Volume 62 · Issue 04 · 2026

This issue focuses on the research progress of cataract. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Qi Hong.

Cataract surgery has fully evolved from traditional vision-restoring surgery to refractive cataract surgery, highlighting the growing clinical importance of maintaining perioperative ocular surface microenvironment homeostasis. Based on the“Chinese expert consensus on prevention and treatment of dry eye disease during perioperative period of cataract surgery (2021)” and with further in-depth exploration, this article elaborates on four aspects: the relationship between the imbalance of the ocular surface microenvironment homeostasis and dry eye disease during the perioperative period of cataract, the impact of the imbalance on the whole process of refractive cataract extraction surgery, the standardized assessment of the ocular surface status during the perioperative period, and the implementation path of managing the ocular surface microenvironment homeostasis. It emphasizes that perioperative management should focus on preserving ocular surface homeostasis and establishing a comprehensive strategy—preoperative optimization, intraoperative protection, and postoperative repair. This approach aims to provide new insights for clinical practice and further improve the visual quality and patient satisfaction following cataract surgery.

Demyelinating optic neuritis (DON) is an autoimmune inflammatory demyelinating disease that affects the optic nerve. In recent years, with the rapid advancement of biotechnology, novel targeted biological agents have demonstrated unique advantages in the treatment of DON, and the number of approved targeted biologics for clinical use has gradually increased. However, the risks of infections and adverse effects caused by the long-term use of biologics cannot be ignored. How to use various biologics reasonably, effectively, and safely presents a new challenge that clinical physicians must address. The experts from the Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association and the Neuro-ophthalmology Professional Committee of Chinese Research Hospital Association have summarized and analyzed the latest clinical research findings on biologics. Combining their clinical experience in Chinese patient populations, they have thoroughly discussed various aspects of using biologics for DON, such as indications, efficacy, infection risks, administration methods, special populations, and safety, reaching consensus opinions. The aim is to provide a theoretical basis and practical guidance for the standardized use of targeted biologics in the clinical treatment of DON in China.

This study aimed to compare the clinical outcomes of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in diabetic patients, and to investigate whether FLACS provides superior early postoperative visual quality recovery.

A retrospective case-control study was performed. A total of 107 diabetic patients (107 eyes) who underwent cataract surgery at Chengdu Aidi Eye Hospital between May 2024 and April 2025 were enrolled. Patients were divided into the FLACS group (52 patients, 52 eyes) and the CPCS control group (55 patients, 55 eyes) according to the surgical technique. Preoperative and postoperative follow-up data within 3 months were collected. Clinical outcomes including best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count, central corneal thickness (CCT), and intraoperative and postoperative complications were analyzed and compared between groups.

In the control group, the mean age was (70.82±8.41) years, including 25 males and 30 females. In the FLACS group, the mean age was (67.17±9.49) years, including 30 males and 22 females. No significant differences were observed in baseline characteristics such as gender, age, or lens nuclear hardness between the two groups (P>0.05). Preoperative BCVA, IOP, CCT, and corneal endothelial cell count were comparable between groups (P>0.05). At early postoperative time points (1 day and 1 week), BCVA in the FLACS group was significantly better than that in the control group: at 1 day postoperatively, the median BCVA (interquartile range) was 0.3 (0.2, 0.6) in the control group and 0.2 (0.1, 0.4) in the FLACS group; at 1 week postoperatively, it was 0.1 (0.1, 0.3) in the control group and 0.1 (0.0, 0.2) in the FLACS group (all P<0.05). At 1 month and 3 months postoperatively, no significant difference in visual acuity was detected between groups (P>0.05). Corneal endothelial cell loss was significantly lower in the FLACS group than in the control group at all postoperative follow-up time points. At 3 months, median endothelial cell loss was 434 (268, 616) cells/mm² in the control group and 205 (74, 423) cells/mm² in the FLACS group (P<0.05). On postoperative day 1, CCT increased to (592.29±41.79) μm in the control group and (573.71±52.24) μm in the FLACS group; the degree of corneal thickening was significantly greater in the control group (P<0.05), indicating more severe corneal edema. This difference was no longer significant from postoperative week 1 onward (P>0.05). IOP was similar between the two groups at all postoperative time points (P>0.05). The incidence of early postoperative corneal edema was significantly higher in the control group (38.2%, 21/55) than in the FLACS group (19.2%, 10/52). During the 3-month follow-up period, macular edema occurred in 2 cases in the control group, while no cases were observed in the FLACS group (P<0.05).

For diabetic patients, FLACS significantly accelerates early postoperative visual rehabilitation and provides superior corneal protection, with less corneal endothelial cell loss and milder early postoperative corneal edema. FLACS thus demonstrates higher safety and faster recovery, and may be considered a preferred surgical option for cataract surgery in diabetic patients.

