Volume 62 · Issue 02 · 2026

This issue focuses on the research progress of cataract. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Jieying.

Blepharospasm-related dry eye is a complex multifactorial comorbidity involving neural, ocular surface, and psychological factors, currently facing core challenges including unclear pathogenesis, ambiguous clinical assessment and diagnostic criteria, non-standardized treatment, and lack of multidisciplinary collaboration. The article proposes that a "dry eye-blepharospasm" vicious cycle may exist with significant individual differences; symptom overlap easily leads to misdiagnosis without unified diagnostic standards or objective indicators; while botulinum toxin type A (BTX-A) is effective, controversies remain regarding dosage and efficacy, necessitating standardization of basic treatments like artificial tears; and establishing a multidisciplinary treatment (MDT) model is urgently needed in clinical practice. Consequently, the authors suggest elucidating mechanisms through multidimensional approaches such as animal models and functional imaging, classifying patients into three subtypes (sensory-triggered, movement-originated, and crossover types) based on onset sequence to establish standardized diagnostic processes, standardizing BTX-A administration with a "low-dose, multi-point, superficial injection" strategy and combination therapies, integrating ophthalmology, neurology, rehabilitation, and psychology resources to build an MDT model, and utilizing artificial intelligence and mobile health technologies for individualized long-term management. Future research should focus on the interaction between neuroinflammation and ocular surface injury, and explore precise combination strategies of BTX-A with novel anti-dry eye medications.

With the increasing popularization and diversification of animal keeping and the closer relationships between humans and animals, there has been a significant upward trend in the incidence of ocular surface infectious diseases caused by close human-animal contact. However, clinical awareness of such diseases remains insufficient, and the current state of diagnosis and treatment is far from satisfactory. This article thoroughly explores the urgent need for improved clinical understanding and considerations and recommendations for refining the diagnostic and therapeutic system and strategies of this kind of infectious diseases, including the epidemiological characteristics and risk factors, challenges in the differential diagnosis, and the improvement and establishment of standardized diagnosis and treatment protocols and prevention strategies. We propose that clinical vigilance should be enhanced to improve early diagnostic awareness, personalized prevention strategies should be developed to strengthen the interruption of transmission routes, and multicenter studies and multidisciplinary collaboration should be promoted to advance the standardized diagnosis and treatment. The aim is to guide clinical practice in providing more timely and effective medical interventions for affected patients, ultimately realizing the vision of harmonious coexistence between humans and animals.

Diseases of the corneal epithelium, Bowman′s membrane, and anterior stroma can cause recurrent eye pain, photophobia, tearing or vision loss. Among various treatment methods, phototherapeutic keratectomy (PTK) has been increasingly widely used in clinical practice due to its advantages of simplicity, precision, safety, and low risk of postoperative irregular astigmatism. In China, however, the lack of consensus regarding the scope of corneal diseases eligible for PTK and the clinicians′ insufficient understanding of this treatment pose challenges to clinical work. To provide guidance for the rational clinical application, the Cornea Group of Ophthalmology Branch of Chinese Medical Association has developed consensus opinions on surgical indications, contraindications, perioperative management, and postoperative complication prevention and treatment of PTK by adopting the Delphi method combined with face-to-face meetings and drawing upon the latest domestic and foreign research results and domestic clinical experience.

Traumatic cataract is a common complication of ocular trauma. The clinical management of traumatic cataract is highly challenged by the complexity of surgical decision-making due to concomitant ocular injury, substantial difficulty in the postoperative complication management, and inherent uncertainty of visual prognosis. In order to standardize and elevate the quality of medical care for patients with traumatic cataract across China, the China Ocular Trauma Society has reached a consensus based on a thorough review of domestic and international literature and extensive discussions. This consensus provides recommendations regarding the etiological mechanism, classification, clinical manifestations, preoperative assessment and management, optimal timing for surgery, and selection of surgical approaches of traumatic cataract, and intends to serve as an authoritative reference for ophthalmologists engaged in the diagnosis and treatment of traumatic cataract.

