Acquired paralytic strabismus is a common neuromuscular disorder in adults,characterized by diplopia, visual confusion, impaired ocular motility, and ocular deviation, which severely affects the patient's quality of life and overall health. The disease has a complex etiology, encompassing multiple pathological mechanisms such as vascular pathologies, trauma, inflammation, neoplasms, and immune-related disorders. Treatment primarily focuses on addressing the underlying cause. While conventional Western approaches, such as medication and surgery, can alleviate symptoms, some carry the risk of adverse effects, and their long-term recurrence rates warrant careful consideration. Traditional Chinese medicine utilizes distinctive therapies such as herbal medicine, acupuncture, and other adjunctive therapies, which have shown promising therapeutic effects but are constrained by a lack of high-quality evidence from large-scale randomized controlled trials. This review systematically summarizes recent advances in the etiological classification and traditional Chinese and Western medical treatments of acquired paralytic strabismus. It innovatively summarizes the clinical features associated with different causes, analyzes current therapeutic strategies and research landscape, aiming to inform clinical practice and suggest future research directions.

OBJECTIVE: To observe the effect of the direct stimulation of acupuncture at extraocular muscle attachment point on acquired extraocular muscle palsy. METHODS: Thirteen patients with acquired extraocular muscle palsy were treated with acupuncture directly at extraocular muscle (paralytic muscle) attachment point. Firstly, the intraocular conjunctival sac drops of topical anesthetic (procaine hydrochloride eye drops) were administered, 0.2 mL each time, once every 10 minutes, for a total of 3 times. Acupuncture was delivered immediately after the third drop. The sterile acupuncture needle for single use, 0.25 mm×25 mm, was inserted at the anatomical location of the corneal limbal attachment of paralytic extraocular muscle, with an angle of 10° to 15° formed between the needle tip and extraocular muscle, and a depth of 0.3 mm to 0.5 mm. Pivoted by the needle tip, the eyeball was moved passively towards the direction of normal action of orbital muscle, 30 to 50 times until the patient felt soreness of the eyeball; afterwards, the needle was removed. After acupuncture, levofloxacin eye drops were administered once (0.2 mL) at the affected eye. The treatment was given twice a week, and completed when diplopia disappeared. Before and after treatment, the diplopia and the synoptophore circumference were observed respectively. RESULTS: After 7 to 24 (15.46±5.56) times of direct stimulation with acupuncture at extraocular muscle attachment point, the symptoms of diplopia disappeared in 13 patients, the eye position restored to orthophoria, and the circumference of synoptophore was reduced to be (4.04±0.82)° from (19.38±3.98)° detected before treatment (P<0.05). CONCLUSION Acupuncture directly at extraocular muscle attachment can attenuate diplopia and improve ocular muscle function in patients with acquired extraocular muscle palsy.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Adult ; Oculomotor Muscles/physiopathology* ; Aged ; Acupuncture Points ; Ophthalmoplegia/physiopathology*

Pulmonary hypertension(PH)is a seri-ous disease characterized by abnormally high pul-monary arterial pressure(PAP),which leads to in-creased cardiac burden and may eventually lead to right heart failure.Levosimendan,as a calcium sen-sitizer,has the dual role of enhancing cardiac con-striction force and promoting vascular dilation.It shows a good prospect in the treatment of PH com-bined with right heart failure by reducing PAP,in-creasing RV contractile force and reducing anterior and posterior cardiac load without increasing myo-cardial oxygen consumption.Since it does not in-crease the intracellular Ca2+concentration,it avoids the arrhythmia-inducing,reduced coronary perfu-sion and other side effects of other positive inotro-pic drugs.At present,levosimandan is mainly trans-fused intravenically,which may lead to systemic hy-potension,arrhythmia and other side effects,while inhalation administration can reduce the occur-rence of adverse reactions,but its effectiveness and safety in the treatment of PH combined with right heart failure remains to be studied.The pur-pose of this review was to investigate the role of in-haled levosimendan in PH combined with right heart failure.