To investigate the differences in optical performance between the novel refractive extended depth of focus (EDof) intraocular lens (IOL), other types of EDof IOLs, and conventional IOLs.

Experimental study. Three non-diffractive EDof IOLs (refractive EDof IOL, wavefront-shaped EDof IOL, rotationally asymmetric regional refractive EDof IOL), an enhanced monofocal IOL, and a monofocal IOL with a power of 20.0 D were included. Using an in vitro IOL optical performance tester, the modulation transfer function (MTF) at far, intermediate and near foci was measured under 3.0 mm and 4.5 mm pupil apertures, different spatial frequencies and corneal spherical aberration models. United States Air Force (USAF) resolution tests were performed, and simulated visual acuity (logarithm of the minimum angle of resolution) was calculated.

At 3.0 mm aperture and 50 line pairs (lp)/mm spatial frequency, the far-focus MTF values in descending order were: monofocal IOL (0.73), enhanced monofocal IOL (0.61), rotationally asymmetric regional refractive EDof IOL (0.43), refractive EDof IOL and wavefront-shaped EDof IOL (both 0.36). The intermediate-focus MTF values in descending order were: rotationally asymmetric regional refractive EDof IOL and wavefront-shaped EDof IOL (both 0.15), enhanced monofocal IOL (0.13), refractive EDof IOL (0.06) and monofocal IOL (0.06). At 4.5 mm aperture, the far-focus MTF values in descending order were: monofocal IOL (0.66), enhanced monofocal IOL (0.61), refractive EDof IOL (0.60), wavefront-shaped EDof IOL (0.36), rotationally asymmetric regional refractive EDof IOL (0.22). The far-focus MTF peak of the refractive EDof IOL was higher at 4.5 mm than at 3.0 mm aperture. The intermediate-focus MTF values in descending order were: rotationally asymmetric regional refractive EDof IOL (0.14), wavefront-shaped EDof IOL (0.09), enhanced monofocal IOL (0.07), refractive EDof IOL (0.06), monofocal IOL (0.02). USAF resolution test showed that at 3.0 mm aperture, the far-focus image clarity was the best in the monofocal IOL and enhanced monofocal IOL groups, followed by rotationally asymmetric regional refractive EDof IOL, while refractive EDof IOL and wavefront-shaped EDof IOL were similar; the intermediate-focus image clarity was the best in the wavefront-shaped EDof IOL group. At 4.5 mm aperture, the far-focus image clarity was the best in the monofocal IOL and enhanced monofocal IOL groups, followed by refractive EDof IOL; the intermediate-focus image clarity was the best in the wavefront-shaped EDof IOL and rotationally asymmetric regional refractive EDof IOL groups. Simulated visual acuity analysis showed that at 3.0 mm aperture, the distance visual acuity of the three EDof IOLs was similar, and the intermediate visual acuity of wavefront-shaped EDof IOL and rotationally asymmetric regional refractive EDof IOL was better. At 4.5 mm aperture, the distance visual acuity of refractive EDof IOL was significantly improved and higher than that of the other two EDof IOLs. The MTF of refractive EDof IOL and wavefront-shaped EDof IOL remained stable under decentration and tilt, and refractive EDof IOL showed better stability at 5° tilt. When the simulated visual acuity was 0.2, the depth of focus of monofocal IOL was -2.33 D, and the depth of focus of all three EDof IOLs increased by more than 0.5 D compared with the monofocal IOL, while the intermediate-focus (-1.5 D) visual acuity was higher than 0.2.

The three non-diffractive EDof IOLs exhibit differential optical performance under different pupil diameters and defocus conditions, all meeting the minimum visual requirements for EDof IOLs proposed by the American Academy of Ophthalmology. The refractive EDof IOL provides stable distance vision unaffected by pupil size and maintains favorable distance image clarity even under large corneal spherical aberration.

To systematically evaluate the influence of capsular tension ring (CTR) co-implantation on the rotational stability of intraocular lenses (IOLs) following cataract surgery.

A systematic search was conducted in PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and Chinese databases (CNKI, Wanfang, VIP) for randomized controlled trials (RCTs) and non-randomized studies comparing postoperative IOL rotational stability with and without CTR implantation, from inception to June 2025. The primary outcomes were mean absolute IOL rotation and the proportions of eyes with IOL rotation>5°,>10°, and >15°. Secondary outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), residual astigmatism (RAS), and postoperative complications. Study quality was assessed using the Cochrane Risk of Bias tool 2.0 (RoB 2.0) for RCTs and the modified Newcastle-Ottawa Scale (NOS) for non-randomized studies. Meta-analysis was performed using R software to calculate standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI).

