Objective:To develop a 3D-printed extraocular muscle teaching model and evaluate its teaching effect and learning experience among residents in standardized training.Methods:A total of 24 residents in standardized training who entered the Department of Ophthalmology, Peking Union Medical College Hospital from 2022 to 2024 were included, with 10, 7, and 7 residents in the first, second, and third grades, respectively. A simulated orbit and movable eyeball were constructed based on 3D printing technology. Tractionable elastic silicone bands were arranged on it to simulate healthy extraocular muscles, and non-elastic ropes were used to simulate diseased extraocular muscles. The model was applied in teaching rounds. Before and after the rounds, the residents were tested on basic knowledge (including diagnosis and judgment of surgical indications, with a full score of 40) and core knowledge (including judgment of mainly involved extraocular muscles and surgical design, with a full score of 60). Pearson correlation analysis was used to evaluate the correlation between the residents′ grades and their scores before the rounds, scores after the rounds, and score increments. A questionnaire survey (full score of 100) was conducted to assess their learning experience.Results:Before the teaching rounds, the average basic knowledge score of all residents was (21.0±7.5) and the core knowledge score was (11.3±7.7). These scores were positively correlated with the residents′ grades ( r=0.74, 0.69, all P<0.001) but generally low. After the teaching rounds, the basic knowledge score increased to (31.7±4.6), and the core knowledge score increased significantly to (48.5±3.8). There were no statistically significant differences in these scores among different grades ( P=0.22, P=0.83). The increments of basic knowledge and core knowledge scores decreased with the increase of residents′ grades, with statistically significant correlations ( r=-0.60, -0.65; P=0.002, P=0.001). The average scores of all residents in appearance, convenience, effectiveness, and total score were (18.2±1.1), (26.6±2.2), (40.0±4.0), and (84.8±5.0), respectively. There was no statistically significant correlation between these scores and the residents′ grades ( P=0.24, P=0.84, P=0.25, P=0.58). Suggestions for improving the current teaching model included: increasing the model size for long-distance viewing; enhancing the adhesion between silicone bands (simulating eye muscles) and the simulated eyeball; reducing the friction between the inner sphere and outer shell of the simulated eyeball to improve the model′s maneuverability and flexibility. Conclusions:The 3D-printed extraocular muscle teaching model can help residents of all grades quickly master the key and difficult points in learning restrictive strabismus caused by thyroid-associated ophthalmopathy. In clinical teaching of complex ocular diseases related to systemic diseases, constructing physical teaching models can effectively improve teaching effects and students′ learning experience.

Malignant tumors can invade ocular tissues or cause reactive ocular lesions through distant metastasis or immune response. Anti-tumor drugs have brought breakthroughs to treatment, while also posing new challenges of adverse ocular reactions. Current precision diagnosis and treatment of patients with tumor-related ocular diseases is undergoing technological and strategic innovations. In the diagnostic aspect, multimodal ophthalmic imaging technology facilitates the identification and monitoring of ocular lesions. Minimally invasive biopsy enhances the level of pathological diagnosis. Molecular markers and artificial intelligence (AI) strengthen the ability of differential diagnosis and prognosis prediction. In the therapeutic aspect, local precise radiotherapy reduces damage to surrounding tissues, and systemic therapies require strategies to overcome the limitations of the blood-ocular barrier. In the management of ocular adverse events caused by anti-tumor drugs, it is necessary to balance tumor control and visual preservation, emphasizing dynamic surveillance and early warning. Future studies in diagnosis and treatment will focus on multimodal data integration, molecular targeting technologies, and intelligent decision-making systems, aiming to establish comprehensive management frameworks encompassing multidisciplinary coordination, full disease-cycle monitoring, and personalized interventions to achieve the precision medical goal of " visual survival" .

Objective:To report the ocular blinding adverse reactions related to fibroblast growth factor receptor (FGFR) inhibitors, in order to improve the awareness level of potential ophthalmic adverse reactions of small molecule targeted anti-tumor drugs.Methods:Two patients with intrahepatic cholangiocarcinoma admitted to Peking Union Medical College Hospital, Chinese Academy of Medical Science in 2022 were retrospectively selected. Both patients experienced ocular adverse events after targeted therapy with FGFR inhibitors.Results:One patient developed corneal epithelial lesions after taking Pemitinib orally for 4 cycles. Due to secondary pseudomonas aeruginosa infection, severe corneal ulcers and reactive endophthalmitis occurred. Despite active local and systemic treatments, irreversible vision loss was still caused. Another patient gradually experienced vision loss after taking pemitinib orally for three cycles. The vision loss sharply worsened after the 22nd month of medication. Ophthalmic examination supported the diagnosis of dilated cataract, and secondary intraocular pressure elevation occurred. After timely surgical treatment, vision and intraocular pressure returned to normal.Conclusions:While inhibitors prolong the survival period of tumor patients, they are also accompanied by potential blinding adverse reactions, which should be given clinical attention.

