To critically evaluate new evidence regarding big language models (LLMs) in cataract and refractive surgery and suggest a clinically responsible validation system. Conceptual synthesis of the recent literature of high impact and comment on a recent JCRS study on the performance of LLM compared to ophthalmology residents. Despite the high benchmark performance of LLMs, there are still severe deficits in clinical reliability, reproducibility, citation traceability, and safety in anterior-segment procedures. It proposes a three-layer validation pipeline, which includes domain-specific benchmarking, multi-dimensional performance reporting, and use-case-based deployment thresholds. It is necessary to shift the accuracy of examination to responsible clinical integration. An equity-sensitive validation framework applicable globally can make the application of AI in cataract and refractive surgery safe, transparent, and effective.
This systematic review and meta-analysis evaluated the literature-pooled association between statins and dry eye disease (DED). Statins, a common treatment modality for dyslipidemia, have been proposed as a potential contributor to DED via their activity in meibomian gland epithelial cells. However, single studies show mixed evidence, and there remains an unmet clinical need to clarify whether statin exposure is associated with DED. This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews of Interventions (PRISMA) 2020 statement and was registered a priori on PROSPERO (CRD420251238004). Ovid MEDLINE, Embase, CINAHL, Web of Science, CENTRAL, and the reference lists of relevant reviews were searched from inception to November 2025 for studies reporting the association between statin use and DED. Random-effects meta-analysis using inverse-variance weighting was conducted to pool effect estimates as odds ratios (ORs) with 95% confidence intervals (CIs). Study risk of bias was appraised using the ROBINS-E tool and the certainty of the evidence was reported using the GRADE framework. Six observational studies were included in the meta-analysis (n = 560,821; 356,012/559,141 [63.7%] statin users). The pooled analysis revealed a significant positive association between statins and DED (OR 1.09, 95% CI 1.05 to 1.13, p < 0.001), with an absolute risk difference of 10.2 more DED cases per 1,000 (95% CI 5.5 more to 15.2 more). This result was derived from very low certainty evidence given limitations in study design and serious inconsistency. Subgroup and sensitivity analyses for risk of bias (p = 0.123), method of outcome ascertainment (p = 0.737), type of effect estimate (p = 0.496), and leave-one-out analyses showed no evidence of effect modification and demonstrated consistent direction of association across studies. Statin use was associated with a small but statistically significant increase in DED, limited by very low certainty evidence. Physicians should monitor for and educate patients on ocular surface symptoms in patients using statins with pre-existing DED risk factors. Future studies should use standardized DED diagnostic criteria to investigate the impact of statin dose, type, and duration to better characterize this potential association.
To conduct a systematic review and meta-analysis evaluating the efficacy and safety outcomes of argon laser treatment for trichiasis, a common eye condition that can lead to blindness. We conducted a systematic review and meta-analysis. PubMed, Cochrane Library, Science Direct, Embase, and ClinicalTrials.gov databases were searched for studies on argon laser treatment of trichiasis, without language restriction, up to March 2025. We computed random-effect meta-analysis and meta-regressions on putative influencing factors. The PRISMA guidelines were followed. The meta-analysis was registered on PROSPERO (ID: CRD42024546074). Twenty-seven articles were included in the systematic review, and 20 in the meta-analysis, for a total of 1044 patients. The prevalence of trichiasis recurrence at the end of follow-up was 4.1% (95% CI 2.7 to 5.5%), ranging from 0% to 37.7%, reflecting substantial heterogeneity between studies (I2 91.5%). After only one session, the prevalence of trichiasis recurrence was 35.8% (25.9 to 45.7%, I2 91.5%). The prevalence of lid complications was 0.1% (-0.2 to 0.5%). Reported complications included notching (0.1%; 95% CI, -0.2% to 0.5%), hypopigmentation (0.0%; 95% CI, -0.1% to 0.2%), and rash (0.0%; 95% CI, -0.3% to 0.3%). The prevalence of pain was 0.0% (-0.1 to 0.2%). The certainty of the evidence was assessed using the GRADE approach, and most outcomes were rated as low certainty due to limitations in study design and heterogeneity. Argon laser for trichiasis is an effective procedure, but several sessions may be necessary. The safety profile of this technique is very good with few and mild complications.
