Modern cataract surgery has completely moved beyond the traditional vision-restoring model and has fully entered a new era of refractive cataract surgery(RCS)centered on precise refractive correction. Its core objective is to provide patients with personalized visual experiences characterized by full-range, clear, and comfortable vision. Currently, although diagnostic and therapeutic technologies for RCS are rapidly evolving, there remain many bottlenecks in the precise management of the entire perioperative process that urgently need to be addressed. Preoperatively, the measurement consistency among ocular biometry devices based on different detection principles remains poor, and systematic measurement errors cannot be completely eliminated. Moreover, the individualized selection of intraocular lenses(IOLs)relies heavily on surgeons' clinical experience, lacking a standardized quantitative decision-making framework, which makes it difficult to achieve precise personalized matching. Intraoperatively, the quality of continuous curvilinear capsulorhexis is affected by multiple factors such as ocular anatomical characteristics and surgical proficiency, and its stability cannot be reliably ensured. Various intelligent surgical navigation systems are compromised by intraoperative ocular conditions, and their clinical performance fails to meet theoretical expectations. At the postoperative stage, existing IOL optical designs and materials have inherent limitations. The longterm prevention and control of posterior capsule opacification(PCO)remains a core factor restricting patients' long-term high-quality visual outcomes. This article systematically reviews the precise diagnostic and therapeutic challenges and core bottlenecks across the preoperative, intraoperative, and postoperative stages of RCS. It further explores frontier technological directions—including cross-device error compensation models, artificial intelligence-assisted decision-making, preoperative VR-based visual simulation, and the construction of intelligent surgical ecosystem platforms—to delineate targeted solutions and optimization pathways. This review aims to provide references and insights for the standardized clinical implementation, technological innovation, and future research endeavors in precision diagnosis and treatment of RCS.

Phacoemulsification represents the mainstream, efficient, and safe surgical modality for cataract treatment, and continuous technological advances have further improved the safety profile of this procedure in ordinary patients. However, patients with high myopia feature inherent anatomical abnormalities of the eyeball, leading to a fundamental incompatibility with conventional phacoemulsification protocols. Such patients face a markedly elevated risk of both anterior and posterior segment perioperative complications, posing a persistent clinical challenge in cataract surgery. Focusing on the unique ocular anatomical characteristics associated with high myopia, this review systematically summarizes the distinct traumatic effects and pathological impacts of phacoemulsification on the anterior and posterior ocular segments of affected patients. Moving beyond generalized discussions of routine cataract management, it consolidates clinical evidence specific to this special-population patients, aiming to provide refined references for perioperative risk prevention and control in cataract patients complicated with high myopia.

Objective:To explore the influencing factors of the subjective well-being of elderly individuals and improve the accuracy of well-being predictions.Methods:A multi-stage stratified sampling method was conducted in Guangdong province and Guangxi Zhuang autonomous region from August 2019 to October 2020. The health status and subjective well-being of older adults were assessed using a self-administered multidimensional health questionnaire, while overall well-being was evaluated with a single-item 5-point scale. The statistical analysis was performed using R software (version 4.3.2), with analytical methods including χ2 tests, univariate analysis, quantile regression and random forest model. Results:A total of 2 620 participants were recruited, and 70.9% of whom reported feeling happy.The depression symptom score of the elderly was 3.00(1.00, 6.00), emotional status score was (28.26±4.14), activities of daily living (ADL) score was 69.00(52.00, 81.00), and the body mass index(BMI) was (22.68±3.81)kg/m 2.The quantile regression results indicated that marital status (married)(Q 10: β=0.049; Q 50: β=0.014; Q 90: β=0.005) and depressive symptoms (no depression, depressive tendency)(Q 10: β=1.000; Q 50: β=1.000; Q 90: β=0.025) had varying effects on older adults' subjective well-being across three quantiles (Q 10, Q 50, Q 90)(all P<0.05). In contrast, social activity (no social activity)(Q 10: β=-0.072; Q 50: β=-0.011; Q 90: β=-0.006), ADL (severe disability, moderate disability, mild disability)(Q 10: β=-0.103, Q 50: β=-0.006, Q 90: β=-0.048; Q 10: β=-0.063, Q 50: β=-0.012, Q 90: β=-0.005; Q 10: β=-0.078, Q 50: β=-0.016, Q 90: β=-0.009), and emotional status (poor emotion, fair emotion)(Q 10: β=-0.261, Q 50: β=-0.009, Q 90: β=-0.025; Q 10: β=-0.140, Q 50: β=-0.017, Q 90: β=-0.029) had a negative impact on elderly subjective well-being at the three quantile points(all P<0.05). Random forest results indicated that depressive symptoms, ADL, emotional status, household monthly income per capita, BMI, social activity, multimorbidity status, and marital status were the most important determinants of subjective well-being. Conclusion:Depressive symptoms and emotional status have a significant impact on the subjective well-being of older adults. Additionally, ADL, household income per capita, BMI, and social engagement also play important roles in influencing well-being, while the emotional support provided by marriage should not be overlooked.

