Volume 61 · Issue 10 · 2025

This issue focuses on the research progress of refractive correction. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Du Zhiyu.

Currently, the clinical application of various refractive correction surgeries has provided more options for patients, and posterior chamber phakic intraocular lens (PC-PIOL) implantation has also become one of the therapeutic options with proven efficacy. However, the potential risks of this procedure still warrant high vigilance. Some self-media outlets claim that PC-PIOL implantation is a "regret-free" surgery causing no ocular damage, stating that the implanted lens can be removed at any time to restore the eye to its preoperative state. This claim equates the "reversibility" of the surgery with "the ability to regret (and remedy it)", which is essentially a misinterpretation of the procedure′s core characteristics. Such misinterpretation may lead physicians and patients to lower their vigilance against surgical risks, paving the way for subsequent medical disputes. This article illustrates that postoperatively, intraocular structures and parameters—including intraocular pressure, corneal endothelial cells, and the anterior lens capsule—are affected to varying degrees. The risks of postoperative complications (e.g., cataracts, glaucoma, corneal endothelial decompensation, and intraocular infection) should not be overlooked. Additionally, it is important to prioritize surgical safety by: conducting thorough preoperative evaluations, maintaining close doctor-patient communication, strictly adhering to surgical standards during the operation, and implementing coordinated postoperative management. This article clarifies that "reversible" does not mean "regret-free", and that safeguarding the best interests of patients is the core responsibility of medical professionals.

Presbyopia refers to a degenerative disease in which the ability of the eye to accommodate gradually decreases with age. As the public demand for better quality of life rises, presbyopic correction surgery has become a clinical hotspot, with various surgery plans, techniques, and designs emerging in clinical practice. Based on the technical principles of how presbyopic surgery compensates for accommodation loss in presbyopia, this article elaborates on the selection of presbyopic correction surgery plans and the designs of corneal laser presbyopic surgery, with a focus on the application of extended-depth-of-focus technology in corneal laser presbyopic surgery, so as to further explore related theoretical and clinical problems and provide reference for relevant clinical work.

Glaucoma, the leading cause of irreversible blindness worldwide, is a chronic and progressive disease requiring lifelong monitoring and treatment. To improve patient adherence and ensure the safe and effective use of multiple medications in the glaucoma management, fixed-combination antiglaucoma medications have emerged as a key therapeutic trend. In 2019, the Glaucoma Group of Ophthalmology Branch of Chinese Medical Association established a consensus on the use of fixed-combination antiglaucoma medications. Upon this foundation, updated consensus recommendations have been formulated through collaboration with the Glaucoma Group of Chinese Ophthalmologist Association. This revision incorporates a comprehensive review of domestic and international research advances over the past five years, along with clinical data analysis and in-depth discussions, aiming to further standardize the clinical practice associated with glaucoma.

Uveitis is an inflammatory disease, mainly involving the iris, ciliary body, choroid, retina, retinal vessels, and sometimes vitreous body. It has various etiologies and types with complex clinical manifestations. Following scientific diagnosis points is usually able to ensure an accurate and timely diagnosis of the disease. The experts in the Ocular Immunology Group of Ophthalmology Society of Chinese Medical Association and the Uveitis and Ocular Immunology Group of Chinese Ophthalmologist Association have developed consensus opinions on the key diagnostic points of uveitis based on an in-depth investigation and literature review, as well as clinical experience, to guide the clinical practice.

To evaluate the clinical safety and efficacy of aspheric phakic intraocular lens (PIOL) implantation for myopia correction.

This prospective, multicenter, single-blind (patient-masked), randomized, controlled clinical trial was conducted from March 2019 to April 2022 across nine ophthalmic centers (including the Eye & ENT Hospital of Fudan University and Beijing Tongren Hospital, Capital Medical University). Eligible myopic patients scheduled for PIOL implantation were randomly assigned via a centralized dynamic randomization system to receive either the experimental aspheric PR PIOL or the control V4c implantable Collamer lens. At postoperative 1, 3, and 6 months, the efficacy index (primary endpoint: proportion achieving≥0.8 at 6 months), safety index, uncorrected distance/near visual acuity, best-corrected distance visual acuity, vault, intraocular pressure, corneal endothelial cell density, visual symptoms, and complications of the two groups were compared, with statistical analyses using the independent t-tests and chi-square tests.

