Glaucoma stands as the leading cause of irreversible blindness globally, affecting over 700 million individuals. It is characterized by progressive degeneration of retinal ganglion cells (RGCs). By 2040, the global prevalence of glaucoma is expected to rise to 112 million, with approximately 10% experiencing blindness in at least one eye. The primary pathological basis for visual function impairment in glaucoma progression is the loss of RGCs induced by elevated intraocular pressure (IOP) and various pathogenic factors. Currently, IOP-lowering treatment is the only intervention available, but it cannot completely halt the progressive injury to RGCs, nor can it reverse the optic nerve damage caused by prior disease progression. Exploring the direct pathogenic factors of RGC degeneration in glaucoma, identifying key therapeutic targets, and developing new neuroprotective treatments are of great importance. This review discusses recent advancements in understanding the mechanisms and therapeutic approaches for RGC degeneration in glaucoma. It proposes targeting early inflammatory responses and mitochondrial stress as potential strategies to inhibit neurodegenerative changes fundamentally, providing neuroprotection. The review also emphasizes the pivotal role of altered ocular blood flow in glaucoma pathogenesis, highlighting its importance in intervention strategies. Future research on glaucoma pathogenesis should focus on factors beyond IOP, exploring pathogenic factors in the pathological environment of blood flow, metabolism, and immune crosstalk for targeted therapeutic interventions. Also, verifying the neuroprotective effects of these interventions in various animal models holds promise for improving the clinical translation success rate of neuroprotection in glaucoma, thus expanding therapeutic concepts and drug options.
Meibomian gland dysfunction (MGD) manifests through two main clinical presentations, characterized by the meibomian gland (MG) ductal obstruction or acinar dropout. While previous research has predominantly associated MGD pathogenesis with hyperkeratinization-related MG ductal obstruction and subsequent acinar atrophy, recent cases have shown significant functional acinar loss in the absence of apparent ductal keratinization or blockage. The deterioration of either MG obstruction or dropout exacerbates the condition of the other, suggesting an independent yet interconnected relationship that perpetuates the vicious cycle of MGD. Understanding the distinct pathological features of MG obstruction and dropout is crucial for delineating their etiology and identifying targeted therapeutic strategies. This review explores the nuanced interrelations of MG obstruction and dropout, elucidating potential pathological mechanisms to establish a foundation for early MGD diagnosis and intervention.
Secondary intraocular lens (IOL) implantation is a common treatment for pediatric aphakia. The accurate prediction of IOL power calculation plays a pivotal role in the postoperative development and improvement of visual function for pediatric secondary IOL implantation. Current IOL power calculation formulas were developed based on data from adult phakic eyes and displayed good performance in adult population. However, the formulas showed poor performance in pediatric aphakic population. To achieve the predetermined target refractive outcomes, the selection and optimization of IOL power calculation formulas is critically important for pediatric secondary IOL implantation.
Secondary intraocular lens (IOL) implantation is a common treatment for pediatric aphakia. The accurate prediction of IOL power calculation plays a pivotal role in the postoperative development and improvement of visual function for pediatric secondary IOL implantation. Current IOL power calculation formulas were developed based on data from adult phakic eyes and displayed good performance in adult population. However, the formulas showed poor performance in pediatric aphakic population. To achieve the predetermined target refractive outcomes, the selection and optimization of IOL power calculation formulas is critically important for pediatric secondary IOL implantation.
Congenital cataract is a common treatable blinding eye disease in children. The existing classification system of congenital cataract is mainly used for clinical and molecular diagnosis of the disease. Still, it does not focus on whether there are differences in visual prognosis after treatment in children with different categories. It provides limited reference information for the evaluation, formulation, and optimization of treatment plans. Research on the classification of congenital cataract still needs further exploration. The relevant research on the classification of congenital cataracts was reviewed, and the direction of research on the classification of congenital cataracts was discussed.
Pediatric cataract is one of the leading causes of treatable childhood blindness worldwide, with surgery being the primary treatment method. Among the postoperative complications, glaucoma-related adverse events (GRAEs) emerge as the predominant cause of secondary blindness post-surgery. This study comprehensively reviews the factors associated with the occurrence of GRAEs, including surgical design, ocular anatomical characteristics, other ocular developmental abnormalities, and systemic diseases. It also summarizes methods for predicting GRAEs, recommends the use of the Cox regression model to establish a predictive model and the evaluation the model's discrimination and calibration through internal validation，aiming to provide references for the early identification of children at high risk of GRAEs.