Objective To compare blood flow velocity measurements obtained using two different color Doppler imaging(CDI)devices with linear probes of varying frequencies.Methods CDI measurements were performed in 99 eyes of 50 participants from Shenyang Aier Excellent Eye Hospital using two different CDI devices,Apogee Type3500 and Esaote MyLab 7 eHD.These measurements included peak systolic velocity(PSV),end-diastolic velocity(EDV),and resistance index(RI)of the ophthalmic artery(OA),central retinal artery(CRA),and short posterior ciliary arteries(SPCA).The differences in measurements between the two devices were analyzed using a paired t-test.The level of agreement between the two CDI devices was calculated using the Bland-Altman method,and the concordance correlation co-efficient(CCC)was calculated.Results There was a statistically significant difference between the two CDI devices in the PSV,EDV of the OA,CRA,and SPCA,and RI of the CRA and SPCA.The PSV and EDV of each vessel were higher in Apogee than in Esaote,and the RI of the CRA and SPCA were lower for Apogee than for Esaote(P＜0.05).The CCC demonstrated poor overall concordance ranging from 0.136 to 0.517.Conclusion The consistency of most measurements obtained from both devices is poor.CDI inter-device reproducibility is unreliable,even when the measurements are conducted consecutively by a single experienced ultrasonographer.

Objective:To explore the influencing factors of the subjective well-being of elderly individuals and improve the accuracy of well-being predictions.Methods:A multi-stage stratified sampling method was conducted in Guangdong province and Guangxi Zhuang autonomous region from August 2019 to October 2020. The health status and subjective well-being of older adults were assessed using a self-administered multidimensional health questionnaire, while overall well-being was evaluated with a single-item 5-point scale. The statistical analysis was performed using R software (version 4.3.2), with analytical methods including χ2 tests, univariate analysis, quantile regression and random forest model. Results:A total of 2 620 participants were recruited, and 70.9% of whom reported feeling happy.The depression symptom score of the elderly was 3.00(1.00, 6.00), emotional status score was (28.26±4.14), activities of daily living (ADL) score was 69.00(52.00, 81.00), and the body mass index(BMI) was (22.68±3.81)kg/m 2.The quantile regression results indicated that marital status (married)(Q 10: β=0.049; Q 50: β=0.014; Q 90: β=0.005) and depressive symptoms (no depression, depressive tendency)(Q 10: β=1.000; Q 50: β=1.000; Q 90: β=0.025) had varying effects on older adults' subjective well-being across three quantiles (Q 10, Q 50, Q 90)(all P<0.05). In contrast, social activity (no social activity)(Q 10: β=-0.072; Q 50: β=-0.011; Q 90: β=-0.006), ADL (severe disability, moderate disability, mild disability)(Q 10: β=-0.103, Q 50: β=-0.006, Q 90: β=-0.048; Q 10: β=-0.063, Q 50: β=-0.012, Q 90: β=-0.005; Q 10: β=-0.078, Q 50: β=-0.016, Q 90: β=-0.009), and emotional status (poor emotion, fair emotion)(Q 10: β=-0.261, Q 50: β=-0.009, Q 90: β=-0.025; Q 10: β=-0.140, Q 50: β=-0.017, Q 90: β=-0.029) had a negative impact on elderly subjective well-being at the three quantile points(all P<0.05). Random forest results indicated that depressive symptoms, ADL, emotional status, household monthly income per capita, BMI, social activity, multimorbidity status, and marital status were the most important determinants of subjective well-being. Conclusion:Depressive symptoms and emotional status have a significant impact on the subjective well-being of older adults. Additionally, ADL, household income per capita, BMI, and social engagement also play important roles in influencing well-being, while the emotional support provided by marriage should not be overlooked.