Malignant tumors can invade ocular tissues or cause reactive ocular lesions through distant metastasis or immune response. Anti-tumor drugs have brought breakthroughs to treatment, while also posing new challenges of adverse ocular reactions. Current precision diagnosis and treatment of patients with tumor-related ocular diseases is undergoing technological and strategic innovations. In the diagnostic aspect, multimodal ophthalmic imaging technology facilitates the identification and monitoring of ocular lesions. Minimally invasive biopsy enhances the level of pathological diagnosis. Molecular markers and artificial intelligence (AI) strengthen the ability of differential diagnosis and prognosis prediction. In the therapeutic aspect, local precise radiotherapy reduces damage to surrounding tissues, and systemic therapies require strategies to overcome the limitations of the blood-ocular barrier. In the management of ocular adverse events caused by anti-tumor drugs, it is necessary to balance tumor control and visual preservation, emphasizing dynamic surveillance and early warning. Future studies in diagnosis and treatment will focus on multimodal data integration, molecular targeting technologies, and intelligent decision-making systems, aiming to establish comprehensive management frameworks encompassing multidisciplinary coordination, full disease-cycle monitoring, and personalized interventions to achieve the precision medical goal of " visual survival" .

Objective:To report the ocular blinding adverse reactions related to fibroblast growth factor receptor (FGFR) inhibitors, in order to improve the awareness level of potential ophthalmic adverse reactions of small molecule targeted anti-tumor drugs.Methods:Two patients with intrahepatic cholangiocarcinoma admitted to Peking Union Medical College Hospital, Chinese Academy of Medical Science in 2022 were retrospectively selected. Both patients experienced ocular adverse events after targeted therapy with FGFR inhibitors.Results:One patient developed corneal epithelial lesions after taking Pemitinib orally for 4 cycles. Due to secondary pseudomonas aeruginosa infection, severe corneal ulcers and reactive endophthalmitis occurred. Despite active local and systemic treatments, irreversible vision loss was still caused. Another patient gradually experienced vision loss after taking pemitinib orally for three cycles. The vision loss sharply worsened after the 22nd month of medication. Ophthalmic examination supported the diagnosis of dilated cataract, and secondary intraocular pressure elevation occurred. After timely surgical treatment, vision and intraocular pressure returned to normal.Conclusions:While inhibitors prolong the survival period of tumor patients, they are also accompanied by potential blinding adverse reactions, which should be given clinical attention.

Objective:To develop a 3D-printed extraocular muscle teaching model and evaluate its teaching effect and learning experience among residents in standardized training.Methods:A total of 24 residents in standardized training who entered the Department of Ophthalmology, Peking Union Medical College Hospital from 2022 to 2024 were included, with 10, 7, and 7 residents in the first, second, and third grades, respectively. A simulated orbit and movable eyeball were constructed based on 3D printing technology. Tractionable elastic silicone bands were arranged on it to simulate healthy extraocular muscles, and non-elastic ropes were used to simulate diseased extraocular muscles. The model was applied in teaching rounds. Before and after the rounds, the residents were tested on basic knowledge (including diagnosis and judgment of surgical indications, with a full score of 40) and core knowledge (including judgment of mainly involved extraocular muscles and surgical design, with a full score of 60). Pearson correlation analysis was used to evaluate the correlation between the residents′ grades and their scores before the rounds, scores after the rounds, and score increments. A questionnaire survey (full score of 100) was conducted to assess their learning experience.Results:Before the teaching rounds, the average basic knowledge score of all residents was (21.0±7.5) and the core knowledge score was (11.3±7.7). These scores were positively correlated with the residents′ grades ( r=0.74, 0.69, all P<0.001) but generally low. After the teaching rounds, the basic knowledge score increased to (31.7±4.6), and the core knowledge score increased significantly to (48.5±3.8). There were no statistically significant differences in these scores among different grades ( P=0.22, P=0.83). The increments of basic knowledge and core knowledge scores decreased with the increase of residents′ grades, with statistically significant correlations ( r=-0.60, -0.65; P=0.002, P=0.001). The average scores of all residents in appearance, convenience, effectiveness, and total score were (18.2±1.1), (26.6±2.2), (40.0±4.0), and (84.8±5.0), respectively. There was no statistically significant correlation between these scores and the residents′ grades ( P=0.24, P=0.84, P=0.25, P=0.58). Suggestions for improving the current teaching model included: increasing the model size for long-distance viewing; enhancing the adhesion between silicone bands (simulating eye muscles) and the simulated eyeball; reducing the friction between the inner sphere and outer shell of the simulated eyeball to improve the model′s maneuverability and flexibility. Conclusions:The 3D-printed extraocular muscle teaching model can help residents of all grades quickly master the key and difficult points in learning restrictive strabismus caused by thyroid-associated ophthalmopathy. In clinical teaching of complex ocular diseases related to systemic diseases, constructing physical teaching models can effectively improve teaching effects and students′ learning experience.

