Volume 62 · Issue 03 · 2026

This issue focuses on the research progress of glaucoma diagnosis and treatment. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Zhuo Yehong.

Axon regeneration and visual function recovery after optic nerve injury remain a major challenge in ophthalmology. Current research on optic nerve regeneration has evolved from merely promoting axon regeneration to a new stage focused on long-distance regrowth, targeted reinnervation, and function restoration. Centering on these core goals, this article discusses strategies for achieving accurate circuit repair by reactivating developmental guidance mechanisms, modulating neural activity, and utilizing neurotrophic factors. It also explores the opportunities brought by high-throughput multi-omics technologies in deciphering regulatory networks of regeneration. In response to key challenges in translating research findings into clinical applications, this article emphasizes the urgent need to optimize gene and drug delivery systems, establish long-acting sustained-release approaches, and develop clinically relevant large-animal models. The aim is to outline a critical pathway toward substantial visual functional recovery in future clinical practice.

Primary open-angle glaucoma (POAG) is a common type of glaucoma in clinical practice and an important irreversible blinding eye disease. Basic and clinical research related to optic nerve protection has been conducted in related fields for many years, but there is still a lack of methods that can truly exert optic nerve protection in POAG clinical practice. This article analyzes and summarizes the challenges and difficulties encountered in clinical research on optic nerve protection in POAG from four perspectives: disease and pathophysiology, research design and ethics, drugs and their mechanisms of action, and translational medicine. In addition, this article actively explores possible coping strategies and future development directions for the aforementioned issues, aiming to provide guidance and reference for clinical research on optic neuroprotection in POAG.

Minimally invasive glaucoma surgery (MIGS) is characterized by minimal injuries and complications, with its surgical volume increasing annually in China. It encompasses a diverse range of surgical techniques. To accurately understand and select appropriate surgical indications and ensure optimal therapeutic outcomes, this article emphasizes the necessity of proposing a new classification system for MIGS. By discussing the structural and functional complexity of the trabecular meshwork and Schlemm′s canal and comparing the efficacy of MIGS with different design principles, we introduce the MIGS 4R classification system based on the structural and functional integrity of the trabecular meshwork and Schlemm′s canal, along with a sequential surgical selection approach, to provide reference for ophthalmologists in clinical practice.

With the rapid aging of the population in China, the prevalence of glaucoma, as the leading cause of irreversible blindness worldwide, continues to rise. The limited public awareness of glaucoma, coupled with inadequate diagnostic and therapeutic capacity at the primary healthcare level, substantially impedes early detection and timely intervention. As a chronic and progressive optic neuropathy requiring lifelong monitoring and management, glaucoma poses a significant and growing public health burden. Consequently, the establishment of a comprehensive and standardized chronic disease management system for glaucoma is critical to reducing the disease burden and preventing vision loss. Against this background, the Committee of Chronic Eye Disease Management of the China Association of Geriatric Health Care, in collaboration with glaucoma experts from across China, convened to discuss strategies and methodologies for the chronic disease management throughout the course of glaucoma. Based on these deliberations, a consensus has been developed to provide guidance and reference for advancing the glaucoma prevention and control efforts in China.

To investigate the correlation between macular edema and the anterior chamber angle status in patients with retinal vein occlusion (RVO).

A retrospective case series analysis was adopted. Consecutive RVO patients treated at the Ophthalmology Department of Peking University Third Hospital from October 2011 to May 2013 were included. All patients underwent fluorescein fundus angiography for RVO classification. They were divided into the macular edema and non-macular edema groups based on the angiography results. Static and dynamic gonioscopy were performed to determine the anterior chamber angle status. The statistical analysis was performed using the independent samples t-test, Welch′s t-test, chi-square test, or Fisher′s exact test. The multivariate logistic regression analysis was used to identify factors associated with the occurrence of macular edema by calculating odds ratios and their 95% confidence intervals.

A total of 308 RVO patients (308 eyes) who completed all required examinations were included in the study, consisting of 155 males and 153 females, with a mean age of (58.78±14.45) years. Among them, 59 cases (19.16%) had angle closure, while 249 cases (80.84%) had open angles; 221 patients had macular edema (71.75%). The multivariate regression analysis revealed that the main risk factor for the development of macular edema in eyes with RVO was angle closure (odds ratio=2.59, 95% confidence interval: 1.23-6.05, P=0.018), while other factors such as age, gender, eye laterality, intraocular pressure, type of RVO, and cup-to-disc ratio showed no statistically significant association (all P>0.05).

The risk of macular edema is significantly higher in RVO patients with angle closure compared to those with open angles.

To observe the efficacy and safety of novel glaucoma implant, Paul glaucoma implant (PGI), in the treatment of refractory childhood glaucoma.

