In his beautiful book, Consilience: The Unity of Knowledge, the eminent biologist Edward O Wilson, advocates the need for integration and reconciliation across the sciences. He defines consilience as “literally a ‘jumping together' of knowledge with a linking of facts … to create a common groundwork of explanation”. It is the premise of this paper that as much as basic biomedical research is in need of data generation using the latest available techniques-unifying available knowledge is just as critical. This involves the necessity to resolve contradictory findings, reduce silos, and acknowledge complexity. We take the cornea and the lens as case studies of our premise. Specifically, in this perspective, we discuss the conflicting and fragmented information on protein aggregation, oxidative damage, and fibrosis. These are fields of study that are integrally tied to anterior segment research. Our goal is to highlight the vital need for Wilson's consilience and unity of knowledge which in turn should lead to enhanced rigor and reproducibility, and most importantly, to greater understanding and not simply knowing.

Central serous chorioretinopathy(CSC), first reported in 1866, is now recognized as the fourth most common macular fluid leakage disease after age-related macular degeneration, diabetic macular edema, and retinal vein occlusion. Although self-limiting in most cases, chronic CSC can cause the outer retinal atrophy and choroidal neovascularization, resulting in serious visual impairment. CSC used to be classified as a macular disease, or an acquired disease involving the macula. Thanks to the rapid development and application of fundus imaging technology, this concept has changed. Since 2013, CSC has been listed as choroidal vessel/Bruch's membrane disease, or choroidal disease, in the authoritative retinal books. CSC now belongs to a common phenotype of pachychoroidal diseases. The pathogenesis of CSC lies in choroidal vessel dilation, venostasis, remodeling and anastomosis between vortex veins, resulting in increased venous pressure and damage in choroidal capillaries, retinal pigment epithelium and outer blood retinal barrier, and then macular fluid leakage. However, the risk factors or causes of choroidal vessel abnormalities have not been elucidated. Current intervention strategies focus on eliminating macular fluid, and there is no effective treatment for eliminating etiology or risk factors. Therefore, the pathophysiology and etiological treatment of CSC deserve more attention.

The rapid development of intelligent ophthalmology research in recent years still faces some challenges in its clinical application or clinical translation process. Two important issues that urgently need to be addressed in the development of intelligent ophthalmology are: promoting clinical application and maintaining medical equity. In response to the aforementioned issues, this article analyzes the reasons and current situation of the insufficient promotion of clinical application and the potential challenges of medical equity, and proposes that promoting clinical application and maintaining medical equity are key issues in the development of intelligent ophthalmology. At the same time, it systematically proposes corresponding specific measures to promote the development of intelligent ophthalmology.

AIM: To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).METHODS: This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz, Iran, from June 2022 to June 2024. A control group of 122 age-matched children without CNLDO was also included for comparison. Data was collected from the children's medical records. RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors, such as preeclampsia, the use of levothyroxine, hypothyroidism, having more than three pregnancies(gravidity >3), natural pregnancy, and gestational diabetes mellitus. Additionally, in children, factors, such as oxygen therapy, anemia, reflux, jaundice, and a family history of CNLDO in first-degree relatives were associated with CNLDO, and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.CONCLUSION: Given that CNLDO affects both premature and full-term children, the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction, thereby preventing the onset of chronic dacryocystitis.

