 1 to 2 weeks postoperatively, with negative corneal fluorescein stainings. Stromal edema completely resolved within 1 month. The superficial large amniotic membrane autolyzed or fell off within 7 to 10 days, while the inner amniotic membrane remained closely attached to the ulcer surface until the ulcer healed, shrinking as the ulcer surface decreased. Epithelial cells around the ulcer proliferated and gradually crawled to the surface of the small amniotic membrane on the ulcer surface, covering the corneal ulcer surface. The deep fibrous tissue of the ulcer and the amniotic membrane fused, filling the defect area of the ulcer tissue together.

Patients with severe marginal ulcerative keratitis treated by glucocorticoid administration combined with amniotic membrane transplantation achieved favorable visual acuity improvement and corneal ulcer healing.

A 52-year-old female patient experienced red eyes and eye pain for more than one year due to suture exposure in the left eye after double eyelid plasty with the embedding suture method. She visited several hospitals outside and was diagnosed with keratitis and conjunctival mass in the left eye. After anti-inflammatory and anti-infection treatments, the condition relapsed. She visited our hospital, and the exposed suture was removed. After a review half a year later, the conjunctival granuloma in the left eye disappeared, and the corneal ulcer lesion transformed into corneal pannus. This case suggests that ophthalmologists should conduct detailed eye examinations for patients with a history of double eyelid plasty, discover and handle suture exposure problems in time to improve prognosis.

A 54-year-old male patient presented with decreased vision in both eyes for 2 years. He had previously undergone retinal photocoagulation, peripheral iridotomy, and phakic implantable Collamer lens (ICL) implantation in Shenzhen Aier Eye Hospital Affiliated to Jinan University 10 years ago. He was diagnosed with complicated cataract. The patient underwent ICL extraction, cataract phacoemulsification, and intraocular lens (IOL) implantation in the right eye. During the procedure, zonular ligament rupture occurred, resulting in the IOL being placed in the ciliary sulcus and subsequent recurrent elevated intraocular pressure. Comparatively, he underwent ICL extraction, femtosecond laser-assisted cataract phacoemulsification, tension ring implantation, and IOL implantation in the left eye without complications. Femtosecond laser-assisted cataract surgery demonstrated advantages in a complicated cataract patient who had previously undergone ICL implantation. However, the precision required for laser positioning may lead to ICL damage, and gas bubble accumulation can hinder complete nuclear fragmentation. Therefore, caution is necessary when focusing the femtosecond laser in eyes with ICL.

The patient was a 44-year-old female. He had sudden pain in his left eye for 1 d and was seen in Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University. Due to discomfort in the left eye, I used tobramycin dexamethasone eye ointment in both eyes, with a daily dose of 1 tube for more than 5 months. He has a history of diabetes for more than 10 years, and his blood sugar control is acceptable. Two years ago, oral administration of isoniazid, ethambutol, linezolid and other drugs caused toxic optic atrophy in both eyes due to tuberculosis. Eye examination: visual acuity is no light sensing in the right eye and light sensing in the left eye; The conjunctiva of the right eyeball is congested, the corneal epithelium is mostly exfoliated, the corneal edema becomes white, the anterior chamber is deep, and the lens is opaque; The cornea of the left eye was edema and whitening, the central area was perforated, and the iris and cloudy lens prolapsed out of the eye from the perforation (Quintessential Picture 1). Clinical diagnosis: keratopathy in both eyes; Corneal perforation in left eye; Cataract in both eyes; Toxic optic atrophy of both eyes.