Objective:To compare the clinical characteristics of neovascular age-related macular degeneration (nAMD) patients with or without secondary subretinal fibrosis (SF).Methods:A retrospective case-control study. A total of 88 patients (92 eyes) diagnosed with nAMD at Department of Ophthalmology, Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2020 to January 2024 were enrolled in this study. All eyes underwent best-corrected visual acuity (BCVA), color fundus photography, and optical coherence tomography (OCT) examinations. BCVA was measured using the international standard visual acuity chart and converted to logarithm of the minimum angle of resolution for statistical analysis. SF area was measured on color fundus images. OCT was used to assess the presence of shallow irregular retinal pigment epithelial (RPE) elevation, RPE detachment, ellipsoid zone/external limiting membrane disruption, subretinal fluid and/or intraretinal fluid, thinning of the inner nuclear layer or inner plexiform layer, complete RPE and outer retinal atrophy (cRORA), epiretinal membrane, and suprachoroidal fluid. Device-integrated software measured central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and the height and width of subfoveal fibrosis in SF eyes. Based on the presence of SF, patients were divided into the SF group (47 eyes) and the non-SF (NSF) group (45 eyes). Baseline characteristics, OCT, and color fundus photography imaging features were compared between groups. Independent samples t tests were used for intergroup comparisons, and multiple linear regression was performed to analyze potential factors influencing SF height. Results:Compared with the NSF group, the SF group had a longer disease duration, longer symptom onset to initial treatment interval to receiving anti-vascular endothelial growth factor (VEGF) drug treatment, a lower proportion of patients receiving 3 anti-VEGF drug injections within 6 months, worse BCVA, thicker SFCT, higher rates of pigment epithelial detachment and inner nuclear layer or inner plexiform layer thinning, and a lower rate of subretinal fluid ( P<0.05). No significant differences were observed in CRT or the proportions of irregular retinal pigment epithelia, ellipsoid zone/external limiting membrane disruption, cRORA, suprachoroidal fluid, or epiretinal membrane between the two groups ( P>0.05). Conclusion:nAMD eyes with secondary SF exhibit distinct OCT imaging features compared to NSF eyes.

Pulmonary hypertension(PH)is a seri-ous disease characterized by abnormally high pul-monary arterial pressure(PAP),which leads to in-creased cardiac burden and may eventually lead to right heart failure.Levosimendan,as a calcium sen-sitizer,has the dual role of enhancing cardiac con-striction force and promoting vascular dilation.It shows a good prospect in the treatment of PH com-bined with right heart failure by reducing PAP,in-creasing RV contractile force and reducing anterior and posterior cardiac load without increasing myo-cardial oxygen consumption.Since it does not in-crease the intracellular Ca2+concentration,it avoids the arrhythmia-inducing,reduced coronary perfu-sion and other side effects of other positive inotro-pic drugs.At present,levosimandan is mainly trans-fused intravenically,which may lead to systemic hy-potension,arrhythmia and other side effects,while inhalation administration can reduce the occur-rence of adverse reactions,but its effectiveness and safety in the treatment of PH combined with right heart failure remains to be studied.The pur-pose of this review was to investigate the role of in-haled levosimendan in PH combined with right heart failure.

Objective:To compare the clinical characteristics of neovascular age-related macular degeneration (nAMD) patients with or without secondary subretinal fibrosis (SF).Methods:A retrospective case-control study. A total of 88 patients (92 eyes) diagnosed with nAMD at Department of Ophthalmology, Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2020 to January 2024 were enrolled in this study. All eyes underwent best-corrected visual acuity (BCVA), color fundus photography, and optical coherence tomography (OCT) examinations. BCVA was measured using the international standard visual acuity chart and converted to logarithm of the minimum angle of resolution for statistical analysis. SF area was measured on color fundus images. OCT was used to assess the presence of shallow irregular retinal pigment epithelial (RPE) elevation, RPE detachment, ellipsoid zone/external limiting membrane disruption, subretinal fluid and/or intraretinal fluid, thinning of the inner nuclear layer or inner plexiform layer, complete RPE and outer retinal atrophy (cRORA), epiretinal membrane, and suprachoroidal fluid. Device-integrated software measured central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and the height and width of subfoveal fibrosis in SF eyes. Based on the presence of SF, patients were divided into the SF group (47 eyes) and the non-SF (NSF) group (45 eyes). Baseline characteristics, OCT, and color fundus photography imaging features were compared between groups. Independent samples t tests were used for intergroup comparisons, and multiple linear regression was performed to analyze potential factors influencing SF height. Results:Compared with the NSF group, the SF group had a longer disease duration, longer symptom onset to initial treatment interval to receiving anti-vascular endothelial growth factor (VEGF) drug treatment, a lower proportion of patients receiving 3 anti-VEGF drug injections within 6 months, worse BCVA, thicker SFCT, higher rates of pigment epithelial detachment and inner nuclear layer or inner plexiform layer thinning, and a lower rate of subretinal fluid ( P<0.05). No significant differences were observed in CRT or the proportions of irregular retinal pigment epithelia, ellipsoid zone/external limiting membrane disruption, cRORA, suprachoroidal fluid, or epiretinal membrane between the two groups ( P>0.05). Conclusion:nAMD eyes with secondary SF exhibit distinct OCT imaging features compared to NSF eyes.