AIM: To prepare a novel functionalized upconversion nanomaterial UCNPs-PEG-Tf through an improved method and observe its specific imaging phenomenon to choroidal melanoma cells(OCM-1).METHODS: NaYF4:Yb/Er(Up-conversion nanoparticles, UCNPs)was Prepared and plasma was treated to carboxylate the surface; then amino polyethylene glycol and transferrin(Tf)were respectively loaded to prepare UCNPs-PEG-Tf. Characterized them accordingly, its biocompatibility was tested accordingly, and the specific fluorescence phenomenon of OCM-1 was detected by fluorescence spectrophotometer and inverted fluorescence microscopy.RESULTS: Characterization confirmed successful synthesis of UCNPs, UCNPs-PEG, and further loading of Tf to form UCNPs-PEG-Tf. UCNPs-PEG-Tf showed excellent biocompatibility and emitted significant green fluorescence. Under the same conditions, fluorescence intensity measurement and observations from the inverted fluorescence microscope both demonstrated its significant specificity in imaging to OCM-1 cells.CONCLUSION: The synthesized novel functionalized UCNPs-PEG-Tf nanocomposite showed good biocompatibility and achieve specific imaging to OCM-1 cells.

AIM:To observe the changes of Th17 related cytokines in tears of conjunctivochalasis(CCH)patients with liver-kidney yin deficiency treated with traditional Chinese medicine Qi Jing Mingmu decoction combined with artificial tears.METHODS:A total of 56 CCH patients(56 eyes)with liver-kidney yin deficiency of grade Ⅱ to Ⅲ were collected and randomly divided into treatment group(treated with Qi Jing Mingmu decoction combined with artificial tears)of 26 cases(26 eyes)and control group(treated with pure artificial tears)of 30 cases(30 eyes). The treatment course was 1 mo, and international ocular surface disease index(OSDI), tear film break-up time(BUT), tear meniscus height(TMH)and conjunctival congestion index of the patients were observed before and after treatment. The patients' tears were collected before and after treatment, and Th17 related cytokines in tears were detected using flow cytometry immunofluorescence luminescence method.RESULTS:After treatment, the OSDI, BUT and conjunctival congestion index of CCH patients in the treatment group and control group were significantly improved(all P<0.01). After treatment, the TMH of CCH patients in the treatment group was significantly reduced(P<0.01), while there was no statistically significant difference in TMH of the control group before and after treatment(P=0.41). After treatment, the levels of Th17 related cytokines IL-17A, IL-22, IFN-γ, IL-17F, and IL-1β in tears of CCH patients in the treatment group were significantly reduced after treatment(all P<0.01), and the changes in the treatment group were more significant(all P<0.05). There was no significant difference in the control group before and after treatment(all P>0.05). After treatment, the levels of IL-6 and TNF-α in the tears of both groups of CCH patients decreased compared to those before treatment(both P<0.05), but the changes in the treatment group were more significant(both P<0.01).CONCLUSION:Qi Jing Mingmu decoction combined with artificial tears can effectively improve the ocular surface microenvironment, enhance tear film stability, and inhibit ocular surface inflammation in CCH patients with liver-kidney yin deficiency. This may be related to its reduction in the secretion of Th17 related cytokines in tears.

AIM: To compare the changes in corneal epithelial thickness(CET)after small incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS: A total of 187 patients(187 eyes)who underwent either SMILE or FS-LASIK at Urumqi Aier Eye Hospital between December 2022 and November 2023 were collected. The patients were divided into SMILE group and FS-LASIK group according to surgical methods. The CET of the patients was measured by optical coherence tomography(OCT)system before surgery and at 1 wk, 1, 3, and 6 mo postoperatively.RESULTS: Changes in corneal epithelial thickness(△CET)in the central, paracentral, and mid-peripheral regions were compared at 6 mo postoperatively. The SMILE group was characterized by the most significant thickening in the central area and the least thickening in the mid-peripheral area; while the FS-LASIK group was characterized by the most significant thickening in the paracentral area and the least thickening in the mid-peripheral region. At 1 wk, 1, 3, and 6 mo postoperatively, within the 0-7 mm corneal area, the △CET for both the SMILE and FS-LASIK groups was correlated with the preoperative spherical equivalent.CONCLUSION: Within 6 mo postoperatively, both SMILE and FS-LASIK showed a similar trend in epithelial thickening but with distinct characteristics. The change in corneal epithelial thickness for both procedures was positively correlated with the preoperative diopter.