The patient was a 63-year-old female. Because of blurred vision for 1 year after cataract extraction surgery in his right eye, he went to Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University. Previous history of uveitis, underwent phacoemulsification cataract aspiration and posterior chamber intraocular lens implantation in his right eye 6 years ago due to complicated cataract. Eye examination: visual acuity in the right eye was 0.05 (uncorrectable) and intraocular pressure was 14 mmHg (1 mmHg =0.133 kPa); The cornea is clear, there is no retrocorneal sediment, the depth of the central anterior chamber is 3 corneal thicknesses, the depth of the peripheral anterior chamber is 1 corneal thickness, the aqueous humor is clear, the position of the intraocular lens is positive and transparent, and the opacified effusion after the lens accumulates in the lens capsular bag, resulting in the expansion of the capsular bag and the opacity of the posterior capsule (A in Quintessential Picture 1). optical coherence tomography (OCT) examination of the anterior segment: the anterior lens capsule is attached to the intraocular lens, fluid accumulates in the lens capsule bag, the capsule bag is expanded and expanded, and the posterior capsule is opaque (B in Quintessential Picture 1). Color fundus images and autofluorescence fundus images showed stable and inactive chorioretinal old lesions. Clinical diagnosis: delayed lens capsular bag inflation syndrome in right eye; Right eye intraocular lens eye. After Nd-doped yttrium aluminum garnet laser lens posterior capsulotomy in the right eye, the symptoms of blurred vision disappeared and the visual acuity was 0.05; OCT examination of the anterior segment of the eye: the posterior capsule of the lens is discontinuous, and the opacity and effusion in the capsular pocket disappear (C in Quintessential Picture 1).

With the continuous evolution of computer technology and the surging advent of the big data era, artificial intelligence (AI) has already manifested extremely broad application prospects. Medical AI, like a capable assistant, can help doctors make more objective and accurate clinical decisions, thus playing an increasingly crucial role in the medical field. In view of the unique particularity of the eyeball′s anatomical structure, ophthalmic AI consequently shows unique and incomparable research advantages, opening up new avenues for the diagnosis and treatment of ophthalmic diseases. Dry eye, as an ocular surface disease caused by the interweaving of a variety of complex factors, has shown a steadily increasing trend in prevalence year by year. Among numerous ocular surface diseases, it has conspicuously become one of the most common disorders, posing a non-negligible threat to the global population′s ocular health. This article will systematically conduct a detailed review of the specific applications of AI in the field of dry eye, deeply analyze and precisely point out the numerous challenges and the infinite application prospects that AI faces in the process of clinical diagnosis of dry eye. The aim is to provide highly valuable reference bases and directional guidance for the further expansion and in-depth development of AI technology in the specific field of dry eye.

The corneal endothelium lines the innermost layer of the cornea. Normal pump and barrier function of corneal endothelial cells is crucial for the maintenance of corneal hydration, thickness and transparency. Numerous clinical studies have demonstrated that individuals with diabetes exhibit decreased endothelial cell counts, impaired pump and barrier functions and increased central corneal thickness when compared to non-diabetic individuals. And anterior segment surgery may exacerbate corneal endothelial injury. Protecting the corneal endothelium during surgery poses significant challenges to clinicians. This review provides an overview of the pathological mechanisms and potential treatments for the impairment of pump and barrier functions in diabetic corneal endothelial cell lesions, with the aim of identifying potential targets and therapies for diabetic corneal endothelial lesions.

Thyroid-associated ophthalmopathy (TAO) is the most common orbital disease in adults. Ocular surface diseases are the most common cause of ocular discomfort in patients with TAO, seriously affecting the quality of life of patients. The manifestations of ocular surface damage include dry eye, conjunctival congestion, edema, exposure keratitis, superficial punctate keratopathy and superior limbal keratoconjunctivitis, among which the incidence of dry eye is the highest. The pathogenesis of dry eye in TAO is rather complex. In addition to the exposure of the ocular surface caused by anatomical changes such as proptosis and eyelid retraction, in recent years, an increasing number of studies have indicated that ocular surface microenvironmental damages such as immune injury of the lacrimal gland, abnormal structure and function of meibomian glands, and chronic ocular surface inflammation are also involved in its pathogenesis. This article reviews the latest research progress on the ocular surface changes in patients with TAO and the pathogenesis of its dry eye, hoping to provide assistance for the clinical treatment of dry eye in TAO.