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Over the past decades, the number of patients with dry eye disease (DED) has increased dramatically. The incidence of DED is higher in Asia than in Europe and North America, suggesting the involvement of cultural or racial factors in DED etiology. Although many definitions of DED have been used, discrepancies exist between the various definitions of dry eye disease (DED) used across the globe. This article presents a clinical consensus on the definition of DED, as formulated in four meetings with global DED experts. The proposed new definition is as follows: “Dry eye is a multifactorial disease characterized by a persistently unstable and/or deficient tear film (TF) causing discomfort and/or visual impairment, accompanied by variable degrees of ocular surface epitheliopathy, inflammation and neurosensory abnormalities.” The key criteria for the diagnosis of DED are unstable TF, inflammation, ocular discomfort and visual impairment. This definition also recommends the assessment of ocular surface epitheliopathy and neurosensory abnormalities in each patient with suspected DED. It is easily applicable in clinical practice and should help practitioners diagnose DED consistently. This consensus definition of DED should also help to guide research and clinical trials that, to date, have been hampered by the lack of an established surrogate endpoint.

Based on current evidence, the efficiency and safety of Descemet's membrane endothelial keratoplasty (DMEK) was compared with that of Descemet's stripping endothelial keratoplasty (DSEK). Pubmed, Embase, Web of Science, the Cochrane Database and conference abstracts were comprehensively searched for studies that compared the efficacy and safety of DMEK and DSEK. The efficacy outcome was the postoperative best-corrected visual acuity (BCVA). The safety outcomes included the postoperative endothelial cell density (ECD) and complications such as graft detachment, graft rejection, graft failure, postoperative elevated intraocular pressure (IOP), tissue loss, etc. The outcomes were pooled using random-effects models with Stata 13.0 software. Heterogeneity was qualified with Q statistic and I2/H2 statistic. Publication bias was assessed using funnel plot, Begg rank correlation test, and Egger or Horbard linear regression. 19 articles were eligible, and 1124 eyes and 1254 eyes were included in the DMEK and DSEK groups, respectively. The overall pooled estimates showed a significantly better postoperative BCVA, a comparable ECD and an increased graft detachment rate in the DMEK group compared with the DSEK group (BCVA: mean difference (MD) = -0.15, 95% CI = -0.19 to -0.11, P<0.001; ECD: MD = 14.88, 95% CI = -181.50 to 211.27, P = 0.882; graft detachment rate: OR = 4.56, 95% CI = 2.43 to 8.58, P<0.001). Except for the postoperative ECD, which was changed to be higher in the DSEK group than the DMEK group, the learning curve did not have a marked effect on the comparison outcome of the BCVA and graft detachment rate based on the estimates pooled from studies that collected data during the DMEK learning phase (ECD (learning curve): MD = -361.24, 95% CI = -649.42 to -73.07, P = 0.014). Although DMEK is a more technically difficult and challenging procedure, it may represent a safe and more efficient alternative to DSEK for the treatment of corneal endothelial diseases, even during its learning curve.

IntroductionExisting detection models for automatic tea-grade determination in open-field, complex habitats suffer from insufficient feature robustness, weak suppression of background interference, and difficulty in balancing lightweight design with accuracy. To address these limitations, this study proposes Tea-DETR, a model tailored for open-air tea garden scenarios based on the end-to-end RT-DETR detection paradigm.MethodsThe proposed method enhances feature representation and attention allocation from two aspects: backbone optimization and feature interaction enhancement. First, a lightweight backbone module is designed to strengthen long-range dependency modeling and improve suppression of complex background interference, thereby enhancing the robustness and discriminability of multi-scale tea-leaf features under occlusion and illumination variations. Second, an efficient attention-enhancement mechanism is introduced to reduce redundant feature interactions and enable adaptive focus on critical target regions, improving the model’s ability to capture subtle semantic differences among tea grades while maintaining computational efficiency. To validate the approach, Anji white tea from Zhejiang Province was selected as the experimental subject, and a single-leaf tea dataset containing 6,542 images was constructed. The dataset was split into training, validation, and test sets at a ratio of 8:1:1, based on which comparative experiments and convergence analyses were conducted.ResultsWith the number of parameters reduced to 14.65M, Tea-DETR achieves an accuracy of 92.2% and improves mAP@0.5 to 82.0%, reducing parameters by 26.8% compared with the baseline model. In addition, Tea-DETR exhibits markedly improved convergence stability and substantially enhanced capability in distinguishing subtle semantic differences among tea grades, effectively alleviating ambiguous discrimination under complex backgrounds.DiscussionOverall, the proposed method enhances the stability of fine-grained feature capture for small tea-leaf targets in open-field environments while maintaining real-time inference efficiency, providing a robust solution for real-time, non-destructive automatic tea-grade determination in field scenarios.