The study enrolled 187 myopic patients (187 eyes), including 47 males (47 eyes) and 140 females (140 eyes), with a mean age of (28.60±5.08) years (range: 25 to 32 years). The experimental group included 91 patients, while the control group included 96 patients. At 6 months postoperatively, the efficacy index was 1.12±0.24 and 1.14±0.21, and the safety index was 1.28±0.26 and 1.26±0.23 in the experimental group and the control group, respectively, with no statistically significant differences between the two groups (both P>0.05). The difference in primary endpoint achievement rates was -1.19% [98.81% (83/84) in the experimental group vs. 100% (86/86) in controls], which exceeded the non-inferiority margin of -10%, demonstrating non-inferiority of the experimental intervention. At 6 months, the experimental group demonstrated uncorrected distance visual acuity of -0.01±0.09 logMAR compared to -0.03±0.08 logMAR in the control group, while best-corrected distance visual acuity was measured at -0.06±0.07 logMAR versus -0.08±0.06 logMAR, with no statistically significant differences observed between groups (both P>0.05). Similarly, there were no statistically significant intergroup differences in intraocular pressure and corneal endothelial cell density (both P>0.05). At both 1 month and 6 months postoperatively, the differences were significant between the two groups in the central vault and the peripheral-central vault difference (all P<0.05); however, no statistically significant difference in the peripheral vault was observed between groups (both P>0.05). At 1 month postoperatively, the incidence of glare in the experimental group [24.72% (22/89)] was significantly lower than that in the control group [54.26% (51/94)] (P<0.05). And there were no statistically significant differences between the two groups in the incidence of other visual symptoms including diplopia, ghosting, and blurred vision (all P>0.05). During the 6-month follow-up period, neither group exhibited any postoperative complications.

Aspheric PIOL implantation shows favorable 6-month safety/efficacy and visual quality in myopia correction, though long-term outcomes warrant further investigations.

To investigate the differences and consistency in measuring corneal astigmatism between autorefractors and corneal topographers, as well as in assessing total ocular astigmatism among autorefractors, wavefront aberrometers, and subjective refraction devices, so as to provide a basis for clinical instrument selection for astigmatism measurements.

A retrospective study was conducted. A total of 245 patients (245 right eyes) who underwent corneal refractive surgery and related examination at the Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University and Chongqing Mingda Eye Hospital from January 2015 to November 2023 were enrolled, including 85 males and 160 females, aged (32.17±10.16) years, with astigmatism degrees ranging from -4.50 to -0.25 D. The patients were divided into three age groups: 17-29 years (96 cases), 30-39 years (77 cases), and 40-50 years (72 cases). They were also classified based on the astigmatism degree:-0.25 to -0.75 D (131 eyes), -1.00 to -1.75 D (65 eyes), and ≤-2.00 D (49 eyes). Corneal astigmatism was measured using an autorefractor and a corneal topographer, while total ocular astigmatism was measured using an autorefractor, a wavefront aberrometer, and a subjective refraction device. The horizontal-vertical astigmatism vector (J₀) and 45° oblique astigmatism vector (J₄₅) of the cornea and the entire eye were calculated. Differences in corneal and total ocular astigmatism were compared. The Pearson correlation analysis of results from different instruments was performed, and the consistency was evaluated using the Bland-Altman analysis.

For corneal astigmatism, there were no statistically significant differences in J₀ measurements in the 30-39 years group and J₄₅ measurements in the 40-50 years group between the two instruments; however, statistically significant differences in J₀ and J₄₅ measurements were observed in other age groups and the overall population (all P<0.05). Moreover, no statistically significant differences were found in J₀ and J₄₅ measurements between the instruments in the ≤-2.00 D group, while statistically significant differences were present in other astigmatism groups and the overall population (all P<0.05). The results presented in a polar coordinate system showed that the measurement values of the two instruments were close in all groups and the overall population. The Pearson analysis indicated that J₀ and J₄₅ in all groups and the overall population were significantly correlated (all P<0.05). The consistency analysis revealed relatively good consistency in the 95% confidence interval (CI) of the 95% limits of agreement (LoA) for the overall results presented in a polar coordinate system. For total ocular astigmatism, statistically significant differences in J₀ measurements among the three instruments were observed in all age groups and the overall population (all P<0.05). Regarding J₄₅ measurements, only the 30-39 years group showed no significant difference among the autorefractor (P>0.05). In addition, there were statistically significant differences in J₀ measurements among the three instruments in all astigmatism groups and the overall population (all P<0.05). Regarding J₄₅ measurements, no significant difference was observed in the overall population and the -1.00 D to-1.75 D group (P>0.05). J₀ and J₄₅ in all groups and the overall population showed significant correlations between each pair of the three instruments (all P<0.05). The consistency analysis demonstrated that the upper limit of the 95%CI of 95% LoA for J₀ in all groups and the overall population was <0.50 D, and most of the lower limits were <0.50 D; the 95%CI of 95% LoA for J₄₅ in all measurements was within 0.50 D, indicating good consistency among the three instruments.