This was a retrospective case series study. Data were collected from patients diagnosed with refractory childhood glaucoma who underwent PGI implantation and had a minimum follow-up of 6 months between May 2022 and July 2024 at the First Affiliated Hospital with Nanjing Medical University and Eye Hospital of Wenzhou Medical University. Diagnoses were made according to the Childhood Glaucoma Research Network criteria. Primary outcome measures included the intraocular pressure (IOP), number of anti-glaucoma medications, surgical success rate, and complications. Secondary outcome measures included the best-corrected visual acuity, cup-to-disc ratio, axial length, and corneal endothelial cell density. A complete surgical success was determined if the IOP was maintained between 6 and 21 mmHg (1 mmHg=0.133 kPa) with at least a 20% reduction from baseline without medications. A qualified success was defined as achieving these IOP criteria with or without medications. The repeated measures ANOVA and the Friedman test were employed to compare the IOP and the number of anti-glaucoma medication types across multiple time points, respectively; pairwise comparisons between two time points were performed using the paired t-tests.

A total of 12 patients (15 eyes) with refractory childhood glaucoma were enrolled, including 7 patients (8 eyes) with secondary glaucoma. There were 8 males (9 eyes) and 4 females (6 eyes), with a median age of 7 (5, 11) years. The patients had undergone an average of (2.27±1.79) anti-glaucoma surgeries. The median follow-up duration after the PGI implantation was 9 (6, 18) months. The IOP decreased from a preoperative level of (33.93±7.38) mmHg to (16.00±8.18) mmHg at 6 months postoperatively. The number of anti-glaucoma medications decreased from a preoperative median of 3 (3, 4) to 0 (0, 0) at 6 months postoperatively. Only one eye, affected by Marshall syndrome, experienced surgical failure due to encapsulation around the drainage plate, while the remaining eyes achieved a complete success at both 6 months and the final follow-up. The complete and qualified success rates were both 14/15, with no PGI-related complications observed. There were no significant differences in best-corrected visual acuity (P=0.198), cup-to-disc ratio, axial length (P=0.429), or corneal endothelial cell density (P=0.358) between preoperative and final follow-up measurements. The 6-0 polypropylene suture stent removal was performed in 12 eyes (12/15) at 41 (26, 104) days postoperatively, resulting in an immediate reduction in IOP from (20.58±6.27) mmHg to (10.5±3.50) mmHg.

The PGI may serve as a safe and effective preliminary option for the treatment of refractory childhood glaucoma. However, its long-term efficacy and complication profile require further observation and evaluation.

To report the recurrence of peripheral angle synechiae (PAS) in primary angle-closure glaucoma (PACG) after phacoemulsification combined with intraocular lens implantation and goniosynechialysis (PEI-GSL) during an intermediate-and long-term follow-up.

This retrospective case series included patients with acute or chronic PACG who underwent PEI-GSL performed by the same surgeon at the Eye Hospital of Wenzhou Medical University between January 2017 and December 2019, with complete postoperative gonioscopic records. The primary outcome measures were the incidence and extent (in clock hours) of recurrent PAS at the last follow-up. The secondary outcomes included the surgical success rate, intraocular pressure, and the number of intraocular pressure-lowering medications. The intergroup comparisons were performed using the generalized estimating equation. The intragroup comparisons before and after surgery were analyzed using the Wilcoxon signed-rank test. The categorical data were compared using the Chi-square test or Fisher′s exact test.

A total of 57 patients (69 eyes) were included, with a mean follow-up of 23.3±9.0 months. Among them, 37 patients (41 eyes) had acute PACG [9 males (24.3%), 28 females (75.7%); mean age, (68.6±8.6) years], and 20 patients (28 eyes) had chronic PACG [8 males (40.0%), 12 females (60.0%); mean age, (65.1±8.8) years]. There were no statistically significant differences in gender or age between the two groups (both P>0.05). At the last follow-up, 46.4% (32/69) of eyes maintained a full-circle anterior chamber angle opening or had only several spot adhesions, 82.6% (57/69) had PAS limited to one quadrant, and 89.9% (62/69) had PAS involving fewer than 6 clock hours. The recurrence rate of PAS was 31.9% (22/69) in all eyes, while it was 26.8% (11/41) in eyes with acute PACG, and 39.3% (11/28) in eyes with chronic PACG, with no statistically significant difference (χ²=1.92, P=0.165). However, the extent of recurrent PAS was greater in chronic PACG patients [4.50 (2.50, 8.50) clock hours] than in acute PACG patients [3.00 (1.50, 4.50) clock hours], and this difference was statistically significant (Wald χ²=5.39, P=0.020).