PurposeTo investigate the therapeutic effect of subconjunctival injection of tumor necrosis factor-α (TNF-α) pre-stimulated bone marrow-derived mesenchymal stem cells (BMMSCs) on ocular alkali burns in a rat model.MethodsAfter applying a 6 mm filter paper soaking in 1 N NaOH on the cornea of rats, the suspension of TNF‐α pre-stimulated BMMSCs, BMMSCs and PBS were given subconjunctivally and respectively. Corneal epithelial defect, corneal opacity, inflammation as well as PTGS2 and TSG-6 expression on day 7 and fibrosis on day 14 were compared.ResultsTNF‐α pre-stimulated BMMSCs group had a more predominate effect on promoting corneal epithelial repairing, decreasing corneal opacity, reducing inflammatory cells and CD68 + macrophages on day 7 and suppressing fibrosis on day 14 compared to BMMSCs group. Besides, it had significant increased expressions of PTGS2 and TSG-6 in vitro. Pre-treated with Indomethacin revealed a reverse effect on above-mentioned changes.ConclusionSubconjunctival injection of TNF‐α pre-stimulated BMMSCs enhanced anti-inflammatory and anti-fibrotic effect in ocular alkali burns, which was possibly though up regulation of PTGS2 and TSG-6 expression.

A woman presented to an ophthalmologist with allergic conjunctivitis. Slit-lamp examination revealed an incidental finding. A 37-year-old woman presented to an ophthalmologist with itching and watering of her eyes. Examination revealed conjunctival papillary reaction and mild hyperemia, findings that were consistent with allergic conjunctivitis. Her visual acuity was 20/20 in both eyes. The intraocular pressure was normal, and the pupils in both eyes were round and equally reactive to light and accommodation (adjustment for distance). On slit-lamp examination, prominent iris collarettes were noted in both eyes (the left eye is shown). The iris collarette is a landmark that separates the central pupillary zone from the peripheral ciliary zone. It is typically flat but can be . . .

Retinal nerve fibre layer (RNFL) is a non-invasive structural biomarker of cardiometabolic health, yet its biological underpinnings remain unknown. Here, we integrate advanced retinal optical biopsy and artificial intelligence (AI) algorithms with two complementary metabolomic assays across ethnically diverse cohorts to elucidate the metabolic basis underlying RNFL degeneration and its link to cardiometabolic disease (CMD) in Western cohort and Eastern cohort (Guangzhou Diabetic Eye Study, GDES). We identify 26 metabolic biomarkers significantly associated with RNFL thickness, most of which (ranging from 19 to 26) are linked to HDL composition and lipid transport, mediating a substantial proportion of the RNFL–CMD association (e.g., 63.7% for type 2 diabetes and 44.7% for myocardial infarction). AI-driven RNFL metabolic state model stratifies CMD risk with up to 21.8-fold enrichment between risk deciles and augments prediction while translating into clinical utility across genetic and demographic strata, particularly within socially vulnerable populations. This integrated approach highlights RNFL metabolic states as a shared basis underlying retinal–cardiometabolic connections and as early indicators that inform equitable CMD management. The retina offers a window into systemic health, but its molecular links to cardiometabolic disease remain unclear. Here, the authors show that metabolomic profiling on retinal nerve fibre layer combined with machine learning reveals shared metabolic states that predict cardiometabolic risk and bridge health inequities.

Background Excessive lipid accumulation in the lacrimal glands under diabetic conditions can lead to lacrimal gland dysfunction and reduced tear secretion, subsequently resulting in ocular surface inflammation, dry eye syndrome, and corneal vulnerability, ultimately compromising the patient’s quality of life. There are limited and easily implemented intervention strategies to reduce excessive lipid accumulation. While intermittent fasting (IF) has emerged as a promising metabolic intervention, its mechanistic underpinnings and therapeutic potential in diabetes-associated lacrimal gland disorders require systematic elucidation. Methods Diabetic mice were divided into three groups for an 8-week dietary intervention: ad libitum, meal feeding, and every-other-day feeding. After dietary intervention, we assessed the damage to lacrimal glands and ocular surface, and elucidated lipid accumulation, ferroptosis, and functional changes in the lacrimal glands. Transcriptomic analysis was used to examine gene expression. CD36 and its palmitoylation were examined around three groups. In addition, damage to the ocular surface and lacrimal glands was assessed in vivo, after the mice were injected with the ferroptosis inhibitor Fer-1 and CD36 shRNA. Results In this study, we found that compared with caloric restriction, IF more effectively reduced lipid accumulation in the lacrimal glands of diabetic db/db mice, decreased lipid peroxidation and ferroptosis, and improved function. IF downregulated CD36 expression and its palmitoylation, potentially mediated by ZDHHC20. CD36 shRNA and ferroptosis inhibition (Fer-1) comparably restored lacrimal secretory function, yet only CD36 knockdown concurrently resolved lipidostasis and ferroptosis. Conclusions This analysis identifies CD36 as a key regulator bridging lipotoxic stress and ferroptotic execution in diabetic lacrimal gland dysfunction. Importantly, our findings suggest that ferroptosis may serve as the critical effector mechanism converting metabolic overload to glandular dysfunction, suggesting potential therapeutic value in dual targeting of lipidostasis and cell death pathways. Significance Intermittent fasting, which appears more effective than that of caloric restriction, may be associated with reduced lipid absorption resulting from decreased CD36 expression and its palmitoylation on lacrimal gland cell membranes. These findings uncover a potential novel treatment strategy for diabetic dry eye. Graphical Abstract

