Although previous prevalence studies of DED were reported from some countries worldwide, national data are unavailable in China. We aimed to conduct an up-to-date national survey on the prevalence of DED in China and find out the potential risk factors including air pollutant. 23,922 eligible outpatients were recruited from ophthalmic clinics of 32 cities in China in 2013 by registration orders. The patients’ demographic characteristics, history of keratorefractive surgery, diseases and medication history were collected and the daily air pollutant data in 2013. Multivariate logistic analysis was performed to identify the potential risk factors associated with DED. The association between related factors and dry eye diseases subtypes evaluated as p value and odds ratios (OR) with 95% confidence intervals (CI). Among 23,922 outpatients, the prevalence of DED was 61.57%, and that of the male patients was 57.64% and of the female was 65.32% (P < 0.0001). Multivariate logistic regression suggested that the possible risk factors for DED included: female, older age, history of keratorefractive surgery, presence of arthritis, thyroid diseases, and antihistamine, diuretic, duodenal ulcer drugs, diazepam. Air pollutants including O3, PM2.5, and SO2 were also identified as the risk factors. The prevalence of DED among ophthalmic outpatients in China was considerably high. Age, gender, history of keratorefractive surgery, diseases, medication history, and air pollutants were associated with DED prevalence.

Dry eye disease (DED) is the most common disease affecting vision and quality of life. PM_2.5 was a potential risk of DED. Herein, we conducted animal exposure and cell-based studies to evaluate the pathogenic effect of PM_2.5 exposure on the ocular surface and DED etiological mechanisms. C57 mice were exposed to filtered air and PM_2.5 aerosol. We assessed health conditions and inflammation of the ocular surface by corneal fluorescein staining and immunohistochemistry. In parallel, cultured human corneal epithelial cells (HCETs) were treated with PM_2.5, followed by characterization of cell viability, intracellular ATP level, mitochondrial activities, and expression level of DED relevant mRNA and proteins. In mice, PM_2.5 exposure induced severe superficial punctate keratopathy and inflammation in their cornea. In HCETs, cell proliferation and ROS generation followed dose-response and time-dependent manner; meanwhile, mitochondrial ROS (mtROS) level increased and mitochondrial membrane potential (MMP) level decreased. Inflammation cascade was triggered even after short-term exposure. The reduction of ATP production was alleviated with Nrf2 overexpression, NF-κB P65 knockdown, or ROS clearance. Nrf2 overexpression and P65 knockdown reduced inflammatory reaction through decreasing expression of P65 and increasing of Nrf2, respectively. They partly alleviated changes of ROS/mtROS/MMP. This research proved that PM_2.5 would cause DED-related inflammation reaction on corneal epithelial cells and further explored its mechanism: ROS from mitochondrial dysfunctions of corneal epithelial cells after PM_2.5 exposure partly inhibited the expression of anti-inflammatory protein Nrf2 led the activation of inflammatory protein P65 and its downstream molecules, which finally caused inflammation reaction. Graphical abstract

Purpose. To determine the effectiveness and safety of trabeculectomy along with amniotic membrane transplantation (AMT) for glaucoma. Methods. This systematic review was performed using RevMan 5.3. We searched PubMed, EMBASE, and the Cochrane Library and included studies published until September 2019. The treatment group included patients with AMT and trabeculectomy (group A), and the control group had only trabeculectomy (group B). We only included randomized controlled trials. The outcomes were intraocular pressure (IOP), complete success rate, number of antiglaucoma medications, and complications. Results. Five studies, including 174 eyes (87 eyes in the AMT group and 87 eyes in the control group), were eligible in this review. The parameters had no significant difference in heterogeneity between the AMT and control groups preoperatively. In the AMT group, the mean IOP was significantly lower at 3 and 12 months after operation (P < 0.0001 and P = 0.02, respectively), while the number of complete successes in the AMT group was significantly higher at 6 and 12 months (P = 0.02 and P = 0.003, respectively) compared with the control group. Complications, including a flat anterior chamber and hyphema, appeared to be decreased in the AMT group compared to the control group (P = 0.02 and P = 0.02, respectively). No differences were observed in the number of antiglaucoma medications, hypotony, encapsulated bleb, or choroidal detachment. Conclusion. Compared with only trabeculectomy, it is more efficient and safer to add AMT to trabeculectomy during glaucoma filtering surgery.

Purpose. The purpose of this meta-analysis was to assess the percent reduction in the intraocular pressure (IOP) after argon laser peripheral iridoplasty (ALPI) and systemic medical therapy in patients with acute primary angle closure (APAC). Methods. We searched a number of electronic databases, including MEDLINE, EMBASE, PubMed, and Cochrane Library. We searched the electronic databases from the inception of the databases to August 2018. The primary outcomes included the IOP reduction (IOPR), percent reduction in IOP (IOPR%) from baseline to the endpoint and peripheral anterior synechiae (PAS). The secondary outcomes included the cup-to-disc ratio (CDR), mean endothelial count, and percent of patients requiring topical glaucoma medication. Summary weighted mean difference (WMD), odds ratio (OR), and 95% confidence intervals (CIs) were calculated. Results. Four eligible studies including 183 eyes (92 in the ALPI group and 91 in the medical therapy group) were identified. When comparing ALPI to medical therapy, the WMDs of the IOPR% were 30.03 (95% CI: 21.33 to 38.72, p<0.00001) at 15 minutes, 27.39 (95% CI: 18.89 to 35.89, p<0.00001) at 30 minutes, 18.15 (95% CI: 10.63 to 25.68, p<0.00001) at 1 hour, and 12.91 (95% CI: 4.50 to 21.32, p=0.003) at 2 hours. There was no statistically significant difference between the two groups at 24 hours and at more than 6 months after therapy. Meanwhile, no significant difference was observed in the degree of PAS, CDR, mean endothelial count, and percent of patients requiring topical glaucoma medication after treatment between the two groups. Conclusions. Both ALPI and systemic medications were effective with regard to decreasing the IOP. ALPI was more effective in lowering the IOP within the first two hours. Therefore, ALPI may be a better choice for rapidly lowering the IOP in patients with APAC within a short period.

