Dry eye and diabetic keratopathy represent the major diabetic complications in ocular surface. Here we found that diabetic mice exhibited the early onset of reduced tear secretion and lacrimal gland weight compared to the symptoms of diabetic keratopathy. Considering to the high bioenergetic needs in lacrimal gland and cornea, we hypothesized that hyperglycemia may cause different severity of mitochondrial bioenergetic deficit between them. Through the measurement of oxygen consumption rate (OCR) and basal extracellular acidification rate (ECAR), we found the apparent alterations of mitochondrial bioenergetic profiles in diabetic lacrimal gland and cornea, accompanied with the mtDNA damage and copy number reduction, as well as the reduced glutathione content. Comparative analysis revealed that mouse lacrimal gland cells exhibited 2-3 folds higher of basal, ATP production, maximal OCR and basal ECAR than corneal epithelial cells in normoglycemia. However, the differences were slightly significant or even not detected in hyperglycemia. Accordingly, the mitochondrial bioenergetic metabolism of lacrimal gland was more compromised than that of corneal epithelium in diabetic mice. Through the administration of mitochondrial-targeted antioxidant SkQ1, the severity of dry eye and diabetic keratopathy was significantly attenuated with the improved mitochondrial function. These results indicate that the susceptibility of mitochondrial bioenergetic deficit in diabetic lacrimal gland may contribute to the early onset of dry eye, while mitochondria-targeted antioxidant possesses therapeutic potential for diabetic dry eye and keratopathy.

Purpose: To investigate risk factors, treatment strategies, and outcomes of endophthalmitis associated with severe fungal keratitis. Methods: Data from 392 patients diagnosed with fungal keratitis were retrospectively examined. Patients had severe disease that was refractory to topical or systemic antifungal therapy, and the infection involved the endothelium or perforated the cornea. The incidence and risk factors for endophthalmitis, and treatment outcomes were evaluated. Results: Thirty-seven of 392 patients (9.4%) had endophthalmitis. Multivariate logistic regression revealed the following risk factors for endophthalmitis: topical steroid use (odds ratio [OR] = 6.35, 95% confidence interval [CI]: 2.01–20.08), previous corneal laceration suturing (OR = 5.05, 95% CI: 1.11–22.93), large corneal ulcer size (≥10-mm diameter; OR = 4.43, 95% CI: 1.71–11.50), hypopyon (OR = 11.05, 95% CI: 2.12–57.55), and aphakia (OR = 15.45, 95% CI: 1.59–149.82). Thirty of the 37 eyes (81.1%) with endophthalmitis were saved by penetrating keratoplasty, vitrectomy, or intravitreal antifungal injection; 7 eyes (18.9%) were eviscerated. Conclusion: Most patients with endophthalmitis secondary to corneal fungal infection were successfully managed by penetrating keratoplasty, vitrectomy, or intravitreal antifungal therapy. Multiple risk factors for endophthalmitis were identified. Timely diagnosis and risk factor assessment were essential for ensuring early surgical intervention for fungal keratitis–related endophthalmitis.

Background: This study aims to describe the epidemiology and clinical features of patients with intraocular foreign bodies (IOFBs) and analyze the prognostic factors influencing final vision. Methods: We retrospectively reviewed medical records of patients with IOFBs admitted to Qingdao Eye Hospital of Shandong First Medical University between January 1, 2014, and December 31, 2021. Inclusion criteria involved complete clinical data details of patients diagnosed with intraocular foreign bodies in our hospital who were treated with concurrent surgery and based on IOFB position and characteristics, different surgical methods were employed. The minimum follow-up duration was 6 months. Exclusion criteria were foreign bodies retained in the orbit, organ failure, surgical contraindications, coagulation abnormalities, autoimmune diseases, history of ocular surgery, and ocular space-occupying lesions. Based on IOFB position and characteristics, different surgical methods were employed. Multivariate logistic regression analysis was performed to predict independent factors influencing final visual acuity after IOFBs. Results: This study analyzed 159 patients (159 eyes) with IOFBs. Based on discharge and follow-up results, IOFB removal was performed through pars plana incision in 105 (67.9%) eyes, corneoscleral limbus incision in 24 (15.1%) eyes, and original wound in 27 (17.0%) eyes. Of these, 44 eyes underwent IOFB removal without vitrectomy, while 55 (34.6%) eyes were treated with silicone oil. Post-vitrectomy, three cases showed secondary macular membrane, five cases exhibited retinal detachment, and enucleation was necessary in three cases. The final best corrected visual acuity (BCVA, logMAR) was 1.06 +/- 0.88, significantly better than preoperative visual acuity of 1.65 +/- 0.87 (t = 8.21, p < 0.01). Multi-factor logistic regression analysis revealed that the length of corneal/scleral wound (OR=0.6 P < 0.05), maximum size of IOFB (OR=0.585 P < 0.05), initial presenting VA (OR=0.900 P < 0.05), and macular lesions(OR=0.400 P < 0.05) were risk factors for postoperative vision prognosis after intraocular foreign body surgery. Conclusion: In a tertiary eye center in northern China, IOFBs predominantly affected the working-age group, particularly males. Factors such as wound length, IOFB size, initial presenting VA, and macular lesions might impact the final visual outcome.