In the undilated pupil state, the autorefractor and corneal topographer have a high correlation and relatively good consistency in measuring corneal astigmatism and can be mutually referential in clinical practice. The autorefractor, subjective refraction device, and wavefront aberrometer have a high correlation and good consistency in the measurements of total ocular astigmatism. Among them, the autorefractor and wavefront aberrometer (objective refraction) can provide references for the subjective refraction device (subjective refraction). Clinically, the selection can base on the applicable scope of the instruments and clinical requirements.

To investigate the postoperative efficacy of a personalized refractive parameter optimization protocol constructed based on retrospective clinical data and regression models in femtosecond laser small-incision lenticule extraction (SMILE) for the correction of myopia and astigmatism.

A cohort study was conducted. Prospectively and consecutively collected and enrolled 75 patients (148 eyes) with refractive errors who underwent SMILE guided by a regression model-based refractive parameter design protocol (nomogram optimized by Visulyze software) at the Refractive Center of West China Hospital, Sichuan University from August to December 2024, and designated them as the experimental group. Additionally, a control group was established using propensity score matching based on the data of the experimental group, with patients selected from those who received conventional SMILE between December 2022 and May 2023 and had complete 3-month postoperative follow-up data. All surgeries were performed using the VisuMax 500 kHz femtosecond laser system. Visual acuity and refractive power were examined using a standard logarithmic visual acuity chart, autorefractor, and phoropter. The primary outcome measures were refractive accuracy (proportion of eyes with spherical equivalent within ±0.50 D) and astigmatism correction (proportion of eyes with residual astigmatism ≤0.50 D) at 3 months postoperatively; the secondary outcome measures included efficacy, safety, and predictability.

The experimental group ultimately comprised 67 patients (133 eyes), yielding an attrition rate of 10.1%. There were 17 males and 50 females, with an age of 28.50 (24.00, 32.25) years. The control group included 67 matched patients (133 eyes), consisting of 15 males and 52 females, with an age of 29.00 (26.00, 31.25) years. The two groups were comparable. In terms of refractive accuracy, the proportion of eyes with spherical equivalent within ±0.50 D was 99.2% (132/133) in the experimental group and 88.7% (118/133) in the control group (P<0.001); the proportion of eyes with residual astigmatism ≤0.50 D was 99.2% (132/133) in the experimental group and 95.5% (129/133) in the control group (P=0.368). There were no statistically significant differences in efficacy and safety between the two groups (both P>0.05). For efficacy, the number of eyes with uncorrected visual acuity ≥20/20 at 3 months postoperatively was 129 (accounting for 97%) in the experimental group and 132 (accounting for 99%) in the control group. For safety, neither group had eyes with a loss of≥2 lines of best-corrected visual acuity. The experimental group showed significantly higher refractive predictability, with coefficients of determination (R²) for spherical equivalent and astigmatism of 0.978 8 and 0.865 3, respectively, compared with 0.950 3 and 0.726 4 in the control group.

In this study, the personalized refractive parameter design protocol constructed based on retrospective clinical data and regression models significantly improves the accuracy of postoperative refractive prediction and the precision of astigmatism correction in femtosecond laser small-incision lenticule extraction (SMILE), and exhibits favorable efficacy and safety during the 3-month postoperative follow-up.

To compare the differences in decentration and tilt between two types of trifocal intraocular lenses (IOL) and their impacts on postoperative objective visual quality.

This was a prospective cohort study. One eye was consecutively enrolled from each cataract patient who underwent bilateral phacoemulsification cataract extraction combined with IOL implantation at Peking University Third Hospital between January 2023 and June 2024. Patients were divided into two groups based on the type of implanted IOL: the 839MP group (AT LISA tri 839MP IOL) and the Panoptix group (AcrySof IQ PanOptix IOL). At 3 months postoperatively, the following parameters were compared between the two groups: uncorrected distance, intermediate (80 and 60 cm), and near visual acuities; best-corrected distance visual acuity; spherical equivalent refraction; IOL decentration distance and tilt angle. Additionally, total higher-order aberrations (HOAs), coma, trefoil, spherical aberration of the whole eye and intraocular, and modulation transfer function (MTF) were measured, and the severity of adverse visual phenomena was graded. Pearson correlation analysis was used to explore the correlation between IOL decentration/tilt and total HOAs of the whole eye. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off values of IOL decentration and tilt for predicting total HOAs of the whole eye >0.3 μm and >0.5 μm, with the area under the curve (AUC) used to evaluate predictive efficacy.