To investigate the clinical characteristics of symptoms and signs of ocular surface lesions in dry eye patients with type 2 diabetes mellitus (T2DM) of different disease durations.

A cross-sectional study was conducted. Consecutive T2DM patients complicated with dry eye who visited the Special Clinic for Diabetic Ocular Surface Diseases at Qingdao Eye Hospital, Shandong First Medical University from January 2020 to December 2024 were enrolled as the T2DM group. Dry eye patients without T2DM from the Dry Eye Clinic and age-and gender-matched healthy volunteers were recruited as the non-T2DM group and control group, respectively. The T2DM group was further divided into four stages according to disease duration: Stage Ⅰ (duration≤5 years), Stage Ⅱ (5 years<duration≤10 years), Stage Ⅲ (10 years<duration≤20 years), and Stage Ⅳ (duration>20 years). Ocular symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Ocular surface function was assessed by corneal sensitivity (CS), corneal fluorescein staining (CFS) score, Schirmer Ⅰ test (SⅠT), tear meniscus height (TMH), non-invasive first tear film break-up time (NIKf-BUT), non-invasive average tear film break-up time (NIKav-BUT), lipid layer thickness (LLT), and meibomian gland loss (MGL) grading score. Anterior segment optical coherence tomography was used to measure central corneal epithelial thickness (CCET) and central corneal thickness (CCT). In vivo confocal microscopy was performed to detect corneal nerve fiber parameters. Spearman′s rank correlation analysis was used to evaluate the correlations between variables.

A total of 278 T2DM patients (556 eyes) were enrolled in the T2DM group, with a mean age of (60.25±8.71) years, a male-to-female ratio of 117∶161, and a mean disease duration of (11.09±8.02) years; among them, 84 cases were Stage Ⅰ, 81 cases Stage Ⅱ, 90 cases Stage Ⅲ, and 23 cases Stage Ⅳ. The non-T2DM group included 60 patients (120 eyes), with a mean age of (58.52±7.93) years and a male-to-female ratio of 23∶37. The control group comprised 53 healthy volunteers (106 eyes), with a mean age of (58.79±5.73) years and a male-to-female ratio of 21∶32. There were no statistically significant differences in age and gender distribution among the three groups (all P>0.05). Compared with the control group, the T2DM group showed significantly higher OSDI score (31.58%±20.56%), MGL grading score (3.59±0.95) and CFS score (1.84±3.01) (all P<0.05); while significantly lower SⅠT [(5.79±3.10) mm], NIKf-BUT [(5.81±3.14)s], NIKav-BUT [(9.31±4.85)s], LLT [(60.48±16.6) nm], CCET [(51.95±5.56) μm], CS [(56.9±8.30) mm], corneal endothelial cell density [(2 596±465.38)/mm²], and all corneal nerve parameters (including paracentral corneal nerve fiber density and length, etc.) (all P<0.05). Compared with the non-T2DM group, the T2DM group had significantly lower LLT, CCET, CS, OSDI score and all corneal nerve parameters, along with significantly higher MGL grading score and CFS score (all P<0.05); no statistically significant differences were found in SⅠT, NIKf-BUT and NIKav-BUT between the two groups (all P>0.05). In T2DM patients with disease duration≤5 years, compared with the control group, the OSDI score (23.98%±18.21%) and MGL grading score (3.35±0.91) were significantly increased, while SⅠT [(5.65±2.93) mm], LLT, NIKf-BUT and all corneal nerve parameters were significantly decreased (all P<0.05); meanwhile, compared with the non-T2DM group, this subgroup had significantly lower OSDI score and significantly higher MGL grading score (all P<0.05). When the disease duration exceeded 10 years, the OSDI score further increased to be comparable with that of the non-T2DM group, and NIKf-BUT [(5.44±2.92)s], CFS score (2.75±3.25), CCET [(51.36±4.17) μm], CS [(55.21±8.02) mm] showed statistically significant differences compared with both the control group and non-T2DM group (all P<0.05). Spearman′s correlation analysis indicated that disease duration was significantly positively correlated with OSDI score, MGL grading score and CFS score, and significantly negatively correlated with NIKf-BUT, CCET, CS and all corneal nerve parameters (all P<0.05).