To evaluate the pooled surgical success rate, postoperative changes in intraocular pressure (IOP) and antiglaucoma medication burden following glaucoma drainage device (GDD) implantation in pediatric glaucoma, with subgroup analyses according to implant type. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Web of Science, PubMed, Scopus, and the Cochrane Library were searched on September 16, 2025. Eligible studies included at least 10 pediatric patients undergoing GDD implantation with a minimum follow-up of 3 months and reporting surgical success, IOP, or medication outcomes. Risk of bias in individual studies was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses using the DerSimonian-Laird method were performed for pooled surgical success, IOP reduction, and medication reduction. Subgroup analyses were conducted for Ahmed glaucoma valve (AGV), Ahmed ClearPath (ACP), Baerveldt glaucoma implant (BGI), Aurolab aqueous drainage implant (AADI), and Paul glaucoma implant (PGI). Twenty-three studies including 1082 pediatric patients (1233 eyes) were analyzed. The overall pooled surgical success rate was 76% (95% CI, 71.1%-80.3%; I2 = 73.6%). Subgroup success rates were 70.7% for AADI, 78.9% for ACP, 73.0% for AGV, 82.3% for BGI, and 80.0% for PGI. The pooled mean IOP reduction was -16.14 mmHg (95% CI, -17.06 to -15.21; I2 = 88.3%), and the mean reduction in glaucoma medications was -1.63 (95% CI, -1.76 to -1.51; I2 = 91.4%). Meta-regression analysis demonstrated that longer follow-up duration was associated with lower surgical success and a smaller reduction in medication use, suggesting that medication requirements increased over time. GDD implantation in pediatric glaucoma is associated with meaningful IOP reduction, decreased medication burden, and an overall favorable surgical success rate across diverse pediatric glaucoma subtypes. However, substantial heterogeneity, non-uniform success definitions, and declining success with longer follow-up suggest that long-term durability may be limited, and outcomes should be interpreted cautiously, particularly in inter-device comparisons.
Orbital reconstruction materials and implants are central to restoring orbital anatomy and function after trauma and related defects. Although research has expanded steadily, the global landscape, thematic evolution, and intellectual structure of this field have not been systematically characterized. This study provides a bibliometric overview of worldwide research on orbital reconstruction materials and implants. Records were retrieved from the Web of Science Core Collection and PubMed on March 10, 2026. After screening, deduplication, and eligibility assessment, 1909 articles and reviews were included. Records were standardized before analysis. CiteSpace and VOSviewer were used to analyze publication trends, collaboration networks, journal distribution, keyword co-occurrence, burst terms, cited references, and thematic clusters. The earliest included study was published in 1965, and publication output generally increased over time. Thematic analyses suggested a shift from conventional trauma repair toward material-oriented optimization, orbital volume restoration, and, more recently, patient-specific and digitally assisted reconstruction. Keyword and clustering analyses remained centered on clinically defined reconstructive problems, particularly orbital fracture repair, implant selection, and imaging-based evaluation. Burst analyses indicated growing attention to patient-specific implants, digital planning, comparative strategies, and clinically meaningful postoperative outcomes. Orbital reconstruction materials research has become multidisciplinary but remains clinically focused. Current evidence suggests a transition beyond simple defect repair toward more precise and individualized implant-guided reconstruction. Future progress will likely depend less on expanding implant options alone and more on stronger comparative evidence for selective, defect-specific, and clinically meaningful use of existing strategies.
Sjögren's syndrome (SjS) is a chronic autoimmune disease primarily characterized by xerostomia, often accompanied by xerophthalmia, cutaneous dryness, arthralgia, and stiffness. Mesenchymal stem cell (MSC)-based therapies have shown promising immunomodulatory potential in autoimmune diseases, yet their efficacy in SjS remains uncertain. Before advancing to clinical application, a systematic evaluation of preclinical evidence is essential to clarify their therapeutic impact and experimental consistency. This systematic review and meta-analysis were registered in PROSPERO (CRD42023471348) and conducted in accordance with PRISMA guidelines. Comprehensive searches were performed in PubMed, Embase, Scopus, Cochrane Library, and Web of Science up to 1 May 2025. Random-effects meta-analyses were conducted to assess changes in salivary flow rate (SFR), inflammatory infiltration, and cytokine expression. A total of 25 studies met the inclusion criteria. Pooled analyses demonstrated that MSCs, MSC-derived exosomes, and MSC-conditioned medium significantly improved stimulated SFR (standardized mean difference = 3.19, 95% confidence interval 2.50-3.88, P < .001) and reduced inflammatory infiltration (standardized mean difference = -2.04, 95% confidence interval -2.66 to -1.43, P < .001). MSC-based therapies decreased serum levels of proinflammatory cytokines (interleukin-6 [IL-6] and interferon-gamma) and increased IL-10. Exploration of heterogeneity indicated that MSC type and dosage influenced SFR outcomes, MSC intervention type affected inflammatory infiltration and serum IL-6 levels, and MSC dosage influenced serum IL-10 levels. MSC-based therapies show potential for treating SjS in animal models, improving salivary secretion, reducing inflammation, and modulating immune cytokines. Substantial heterogeneity across studies highlights the need for standardized protocols regarding MSC source, dosage, and treatment duration before clinical translation.