Approximately 30% of eyes with PACG develop recurrent PAS after PEI-GSL, but 90% maintain an angle opening over 180°.

To evaluate the safety of trabeculotome tunnelling trabeculoplasty (3T) in treating primary open-angle glaucoma (POAG) by observing the changes in corneal endothelial cell quantity and morphology after surgery.

This was a retrospective case series study. Patients diagnosed with POAG who underwent successful 3T surgery were recruited from the Department of Ophthalmology, Chengdu First People′s Hospital between April 2023 and September 2025. Parameters such as the number of cells, corneal endothelial cell density, average size, hexagonal cell ratio of endothelial cells, and central corneal thickness were recorded preoperatively and at 6 months postoperatively. Data were analyzed using the t-test.

The cohort comprised 48 patients, involving 52 eyes (27 left eyes, 25 right eyes), of whom 36 (75%) were male and 12 (25%) were female. The mean age of the patients was (51.37±12.90) years, ranging from 18 to 72 years. The preoperative number of cells was (196±40) cells, which decreased to (170±56) cells at 6 months postoperatively (P<0.05). The preoperative endothelial cell density was (2 686±416) cells/mm², compared to (2 302±563) cells/mm² at 6 months postoperatively (P<0.05). The average size increased from (381±76) μm² preoperatively to (470±161) μm² at 6 months postoperatively (P<0.05). The hexagonal cell ratio was (52±9)% preoperatively and (50±8)% at 6 months postoperatively, with no significant difference (P>0.05). The central corneal thickness was (517±49) μm preoperatively and (514±39) μm at 6 months postoperatively, with no significant difference (P>0.05).

Although the 3T surgery for POAG results in a slight reduction in corneal endothelial cell count, as well as changes in corneal endothelial cell morphology and size, it does not induce corneal endothelial decompensation during the 6-month follow-up period and shows favorable short-term safety.

To investigate the clinical, pathological and molecular genetic characteristics of conjunctival melanoma (CoM).

A retrospective case series study was conducted. The clinical, imaging and pathological data of patients diagnosed with CoM from January 2004 to June 2025 at Shaanxi Eye Hospital of Xi′an People′s Hospital (Xi′an Fourth Hospital) and Xi′an First Hospital were analyzed. Some patients were detected for the BRAF V600E mutation. The χ² test or the χ² correction test was used for statistical analysis.

A total of 70 patients (70 eyes) with CoM were enrolled, aged (60.8±10.6) years, including 40 males (57.1%) and 30 females (42.9%). There were 33 cases (47.1%) in the left eye and 37 cases (52.9%) in the right eye. The tumor was located at the bulbar conjunctiva in 37 cases (52.9%), at the vault conjunctiva in 24 cases (34.2%), and at the palpebral conjunctiva in 9 cases (12.9%), involving the orbit in 13 cases (18.6%), the eyeball in 3 cases (4.3%), and the lacrimal sac in 6 cases (8.6%). Most patients presented with black nodules or cauliflower-like masses in the conjunctival area. Some tumors were accompanied by superficial vascular hyperplasia and pigmentation of adjacent tissues, while some invaded the cornea or orbit, resulting in clinical manifestations such as visual field defects, exophthalmos and limited movement. Imaging showed irregular soft tissue density shadows at the conjunctival site. According to the criteria of the American Joint Committee on Cancer, the tumor was at the T1 stage in 10 cases (14.3%), T2 stage in 41 cases (58.6%), and T3 stage in 19 cases (27.1%), with superficial ulcers in 6 cases (8.6%). Histopathology results disclosed that 67 cases (95.7%) were of the nodular type, 3 cases (4.3%) were of the superficially diffuse type, 47 cases (67.1%) were of the epithelial cell type, and 23 cases (32.9%) were of the mixed cell type. Sixty-three cases (90.0%) were accompanied by melanin, 32 cases (45.7%) were accompanied by primary acquired melanosis, including 23 cases (32.9%) with atypical primary acquired melanosis and 2 cases (2.9%) with conjunctival nevus, and 48 cases (68.6%) had tumor infiltrating lymphocytes. Immunohistochemistry demonstrated positive melanin markers such as human melanoma-associated antigen 45, melanocyte antigen A, S-100 protein and sex-determining region Y-frame protein 10. Thirty cases (42.9%) completed the detection of BRAF V600E mutations, of which 11 had BRAF V600E point mutations, with a positive rate of 36.7%. Sixty-two patients (88.6%) were followed up, with a recurrence rate of 27.4% (17/62), a metastasis rate of 19.4% (12/62), and a case fatality rate of 54.8% (34/62). The recurrence rate was 4/5 among patients with ulcers, versus 22.8% (13/57) among patients without ulcers (χ²=4.96, P=0.026); it was 8/13 among patients with orbital invasion, versus 18.3% (9/49) among patients without orbital invasion (χ²=9.62, P=0.002). Thirty-four patients (48.5%) underwent complete resection of the ocular mass, 16 (22.9%) underwent partial resection, and 20 (28.6%) underwent ocular or intraorbital enucleation. Ten patients (14.3%) received BRAF inhibitor-targeted therapy. Seven patients had a significant reduction of the residual mass and no tumor progression, and 3 patients did not respond to the treatment and died from the disease progression.