Objective To evaluate the efficacy and safety of prompt phacoemulsification, intraocular lens implantation, visco-goniosynechialysis, combined with pseudo-pupilloplasty for refractory acute primary angle closure (APAC) with atonic dilated pupil and to describe a feasible method of pupilloplasty. Methods A consecutive series of refractory APAC patients who had atonic dilated pupil and undergone prompt phacoemulsification combined with pseudo-pupilloplasty at our center were retrospectively analyzed. Pseudo-pupilloplasty referred to a method of pupilloplasty which included 4.5-mm capsulorhexis, postoperative opacification of anterior capsule residue, and ultimate pseudo-pupil formation. Preoperative and postoperative measurements included intraocular pressure (IOP), best corrected visual acuity (BCVA), and anterior chamber depth (ACD). Intraoperative and postoperative complications were documented. The process of pseudo-pupil formation was also observed. Results A total of 20 eyes of 19 APAC patients were followed up for 19.7 ± 9.8 months. IOP was lowered from preoperative 44.0 ± 9.8 mmHg to 15.5 ± 2.6 mmHg at final visit (t=11.945, P < 0.001). ACD was deepened from preoperative 1.77 ± 0.21 mm to 3.40 ± 0.20 mm at final visit (t=-27.711, P < 0.001). Twelve of 20 eyes had residual angle synechiae, whereas only 3 eyes needed anti-glaucoma medications. No severe complication was observed. All eyes had pseudo-pupil gradually formed within 3 months, accompanied with the gradual improvement of BCVA from preoperative 1.18 ± 0.55 to 0.58 ± 0.22, 0.26 ± 0.09, 0.11 ± 0.09, and 0.11 ± 0.09 at postoperative day 1, month 1, month 3, and last visit. Conclusions Prompt phacoemulsification-goniosynechialysis is effective and safe for refractory APAC with atonic dilated pupil. Pseudo-pupilloplasty is a feasible procedure for pupil reconstruction.

Objective To compare the fast blood flow density (FBFD) of intermediate choroid between endogenous Cushing syndrome (ECS) patients and healthy control subjects.Methods Thirteen eyes of 7 eligible ECS patients (ECS group) and 13 eyes of 7 gender,age,axial length matched healthy volunteers (control group) were enrolled in this study.For each subject,macular radial scan with swept source optical coherence tomography (SS-OCT) was performed and subfoveal choroidal thickness (SCT) was measured.Then 3.0 mm× 3.0 mm macular scan with SS-OCT angiography was performed,and selected blood flow image at intermediate choroid level or 1/2 SCT beneath Bruch membrane.The grayscale images were then binarized for the analysis of FBFD.Results The SCT in ECS group was (394.7±77.7) μm,which was significantly thicker than (332.1 ± 68.1) μm in control group (t=2.923,P=0.008).The FBFD of intermediate choroid in ECS group were (76.35± 14.46)％,which were significantly greater than (63.57± 13.42)％ in control group (t=2.775,P=0.01).Conclusion ECS patients had increased FBFD at intermediate choroid level compared with healthy controls.

Objective To evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC).Methods 35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT.Best-corrected visual acuity(BCVA),central macular thickness (CMT) were measured before and after treatment (1,3 and 6 months).The mean BCVA was 0.28± 0.22,mean CMT was(384.5 ± 85.0) μm.The situation of subretinal fluids (SRF) absorption was observed.Results In 35 eyes,SRF of 29 eyes (82.9％) completely absorbed and 6 eyes (17.1％) not completely absorbed after one month of treatment.SRF of all eyes (100.0％) completely absorbed after three months of treatment.After 6 months of treatment,SRF of 3 eyes (8.6％) were recurrence,which might be completely absorbed when a half-dose maintenance therapy PDT was used again.The mean BCVA significantly improved to 0.14±0.13 at 1 months,0.05±0.11 at 3 months and 0.05± 0.12 at 6 months after PDT (t=5.410,7.830,7.758; P＜0.05).The mean CMT decreased to (224.3± 61.4) μm at 1 months,(199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856,11.781,11.900; P＜0.05).The mean CMT of controlled 32 eyes after treatment was (198.5± 33.9) μm,much lower than the fellow eyes(232.3 ± 17.5) μm (t =-3.988,P＜0.05).Conclusions Half-dose verteporfin PDT was safe and effective in treating chronic CSC,but may cause thinning of CMT.

Adenosine is an important signaling molecule of the central nervous system (CNS). Adenosine typically released in the phosphorylated form(ATP), together with neurotransmitter, both of which are encapsulated in the synaptic vesicles. Once released into the synaptic space, adenosine molecules will bind to their three categories of receptors, namely A1 receptor (A1R), A2 receptor (A2R), A3 receptor (A3R), and therefore start G protein mediated signaling pathways, resulting in various and extensive biological effects. It has been discovered in recent years that adenosine has a certain level of anti-depression effect, although its mechanisms are yet to be elucidated. This review summarized the researches focusing on anti-depression roles of both adenosine and its receptors.