AIM: To analyze the current status, research hotspots, and development trends of international studies on ocular surface microbiota based on bibliometrics.METHODS: Leveraging the Web of Science database, we conducted a targeted literature search on ocular surface flora. The retrieved data were meticulously screened and weighted to enhance relevance. The bibliometric analysis delved into publication trends, authorship patterns, institutional collaborations, and pivotal research themes. Employing Cite Space software, we visually dissected the landscape of institutional and national partnerships, citation impact, keyword co-occurrences, keyword clustering dynamics, and the emergence of new research trends.RESULTS: A total of 3 884 publications were ultimately included, with an overall upward trend in the number of publications in the field of ocular surface microbiota from 2003 to 2023, with the most rapid growth occurring from 2019 to 2022. The top three regions/countries by publication volume are the United States(1 039 papers), China(570 papers), and India(302 papers). The top three authors by publication volume are Willcox Mark(48 papers), Sharma Savitri(33 papers), and Fleiszig Suzanne M.J(27 papers). The top three institutions by publication volume, all from the United States, are the University of California, L.V. Prasad Eye Institute, and Harvard University. The citation network map of the literature includes 801 nodes and 1 508 connections, with the most frequently cited document being Temporal Stability and Composition of the Ocular Surface Microbiome. The top 5 keywords by frequency of occurrence are, in order, keratitis, bacterial flora, identification, inflammation, and endophthalmitis. The keyword clustering analysis yielded a total of 8 clusters, which are specifically reflected in three aspects: ocular-related diseases, the relationship between ocular surface microbiota and ocular surface structures, and detection methods for ocular surface microbiota. The keyword with the highest burst strength is ciprofloxacin. Keywords that have emerged in recent years and continue to the present include diversity, gut microbiome, and ocular surface microbiome.CONCLUSION: Currently, the study of ocular surface microflora is gaining momentum globally, with a particular focus on the diversity of microflora, the composition of the core microbiome, and its impact on ocular diseases. In the future, research should concentrate on elucidating the functional metabolism of the ocular surface microflora and further investigate the causality and mechanisms by which changes in the ocular surface microflora are related to diseases.

Correcting high myopia has always been challenging in clinical practice. For patients with high myopia, the implantation of an implantable collamer lens(ICL)has become the main treatment option. Recent studies have shown that ICL implantation is effective not only for correcting moderate-to-high myopia but is also increasingly used for mild-to-moderate myopia. Furthermore, ICL implantation can address difficult refractive problems and can be combined with corneal refractive surgery to extend the range of correction. ICL implantation offers a wide range of corrections, good postoperative visual quality, high predictability, reversibility, and preservation of the natural accommodative capacity. It is gradually demonstrating its unique advantages in clinical practice. Postoperative complicated cataract is a common cause of visual impairment, and severe cases may require secondary surgery. The design, material, and vault of the ICL, along with patient-specific factors, are related to the mechanism of postoperative complicated cataracts after ICL implantation. The purpose of this article is to review the updates and iterations in ICL design, the mechanism of postoperative complicated cataracts, and their prevention.

Strabismus, a common ocular condition, arises from an imbalance in the extraocular muscle force and deviation of the visual axis due to various factors. Concomitant strabismus is the predominant form of exotropia, with its pathogenesis believed to be associated with hereditary factors, abnormal eye accommodation function, and anomalies in binocular anatomy. Surgical intervention is often necessary for aligning the visual axes of both eyes and facilitating the recovery and establishment of stereoscopic vision. Despite this, the etiology of concomitant exotropia remains incompletely understood. This review consolidates recent research on aberrant molecular expression and pathological morphological changes within extraocular muscles affected by concomitant exotropia, offering insights into disease causation at molecular and pathological levels to underpin future preventive measures and clinical interventions. The discussion encompasses histological changes observed under electron microscopy as well as the impact of heavy chain protein, satellite cells, cadherin, growth factors on extraocular muscle protein expression.