Ocular surface lesion characteristics vary among dry eye patients with T2DM of different disease durations: decreased tear secretion, meibomian gland dysfunction and corneal nerve structural changes occur when the disease duration is ≤5 years, and corneal hypoesthesia and epithelial thinning develop when the duration exceeds 10 years, with lesions gradually worsening as the disease progresses. Compared with non-diabetic dry eye, significant differences exist in meibomian gland function, corneal nerves and epithelial barrier between the two groups.

To evaluate the clinical efficacy of transepithelial phototherapeutic keratectomy (trans-PTK) in the treatment of band keratopathy (BK).

A retrospective case series study was conducted. Clinical data of 40 patients (51 eyes) with BK who underwent trans-PTK treatment in the Department of Refractive Cornea, Tianjin Medical University Eye Hospital from January 2020 to October 2024 were collected, including basic patient information, visual acuity, etiologies and other data. Changes in symptom scores, corrected distance visual acuity (CDVA), spherical equivalent (SE), corneal curvature, corneal astigmatism, index of surface variance (ISV), index of vertical asymmetry (IVA), corneal optical density, and central corneal thickness before surgery, 3 months and 12 months after surgery were statistically analyzed; the recurrence of lesions at the last follow-up was recorded. Spearman correlation analysis was used to analyze the correlation between central corneal thickness and spherical equivalent, and Kaplan-Meier survival curve was used to analyze the recurrence of BK.

A total of 40 patients (51 eyes) were enrolled, including 24 females and 16 males, with an age of (49.31±25.48) years. Among them, 29 cases (72.5%) had monocular BK and 11 cases (27.5%) had binocular BK. The most common etiologies were chronic uveitis (12 cases, 30.0%) and chronic renal failure (8 cases, 20.0%). The corneal epithelial healing time after trans-PTK was (5.51±2.37) days. At 3 months postoperatively, 24 eyes(85.71%) achieved a visual improvement of ≥2 lines; at 12 months postoperatively, this proportion increased to 92.86%(26 eyes). Core efficacy indicators showed significant improvements before surgery, 3 months and 12 months after surgery: symptom scores [7.000(5.250, 10.000), 2.000(2.000, 3.000), 2.000(1.000, 2.000) points], CDVA [0.900(0.425, 1.700), 0.250(0.125, 0.500), 0.150(0.100, 0.475), all expressed as logarithm of the minimum angle of resolution (logMAR)], and corneal optical density [27.650(24.075, 36.975), 15.750(13.925, 21.125), 15.200(12.200, 19.400) grayscale units (GSU)]. Statistically significant differences were observed in the overall comparisons of the above indicators as well as SE, corneal curvature K2, corneal astigmatism, ISV, IVA, and central corneal thickness before surgery, 3 months and 12 months after surgery (all P<0.05). Recurrence was noted in 5 out of 49 eyes (10.20%), with a mean recurrence time of (23.0±3.71) months. Among them, BK associated with chronic renal failure had the highest recurrence rate (3 out of 12 eyes, 25.0%), and no retreatment was required for all recurrent cases.

Trans-PTK enables both pathological clearance and refractive reconstruction in BK, significantly outperforming traditional methods in alleviating symptoms, enhancing visual acuity and corneal transparency, and reducing corneal irregularity and recurrence rate. It exhibits distinct clinical advantages especially in managing refractory cases such as pediatric patients.

To explore the changing trends in surgical approaches and timing selection for patients with keratoconus in a single center from 2004 to 2023.

A retrospective case series study was conducted. Clinical data of patients diagnosed with keratoconus and who underwent surgical treatment at the Eye Hospital of Shandong First Medical University from January 2004 to December 2023 were collected. Statistical analysis was performed on the distribution of surgical procedures for keratoconus treatment, including femtosecond laser-assisted penetrating keratoplasty (FL-PK), conventional penetrating keratoplasty (C-PK), deep anterior lamellar keratoplasty (DALK), femtosecond laser-assisted deep anterior lamellar keratoplasty (FL-DALK), epikeratophakia (EP), thermokeratoplasty followed by lamellar keratoplasty (TK-LK), corneal cross-linking (CXL), and femtosecond laser-assisted minimally invasive lamellar keratoplasty (FL-MILK), as well as the clinical staging of keratoconus at the time of surgery, to evaluate the changing trends in surgical approaches and timing selection over time. Nonparametric tests were used for comparisons between groups and for gender composition across different surgical types, and the Mann-Kendall trend test was used to analyze the temporal growth trend of surgical volume.

