Human γS-crystallin (γS) is a highly soluble protein found in the eye lens, where it is densely packed with other proteins to form the refractive tissue required for vision. Mutations in γS can compromise its solubility and cause congenital cataract, while post-translational modifications (PTMs) can lead to age-related cataract. γS is especially susceptible to oxidative PTMs, which accumulate from lifelong exposure to UV light. We previously investigated the effects of side chain oxidation at tryptophan 163 (W163) by incorporating an oxidation mimic, 5-hydroxytryptophan (5HTP), in a site-specific manner using genetic code expansion. The resulting variant, γS-W163(5HTP), retains the overall fold of the wild-type γS (γS-WT) even under thermal and chemical stress, yet readily forms large oligomers at physiological temperature. Here, we probe the mechanism underlying this behavior. We first characterize γS-W163S, a serine variant in which the indole ring at position 163 is effectively removed, to further define the role of W163 in γS-crystallin structure and stability. We also map changes in backbone dynamics caused by W163 oxidation in γS-W163(5HTP) using solution-state NMR. Together, our findings support the established model in which crystallin aggregation is decoupled from global destabilization: although the oxidative modification at W163 is structurally tolerated through rearrangement of the local hydrogen bond network, the resulting changes in backbone flexibility render aggregation-competent conformations accessible. This work provides mechanistic insights into how covalent damage to crystallin monomers promotes aberrant intermolecular interactions that lead to cataract formation.

Convolution-based human vision simulation requires point spread functions (PSFs) that vary continuously across a high-dimensional parameter space encompassing field angle, pupil diameter, and eye-specific anatomy. Current state-of-the-art methods precompute PSFs on a discrete grid and rely on trilinear interpolation at runtime, incurring substantial memory overhead and resolution limitations. We propose Neural Aberration Fields (NAF), a framework that replaces discrete lookup tables with continuous neural implicit representations mapping optical coordinates directly to Zernike aberration coefficients. We systematically evaluate three neural encoding strategies-positional encoding, multiresolution hash encoding, and direct input-conditioned on patient-specific eye parameters, against the conventional trilinear scheme. Training data are generated from a physically grounded pipeline comprising a parametric four-surface eye model and Snell's-law ray tracing through 200,000 configurations spanning five ocular conditions. The positional-encoding variant (NAF-PE) achieves a Zernike coefficient MAE of 0.0032 mm and PSF PSNR of 53.3 dB while requiring only 139 KB of storage-an 84% memory reduction and 2.1× accuracy improvement over trilinear interpolation (MAE 0.0067 mm, 864 KB). On unseen cataract parameters, NAF-PE reduces MAE by 43% relative to the discrete baseline (0.0051 versus 0.0089 mm), demonstrating the generalization advantage of conditioned implicit representations. A conditioning ablation reveals that the accuracy gains stem primarily from patient-specific conditioning rather than representational capacity alone, identifying conditioning as a structural necessity for continuous PSF modeling. We further show that hash encoding achieves the highest single-configuration PSNR (56.1 dB) when the table capacity is matched to the data density, but degrades sharply when oversized. These results establish neural implicit fields as a viable, compact, and generalizable alternative to discrete PSF grids for real-time vision simulation individualized within parametric eye models.

BACKGROUND Management of posterior segment intraocular foreign bodies is challenging, requiring the preservation of ocular integrity and restoring vision. Traumatic endophthalmitis occurs in 7% to 13% of penetrating injuries, particularly with coexisting intraocular foreign bodies. Managing posterior segment intraocular foreign bodies poses significant challenges due to their complex clinical presentation and the need to achieve multiple goals during treatment. This unusual case of a large metallic intraocular foreign body associated with traumatic cataract, retinal detachment, and endophthalmitis underscores the challenges of diagnosis and management. CASE REPORT A 31-year-old man presented with pain and vision loss in the left eye 7 days after penetrating trauma by a metallic foreign body. Examination showed visual acuity 20/20 (logMAR 0.00) in the right eye and hand movement (logMAR 3) in the left. There was a full-thickness inferior 2-mm corneal laceration with iris incarceration, anterior chamber reaction with fibrinous exudation, and a traumatic cataract, with no retinal view. Imaging confirmed the presence of an intraocular foreign body and endophthalmitis with an associated rhegmatogenous retinal detachment at the time of vitrectomy. The 35-mm foreign body was successfully removed. However, the intraocular foreign body was not detected initially on B-scan ultrasonography, reflecting the diagnostic and therapeutic challenges, as well as the importance of computed tomography imaging. CONCLUSIONS This case report highlights the complexity of managing a large retained intraocular foreign body, underscoring the rarity of its size, complicated by endophthalmitis, traumatic cataract, and rhegmatogenous retinal detachment, emphasizing the importance of multimodal imaging, individualized treatment approaches, and continued research to improve management of similar conditions.