Objective To compare blood flow velocity measurements obtained using two different color Doppler imaging(CDI)devices with linear probes of varying frequencies.Methods CDI measurements were performed in 99 eyes of 50 participants from Shenyang Aier Excellent Eye Hospital using two different CDI devices,Apogee Type3500 and Esaote MyLab 7 eHD.These measurements included peak systolic velocity(PSV),end-diastolic velocity(EDV),and resistance index(RI)of the ophthalmic artery(OA),central retinal artery(CRA),and short posterior ciliary arteries(SPCA).The differences in measurements between the two devices were analyzed using a paired t-test.The level of agreement between the two CDI devices was calculated using the Bland-Altman method,and the concordance correlation co-efficient(CCC)was calculated.Results There was a statistically significant difference between the two CDI devices in the PSV,EDV of the OA,CRA,and SPCA,and RI of the CRA and SPCA.The PSV and EDV of each vessel were higher in Apogee than in Esaote,and the RI of the CRA and SPCA were lower for Apogee than for Esaote(P＜0.05).The CCC demonstrated poor overall concordance ranging from 0.136 to 0.517.Conclusion The consistency of most measurements obtained from both devices is poor.CDI inter-device reproducibility is unreliable,even when the measurements are conducted consecutively by a single experienced ultrasonographer.

AIM: To evaluate the binocular visual function in high myopia patients after the implantation of implantable collamer lens(ICL)V4c.METHODS: A total of 35 cases(70 eyes)that received binocular ICL implantation at our hospital from May 2019 to May 2021 were enrolled in this prospective study. Binocular full-range visual acuity, contrast sensitivity, stereopsis, mesopic vision and glare sensitivity, and monocular wavefront and the quality of vision questionnaire were assessed before the surgery and at 1 mo postoperatively.RESULTS: At 1 mo postoperatively, 35 cases(100%)had binocular uncorrected distance visual acuity(UDVA)≤0.00(LogMAR), 16 cases(46%)had binocular UDVA≥preoperative corrected distance visual acuity(CDVA). Binocular UDVA and uncorrected intermediate visual acuity(UIVA,80 cm)were improved compared to preoperative CDVA and distance-corrected intermediate visual acuity(DCIVA,80 cm)(all P<0.05).While there were no differences in the binocular postoperative UIVA(60 cm)and preoperative DCIVA(60 cm),and uncorrected near visual acuity(UNVA,40 cm)and preoperative distance-corrected near visual acuity(DCNVA,40 cm)(all P>0.05). The binocular contrast sensitivity was significantly improved postoperatively(P=0.001), and the postoperative binocular mesopic vision, glare sensitivity(no glare/glare)and binocular stereopsis(5 m/40 cm)had no differences(all P>0.05). The postoperative total higher-order aberration, trefoil aberration, coma and spherical aberration were increased, besides the median of total coma in the right eye with a pupil diameter of 3.0 mm was decreased after surgery. The mean total score of quality of vision questionnaire was significantly increased from 54.87 preoperatively to 80.92 after implantation(P<0.05), with high satisfaction and no obvious visual disturbance in patients.CONCLUSION: Although the monocular high-order aberrations increased in the early stage after ICL V4c binocular implantation in patients with high myopia, the binocular visual function was improved.