A total of 1 497 patients (2 093 eyes) with keratoconus were included, including 1 132 males and 365 females, with a median age of 32.5 years at the time of surgery. The number of surgeries increased from 28 cases in 2004 to 335 cases in 2021 (an 11.0-fold increase, τ=0.784, P<0.001). C-PK decreased from 36 eyes (22.2%) in 2004-2008 to 13 eyes (1.0%) in 2019-2023; the overall proportion of lamellar keratoplasty (LK) decreased from 126 eyes (77.8%) in 2004-2008 to 626 eyes (49.2%) in 2019-2023; DALK decreased from 88 eyes (54.3%) in 2004-2008 to 64 eyes (5.0%) in 2019-2023; FL-DALK increased from 0 eyes in 2004-2008 to 261 eyes (20.5%) in 2019-2023. FL-MILK was first applied in 2017 and increased to 216 eyes (17.0%) in 2019-2023. Femtosecond laser-assisted LK accounted for 72.1% (721/1 000) of all LK procedures during 2014-2023 and dominated corneal transplantation in 2019-2023. After CXL was introduced in 2016, its volume increased to 632 eyes (49.6%) in 2019-2023; the combined proportion of FL-MILK and CXL accounted for 66.6% of the total surgical volume (1 273 eyes) in 2019-2023. The proportion of surgeries for stage Ⅰ and Ⅱ patients increased from 23 eyes (18.5%) in 2004-2008 to 1 013 eyes (79.6%) in 2019-2023, while that for stage Ⅲ and Ⅳ patients decreased from 139 eyes (81.5%) in 2004-2008 to 260 eyes (20.4%) in 2019-2023. There were statistically significant differences in surgical approaches for the same keratoconus stage between 2004-2008 and 2019-2023 (P<0.001).

Over the past 20 years, the main surgical approaches for keratoconus have shifted from PK to less invasive DALK, MILK, and CXL. The proportion of more precise femtosecond laser-assisted corneal transplantation surgeries has continuously increased.

To investigate the anterior segment parameters and morphological characteristics of corneoscleral topography in patients with simple refractive errors, so as to provide a basis for the design and fitting of scleral lenses.

This was a cross-sectional study. A total of 41 adult patients (82 eyes) with low to moderate myopia who visited the Contact Lens Clinic of the Eye Hospital Affiliated to Nanjing Medical University from August to September 2023 were enrolled, including 28 females and 13 males, with an age of (26.20±5.44) years. All patients underwent routine ophthalmic examinations. In addition, the Corneal-Scleral Profile (CSP) Analysis Module of the Pentacam anterior segment analysis system was used to obtain sagittal plane images and corneoscleral topographic maps within a diameter of 18.0 mm in the anterior ocular segment. Data such as sagittal height (SH), corneal angle (CA), and scleral angle (SA) at chord lengths (CL) of 10.0, 12.8, 13.5, 15.0, 16.0, and 17.0 mm were collected respectively. After adjusting for the non-independence of binocular data using Generalized Estimating Equations, univariate linear regression analysis was performed to explore the quantitative relationship between chord length and mean sagittal height.