To evaluate the effectiveness and safety of adjunctive photobiomodulation (PBM) or low-level laser therapy (LLLT) combined with exercise-based rehabilitation in reducing pain and improving function in individuals with patellofemoral pain syndrome (PFPS). PubMed, Scopus, Embase, Web of Science, PEDro, the Cochrane Library, and China National Knowledge Infrastructure were searched from inception to October 2025. Randomized controlled trials (RCTs) were included if they examined PBM/LLLT with clearly reported parameters compared with placebo, sham, or no-intervention controls in individuals with PFPS. Studies with mixed knee pathologies or nonrandomized designs were excluded. Two reviewers independently extracted data on participant features, PBM parameters, interventions, comparators, outcomes, and adverse events. Risk of bias was assessed using the Cochrane tool, with disagreements resolved by consensus. Four RCTs (n=162) were eligible. Meta-analysis using a random-effects model showed a statistically nonsignificant trend favoring PBM for pain reduction (effect size=-1.520; 95% confidence interval: -3.542 to 0.502; P=.097), with substantial heterogeneity (I2=91.1%) and a wide 95% prediction interval (-5.880 to 2.840). Importantly, the 4 included trials used distinct PBM delivery approaches, including laser acupuncture, PBM combined with trigger point therapy, classic PBM, and monochromatic infrared energy. This diversity may limit the validity of pooling these heterogeneous interventions within a single meta-analysis. Individually, PBM produced greater short-term pain reduction and some functional improvements in certain trials. No adverse events were reported. PBM/LLLT may provide short-term pain relief and modest functional benefits for young adults with PFPS and appears to be safe. However, the considerable variability among PBM modalities, including acupuncture-based laser stimulation, PBM combined with trigger point therapy, conventional PBM, and monochromatic infrared energy, introduces important methodological heterogeneity and raises concerns regarding the appropriateness of aggregating these interventions. In addition, the limited sample sizes and heterogeneous PBM protocols reduce confidence in these findings. Larger, standardized RCTs are needed.
Silicone oil (SO) is widely used as a long-term intraocular tamponade, yet its multiphase behavior in vivo remains incompletely understood. While oil-in-water (O/W) emulsification has been extensively studied, the potential formation of water-in-oil (W/O) droplets within the oil phase has received little attention. Here, we provide the first systematic in vivo evidence for W/O droplet formation during long-term vitreous tamponade using a controlled porcine model complemented by analysis of explanted human SO samples. W/O droplets were detected directly within the vitreous cavity, demonstrating that intraocular SO functions as a dynamic multiphase soft material rather than a strictly single continuous phase. A pronounced dependence of droplet size distributions on sampling conditions was observed. Aspiration through narrow-gauge needles induced shear-driven droplet fragmentation, whereas coaspiration of aqueous fluid during infusion generated large artifactual droplets, highlighting that explantation procedures can strongly bias ex vivo observations. Oil viscosity modulated the sensitivity of the system to shear but did not determine droplet occurrence. Complementary in vitro experiments confirmed that needle passage fragments pre-existing droplets rather than inducing de novo droplet formation. By integrating in vivo observations with in vitro phase behavior and interfacial viscoelasticity data, we establish a mechanistic framework in which shear-driven emulsification and protein-mediated interfacial stabilization govern W/O droplet formation and persistence in oil-dominated biological environments. These findings demonstrate that intraocular SO should be regarded as a confined, protein-active multiphase material system and that clinical sampling itself represents a microcapillary shear process influencing observed microstructures. Beyond ophthalmology, this work highlights the critical role of interfacial phenomena and sampling-induced artifacts in the characterization of oil-based biomaterials and soft multiphase systems in complex biological settings.