Objective To compare the hepatic lipid droplet metabolism in normal BKS-db/m mice and BKS-db/db mice,a model of type 2 diabetes mellitus (T2DM),and to investigate the characteristics of hepatic lipid droplet metabolism and the molecular mechanisms underlying the imbalance of metabolic homeostasis at the level of lipid droplet synthesis and lipid droplet catabolism in db/db mice. Methods Eight SPF 8 weeks BKS-db/m and 8 BKS-db/db mice were used in this study. The lipid metabolism level was tested. Oil red and HE staining was used to evaluate the degree of liver lipid deposition,and immunofluorescence staining and Western blot was used to observe the level of hepatic lipid droplet catabolism and metabolism. Results The body weight,liver weight,liver index,FPG,AUC of the OGTT,AUC of the ITT,TG,TC,HDL-C,LDL-C,FFA and SREBP1 positive fluorescence area and nuclear translocation were higher in db/db group than in db/m group (P<0.05). The lipophagia level of primary hepatocytes was higher in db/db group than in db/m group (P<0.05). Compared with the db/m group,the expressions of SREBP1,SCD1,PLIN2,LC3,LAMP2A and ATGL protein increased(P<0.05),while the expression of p-ACC/ACC protein decreased in the db/db group(P<0.05). Conclusions Compared with normal mice,T2DM mice had dyslipidemiaand marked hepatocellular lipid deposition.Although lipid droplet lipolysis and lipophagy were enhanced and catabolism was significant,the lipid droplet metabolism was in a state of imbalance between synthesis and catabolism,and the synthesis of lipid droplets was greater than that of catabolism,which led to the aggregation of hepatocellular lipids.

Subretinal fibrosis(SRF),the end pathological stage of neovascular age-related macular degeneration(nAMD),can cause severe and irreversible vision loss in patients.In recent years,the high clinical incidence of SRF and the severe visual impairment it causes have led to a rapid development of SRF-related research.In order to systematically understand the clinical progress of SRF,recent studies on SRF secondary to nAMD were reviewed in this article.

Objective To compare the hepatic lipid droplet metabolism in normal BKS-db/m mice and BKS-db/db mice,a model of type 2 diabetes mellitus (T2DM),and to investigate the characteristics of hepatic lipid droplet metabolism and the molecular mechanisms underlying the imbalance of metabolic homeostasis at the level of lipid droplet synthesis and lipid droplet catabolism in db/db mice. Methods Eight SPF 8 weeks BKS-db/m and 8 BKS-db/db mice were used in this study. The lipid metabolism level was tested. Oil red and HE staining was used to evaluate the degree of liver lipid deposition,and immunofluorescence staining and Western blot was used to observe the level of hepatic lipid droplet catabolism and metabolism. Results The body weight,liver weight,liver index,FPG,AUC of the OGTT,AUC of the ITT,TG,TC,HDL-C,LDL-C,FFA and SREBP1 positive fluorescence area and nuclear translocation were higher in db/db group than in db/m group (P<0.05). The lipophagia level of primary hepatocytes was higher in db/db group than in db/m group (P<0.05). Compared with the db/m group,the expressions of SREBP1,SCD1,PLIN2,LC3,LAMP2A and ATGL protein increased(P<0.05),while the expression of p-ACC/ACC protein decreased in the db/db group(P<0.05). Conclusions Compared with normal mice,T2DM mice had dyslipidemiaand marked hepatocellular lipid deposition.Although lipid droplet lipolysis and lipophagy were enhanced and catabolism was significant,the lipid droplet metabolism was in a state of imbalance between synthesis and catabolism,and the synthesis of lipid droplets was greater than that of catabolism,which led to the aggregation of hepatocellular lipids.

Objective:To evaluate the effectiveness and safety of glucocorticoids in the treatment of non-arteritic anterior ischaemic optic neuropathy (NAION).Methods:Glucocorticoids published in the National Library of Medicine PubMed; Netherlands Medical Abstracts Database Embase; Cochrane Library, an evidence-based medical library; China Cnkipedia; China Biomedical Literature Service; Chongqing Vipul Chinese Science and Technology Journal Database, and Wanfang Science and Technology Journal Full Text Database were searched about computer. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) for the treatments of NAION were subjected to meta-analysis. The search period was from the establishment of each database to March 2020. The literature was screened and data were extracted according to the inclusion and exclusion criteria. The methodological quality of the RCT and NRCT studies was evaluated using the Risk of Bias Assessment Tool and the MINORS evaluation scale, respectively. The data were analyzed using RevMan version 5.3 software which was provided by the Cochrane Collaboration Network.Results:An initial search of 395 papers was conducted, and 10 papers were finally included for this meta-analysis, including 3 RCT studies and 7 NRCT studies. A total of 1057 patients with NAION were included. The 3 RCT studies were analyzed descriptively as the outcome indicators were described in different ways. A meta-analysis of 7 NRCT studies showed that patients in the treatment group showed significantly better visual prognosis (relative risk=1.28, 95% confidence interval 1.09 to 1.51, P=0.003) and retinal nerve fibre layer thickness were obviously improved (mean difference=7.76, 95% confidence interval 1.58 to 13.94, P=0.01) than the control group. Four studies reported the occurrence of adverse reactions in the treatment versus control groups. None of the above studies provided a detailed analysis of the prognosis of patients with adverse reactions. Conclusion:The efficacy and safety of glucocorticoids in the treatment of NAION is unclear and needs to be validated in a larger sample of RCTs.