A total of 15 studies (5 RCTs and 10 non-randomized studies) involving 1 536 eyes were included (CTR group: 796 eyes, non-CTR group: 740 eyes), with follow-up durations ranging from 3 to 12 months. At the final follow-up, the mean absolute IOL rotation was significantly lower in the CTR group than in the non-CTR group (SMD=-0.45, 95%CI:-0.72 to -0.17, P=0.002), with significant heterogeneity among studies (I²=80.8%, P<0.001). Time-trend analysis showed that the stabilizing effect of CTR was not significant at 1 week postoperatively (P=0.084), but became significant at 1 month (SMD=-0.48, 95%CI:-0.79 to -0.18, P=0.002) and persisted through 6 months or longer (SMD=-0.52, 95%CI:-0.99 to -0.04, P=0.033). The proportions of eyes with IOL rotation>5° (RR=0.50, 95%CI: 0.32 to 0.78, P=0.002) and>10° (RR=0.37, 95%CI: 0.17 to 0.81, P=0.014) were significantly lower in the CTR group, whereas no significant difference was found for rotation>15° (P>0.05). Subgroup analyses revealed that the beneficial effect of CTR was more pronounced in Asian populations compared with European populations (P for interaction <0.001) and in plate-haptic IOLs compared with C-loop IOLs (P for interaction<0.001). Regarding visual and refractive outcomes, no significant differences were observed between the two groups in UDVA, CDVA, or UNVA (all P>0.05), whereas postoperative RAS was significantly lower in the CTR group (SMD=-0.86, 95%CI:-1.40 to -0.32, P=0.002). No significant differences were found in the incidence of posterior capsule opacification, anterior capsule opacification, or elevated intraocular pressure between the groups (all P>0.05).

Co-implantation of a CTR demonstrates good postoperative safety, significantly enhances IOL rotational stability, and effectively reduces postoperative residual astigmatism, though it does not lead to a significant improvement in visual acuity.

To explore the application and effectiveness of surgical simulation training in phacoemulsification cataract surgery training.

A randomized controlled trial was conducted. A total of 10 attending ophthalmologists who received cataract surgery training in our hospital from April 2022 to October 2025 were enrolled as the study subjects. After completing theoretical training and assessment related to phacoemulsification cataract surgery, the participants were randomly divided into a simulator training group and an animal eye training group according to the training protocol, with 5 participants in each group. The simulator training group and the animal eye training group trained using the HelpMeSee surgical simulation system and pig eyes, respectively. After training, each trainee performed step-by-step operations on real human eyes and was assessed with scoring. The overall training effectiveness of the two groups was evaluated, including surgical time, best corrected visual acuity, intraocular pressure and corneal edema on the first postoperative day,, and corneal endothelial cell count at one month postoperatively.

The mean age of physicians in the simulator training group and the animal eye training group was (36.40±5.18) years and (35.40±3.85) years, respectively, and the male-to-female ratios were 2∶3 and 3∶2, respectively. During the step-by-step assessment, the scores of continuous curvilinear capsulorhexis, phacoemulsification, and cortical removal in the simulator training group were (5.64±0.56), (6.04±1.56), and (5.82±0.87), respectively, which were higher than those in the animal eye training group [(5.22±0.82), (5.20±2.20), and (5.26±1.43), respectively], and the differences were statistically significant (all P<0.05). The incidence of posterior capsule rupture during phacoemulsification and cortical removal in the simulator training group was 4% and 2% (2/50 and 1/50), respectively, which was lower than that in the animal eye training group [12% and 6% (6/50 and 3/50), respectively], but the differences were not statistically significant (all P>0.05). When independently performing surgeries, the surgical time of the simulator training group was (17.15±1.50) min, which was shorter than that of the animal eye training group [(18.81±1.08) min] (P<0.001). On the first postoperative day, intraocular pressure was within the normal range in both groups, but was higher in the animal eye training group than in the simulator training group (P<0.05); corneal edema in the simulator training group (0.60±0.50) was also better than that in the animal eye training group (1.12±0.67) (P<0.05). At one month postoperatively, the corneal endothelial cell count in the simulator training group was (2 257.52±300.05) cells/mm², which was higher than that in the animal eye training group [(2 077.40±179.52) cells/mm²] (P<0.05).

Compared with animal eye training, the application of the HelpMeSee surgical simulation system in phacoemulsification cataract surgery training can significantly improve surgeons′ microsurgical skills in cataract extraction, shorten surgical time, reduce surgical trauma and complications, and provide a new model, idea and approach for establishing standardized cataract extraction surgery training.