There were no statistically significant differences in corneoscleral sagittal height between the right and left eyes at different chord lengths and orientations (all P>0.05). At the chord length of 10.0 mm, the superior sagittal height was the highest in both eyes [right eye: (1 818.00±12.13) μm, left eye: (1 815.41±14.23) μm], and the temporal sagittal height was the lowest [right eye: (1 724.68±9.72) μm, left eye: (1 717.12±10.82) μm]. For chord lengths of 12.8 mm and above, the inferior sagittal height was the highest and the nasal sagittal height was the lowest; moreover, the nasal sagittal height was smaller than the temporal one, and the superior sagittal height was smaller than the inferior one (P<0.05). At all chord lengths, the nasal corneoscleral angle of both eyes was smaller than the temporal one (P<0.05). At chord lengths of 10.0, 12.8, 13.5, 15.0, 16.0, and 17.0 mm, the proportions of eyes with corneoscleral sagittal height difference>150 μm between orthogonal meridians were 2.44% (2/82), 18.29% (15/82), 26.83% (22/82), 75.61% (62/82), 87.80% (72/82), and 92.68% (76/82), respectively. Taking the mean sagittal height as the dependent variable (y) and chord length as the independent variable (x), the univariate linear regression equations after adjusting for relevant factors were: right eye: y=-2 663.71+434.86x (adjusted R²=0.99), left eye: y=-2 516.56+422.82x (adjusted R²=0.99) (both P<0.001).

The corneoscleral morphology of low to moderate myopic eyes presents non-rotational symmetry, which is characterized by a flatter nasal sclera than the temporal side, significant differences in sagittal height between the superior and inferior regions, and increasing sagittal height difference with longer chord length. There is a strong linear correlation between chord length and mean sagittal height. These morphological characteristics can provide a basis for the design and fitting of scleral lenses.

To construct a risk prediction model for diabetic retinopathy (DR) in patients with type 2 diabetes in Gansu Province.

It was a diagnostic study. Clinical data of patients with type 2 diabetes who were hospitalized in the Department of Endocrinology of the Second Hospital of Lanzhou University and received ophthalmology consultation from November 2023 to October 2024 were collected, including gender, age, duration of diabetes, body mass index, blood pressure, history of hypertension, and laboratory test indicators [fasting blood glucose, glycated hemoglobin, serum creatinine, estimated glomerular filtration rate (eGFR), 24-hour urine protein quantification (24-hUP), and serum uric acid]. The patients were divided into the non-DR group and the DR group based on the results of fundus examination and randomly assigned into the training set and the test set at a ratio of 7∶3 using the computer-generated random sequence method. The univariate binary Logistic regression analysis and least absolute shrinkage and selection operator (LASSO) regression were used to screen variables, and with the multivariate binary Logistic regression analysis, a DR risk prediction nomogram model was constructed. The performance of the prediction model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, precision-recall curve, confusion matrix, and clinical decision curve. The sensitivity was set at 0.8 and 0.9 to compare the corresponding specificity and precision. The statistical analysis was performed using the Mann-Whitney U test and the χ² test.

A total of 1 338 patients with type 2 diabetes were enrolled, including 836 males and 502 females. The average age was (61±11) years, with an age range of 18 to 88 years. The total detection rate of DR was 44.4% (594/1 338), with 44.3% (370/836) in males and 44.6% (224/502) in females. Compared with the non-DR group (744 cases), the DR group (594 cases) had a longer duration of diabetes [12.00 (7.00, 20.00) years], higher fasting blood glucose level [8.80 (7.00, 11.00) mmol/L], higher glycated hemoglobin level [8.70% (7.50%, 10.33%)], higher proportion of patients with a history of hypertension [54.5% (324/594)], higher systolic blood pressure [133.00 (120.00, 148.00) mmHg (1 mmHg=0.133 kPa)], and higher proportion of patients with concurrent diabetic nephropathy [56.7% (337/594)], and the differences were statistically significant (all P<0.05). In terms of laboratory tests, the eGFR of the DR group [94.09 (69.67, 103.04) ml/(min·m²)] was lower than that of the non-DR group [97.62 (89.04, 106.50) ml/(min·m²)], and the serum creatinine [68.50 (54.48, 93.18) μmol/L], 24-hUP [0.28 (0.15, 0.81) g], and serum uric acid [334.00 (270.00, 398.00) μmol/L] were higher than those of the non-DR group, and the differences were statistically significant (all P<0.05). The LASSO regression and multivariate binary Logistic regression analysis identified five key variables: duration of diabetes, eGFR, concurrent diabetic nephropathy, 24-hUP, and fasting blood glucose level. The AUC of the DR risk prediction nomogram model constructed using these variables was 0.743 in the training set and 0.736 in the test set. The corresponding specificity for sensitivity of 0.8 and 0.9 was 0.484 and 0.263, and the precision was 0.628 and 0.556, respectively. The comprehensive analysis of calibration curve, precision-recall curve, confusion matrix, and clinical decision curve indicated good discrimination, calibration, and predictive accuracy of the prediction model.

