This study aimed to investigate factors affecting visual outcomes after phacoemulsification in highly myopic patients with cataracts, based on the detection of nanobacteria (NB) in aqueous humor. Fifty highly myopic patients with cataracts who underwent phacoemulsification surgery at The First People's Hospital of Ziyang from December 2022 to June 2023 were enrolled. Aqueous humor samples were gathered from patients before surgery, and NB were isolated and cultured from the aqueous humor. They were identified using scanning electron microscopy and transmission electron microscopy. The calcium-phosphorus ratios in NB cultures (NB group) and nanohydroxyapatite (nHA) cultures (nHA group) were determined by energy-dispersive X-ray spectroscopy. Cell inhibition was compared using a CCK-8 assay. The expressions of calcification-related proteins, bone morphogenetic protein 2, osteopontin, apoptosis-related proteins, B-cell lymphoma 2 (Bcl-2), and Bcl-2-associated X protein in cells were examined by western blot. Based on the best-corrected visual acuity (VA) 3 months after surgery, patients were classified into a normal vision (NV) group (best-corrected VA ≥0.3) and an abnormal vision (AV) group (best-corrected VA <0.3). The factors influencing postoperative VA and efficacy were analyzed. Results revealed that the characteristics of the aqueous humor cultures were consistent with the features of NB described in the literature, with NB measuring approximately 90 to 340 nm in transmission electron microscopy. Energy-dispersive X-ray results indicated no remarkable difference in calcium-phosphorus ratios between the NB and nHA groups (p > 0.05), but the NB group exhibited remarkably stronger cell inhibition relative to the nHA group (p < 0.05). Western blot results revealed obviously higher levels of bone morphogenetic protein 2, osteopontin, and Bcl-2-associated X proteins in the NB group compared to the nHA group (p < 0.05), while Bcl-2 expression was sharply lower, with a great difference in the NB group (p > 0.05). The gap in best-corrected VA 1 month after surgery between the NV group (68%) and the AV group (32%) was obvious (p < 0.05). With increasing recovery time, the number of patients with best-corrected VA ≥0.3 at 6 months postoperatively substantially increased (86%). The NB-positive rate in the aqueous humor samples was observably lower in the NV group than the rate in the AV group (p < 0.05). Univariate logistic regression analysis revealed great differences in age, duration of high myopia, axial length (AXL), corneal astigmatism, incidence of macular disease, and NB-positive rate (p < 0.05). Multivariate logistic regression analysis indicated that AXL and the presence of NB in the aqueous humor were independent factors influencing the postoperative visual prognosis of highly myopic patients with cataracts (p < 0.05). The experimental results signified that NB cultures suppressed cells and, at the cellular level, influenced the visual recovery after surgery by regulating the expression of calcification-related proteins and mitochondrial apoptosis-related proteins. Multivariate logistic regression analysis further confirmed that AXL and the presence of NB in the aqueous humor were independent factors affecting the postoperative visual prognosis. This finding offered strong support for the future development of relevant treatment modalities.

Diabetic retinopathy (DR) is a common and severe complication of diabetes, which poses a serious threat to vision, and its pathogenesis is complex. Inflammatory response plays a crucial role in the progression of DR, but currently, anti-vascular endothelial growth factor therapy, the preferred treatment for DR, only targets the vascular part. Therefore, determining a treatment method targeting the inflammatory response in DR is an important step in addressing DR. As immune cells within the retina, microglia play a key role in the inflammatory response in DR, which is a crucial link in its pathogenic mechanism. By regulating the inflammatory response of microglia, the progression of DR can be effectively slowed down. This review deeply explores the mechanism of action of microglia in DR by reviewing relevant research achievements and evaluates the potential of treatment strategies targeting microglia in slowing down the progression of DR. The study focuses on how to further optimize the treatment regimen for DR by regulating different pathways such as the release of inflammatory factors, the occurrence of oxidative stress, phenotypic transformation, intercellular interactions, and phagocytic activity of microglia, providing important clues for the development of novel treatment methods for DR. Through a comprehensive analysis and evaluation of the effectiveness and safety of these treatment strategies, the study aims to provide more precise and effective treatment regimens for patients with DR, so as to improve their visual prognosis and quality of life.

Fibrosis is strictly a histopathological term that refers to the replacement of functional tissue with permanent deposition of nonfunctional extracellular matrix (ECM), following an injury or disease, and can occur in any tissue in the body. In this histological setting, there is no overt difference between fibrosis and scarring. However, in the clinical context, fibrosis tends to be associated with chronic disease, as it ensures ongoing ECM deposition. This could be considered "excessive" when compared to ECM deposition in acute or end-stage chronic disease. This perspective highlights how fibrosis in neovascular age-related macular degeneration follows a stereotypical tissue repair process similar to that seen in other tissues and how salient biologic processes, such as aging and metabolic health, impact fibrosis development. In addition, we highlight the emerging and pivotal profibrogenic role played by progressive endothelial cell (EC) dysfunction, together with secondary blood flow impedance in the neovasculature. This results in abnormal vascular permeability, endothelial-to-mesenchymal transition, and EC senescence-associated secretory phenotype, processes that could potentially be targeted therapeutically. Finally, the dramatic impact of anti-vascular endothelial growth factor therapy, by primarily targeting permeability of the nascent microvasculature, on the natural history of fibrosis in neovascular age-related macular degeneration indirectly highlights the potentially significant role of ECs in fibrosis development and points toward how novel future targeting of these cells could further modulate the development of fibrosis.