Meibomian Gland Dysfunction (MGD), as a meibomian gland disease caused by many factors, is a chronic and diffuse disease, which is often manifested by different degrees of meibomian gland terminal duct obstruction and acinar atrophy, and the quality and/or quantity of eyelid ester secreted by meibomian gland will also change abnormally, which may cause eye surface microenvironment imbalance, eye discomfort and even visual dysfunction. With the deepening of research at home and abroad in recent years, it is found that many risk factors are closely related to the occurrence and development of MGD, including systemic factors, eye diseases, systemic diseases, treatment-related factors (local medication, systemic medication, surgical treatment, etc.), environmental factors, lifestyle-related factors, etc., which can all lead to MGD in patients. Long-term MGD patients are prone to cause eye inflammation, which further causes corneal conjunctival injury, so patients have more eye discomfort symptoms and cause dry eye. Dry eye is closely related to MGD, and the damage of ocular surface and tear film often causes dry eye. Dry eye is mainly characterized by sore eyes and accompanied by decreased vision, and patients with MGD also have these manifestations. As a common ocular surface disease in ophthalmology outpatient department, some patients with MGD may be misdiagnosed or missed because of the lack of relative specificity of its symptoms. Therefore, studying the risk factors leading to MGD can help to clarify the clinical diagnosis and grading of MGD and provide individualized treatment for MGD patients.
Abstract Purpose: This study aims to explore an efficient teaching method in ophthalmology that follows present policies by applying Total Quality Management (TQM), using an online platform DingTalk in standardized training of ophthalmic residents. Methods: The research team, based at Zhongshan Ophthalmic Center, selected 82 first-year residents undergoing standardized training of ophthalmic residents as participants, randomly allocating them into two groups. The experimental group consisting of 41 trainees received TQM-modeled online learning via the DingTalk platform，adopting a management model of full participation, full process tracking, and comprehensive evaluation to ensure teaching quality. While the control group, also comprising 41 trainees, underwent traditional offline instruction. The TQM group engaged in live streaming lectures on the DingTalk platform, whereas the conventional group continued with face-to-face teaching in classroom. Data including pre- and post-teaching scores, as well as scores from satisfaction surveys are analyzed. Results: Comparing pre- and post-teaching scores, significant statistical differences were found between the TQM and traditional groups, with mean score improvements of (35.38±1.44) points and (30.93±3.19) points, respectively, indicating statistical significance (P=0.013). Furthermore, the questionnaire survey revealed that the TQM group scored higher than the traditional group in aspects such as course design, clinical relevance, content mastery, and instructor satisfaction. In addition, the questionnaire survey showed that there was no statistically significant difference in the total satisfaction score between the two groups (9.85 ± 0.55 points vs. 9.37 ± 1.01 points P=0.009), but in terms of mastery of satisfaction sub items, the TQM model group scored higher than the traditional model group (4.84 ± 0.12 points vs. 4.48 ± 0.80 points, P=0.007). Conclusion: The application of a TQM-based model on the DingTalk platform significantly enhances the teaching quality and student satisfaction in the residency training of ophthalmologists, demonstrating greater pedagogical advantages over traditional methods. This innovative and practical teaching reform approach thus provides a promising solution for standardized residency training in ophthalmology, and holds considerable importance for nurturing highly competent ophthalmologists who can meet the demands of the current era.
Abstract：Diabetic Retinopathy (DR), a devastating ocular consequence of diabetes, is marked by damage to the retinal microvasculature, heightened vascular permeability, retinal ischemia, and neovascularization. The Ins2Akita (Akita) diabetes mouse model, renowned for its high stability and accurate simulation of the pathogenesis and pathological traits of human type 1 diabetes, serves as an exemplary animal model for exploring the underpinnings and therapeutic strategies of DR. Within the realm of immunology, the T helper cell 17 (Th17) subset of CD4+ T cells stands out, distinguished by its secretion of interleukin-17 (IL-17), a cytokine crucial in the pathogenesis of retinal inflammatory diseases. NF-κB activator 1 (Act1), alias CIKS, is a 60 kD NF-κB activator and intracellular signaling molecule harboring a TRAF6 binding sequence along with E3 ubiquitin ligase activity. Upon stimulation by IL-17, Act1 facilitates the ubiquitination of TRAF6 via its U-box region, thus activating the TRAF6, TAK1 kinase, and IKK kinase complexes. This, in turn, triggers the activation of the transcription factor NF-κB and leads to the expression of numerous pro-inflammatory genes. This paper delves into the role of the ACT1-mediated IL-17 signaling pathway in diabetic retinopathy, aiming to furnish a profound medical theoretical foundation and potential molecular targets for the investigation of the disease's pathogenesis as well as the development of targeted treatment strategies.