Objective:To analyze and evaluate the items of the general module of multidimensional health measurement instruments system for elderly patients with chronic disease (MHIEC-GM)(V1.0) based on classical test theory (CTT) and item response theory (IRT).Methods:A self-administered survey of 2 375 elderly patients with chronic diseases was conducted using the MHIEC-GM(V1.0) scale. The quality of items was analyzed using the variability method, correlation coefficient method, factor analysis method, and Cronbach's α coefficient method based on CTT. The difficulty coefficient, differentiation coefficient, and information content of items were analyzed using the IRT analysis software MULTILOG 7.03.Results:The CTT results showed that the standard deviations of all nine items were greater than 0.9. The results of the correlation coefficient method, the factor analysis method and the Cronbach′s α coefficient method showed that except for the GMI9 item, the correlation coefficients between the other items and the total scale were all greater than 0.5, and the factor loads were all greater than 0.5, and the Cronbach′s α coefficients after the deletion of the items were all less than 0.763. Based on the results of the four analysis methods, except for the GMI9 item, all the other items had good characteristics. The IRT results showed that the information contents of all items were >0.333 (5/15) except for the GMI4, GMI6, and GMI8, and the differentiation coefficient of each item was 1.44. The items that difficulty coefficient met the [-4, 4] inclusion criteria were the GMI2, GMI3, GMI5, GMI7 and GMI9, showing a monotonically increasing trend with increasing difficulty level. The items of GMI1, GMI4, GMI6, and GMI8 needed further improvement.Conclusion:Most of items of the MHIEC-GM(V1.0) scale have good psychometric properties, but some items need to be further revised and validated according to the characteristics of chronic diseases in the elderly.

BACKGROUND: Delayed graft function (DGF) is the main cause of renal function failure after kidney transplantation. This study aims at investigating the value of hypothermic machine perfusion (HMP) parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor (DD) kidney transplantation. METHODS: HMP parameters, perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1, 2019 to August 31, 2019 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression analysis. RESULTS: In this study, the DGF incidence was 17.7% (20/113); The multivariate logistic regression results showed that terminal resistance (OR: 1.879, 95% CI 1.145-3.56) and glutathione S-transferase (GST)(OR = 1.62, 95% CI 1.23-2.46) were risk factors for DGF; The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time (HR = 0.823, 95% CI 0.735-0.981). The model combining terminal resistance and GST (AUC = 0.888, 95% CI: 0.842-0.933) significantly improved the DGF predictability compared with the use of terminal resistance (AUC = 0.756, 95% CI 0.693-0.818) or GST alone (AUC = 0.729, 95% CI 0.591-0.806). CONCLUSION According to the factors analyzed in this study, the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.
Biomarkers ; Delayed Graft Function ; Graft Survival ; Humans ; Kidney/physiology* ; Kidney Transplantation/adverse effects* ; Organ Preservation ; Perfusion ; Retrospective Studies ; Tissue Donors

Objective:To explore the prognostic utility of LifePort perfusion parameters plus perfusate biomarkers for predicting delayed graft function(DGF)and recovery time during deceased donor kidney transplantation(KT).Methods:From January 1, 2019 to August 31, 2019, retrospective analysis was performed for clinical data of 113 KT recipients. Based upon whether or not DGF occurred within 3 months, they were divided into two groups of DGF group(20 cases)and non-DGF (93 cases). Two groups were compared using LifePort perfusion parameters, biomarker concentrations, incidence of DGF and kidney recovery time. Statistical analysis was performed.Results:The incidence of DGF was 17.7%(20/113); Multivariate Logistic regression results indicated that terminal resistance(OR 1.879, 95% CI 1.145~3.56)and glutathione S-transferase(GST)(OR 1.62, 95% CI 1.23~2.46)were independent risk factors for DGF; Cox hazard model revealed that terminal resistance was a risk factor for recovery time of renal function(HR=0.823, 95% CI 0.735~0.981). The model combining terminal resistance and GST(AUC=0.888, 95% CI 0.842~0.933)significantly improved the predictive efficacy for DGF as compared with using terminal resistance(AUC=0.756, 95% CI 0.693~0.818)or GST alone(AUC=0.729, 95% CI 0.591~0.806).Conclusions:Combining LifePort perfusion parameters and fluid biomarkers can improve the predictive utility of DGF.