Forty-five patients (45 eyes) were recruited in each group, and 42 patients (42 eyes) in each group completed the follow-up, with a total of 84 patients (84 eyes). Among them, there were 28 males and 56 females, with a mean age of 65 years. No statistically significant differences were observed between the two groups in terms of gender, age, eye laterality, axial length category, IOL power, preoperative lens decentration and tilt, Kappa angle, or Alpha angle (all P>0.05). At 3 months postoperatively, there were no significant differences between the 839MP and Panoptix groups in uncorrected distance, intermediate (80 cm), and near visual acuities or best-corrected distance visual acuity (all P>0.05). However, for uncorrected intermediate visual acuity at 60 cm, the Panoptix group performed better than the 839MP group (P<0.001). Regarding IOL decentration, the total decentration distance and vertical decentration distance in the 839MP group were (0.27±0.16) mm and (0.17±0.11) mm, respectively, which were significantly lower than those in the Panoptix group [(0.44±0.26) mm and (0.35±0.28) mm, respectively; all P<0.05]. For IOL tilt, no significant difference was found in the total tilt angle between the 839MP group (3.83°±2.15°) and the Panoptix group (3.08°±1.70°) (P>0.05). In terms of objective visual quality, the total HOAs of the whole eye, ocular HOAs, and total intraocular HOAs in the 839MP group were (0.222±0.094) μm, (0.099±0.071) μm, and (0.195±0.094) μm, respectively, which were significantly lower than those in the Panoptix group [(0.324±0.243) μm, (0.168±0.166) μm, and (0.304±0.240) μm, respectively; all P<0.05]. No correlation was observed between IOL tilt/decentration and intraocular HOAs in either group (P>0.05). ROC curve analysis showed that for evaluating IOL tolerance to decentration and tilt: when total HOAs of the whole eye>0.3 μm, the cut-off values of IOL decentration and tilt were 0.29 mm (AUC=0.69) and 5.1° (AUC=0.79) in the 839MP group, and 0.33 mm (AUC=0.76) and 3.2° (AUC=0.81) in the Panoptix group; when total HOAs of the whole eye>0.5 μm, the cut-off values of IOL decentration and tilt were 0.54 mm (AUC=0.64) and 6.9° (AUC=0.85) in the 839MP group, and 0.61 mm (AUC=0.72) and 4.7° (AUC=0.88) in the Panoptix group. No significant difference was noted in the incidence of adverse visual phenomena between the two groups (all P>0.05).

In the early postoperative period after trifocal IOL implantation, compared with the Panoptix IOL, the 839MP IOL exhibits smaller decentration and better objective visual quality. Furthermore, at the same tilt level, the 839MP IOL provides better objective visual quality; whereas at the same decentration level, the Panoptix IOL shows superior objective visual quality.

To explore the reliability and validity of the self-reported questionnaire for assessing frame glasses-wearing compliance in myopic children.

The initial item pool of the questionnaire was preliminarily constructed by systematically sorting out the research results related to the compliance of myopic children with spectacle wearing through the literature review method, combined with structured interviews with 5 myopic children. First, 18 experts meeting the specified criteria were selected to conduct 3 rounds of expert consultation to optimize the item pool. Then, 5 experts with a master′s degree or above and proficient in scale development methods were selected from them to conduct content validity evaluation. The item-level content validity index (I-CVI) and scale-level content validity index (S-CVI) were calculated to assess the content validity. Meanwhile, the items were optimized in combination with a pilot test (50 myopic children were selected for 3 rounds of pilot surveys) to form the final version of the questionnaire. From November 2022 to January 2023, 494 myopic children aged 10-15 years who wore frame glasses for myopia prevention and control were recruited from urban areas of Ji′an City, Jiangxi Province to conduct a questionnaire survey. For reliability analysis, split-half reliability and Cronbach′s α coefficient were used for evaluation; for validity analysis, content validity and construct validity were adopted. Among them, content validity was measured with I-CVI and S-CVI as indicators; construct validity was analyzed through exploratory factor analysis, where the suitability of data was first determined by the Kaiser-Meyer-Olkin (KMO) test and Bartlett′s test of sphericity, and then evaluated using indicators including the cumulative variance contribution rate of common factors, item factor loading coefficient, and common factor variance.