We report a case of distinctive ripple-like Descemet membrane folds after combined microhook ab interno trabeculotomy (µLOT) and cataract surgery. A 70-year-old Japanese man with primary open-angle glaucoma and cataract underwent nasal µLOT followed by phacoemulsification and intraocular lens implantation in the right eye. At 1 week postoperatively, unusual ripple-like Descemet membrane folds, which had not been noted at the examination on postoperative day 1, were observed in the inferior cornea with localized corneal edema. Best-corrected visual acuity was 0.4 in decimal notation. Multimodal imaging revealed no apparent Descemet membrane detachment or tears. Review of the surgical video showed inadvertent aspiration of the Descemet membrane during irrigation/aspiration (I/A), followed by the appearance of the folds. The patient was managed conservatively, and the folds resolved completely by 3 months postoperatively, with best-corrected visual acuity improving to 1.2. We hypothesize that incision of peripheral supporting structures during µLOT may have reduced tangential tension in the Descemet membrane, increasing its susceptibility to aspiration during subsequent I/A. This mechanism remains unconfirmed. Careful I/A manipulation following µLOT is warranted, and conservative management may be appropriate for similar folds without associated Descemet membrane detachment or tears. As minimally invasive glaucoma surgery is often performed by ophthalmology trainees and surgeons with limited surgical experience, this report may serve as an educational example of an intraoperative complication during combined surgery.

The standard method for achieving presbyopia correction after cataract extraction has traditionally centered on intraocular lens (IOL) optics featuring concentric diffractive patterns or combinations of diffractive and refractive elements, or "rings". While there has been a transition from simple monofocality to intricate polyfocality in IOLs, this has been accompanied by associated side effects. Halos, glare, reduced contrast sensitivity, waxy vision, low reading speed, reduced depth of focus and difficulty in night vision and driving are important photic phenomena that IOL developers have attempted to improve for decades. "Ringless IOLs" refers to lenses that provide an extended range of vision without relying on concentric diffractive rings or annular diffractive structures on the optic. We have also clarified that ringless designs may use different optical strategies, including refractive, asymmetric, transitional, or other non-annular optical profiles. Recently introduced IOLs without concentric diffractive rings include light-adjustable IOLs, polyfocal progressive IOLs, spiral architecture IOLs and non-diffractive segmented multifocal IOLs. These advanced-technology IOLs circumvent the drawbacks of concentric annuli through the use of continuous optical profiles. As far as we know, the present narrative review is the first such review that includes published articles from 2000 to 2026 to describe the current status of these IOLs and the nuances required to achieve best results after IOL implantation.

With the rapid development of intraocular lens (IOL) technology, the traditional classification system based on optical design has become unable to accurately present IOL properties and predict patients' real-world visual outcomes. In 2024, the Functional Vision Working Group (FVWG) of the European Society of Cataract and Refractive Surgeons (ESCRS) first proposed an evidence-based functional classification framework quantified by monocular best-corrected visual acuity defocus curves, depth of field and visual acuity increase from intermediate to near, which categorizes IOLs into six functional subtypes. Further refined by the American Society of Cataract and Refractive Surgery, the Asia Pacific Association of Cataract and Refractive Surgeons, and the Latin American Society of Cataract and Refractive Surgeons, this framework was formally endorsed in a global multi-society consensus in 2026. Shifting from nominal classification by optical configuration to quantitative grading based on actual postoperative visual performance, the new system enables ophthalmologists to objectively evaluate IOL functional profiles and facilitates individualized preoperative IOL selection; it also provides valuable references for optimizing domestic IOL registration and volume-based procurement categorization in China. This article systematically reviews the background, methodology, evolutionary process, current domestic situation and clinical application of this classification system, aiming to help Chinese ophthalmologists fully understand and standardize the clinical application of this novel evidence-based classification method.

