Corneal refractive surgery is currently main stream of refractive surgery. With the development of femtosecond and laser surgery, the surgery has become safer and more accurate, resulting in less corneal trauma and a shorter postoperative recovery time. In recent years, biomechanics research has rapidly progressed, and its clinical application has gradually increased. The cornea not only possesses refractive properties but also exhibits typical biological soft tissue mechanical properties. Corneal mechanical properties not only play a role in maintaining corneal morphology but also influence the outcome and prognosis of corneal surgery, especially refractive surgery, and are closely related to the occurrence and development of some corneal diseases. Corneal refractive surgery involves cutting the cornea according to the patient's diopter, which disrupts the integrity of the cornea and inevitably affects its biomechanical stability. Changes in corneal biomechanics are associated with various factors, such as preoperative corneal morphology, the selection of different surgical methods, and postoperative changes in corneal thickness. However, the self-morphology changes caused by surgery are irreversible. If the postoperative changes in corneal biomechanics are significant, it may lead to complications such as postoperative corneal dilation and secondary keratoconus. To avoid postoperative iatrogenic corneal dilation and guide personalized surgical choice, it is crucial to understand the limits of influence of corneal biomechanical properties. This article reviews the research progress regarding corneal biomechanical properties and changes associated with corneal refractive surgery.

Objective: To introduce the LRC Stepwise Collaborative Learning Model, a novel teaching approach designed to improve clinical thinking skills in ophthalmology training. Methods: From July 2023 to December 2024, 26 ophthalmology residents were included in the experimental group, underwent training using LRC Stepwise Collaborative Learning Model of Lectures, Rounds and Case Discussions. Their educational outcomes were quantitatively analyzed. Results: The LRC Stepwise Collaborative Learning Model improved average resident scores from pre-training [50(40, 50) points] to post-training [90(80,100) points], with a statistical significance (P < 0.001). The questionnaire survey had a maximum score of 5 points, and the rates of full marks for the three teaching forms of lectures, rounds, and case discussions were 92.3% (24/26), 84.6% (22/26), and 76.9% (20/26), respectively. The satisfaction scores for the three teaching forms were 5.00 (5.00, 5.00), 5.00 (5.00, 5.00), and 5.00 (4.75, 5.00) points, respectively. Conclusions: The LRC Stepwise Collaborative Learning Model, as a new training system for residency education, has been recognized by ophthalmology residents. It facilitates the overall improvement of clinical thinking, contributes to competency development, and provides valuable insights for future teaching model designs.

Objective: To employ Mendelian randomization (MR) methods to explore bidirectional causal relationships between outdoor activities and myopia. Methods: Large-scale cohort study data from the UK Biobank were utilized, selecting independent genetic loci associated with outdoor activities and myopia within the European ancestry population as instrumental variables. The outdoor activities GWAS data included 419,314 individuals of European descent, while the myopia GWAS data comprised 460,536 individuals, including 37,362 myopia cases and 423,174 controls. MR analyses were conducted using inverse variance-weighted (IVW), weighted median, and MR Egger methods, employing the odds ratio as the effect measure to thoroughly investigate bidirectional causal connections. Mendelian randomization pleiotropy residual sum and outlier (MR PRESSO) detection method were employed to eliminate SNP outliers. Cochran's Q test, within MR Egger and IVW methods, was utilized to assess heterogeneity among individual single nucleotide polymorphisms (SNPs). MR Egger intercept testing assessed potential pleiotropy, and sensitivity analysis using the "leave-one-out" method examined the influence of individual SNPs on overall results. Results: IVW analysis demonstrated that outdoor activities significantly reduce the risk of myopia (OR = 0.934, 95% CI: 0.922~0.948, P < 0.01). Reverse Mendelian randomization analysis revealed a non-significant lower propensity for myopic individuals to engage in outdoor activities (OR = 0.925, 95% CI: 0.777~1.103, P = 0.39). Cochran's Q test, MR PRESSO, and MR Egger intercept tests in bidirectional Mendelian randomization analysis all indicated no significant heterogeneity or horizontal pleiotropy issues among the selected instrumental variables. Furthermore, sensitivity analysis using the "leave-one-out" method confirmed that individual SNPs did not significantly impact the overall results. Conclusion: Outdoor activities significantly reduce the risk of myopia.