A 42-year-old female patient with bilateral myopia for over 30 years and progressive near vision blur for 6 months presented to Ningbo Eye Hospital. Based on the binocular refractive status and visual function examination results, she was diagnosed with bilateral myopia combined with presbyopia. To achieve simultaneous clear distance and near vision, a micro-monovision approach was adopted, and toric orthokeratology lenses with a four-zone design were fitted. Visual quality was improved by adjusting the back optic zone diameter of the lenses, resulting in satisfactory correction outcomes. This case suggests that corneal reshaping therapy for correcting myopia combined with presbyopia offers unique advantages and is expected to become one of the viable correction methods.

A 10-year-old boy with bilaterally reduced palpebral fissure opening since early childhood presented to the Department of Ophthalmology, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine. The diagnosis of Apert syndrome was based on syndactyly of the fingers and toes, midfacial hypoplasia, proptosis, hypertelorism, and other craniofacial dysmorphic features, and was further supported by molecular genetic testing identifying a heterozygous missense variant in FGFR2, c.758C>G(p.P253R). This case underscores the importance of early recognition and timely intervention for ophthalmic manifestations in Apert syndrome—including proptosis, ptosis, strabismus, amblyopia, and optic neuropathy/atrophy—to avert irreversible visual impairment.

A 61-year-old female patient presented to the Eye Hospital of the China Academy of Chinese Medical Sciences with a 1-day history of floating shadows and visual impairment in her right eye following periocular acupuncture treatment. Ophthalmic examination revealed a traumatic retinal hole in the nasal mid-periphery of the right fundus, accompanied by localized retinal detachment. The diagnosis was established as penetrating ocular injury (presumed to be caused by an acupuncture needle) and traumatic rhegmatogenous retinal detachment in the right eye. The patient subsequently underwent laser photocoagulation around the retinal detachment area in the nasal periphery, followed by an exploration of the scleral laceration combined with transscleral retinal cryopexy in the right eye. During the 3-month postoperative follow-up, the retina was well reattached and the retinal hole was sealed. This case underscores the importance of rigorous protocols and extreme caution during periocular acupuncture procedures. Associated injuries must be detected early and managed promptly in order to achieve successful outcomes.

Surgeon Introduction Jin Haiying, Chief Physician, Associate Professor, Ph.D., Heidelberg University, Germany, Ph.D. Supervisor. Director of the Department of Ophthalmology, Shanghai Oriental Hospital. Member of Youth Committee of Ophthalmology Branch of Chinese Medical Association, Member of Cataract and Refractive Surgery Group; Member of Ophthalmology Group of Microsurgery Society of Chinese Medical Association, Cataract Group of Ophthalmologist Branch of Chinese Medical Doctors Association, Cataract Group of Chinese Geriatric Association, Cataract and Refractive Surgery Group of Ophthalmology Professional Committee of Cross-Strait Medical and Health Exchange Association, and Cataract Group of Ophthalmology Branch of Shanghai Medical Association.

Corneal endothelial intercellular junctions predominantly consist of gap junctions, followed by tight junctions and adhesive junctions. Collectively, these junctions establish a mechanical barrier between corneal endothelial cells and facilitate the maintenance of the cornea′s natural dehydration, thereby preserving corneal transparency. While previous studies and reviews have elucidated the correlation between corneal endothelial decompensation and the corneal endothelial cell density, there is a paucity of reviews that specifically address the role of corneal endothelial intercellular junctions and their influence on endothelial function. This review aims to delineate the various types of corneal endothelial intercellular junctions, their respective functions, and their clinical significance. It is important to note that the condition of intercellular junctions significantly impacts a range of biological processes, including corneal endothelial growth and development, healing following injury, and barrier function, and is closely associated with numerous clinical diseases. Investigations centered on intercellular junctions may facilitate a deeper understanding of the mechanisms underlying corneal endothelial diseases and are anticipated to yield novel insights for the treatment of such conditions.

Cataract is the world's first blinding eye disease, and phacoemulsification cataract aspiration is its mainstream clinical treatment. This procedure has strict requirements for operation technology and a long learning period. However, there is a large gap in ophthalmologists with the ability to operate internal eye surgery in China. The rapid development of virtual simulation technology provides important technical support for optimizing the training mode of phacoemulsification cataract aspiration doctors. Combined with the actual situation of ophthalmic medical development in China, this paper applies the Dry-to-Wet Lab teaching mode to the physician training of phacoemulsification cataract aspiration, introduces in detail the key points of teacher formation and platform construction of the supporting teaching and training base of this mode, explains the clinical practice lesson plan design ideas including three core stages of theoretical cognition, systematic training and advanced training, explains the method of building a multi-assessment system that integrates theoretical knowledge assessment, EYEsi simulator operation assessment and animal eye practical assessment, and introduces the construction ideas and methods of standardized phacoemulsification cataract aspiration teaching video library, aiming at building a scientific and systematic standardized training system for cataract surgeons in China, improving training efficiency and physician practical skills, alleviating the shortage of professional doctors, and adapting to the needs of clinical cataract surgery treatment.