Dry eye disease (DED) is a prevalent and multifactorial condition that significantly impacts the ocular surface, characterized by symptoms of discomfort, visual disturbance, and tear film instability. Recent research has increasingly focused on the ocular surface microbiome (OSM) and its potential role in the pathogenesis and progression of DED. The OSM consists of a diverse community of microorganisms, including bacteria, fungi, and viruses, that interact with the host to maintain ocular surface health. Dysbiosis, or the imbalance of these microbial communities, has been linked to various ocular surface disorders, including DED. This review comprehensively summarizes the current understanding of the differences in OSM between healthy individuals and patients with different types of DED, such as aqueous-deficient dry eye, evaporative dry eye, and DED associated with autoimmune conditions. Additionally, it explores the detection methods used to study the OSM, highlighting the strengths and limitations of culture-based approaches, 16 S rRNA sequencing, metagenomic shotgun sequencing, and emerging technologies like 2bRAD-M. The review also outlines future research directions, emphasizing the need for advanced multi-omics approaches, personalized microbiome-based therapies, and longitudinal studies to further elucidate the role of the OSM in DED. By enhancing our understanding of the OSM composition and function, these insights may lead to innovative diagnostic and therapeutic strategies for managing DED.
The anterior chamber of the eye (ACE) provides a minimally invasive, immune-privileged site for pancreatic islet engraftment. However, loss of immune privilege during revascularization can trigger inflammation and graft rejection. In this study, we compared ocular and systemic immunologic responses associated with accepted and rejected islet allografts in the ACE. Lewis rat recipients underwent ACE allogeneic islet transplantation without immunosuppressive agents. Ocular grafts and spleens were examined by histology and immunofluorescence for effector and regulatory T-cell (Treg) populations. Systemic and local cytokines were also quantified and compared between accepted and rejected groups. Graft function (glycemic control) was monitored for 30 days, and diabetic retinopathy development was evaluated histologically. We found glycemic control was lost by 3 weeks in allo-rejected rats, whereas allo-accepted rats maintained euglycemia throughout this period. Rats with accepted grafts demonstrated reduced local immune cell infiltration in ACE locally and increased splenic Foxp3+ Treg systemically. In contrast, rats with rejected grafts exhibited extensive T-cell infiltration in both the eye and spleen, decreased splenic Treg populations, elevated local and systemic inflammatory cytokines, and worsened glucose control and diabetic retinal development. Taken together, these results suggest that integrated profiling of local and systemic immunologic signatures effectively distinguishes accepted from rejected ACE islet allografts, and early postoperative monitoring of interleukin 6 (IL-6), interferon gamma (IFN-γ), and IL-10 within the first 3 weeks could facilitate timely, targeted immunosuppression therapy.
Dry eye disease (DED) is commonly described through tear-film instability, tear deficiency, evaporative stress, and ocular surface inflammation. These models remain central to diagnosis and treatment, but they do not fully explain symptom-sign discordance, persistent discomfort after surface-directed therapy, epithelial disease with reduced corneal sensation, or variable treatment responses. In this structured narrative review, we synthesize DED-specific, phenotype-specific, adjacent ocular surface, and translational evidence relevant to a bidirectional neuro-immune-epithelial axis involving corneal sensory nerves, trigeminal-parasympathetic reflexes, epithelial and goblet-cell barrier function, and immune-cell activation. Available sensory evidence indicates that corneal abnormalities in DED are heterogeneous: mechanical esthesiometry more often shows reduced sensitivity, whereas non-contact esthesiometry and pain-enriched cohorts may show hypersensitivity or mixed findings. In vivo confocal microscopy (IVCM) studies suggest concurrent changes in corneal nerve morphology and epithelial immune-cell density, but validated thresholds are not sufficient to define a routine neural DED subtype. Neural dysfunction is therefore considered a phenotype-dependent contributor or amplifier, rather than a universal nerve-first mechanism. Treatment implications are discussed according to evidence strength and directness. Varenicline nasal spray and acoltremon engage reflex or sensory tear pathways where approved; motugivatrep illustrates region-specific TRPV1 translation in Japan; diquafosol and rebamipide are epithelial/mucin-supportive therapies with indirect axis relevance; and cenegermin remains primarily a neurotrophic keratitis therapy with restricted relevance to selected DED phenotypes. Neuropeptide-specific targets, availability-limited device stimulation, and direct nerve-regenerative claims for photobiomodulation remain preliminary. This framework may support mechanism-based stratification and rational adjunctive therapy without replacing established DED classifications.