Aims: To establish and evaluate predictive models for glaucoma-related adverse events (GRAEs) following secondary intraocular lens (IOL) implantation in paediatric eyes. Methods: 205 children (356 aphakic eyes) receiving secondary IOL implantation at Zhongshan Ophthalmic Center with a 3-year follow-up were enrolled. Cox proportional hazard model was used to identify predictors of GRAEs and developed nomograms. Model performance was evaluated with time-dependent receiver operating characteristic (ROC) curves, decision curve analysis, Kaplan-Meier curves and validated internally through C-statistics and calibration plot of the bootstrap samples. Results: Older age at secondary IOL implantation (HR=1.5, 95% CI: 1.03 to 2.19), transient intraocular hypertension (HR=9.06, 95% CI: 2.97 to  27.67) and ciliary sulcus implantation (HR=14.55, 95% CI: 2.11 to 100.57) were identified as risk factors for GRAEs (all p<0.05). Two nomograms were established. At postoperatively 1, 2 and 3 years, model 1 achieved area under the ROC curves (AUCs) of 0.747 (95% CI: 0.776 to 0.935), 0.765 (95% CI: 0.804 to 0.936) and 0.748 (95% CI: 0.736 to 0.918), and the AUCs of model 2 were 0.881 (95% CI: 0.836 to 0.926), 0.895 (95% CI: 0.852 to 0.938) and 0.848 (95% CI: 0.752 to 0.945). Both models demonstrated fine clinical net benefit and performance in the interval validation. The Kaplan-Meier curves showing two distinct risk groups were well discriminated and robust in both models. An online risk calculator was constructed. Conclusions: Two nomograms could sensitively and accurately identify children at high risk of GRAEs after secondary IOL implantation to help early identification and timely intervention.

Congenital cataract is a significant condition that profoundly impacts the visual function of infants and young children. Advancements in cataract surgery and intraocular lens implantation have enabled the achievement of high-quality visual rehabilitation after congenital cataract surgery. Nevertheless, effective prevention and treatment of surgery-related adverse events and complications, as well as managing other ocular dysplasia and form deprivation amblyopia that may arise in conjunction with the surgery, continue to pose important clinical challenges following congenital cataract surgery. This article provides a comprehensive overview of the occurrence, risk factors, treatment and prevention of high intraocular pressure and secondary glaucoma after congenital cataract and intraocular lens implantation. Its aim is to enhance the comprehension of preventive and therapeutic measures for high intraocular pressure and glaucoma after congenital cataract surgery, thereby minimizing potential postoperative complications and preserving visual function.

Anterior megalophthalmos is a rare congenital enlargement of the anterior segment, characterized by bilateral nonprogressive megalocornea (diameter ≥12.5 mm), extremely deep anterior chamber, normal or moderate thinning of the cornea, and elongation of the ciliary ring. Cataract and lens dislocation are the main causes of decreased vision in patients with AM. However, cataract surgery on patients with AM are challenging due to the anatomical abnormalities. This case reports a 48-year-old male patient diagnosed with AM and cataract, who successfully underwent a manual small incision cataract extraction combined with intraocular lens implantation. Finally, our patient showed a good visual outcome with a well centered IOL and without obvious refractive error. In this typical AM case, we reviewed and summarized the clinical characteristics and the challenges of surgical treatment so that other ophthalmologists can learn about this disease.

A case of intrapapillary hemorrhage with adjacent peripapallary subretinal hemorrhage (IHAPSH) was reported in this article. An 26-year-old female with mild myopia presented with symptoms of blurry vision and black filamentous floaters for 6 days. Her BCVA was 1.0 in both eyes. The fundus showed that the optic disc of both eyes appear small and elevated in the nasal regions, and intrapapillary hemorrhage, peripapillary subretinal hemorrhage and vitreous hemorrhage in her left eye, while only peripapillary subretinal hemorrhage in her right eye. The hemorrhage was resolved after 2 months, without any complication. Cases of IHAPSH have been reported only very rarely. The cases usually appear in young myopic eyes with tilted optic discs. It largely occurs monocularly, can improve without any specific treatment, and very rarely recur. Patients often have sudden discomfort with symptoms such as shadow floating, scotoma and non-specific vision loss. The main lesions were the flame-shaped hemorrhage on the surface of the optic disc. Or note the red or black-red adjacent peripapillary subretinal hemorrhage with a clear boundary around the disc margin is mostly located on the nasal side. A few cases are accompanied by vitreous hemorrhage. The clinical characteristics, pathogenesis, diagnosis, differential diagnosis, treatment and prognosis were summarized through the literatura review.

Author Affiliations: Shandong First Medical University (Shandong Provincial Academy of Medical Sciences), Shandong Ophthalmology Research Institute, Shandong Key Laboratory of Ophthalmology, Shandong Provincial-Ministry Jointly-Built State Key Laboratory Cultivation Base, Qingdao Ophthalmic Hospital, Qingdao, Shandong 266000, P.R. China Abstract: Objective To explore the distribution and drug-resistant characteristics of infectious keratopathies, and to provide diagnosis and treatment basis for corneal infectious diseases. Methods Retrospective analysis of corneal scrapings and tissue cultures from 2013-2023 in Qingdao Eye Hospital of Shandong First Medical University was carried out using WHONET5.6 and SPSS26 software for the analysis of pathogenic bacteria distribution and resistance characteristics, and the changes in resistance in different years were analyzed using Person's chi-square test and Fisher's exact probability method. Results A total of 13,254 corneal specimens were sent for examination from 2013 to 2023, of which 4,097 cases of positive corneal culture accounted for 30.9%, a total of 1,132 bacterial infected specimens accounted for 8.6%, and 2,965 fungal infected specimens accounted for 22.3%. The main infecting bacteria were Staphylococcus epidermidis in 657 cases (58%), Pseudomonas aeruginosa in 135 cases (11.9%) and Staphylococcus aureus in 113 cases (10.0%). The major infecting fungi were Fusarium oxysporum in 1334 cases (45%), Streptococcus spp. in 771 cases (26%), and Aspergillus spp. in 386 cases (13%). The change of resistance of Staphylococcus epidermidis to benzoxacillin and levofloxacin was statistically significant (P<0.05), and the rate of resistance to ocular antimicrobials of Pseudomonas aeruginosa in different years was statistically significant (P<0.05); and the rate of resistance of Staphylococcus aureus to tobramycin and gatifloxacin was statistically significant (P<0.05) Conclusion The rate of fungal detection was higher than that of bacterial detection in infectious keratoconus, and corneal bacterial infection were mainly caused by Staphylococcus epidermidis, and corneal fungal infections were mainly caused by Fusarium. The antimicrobial resistance rates of different bacteria varied with the year.