The results of the single-center study suggested that the duration of diabetes, blood glucose level, and renal function-related indicators were risk factors for concurrent DR in patients with type 2 diabetes in Gansu Province. The DR risk prediction model established based on these routine clinical indicators had high screening potential and clinical application value, and could better identify high-risk populations.

A 6-year-old male pediatric patient with Malan syndrome presented to the Ningxia Fye Hospital of Ningxia Hui Autonomous Region People′s Hospital with low vision in both eyes. The patient had a history of night blindness and exhibited bilateral enophthalmos. Best-corrected visual acuity was 0.2 in both eyes, with no improvement after refractive correction. Both direct and consensual pupillary light reflexes were sluggish. Fundus examination revealed bilateral pale optic discs, with a cup-to-disc ratio of approximately 0.6. Optical coherence tomography revealed marked thinning of the peripapillary retinal nerve fiber layer and the macular ganglion cell and inner plexiform layer in both eyes. The field electroretinogram indicated moderately impaired rod and cone function bilaterally, while the flash visual evoked potential suggested bilateral optic nerve atrophy. These findings indicate that children with Malan syndrome require comprehensive ophthalmic evaluation, routine assessment of the optic nerve status across all age groups, and timely implementation of appropriate interventions to maximize residual visual function and improve quality of life and social adaptability.

The patient was a 44-year-old female. He went to the Department of Ophthalmology of the General Hospital of the Eastern Theatre Command of the People's Liberation Army because of painless vision loss in his right eye for 4 days. Eye examination: the best corrected visual acuity was 0.02 for the right eye and 1.0 for the left eye; IOP was 15.4 mmHg (1 mmHg =0.133 kPa) in the right eye and 20.7 mmHg in the left eye; The conjunctiva of the right eye is not congested, the cornea is transparent, the anterior chamber is moderately deep, the aqueous humor is clear, the pupil is round, the lens is transparent, and the vitreous body is slightly opaque; The border of the optic disc in the fundus is clear and the color is acceptable. A large retinal aneurysm can be seen at the vascular arch above the temporal portion of the optic disc, and scaphoid hemorrhage can be seen below it, and the hemorrhage involves the macular area (A in Essence Picture 1). The near-infrared light imaging examination of the right eye fundus is shown in B in Essence Picture 1. There was no obvious abnormality in the anterior segment of the left eye, the vitreous body was slightly turbid, and there was no obvious abnormality in the fundus of the eye. Clinical diagnosis: great aneurysm of the retina (secondary preretinal hemorrhage) in the right eye.

Pythium insidiosum is an aquatic algal oomycete that can induce Pythium insidiosum keratitis (PIK). PIK typically presents as acute, highly invasive corneal ulcers, rapidly progressing to corneal dissolution and perforation, and in severe cases, may lead to blindness. Due to its clinical presentation resembling fungal infections, it is often misdiagnosed as fungal keratitis. Epidemiological studies indicate that PIK is predominantly found in tropical and subtropical regions, with a higher incidence during the monsoon season. It is often associated with exposure to contaminated water sources or minor trauma caused by plants. Diagnostic methods include staining of corneal scrapings, PCR, metagenomic next-generation sequencing, and confocal microscopy. Since PIK shows a poor response to conventional antifungal treatments, antibiotics are the preferred treatments, with a combination of linezolid and azithromycin often used as the first-line therapy. Severe cases may require penetrating keratoplasty. In China, reports of PIK cases are relatively rare. This review summarizes the epidemiology, etiology, clinical manifestations, diagnosis, and treatment of PIK, aiming to provide a reference for its clinical management.