Background: Dry eye disease (DED) is a multifactorial inflammatory disease of the ocular surface. It is hypothesized that dysbiosis of the conjunctival microbiota contributes to the development of DED. However, species-level compositions of the conjunctival microbiota in DED and the potential dysbiosis involving microorganisms other than bacteria remain largely uncharacterized. Methods: We collected conjunctival impression samples from a cohort of 95 individuals, including 47 patients with DED and 48 healthy subjects. We examined the conjunctival microbiota of these samples using shotgun metagenomic sequencing and analyzed microbial dysbiosis in DED at the species level. Results: The conjunctival microbiota in DED exhibited a decreased α-diversity and an increased inter-individual variation. The α-diversity of female patients with DED was higher than that of male patients. Despite a decreased prevalence in DED, 23 microbial species were identified to show abnormally high abundance in DED samples positive for the species. Among these species, a fungal species Malassezia globosa was enriched female patients. In addition, distinct patterns of associations with disease status were observed for different species of the same genus. For DED subtypes, Staphylococcus aureus and S. capitis were associated with meibomian gland dysfunction (MGD), whereas S. hominis was enriched in patients solely with aqueous tear deficiency (ATD). The microbiota of patients with a mixed type of diagnosis was more similar to MGD patients than ATD patients. Conclusion: We demonstrated that the conjunctival microbiota dysbiosis in DED is characterized by significant heterogeneity. Microbial signatures may offer novel insights into the complicated etiology of DED and potentially promote the development of personalized treatment for DED in the future.

To analyze the genus profile of isolated pathogens and antibiotic susceptibility trends of microbial keratitis over nine years at a large referral eye center in southern China. Data of corneal specimens from January 2010 to August 2018 of patients clinically diagnosed with infectious keratitis were obtained from the center's microbiology database. Results with positive cultures along with antibiotic susceptibility were reviewed and analyzed. We collected and reviewed 7,229 specimens, including 3,092 with positive cultures. Among them, 1,630 (52.72%) were bacterial, 1781 (57.60%) were fungal, and 319 (10.32%) were coinfected. A significant decreasing trend was observed in the isolates of Gram-positive cocci (r =-0.711, =0.032), among which the proportion of coagulase-negative staphylococcus (CNS) was also reduced (r =-0.883, =0.002). In contrast, an increasing trend in the proportion of Gram-negative bacilli was observed (r=0.661, =0.053). The susceptibility rates of Gram-positive cocci to cephalosporins were near 90%, which was relatively high compared to fluoroquinolones. Fluoroquinolones represented the antibiotics to which Gram-negative bacilli were the most susceptible. Their susceptibility to moxifloxacin was 78.79%. The overall performance of aminoglycosides and vancomycin was both around 70%. The susceptibility of Gram-positive cocci to several antibiotics including levofloxacin (r=-0.717, =0.03), tobramycin (r= -0.933, <0.001), cefazolin (r= -0.964, <0.001), ceftazidime (r=-0.929, =0.003), chloramphenicol (r=-0.929, =0.003), and cefuroxime (r=-0.829, =0.042) decreased over time. The susceptibility of Gram-negative bacilli to ofloxacin increased over time (r=0.854, =0.004), whereas that to cefazolin (r=-0.833, =0.005) and chloramphenicol (r=-0.886, =0.019) decreased over time. From 2010 to 2018 in Zhongshan Ophthalmic Center, most isolates from infectious keratitis were Gram-positive cocci (mainly CNS), which decreased over time, with an increase in Gram-positive bacilli. More than half of the antibiotics showed reducing trend of susceptibilities, and the antibiotic resistance situation in southern China was not encouraging.

Circadian rhythm plays a critical role in the progression of autoimmune diseases. While our previous study demonstrated the therapeutic effects of melatonin in experimental autoimmune uveitis, the involvement of circadian rhythm remained unclear. Using a light‐induced circadian rhythm disruption model, we showed that disrupted circadian rhythms exacerbate autoimmune uveitis by impairing the stability and function of Treg cells. Mechanistically, we identified the core clock gene Per1, which is significantly reduced under circadian disruption, is essential for Treg cell metabolism and immunoregulatory function. This study underscores the pivotal role of circadian rhythm‐related Treg cells in autoimmune disease progression. Circadian rhythms emerge as significant factors in the progression of autoimmune diseases. However, whether and how circadian rhythms are involved remains uncovered. Using a light‐induced rhythm‐disrupting model, it is demonstrated that circadian rhythm disruption aggravates autoimmune uveitis due to Treg impairment. Mechanically, the core‐clock gene, Per1, is identified as essential for Treg metabolism and function. This study highlights the importance of circadian rhythm‐related Treg in autoimmune disease.