Diabetic Cardiac Autonomic Neuropathy (DCAN), a critical yet frequently underdiagnosed microvascular complication, is associated with increased mortality. Standard cardiovascular autonomic reflex tests (CARTs) are complex and time-consuming, hindering their widespread use in routine screening in clinical settings. This study aimed to develop and validate a predictive nomogram for DCAN in patients with diabetes using readily available clinical variables. We retrospectively analyzed the clinical data of 453 patients with type 1 or type 2 diabetes hospitalized at Shenzhen People's Hospital between February 2022 and December 2025. The dataset was randomly divided into training (70%) and validation (30%) cohorts. Key predictors were identified using a rigorous selection strategy that combined univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression. Four candidate prediction models (Logistic Regression (LR), Random Forest, Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM) were constructed and evaluated for discrimination, calibration, and clinical utility. The optimal model was visualized as a nomogram and interactive web calculator. The prevalence of DCAN in the study population was 45.0% (204/453). The following seven independent predictors were identified: a history of diabetic retinopathy (DR) or diabetic kidney disease (DKD), diabetes duration, age, heart rate (HR), fasting plasma glucose (FPG), and HbA1c. Among the algorithms tested, the LR model exhibited the most balanced performance in the validation cohort (area under the curve (AUC) = 0.838) with the highest sensitivity (77.0%) and was thus selected as the optimal prediction tool. Consequently, the LR model was transformed into a predictive nomogram. This nomogram demonstrated good calibration and potential clinical utility for individualized risk assessment. We successfully developed and validated a high-sensitivity prediction model for DCAN applicable to type 1 and type 2 diabetes. The developed visual nomogram and interactive web-based tool are cost-effective and user-friendly instruments that can facilitate early risk assessment and personalized clinical management.
The purpose of this study was to develop a machine learning-based algorithm based on a combination of magnetic resonance imaging (MRI) and color-Doppler ultrasound (CDUS) to characterize lacrimal gland lesions. All patients with a lacrimal gland lesion who underwent MRI examination and CDUS between 2014 and 2025 were retrospectively included. Thirty-four imaging features were systematically assessed. A machine learning algorithm was trained with repeated nested cross-validation (RNCV) using random forest classifiers. Shapley additive explanations values were used to assess feature contributions. Simplified models using top 5 and top 10 best features were also developed. Diagnostic performance of the models was assessed using area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (PR AUC), balanced accuracy, precision, sensitivity, specificity, Brier score, Matthew's correlation coefficient and F1-score. One hundred patients (mean age, 49.6 years ± 17.8 [standard deviation] years) with 130 lesions (101 non-epithelial (NEL) and 29 epithelial (EL); 45 malignant) were included. The random forest binary machine learning model yielded 75.9% sensitivity (95% confidence interval [CI]: 39-100), 86.0% specificity (95% CI: 62.4-100), and an AUC of 0.883 (95% CI: 0.692-1.0) for differentiating between malignant and benign lesions and 73.2% sensitivity (95% CI: 33.5-100), 92.9% specificity (95% CI: 69.9-100), and an AUC of 0.93 (95% CI: 0.683-1) for differentiating between EL and NEL. In multiclass analysis (benign NEL, benign EL, malignant NEL and malignant EL), the random forest yielded a macro-averaged AUC of 0.857 (95% CI: 0.722-0.972) for the all-features model. A 5-top features signature comprising apparent diffusion coefficient and resistance index values, echogenicity, age and lesion type (infiltrative vs. well-delineated mass), yielded an AUC of 0.785 (95% CI: 0.641-0.941) to distinguish between the four classes. A combination of MRI and CDUS features demonstrated high diagnostic performance for characterizing lacrimal gland lesions. A simplified 5-feature signature showed similar diagnostic performance compared to the all-features model and warrants prospective multicenter validation for clinical application.