The aim of this study is to describe a modified technique for internal refixation of dislocated scleral-sutured polymethylmethacrylate (PMMA) intraocular lenses (IOLs) with eyelets. Three-port pars plana vitrectomy was performed. Through the scleral fixation site, a 30-gauge needle loaded with an 8-0 polypropylene suture was inserted into the vitreous cavity. The suture end was passed through the eyelet of IOL with 25-gauge forceps. Next, it was guided out of the eye through the original scleral fixation point. The end of the exterior suture was buried with a flapless intrascleral knotting technique. Six eyes of six patients were successfully treated with this technique and followed up for 6–12 months postsurgery. In all cases, there was significant improvement in uncorrected visual acuity. IOLs were stable with proper centration and no major complications. This modified technique offers an effective and minimally invasive surgical alternative for refixation of dislocated scleral-sutured PMMA IOLs with eyelets.

Purpose: To evaluate a modified minimally invasive technique for trans‐scleral repositioning of dislocated Akreos Adapt intraocular lenses (IOLs) without scleral flaps. Methods: This retrospective case series included 17 eyes with subluxated or dislocated IOLs that underwent repositioning using a suture‐in‐needle, closed‐loop technique. The procedure involved passing an 8‐0 polypropylene suture through the IOL’s four fenestrated haptics using a bent 30‐gauge needle. The exterior suture knot was buried into the sclera without creating scleral flaps or dissecting the conjunctiva. Data on pre‐ and postoperative intraocular pressure, best‐corrected visual acuity, IOL position, corneal endothelial cell counts, and intra‐/postoperative complications were collected and analyzed. The follow‐up period lasted at least 6 months. Results: All 17 cases demonstrated stable and well‐centered IOLs with improved visual acuity. No significant complications, including IOL tilt, decentration, vitreous hemorrhage, hypotony, iris capture, or suture erosion, were observed during the follow‐up. Conclusion: The suture‐in‐needle, closed‐loop technique for trans‐scleral refixation of dislocated Akreos Adapt IOLs is minimally invasive, achieves excellent anatomical and functional outcomes, and reduces the risk of complications.

To report the epidemiological characteristics, causative pathogens, treatment approaches, and outcomes of culture-proven exogenous fungal endophthalmitis (EFE). This retrospective, interventional case series analysed the data of 112 patients with culture-positive EFE treated at a tertiary centre in North China between 2001 and 2020. The medical data of patients were extracted from hospital records. EFE was associated with fungal keratitis, penetrating trauma, and intraocular surgery in 67 (59.8%), 39 (34.8%), and six eyes (5.4%), respectively. The primary cause of infection was mould (106/112, 94.6%), followed by yeast infection (6/112, 5.4%). Most keratitis cases were caused by Fusarium (32/67, 47.8%). Moreover, Aspergillus was the predominant species associated with penetrating trauma (15/39, 38.5%). Furthermore, Fusarium accounted for 50% (3/6) of postoperative cases. More than half of the eyes (89/112, 79.5%) were preserved through penetrating keratoplasty, vitrectomy, or intravitreal antifungal injections. However, 23 eyes (20.5%) were eviscerated, including 16 with fungal keratitis and seven with penetrating trauma. Fusarium and Aspergillus were the predominant pathogens in EFE, with fungal keratitis as the leading cause. Visual prognosis varied, with keratitis-associated cases showing the poorest outcomes, underscoring the need for early diagnosis and timely intervention.