Purpose: To investigate clinical efficacy and continuity of care measures for foldable capsular vitreous body (FCVB) implantation and to evaluate its nursing effect and adverse complications. Methods. Retrospective analysis. The test group consisted of 75 eyes of 75 patients who underwent FCVB implantation for severe ocular trauma, complex retinal detachment and silicone oil-dependent eyes between August 2017 and April 2022 in our hospital. The control group consisted of 80 eyes of 80 patients who underwent vitrectomy and silicone oil filling for vitreous hemorrhage and retinal detachment at the same period. All patients were treated with a continuity of care model, and the postoperative Best-corrected visual acuity changes, intraocular pressure (IOP), retinal reset rate, adverse complications and regression, number of follow-up visits, and patient satisfaction were compared between the two groups. Results: No changes were presented on BCVA after treatment in test group. The percentage of BCVA improvement was greater in the control group compared with the test group (P < 0.05). No changes were presented on IOP after treatment in both groups. The postoperative IOP in the control group was significantly higher than that in the test group (P < 0.001). The retinal reset rate, incidence of low IOP, incidence of anterior chamber hemorrhage, incidence of corneal degeneration, proportion of anterior chamber inflammatory cell grade ≥2, number of sympathetic ophthalmia, and the average number of follow-up visits in the test group were significantly higher than those in the control group, while the incidence of high IOP and vitreous hemorrhage were significantly lower than those in the control group 3 months after treatment. Corneal degeneration was classified as not cured, low IOP and sympathetic ophthalmia were classified as improved, and the rest of the adverse complications were classified as cured. The average number of follow-up visits in the test group was significantly higher than that in the control group (P < 0.05), and patient satisfaction in the test group was higher than that in the control group, but there was no significantly statistical difference (P > 0.05). Conclusion: The FCVB is a safe, feasible, and effective vitreous substitute. Strengthening the nursing measures of FCVB implantation, emphasizing person-centred care and continuity of care, and improving surgical efficacy and patient satisfaction.

Purpose: To investigate clinical efficacy and continuity of care measures for foldable capsular vitreous body (FCVB) implantation and to evaluate its nursing effect and adverse complications. Methods. Retrospective analysis. The test group consisted of 75 eyes of 75 patients who underwent FCVB implantation for severe ocular trauma, complex retinal detachment and silicone oil-dependent eyes between August 2017 and April 2022 in our hospital. The control group consisted of 80 eyes of 80 patients who underwent vitrectomy and silicone oil filling for vitreous hemorrhage and retinal detachment at the same period. All patients were treated with a continuity of care model, and the postoperative Best-corrected visual acuity changes, intraocular pressure (IOP), retinal reset rate, adverse complications and regression, number of follow-up visits, and patient satisfaction were compared between the two groups. Results: No changes were presented on BCVA after treatment in test group. The percentage of BCVA improvement was greater in the control group compared with the test group (P < 0.05). No changes were presented on IOP after treatment in both groups. The postoperative IOP in the control group was significantly higher than that in the test group (P < 0.001). The retinal reset rate, incidence of low IOP, incidence of anterior chamber hemorrhage, incidence of corneal degeneration, proportion of anterior chamber inflammatory cell grade ≥2, number of sympathetic ophthalmia, and the average number of follow-up visits in the test group were significantly higher than those in the control group, while the incidence of high IOP and vitreous hemorrhage were significantly lower than those in the control group 3 months after treatment. Corneal degeneration was classified as not cured, low IOP and sympathetic ophthalmia were classified as improved, and the rest of the adverse complications were classified as cured. The average number of follow-up visits in the test group was significantly higher than that in the control group (P < 0.05), and patient satisfaction in the test group was higher than that in the control group, but there was no significantly statistical difference (P > 0.05). Conclusion: The FCVB is a safe, feasible, and effective vitreous substitute. Strengthening the nursing measures of FCVB implantation, emphasizing person-centred care and continuity of care, and improving surgical efficacy and patient satisfaction.