To investigate the associated risk factors and potential molecular mechanisms affecting visual acuity (VA) in the elderly, this cross-sectional, population-based study collected the general information, past medical history and ophthalmologic data of 841 Shanghai elderly residents (mean age 69.61 ± 5.70 years, range 52-92 years). Univariate and multivariate logistic regression analyses revealed that the presenting worse VA problem was significantly associated with being underweight (OR = 3.071, P = 0.002). Across nine distinct macular retinal regions, thinning within 0.5-3.0 mm of the fovea (excluding the superior inner retina) was significantly associated with worse VA (all P < 0.05). Mouse models demonstrated that, compared to the simple retinal thinning group, the retinal thinning combined with underweight group exhibited more severe structural damage and elevated cell apoptosis rates via hematoxylin and eosin (HE) and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining. Electroretinogram showed that combined retinal thinning and underweight synergistically exacerbated visual dysfunction. To further explore the molecular mechanism underlying the retinal thinning-underweight phenotype, bulk RNA-seq analysis revealed a significant downregulation of vitamin D-binding protein (Gc), which was positively regulated by the transcription factor, early growth response 1 (Egr1). Pathway analysis highlighted the involvement of vitamin transmembrane transporter activity. Consistent with bioinformatics predictions, Western blot confirmed a significant downregulation of both Gc and Egr1 in the retinal thinning-underweight group. Collectively, we identified underweight and retinal thinning as systemic and ocular risk factors for worse VA in the elderly. Their synergistic effect deteriorated VA through the Egr1/Gc/vitamin transport axis.

Background/Objectives: Whole-blood fatty acid composition provides an objective biomarker of fatty acid status, but its relationships with nutritional characteristics and subsequent quality-of-life (QoL) changes among cancer survivors remain incompletely understood. We aimed to identify whole-blood fatty acid phenotypes and examine their associations with nutritional characteristics, cross-sectional QoL profiles, and subsequent QoL changes in an overlapping longitudinal subcohort. Methods: In this cohort study, the 2023 baseline investigation included 3175 community-dwelling adult cancer survivors with whole-blood fatty acid profiles and paired questionnaires. After excluding participants with substantial missing QoL data, implausible fatty acid measurements, or missing age, sex, or cancer type, 3009 participants comprised the baseline analytical sample. Among these, 423 overlapped with an independent longitudinal cohort contributing QoL data from June 2021 and June 2024, and 398 had complete covariate data for the core adjusted longitudinal analyses. Whole-blood fatty acid phenotypes were identified using principal component analysis and unsupervised clustering. Nutritional characteristics were assessed using habitual dietary intake, Diet Balance Index 2022 scores, and nutrition literacy measures. QoL was assessed using the EORTC QLQ-C30. Multivariable models examined cross-sectional QoL and annualised QoL changes. An open-source phenotype assignment tool was developed to support reproducible classification in future cohorts. Results: Among 3009 baseline participants (mean [SD] age, 64.9 [7.0] years; 2397 women [79.7%]), five whole-blood fatty acid phenotypes were identified. Phenotypes 2 and 3 were rarely observed in the available general-population reference sample and appeared enriched among survivors. Phenotype 2, a high-SFA/low-PUFA phenotype accompanied by higher red meat intake and greater DBI-22 excess scores for red meat and related animal foods, was associated with statistically significant worsening across multiple QoL domains over 12 months despite relatively favourable baseline QoL. Compared with the general-population-mapped reference pool (Phenotypes 1, 4, and 5), Phenotype 2 showed annualised declines in summary score (−4.66 [95% CI, −8.14 to −1.19]) and role functioning (−5.35 [−9.88 to −0.83]), and worsening pain (8.28 [2.58 to 13.98]), dyspnoea (6.83 [0.16 to 13.50]), and constipation (14.10 [7.30 to 20.90]). Prebaseline annualised QoL changes over the preceding 24 months did not differ significantly across phenotypes. Conclusions: Whole-blood fatty acid profiling identified distinct nutritional-metabolic phenotypes among community-dwelling cancer survivors. The high-SFA/low-PUFA phenotype, accompanied by higher red meat intake and greater DBI-22 excess scores for red meat and related animal foods, was associated with worsening across multiple QoL domains over the subsequent 12 months despite relatively favourable baseline QoL. These findings highlight whole-blood fatty acid phenotyping as a potentially informative framework for characterising nutritional-metabolic heterogeneity and subsequent QoL vulnerability among cancer survivors. The open-source phenotype assignment tool may facilitate reproducible phenotype assignment and external validation in future cohorts.