The final questionnaire consisted of 8 scale items and 1 non-scale item. Exploratory factor analysis of the 8 scale items (KMO=0.713, Bartlett′s test of sphericity P<0.001) extracted 3 common factors, with a cumulative variance contribution rate of 62.565%. The factor loading of each item ranged from 0.52 to 0.88, and the common factor variance of all items was>0.5. Based on this, the 3 factors were named as three dimensions: Glasses-Wearing Habits (3 items), Extent of Glasses Usage (3 items), and Self-Monitoring (2 items). The 1 non-scale item was used to explore the barriers to glasses-wearing compliance. In terms of reliability, the Cronbach′s α coefficient of the scale was 0.720, and the split-half coefficient was 0.719. In terms of validity, the S-CVI was 0.875, and the I-CVI ranged from 0.800 to 1.000.

The questionnaire has good reliability and validity, and can be used as a standardized tool for assessing glasses-wearing compliance in myopic children aged 10-15 years.

A 35-year-old male patient presented with decreased visual acuity in both eyes for 4 years. His medical history included hypertension, type 2 diabetes mellitus, renal failure, and kidney transplantation. In 2021, he was diagnosed with primary hyperoxaluria based on genetic testing, which revealed a homozygous variant of the AGXT gene (c.32C>G). During this ophthalmic examination, decreased corrected visual acuity was noted in both eyes; fundus examination showed crystalline deposits in the retina and perimacular ring-shaped pigment deposition. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) indicated abnormalities in retinal structure and blood vessels. Systemic examination revealed elevated 24-hour urinary oxalic acid. His second eldest sister carried the same homozygous variant of the AGXT gene with renal symptoms. The final diagnoses were: bilateral oxalate retinopathy, bilateral diabetic retinopathy, primary hyperoxaluria, and type 2 diabetes mellitus. The patient refused laser treatment, and no significant changes in the lesions were observed during the 3-month follow-up. This case suggests that primary hyperoxaluria caused by AGXT gene variation can lead to ocular oxalate deposition, and diagnosis should be made by combining genetic testing and imaging examinations, with long-term follow-up required.

A case of atopic keratoconjunctivitis complicated by non-infectious corneal ulcer in a 14-year-old female child. The patient had a history of allergic conjunctivitis, allergic rhinitis, and atopic dermatitis since childhood. She presented with redness, photophobia, lacrimation, and decreased vision in the left eye. After examination, she was diagnosed with corneal ulcer in the left eye, atopic keratoconjunctivitis in both eyes, and meibomian gland dysfunction in both eyes. After admission, the patient was treated with a variety of medications and underwent corneal lesion resection+amniotic membrane covering surgery. After regular follow-ups, the eye condition improved significantly one year later, and the allergic symptoms did not recur during the 7-year follow-up. This case is characterized by a young onset age, unilateral lesion, misdiagnosable corneal mucus plaque, and an unusual location of giant papilla. Moreover, good therapeutic effects were achieved through prevention and control, providing a reference for clinical practice.

A 37-year-old female diabetic patient presented with decreased vision in the right eye for 3 days. Ophthalmic examination revealed milky white turbidity of the aqueous humor in the right eye, accompanied by elevated intraocular pressure. Laboratory tests indicated poor control of blood glucose levels and hyperlipidemia. Subsequently, the left eye showed the same manifestations. The clinical diagnosis was bilateral chylous aqueous humor. Systemic hypoglycemic and lipid-lowering drugs were administered, combined with anterior chamber irrigation of the right eye. Glucocorticoids, cycloplegics and intraocular pressure-lowering drugs were used in both eyes. On the 8th day after the treatment, the ocular and systemic conditions improved significantly.

The patient was a 53-year-old male. He went to the Department of Ophthalmology, General Hospital of Eastern Theatre Command of the People's Liberation Army, because his painless vision in his left eye suddenly dropped to 2 days without sight. Eye examination: The best corrected visual acuity is 1.0 for the right eye and manual in front of the eye for the left eye; IOP was 16.5 mmHg (1 mmHg =0.133 kPa) in the right eye and 18.4 mmHg in the left eye; The left eye conjunctiva is not congested, the cornea is transparent, the anterior chamber is moderately deep, the aqueous humor is clear, the pupil is round and dilated, the direct response to light is extremely slow, the indirect response to light exists, and the lens density is increased; An orange-red tongue-shaped area (blood supply from ciliary retinal artery) can be seen in the temporal macular bundle area of the optic disc of the fundus, the color of the macular area is normal, and the surrounding retina is gray and white (essence picture 1); No obvious abnormalities were observed in the right eye. Clinical diagnosis: occlusion of the central retinal artery in the left eye.