Objective: To compare clinical outcomes of combined trabeculotome tunnelling trabeculoplasty (3T) and phacoemulsification vs. 3T alone for primary open-angle glaucoma (POAG) with cataract. Methods: Retrospective cohort study. Patients with POAG and cataract who underwent 3T combined with phacoemulsification and intraocular lens implantation or 3T alone at Chengdu Integrated Traditional Chinese and Western Medicine Hospital between January 2023 and December 2024 were enrolled. They were divided into two groups according to surgical modality: the observation group with eyes receiving 3T combined with phacoemulsification and intraocular lens implantation and the control group with those receiving 3T alone. The intraocular pressure (IOP), best-corrected visual acuity [converted to logarithm of the minimum angle of resolution(logMAR)], number of antiglaucoma medications, and complications were recorded on postoperative day 1, week 1, month 1, month 3, and month 6, and the success rate at 6 months was evaluated. Results: There were 59 patients (71 eyes), with a mean age of (62.81±7.80) years, including 38 males and 21 females. The observation group comprised 35 eyes and the control group 36 eyes. The preoperative IOP was (23.76±5.01) mmHg (1 mmHg=0.133 kPa) in the observation group and (24.56±6.08) mmHg in the control group; at 6 months postoperatively, the IOP decreased to (15.28±2.80) mmHg and 15.00 (13.50, 18.00) mmHg, respectively. Both groups showed a significant IOP reduction from baseline (P<0.05), but the difference between groups was not statistically significant (P>0.05). At 6 months, the best-corrected visual acuity in the observation group improved significantly from baseline, with a mean improvement of 0.38 logMAR (P<0.05), whereas no significant improvement was observed in the control group (P>0.05). The number of antiglaucoma medications decreased postoperatively in both groups, with no statistically significant difference between groups (P>0.05). Regarding complications, the incidence of hyphema was 5.7% (2/35) in the observation group and 11.1% (4/36) in the control group, with no statistically significant difference (P>0.05). The incidence of IOP rebound was 20.0% (7/35) in the observation group, which was significantly lower than that in the control group (41.7%, 15/36) (P<0.05). At 6 months postoperatively, the overall success rate was 88.6% in the observation group and 80.6% in the control group, with no statistically significant difference (P>0.05). Conclusions: The 6-month follow-up results of this study indicate that 3T combined with cataract extraction is a safe and effective treatment for POAG with cataract, significantly improving visual acuity, effectively reducing IOP, and decreasing the number of antiglaucoma medications, with a low rate of postoperative complications.

Age-related cataract, the primary cause of blindness among middle-aged and elderly populations, represents a clinical condition where the bilateral surgical strategy cannot be simplified to the superposition of two independent operations, but constitutes a systematic project targeting the reconstruction of binocular visual function. With the increasing diversity of presbyopia-correcting intraocular lenses, clinical decision-making for bilateral cataract surgery has encountered new challenges: how to formulate a reasonable bilateral cataract surgical protocol? This paper reviews the clinical trends and evaluation systems for bilateral cataract surgery, focusing on comparing the advantages and indications of symmetrical and asymmetrical IOL implantation; it also clarifies the influence of dominant eye evaluation on postoperative visual quality, and conducts an in-depth discussion on the crucial role of neuroadaptation in postoperative visual construction. This review is expected to provide a reference for the clinical practice of bilateral cataract surgery, and more high-quality evidence-based medical research is still required to guide the formulation of individualized treatment strategies in the future.