CoM mostly occurs in the unilateral eye of middle-aged and elderly patients, more common at the bulbar conjunctiva and fornix conjunctiva, and histopathological epithelial cell types are the main types, with a high recurrence and metastasis rate.

A 28-year-old male presented to the ophthalmology department with decreased visual acuity in the left eye for 4 months. Four months prior, he was diagnosed with central retinal vein occlusion (CRVO) in the left eye at another hospital and received three intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents. Laboratory examinations revealed elevated levels of homocysteine, lupus anticoagulant (LA) 1 screening test result, LA1/LA2 ratio, and anti-β2 glycoprotein 1 antibody. The patient was treated with oral folic acid tablets, systemic anticoagulants, and additional intravitreal anti-VEGF therapy. He achieved a favorable prognosis after treatment.

The patient was a 69-year-old female. Due to dry foreign body sensation in his left eye for 1 month, he went to Xiamen Ophthalmology Center affiliated to Xiamen University. Ten years ago, due to angle-closure glaucoma and age-related nuclear cataract in the left eye, phacoemulsification and cataract aspiration of the left eye, folding intraocular lens implantation combined with glaucoma drainage nail implantation were performed in an external hospital, and the postoperative intraocular pressure was controlled smoothly. Eye examination: visual acuity in the left eye was 0.25 (no improvement in corrected visual acuity), intraocular pressure was 11 mmHg (1 mmHg =0.133 kPa); There is no conjunctiva congestion, the filter vesicles above the nose are flat and diffuse, the cornea is transparent, the anterior chamber is deep, the drainage nail is in place at the angle of the chamber at 11: 00, the pupil is round, with a diameter of 5 mm, the upper iris is depigmented and posterior adhesion, and several transparent round particles of different sizes are visible at the edge of the pupil at 12: 00 (Quintessence Pictures 1 and 2). The intraocular lens is in the right position, the posterior capsule of the lens is intact, the vitreous body is still clear, the retina is flat at the fundus, and the ratio of the diameter of the optic cup to the optic disc is about 0.7. Anterior segment coherence optical tomography examination: Several round-like vacuoles can be seen at the pupil margin at 12: 00, convex toward the anterior chamber (Quintessential Picture 3). Clinical diagnosis: Elschnig pearl in the anterior chamber of the left eye; Left eye intraocular lens eye; After anti-glaucoma surgery in the left eye.

Ocular tumors encompass ocular surface tumors, orbital tumors, and intraocular tumors, characterized by high heterogeneity and complex classifications, which pose considerable challenges to pathological diagnosis. The scarcity of specialized ophthalmic pathologists further exacerbates the difficulty in diagnosing these tumors. In recent years, artificial intelligence (AI) has penetrated diverse areas of healthcare, particularly in departments with intensive medical imaging and image-based workflows, such as radiology, pathology, and ultrasonography. With the advent of the digital pathology era, the role of AI in aiding pathological diagnosis has become increasingly prominent. In recent years, it has been tentatively applied to several ocular tumors, including eyelid sebaceous carcinoma, basal cell carcinoma, malignant melanoma, and orbital lymphoproliferative disorders, exerting an auxiliary diagnostic function. AI can also assist in predicting the prognosis of uveal malignant melanoma and retinoblastoma. In the future, with the increasing popularization and refinement of AI-assisted pathological diagnosis technologies, it will not only enhance the diagnostic accuracy and work efficiency of ocular tumors, better guide clinical treatment, but also alleviate the issues of inadequate medical resources and a shortage of specialized ophthalmic pathologists.

Minimally invasive glaucoma surgery (MIGS) can improve aqueous humor outflow and/or reduce aqueous humor production with minimal damage to ocular tissue, thereby reducing intraocular pressure. It has been promoted and innovatively developed in China for more than 20 years and is becoming a new trend for surgical treatment of glaucoma. This article focuses on the extensive clinical research and application of MIGS in China, clarifies the mechanism, indications, efficacy and safety of surgery, and focuses on the innovation and characteristic development in the field of MIGS in China, in order to demonstrate the level and development status of MIGS in China, and provide reference for clinicians to carry out related work.