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To evaluate whether prompt-driven synthetic anterior segment disease (ASD) images preserve disease-relevant semantics for transferable ASD recognition. A total of 17,853 slit-lamp images from eight ASD categories were retrospectively collected. Expert ophthalmologists provided lesion annotations to construct aligned image-text pairs for fine-tuning a Stable Diffusion-based (SD) model. Generated images were evaluated by expert quality control, Turing test, Fréchet Inception Distance (FID), and Kernel Inception Distance (KID). Their diagnostic utility was assessed on an independent test set of 5,466 images using precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). Performance was compared across three model, against a real-image baseline, and under different synthetic data scales. Feature separability and interpretability were further examined using t-SNE and Grad-CAM. The SD model generated high-fidelity and semantically consistent ASD images guided by textual prompts. Expert assessment, Turing testing, and FID/KID analyses supported the quality of the synthetic images. On test set, the classifier achieved a micro-AUC of 0.977 (95% CI, 0.975-0.979) and a macro-AUC of 0.979 (95% CI, 0.977-0.981), with F1-scores ranging from 89.28% to 99.52% across disease categories. Synthetic-image training outperformed the real-image baseline, and performance improved with increasing numbers of generated training images. t-SNE visualization demonstrated clear inter-class feature separation, and Grad-CAM highlighted lesion regions. Prompt-driven synthetic anterior segment images preserved disease-relevant semantics and supported synthetic-to-real transfer in eye disease recognition, suggesting their potential value as complementary training resources for clinical artificial intelligence.
Herpes zoster ophthalmicus (HZO) is a vision-threatening disease, yet the long-term impact of the COVID-19 pandemic on its relative frequency and ocular complication profile remains insufficiently understood. This retrospective observational study aimed to quantitatively evaluate the pandemic's influence on the long-term relative frequency trends of HZO and its ocular complications. We analyzed 15 years of clinical data from January 2011 to June 2025 at a single institution in Japan. Interrupted time series analysis was employed to distinguish immediate level changes from long-term trend changes in disease relative frequency following the pandemic's onset in early 2020. Comparing the pre-pandemic and post-pandemic cohorts, the mean age of patients with HZO increased significantly by approximately eight years, and the proportion of cases complicated by uveitis increased from 22.7% to 41.6%. While the time series analysis indicated no immediate surge in the relative frequency of HZO at the pandemic's start, it revealed a highly significant acceleration in the long-term increasing trend of HZO cases. Furthermore, the frequency trend of herpetic uveitis exhibited a similar and statistically significant upward shift during the post-pandemic period. These findings suggest that the pandemic period was associated with a transient fluctuation in healthcare utilization, but it was also associated with a sustained acceleration in the relative frequency of HZO and a notably higher frequency of HZO-associated uveitis. The pronounced increase in cases among older adults underscores the critical importance of proactive herpes zoster vaccination and enhanced ophthalmic triage to prevent permanent vision loss in the post-pandemic era.
Lymphatic vessels perform diverse functions, ranging from fluid homeostasis to immune regulation, and arise from multiple cellular origins to form organ-specific networks. Despite their importance in kidney disease and transplant immunity, the origins of kidney lymphatics are unknown. Using genetic lineage tracing in mice, we identify two origins of kidney lymphatics. Most kidney lymphatics arise from a Tie2+ endothelial origin shared by other organs. However, Osr1+ mesoderm generates approximately 15% of kidney lymphatics, without contributing to heart, mesentery, and skin lymphatics. Interrogating single-cell transcriptomics data of mice and humans reveals lymphatic progenitors within Osr1+ mesoderm. Lymphatic clusters forming by de novo assembly originate from both Osr1+ and Tie2+ lineages. Deleting the lymphatic specification gene Prox1 in Osr1+ mesoderm reduces lymphatic cluster number, impairing overall lymphatic network complexity, with lower glomerular number. Thus, an Osr1+ mesodermal origin contributes to organ-specific lymphatic assembly, with consequences for kidney health, disease, and regeneration.
Ophthalmic manifestations as the initial presentation of chronic myeloid leukemia (CML) are rare. This case describes a 38-year-old man who presented with unilateral severe vision loss alongside bilateral ocular findings, including intraretinal hemorrhages, vascular tortuosity, cotton wool spots, and optic disc edema. Ophthalmic imaging, particularly optical coherence tomography (OCT), revealed bilateral retinal involvement, which was more severe in the left eye despite worse vision in the right eye. Systemic evaluation revealed critical hyperleukocytosis, splenomegaly, and Philadelphia chromosome positivity, confirming CML. The subsequent MRI during remission showed no abnormality. Treatment with hydroxyurea and nilotinib rapidly normalized white blood cell counts and reached major molecular response (MMR) along with complete visual recovery and normal retina and optic nerve. This case highlights the importance of recognizing ocular signs as potential indicators of life-threatening systemic diseases such as CML, warranting prompt diagnosis and intervention. Ocular signs not only help to confirm the primary diagnosis, but also may serve as a useful adjunctive marker for monitoring treatment response.