Conjunctival homeostasis is crucial for ocular health; however, the lack of highly biomimetic in vitro models has hindered research on the mechanisms of conjunctival diseases. Organoid technology, which can simulate the in vivo microenvironment, recapitulate 3D structures and key functions, provides a new tool for this field, and this review focuses on the research of conjunctival organoids. Research on organoids began in 1907, and conjunctival organoids derived from adult stem cells were first established in 2024. Currently, four core culture methods have been developed, including the induction of functional conjunctival cells from induced pluripotent stem cells (iPSC), construction of 3D-printed bilayered tissue-engineered conjunctiva, development of full-thickness models containing goblet cells, and establishment of high-throughput preparation models. Among these, iPSC differentiation can yield functional epithelial cells, and the high-throughput model has also completed in-situ transplantation verification in mice. Conjunctival organoids have three main applications: facilitating the study of pathogenesis by simulating inflammation or viral infection, supporting drug screening, and serving as transplant donors—their survival and integration capabilities have been verified in mice. Nevertheless, current research still has limitations, such as a single cell type, restricted cell sources, complex culture processes with high costs, and unproven safety after transplantation. In the future, this field needs to focus on optimizing culture systems, constructing multi-cell models, innovating biomaterials, and promoting standardization. Meanwhile, it should expand application scenarios such as gene-edited disease models and microfluidic drug evaluation to advance the translation of conjunctival organoids from basic research to clinical practice.

This article focuses on the application of adaptive optics (AO) technology in the observation of photoreceptor cells (PRs) in the macular area. Firstly, the principle and development process of AO technology are described. It can actively measure and correct optical aberrations to achieve high-resolution imaging. Since its invention, it has been increasingly used in ophthalmic research. Then, a detailed review is presented on the observation results of PRs by AO in healthy individuals and various ophthalmic diseases, including the performance characteristics of PRs in inherited retinal diseases, retinal degenerative diseases, uveitis involving PRs, and other lesions. At the same time, the current shortcomings of AO technology are analyzed in depth, such as small-sample research, non-standardized parameters, and limited clinical applications. The aim is to comprehensively summarize the research progress of AO in the observation of PRs in the macular area and provide a reference for subsequent related research and clinical applications.

Lacrimal gland adenoid cystic carcinoma (LGACC), the most prevalent malignant epithelial tumor of the lacrimal gland, exhibits high invasiveness and poor prognosis. Despite aggressive local therapies, the 5-year and 10-year survival rates remain at 50% and 20% respectively. This review comprehensively synthesizes histopathological features, molecular mechanisms, and therapeutic advances in LGACC. Histopathological analysis highlights three classical subtypes (tubular, cribriform, and solid) with distinct prognostic implications, particularly emphasizing the detrimental survival impact of tumors undergoing high-grade transformation. At the molecular level, in-depth elucidation reveals the pivotal roles of NOTCH pathway mutations and MYB overexpression in driving oncogenesis through hyperactivation of receptor tyrosine kinase, PIP3/AKT, and ATR/BRCA signaling cascades. Current evidence demonstrates persistent therapeutic challenges: expanded surgical resection fails to significantly improve survival outcomes, while local excision combined with adjuvant therapies still faces substantial recurrence (80% at 5 years) and metastasis rates (66.9%). Emerging breakthroughs in targeted therapies warrant attention, including antisense oligonucleotides targeting MYB-NFIB fusion genes, clinical trial data of NOTCH inhibitors (e.g., AL101), and PARP inhibitor-based combinatorial regimens leveraging DNA damage repair mechanisms. By integrating fundamental research and clinical translational evidence, this review provides a theoretical framework for optimizing LGACC diagnosis and treatment paradigms.

Professor Zhao Jialiang, a Chinese ophthalmic epidemiology and glaucoma expert, ophthalmology educator, and academician of the International Academy of Ophthalmology, has left us on June 23, 2024, at the age of 79, due to ineffective treatment of his illness. Professor Zhao Jialiang is my senior brother. I was lucky enough to work with him in the Ophthalmology Branch of Chinese Medical Association [Chinese Ophthalmological Society (COS)] for more than 10 years, and witnessed his efforts and efforts in the construction of COS.