Lei Liu

Purpose: To investigate factors associated with graft rejection after penetrating keratoplasty in patients with mechanical corneal injury and evaluate their predictive value. Methods: This retrospective study included 50 patients with mechanical corneal injury who underwent penetrating keratoplasty between 2019 and 2025. Clinical variables, including onset duration, preoperative treatment, and corneal pathological changes, were analyzed. Univariate and multivariable logistic regression, time-to-event analysis, stratified analysis, mediation analysis, and receiver operating characteristic curve analysis were performed. Results: Prolonged onset duration and preoperative corneal ulceration were associated with an increased risk of postoperative graft rejection, whereas preoperative treatment was associated with a reduced risk. With increasing onset duration, corneal neovascularization and fibrosis increased, whereas corneal edema decreased. Mediation analysis showed that these associations were mainly driven by direct effects. Prediction models demonstrated good discriminatory performance. Conclusions: Prolonged onset duration and preoperative corneal ulceration may be risk factors for postoperative graft rejection in patients with mechanical corneal injury undergoing corneal transplantation, whereas preoperative treatment may be protective. Therefore, early intervention and disease course control are of great importance for improving transplant prognosis. These findings may provide a reference for preoperative risk stratification and perioperative management.

Background/Objectives: To determine whether prior cardiovascular disease (CVD) independently predicts diabetic retinopathy (DR) in adults with newly diagnosed type 2 diabetes mellitus (T2DM). Methods: A retrospective nationwide population-based cohort study was conducted using the Korean National Health Insurance Service database. Adults aged ≥40 years with newly diagnosed T2DM were identified after a 7-year washout period. After 1:1 propensity score matching on age and sex, the analytical cohort comprised 38,812 patients per group. Results: After full covariate adjustment, prior CVD was not independently associated with any DR (HR, 1.01; 95% confidence interval [CI], 0.99–1.04; p = 0.262), NPDR (HR, 1.01; 95% CI, 0.98–1.03; p = 0.605), PDR (HR, 1.01; 95% CI, 0.95–1.06; p = 0.835), or VTDR (HR, 1.00; 95% CI, 0.95–1.06; p = 0.893). Fine–Gray models, accounting for higher all-cause mortality in the prior CVD group after matching (25.2% vs. 22.1%), revealed slightly lower sHR for any DR (sHR, 0.97; 95% CI, 0.95–0.99; p = 0.014) and NPDR (sHR, 0.97; 95% CI, 0.94–0.99; p = 0.005). Conclusions: Prior CVD was not independently associated with incident DR. The lower sHRs may partly reflect competing mortality and should not be interpreted as DR protection. Overall, CVD history was not a criterion for intensified DR screening.

Background: Healthier lifestyles are associated with better healthy ageing, yet whether these benefits are comparable across countries, and to what extent they depend on broader social and environmental contexts, remains poorly understood. Methods: We harmonised data from six representative ageing cohorts spanning 32 countries. Longitudinal analyses were conducted in 76,366 participants from five cohorts, and cross-sectional analyses included 155,644 adults aged 50 years or older. We constructed a four-component healthy lifestyle score (HLS-4) based on smoking status, alcohol consumption, physical activity, and body mass index (BMI), and examined its association with the ATHLOS Healthy Ageing Index (HAI). Using survey-weighted country-specific models, we estimated standardised predictive differences across lifestyle levels and quantified between-country heterogeneity. Effect modification by country-level social determinants of health (SDOH) was assessed using random-effects meta-analysis and meta-regression. Results: Across nearly all countries, healthier lifestyles were associated with higher healthy-ageing scores, but the magnitude of these associations varied substantially. Under the primary model adjusted for age, biological sex, living region, education, wealth, and marital status, the HAI difference between the healthiest and least healthy lifestyle levels ranged from 1.57 (95% CI: 1.18–1.97) in India to 7.24 (95% CI: 5.23–9.26) in Austria; estimates were slightly attenuated after additional adjustment for chronic disease burden. Indicators reflecting greater economic development, higher healthcare access and quality, stronger climate-adaptation capacity, and broader urban infrastructure coverage showed positive effect modification of the HLS-4 and healthy-ageing association, whereas income inequality, greater exposure to extreme climate events, and higher reliance on out-of-pocket health expenditure showed negative effect modification. Longitudinal joint modelling yielded directionally consistent cumulative patterns over time. Conclusions: Findings suggest that health returns associated with healthy lifestyles are not universally equivalent across countries, and that structural factors may modify the extent to which individual lifestyle patterns translate into healthy ageing.

Purpose: Congenital microphthalmia is characterized by arrested ocular development, resulting in restricted biomechanical stimulation associated with orbital bone growth and craniofacial deformity on the affected side. Self-inflating spherical hydrogel orbital implantation has been clinically used to compensate for orbital volume deficiency and stimulate orbital growth. However, postoperative hydrogel implant malposition occasionally occurs. This study aimed to investigate the biomechanical effects of displaced self-inflating spherical hydrogel implants on biomechanical stimulation associated with orbital bone growth using a three-dimensional finite element model of congenital microphthalmia. Methods: Orbital CT data from a child with congenital microphthalmia were selected from the institutional database. CT images were imported into a simulation platform to reconstruct the geometric structure of the skull. Based on CT measurements of the globe and extraocular muscles, three-dimensional CAD models of the globe, extraocular muscles, and self-inflating spherical hydrogel implant were generated. A three-dimensional finite element model of the orbital bones and intraorbital tissues was then established. A 3-mL self-inflating spherical hydrogel implant was placed at two extraconal retrobulbar positions: inferonasal (Model 1) and inferotemporal (Model 2). The expansion process of the hydrogel implant was simulated, and finite element analysis was performed to obtain stress distribution and radial displacement maps of the orbital bones for biomechanical evaluation. Results: Model 2 showed higher orbital biomechanical response than Model 1. Von Mises stress increased from 10.15–278.15 kPa (Model 1) vs. 200.05–425.36 kPa (Model 2) with hydrogel expansion (3–9×), and displacement reached 0.406 μm vs. 0.703 μm, respectively. Stress and displacement were concentrated near implant-adjacent walls, with inferotemporal dominance in Model 2. Central-point analysis confirmed consistent stress–displacement coupling, with greater overall and regional orbital deformation in Model 2. Conclusion: In children with congenital microphthalmia, displaced hydrogel implants located in the deep inferotemporal orbit may still effectively stimulate biomechanical stimulation associated with orbital bone growth and therefore may support careful clinical observation in selected cases and warrants further validation in larger clinical studies. However, when malposition occurs in the superficial inferotemporal orbit and causes visible cutaneous protrusion, surgical correction should be considered.

Myopia has emerged as one of the most pressing global public health challenges, characterized by rapidly increasing prevalence, earlier onset, and growing risk of vision-threatening complications. While genetic susceptibility contributes to refractive development, accumulating evidence indicates that environmental exposures play a dominant role in shaping ocular growth trajectories. Spatial altitude represents a unique ecological exposure integrating hypobaric hypoxia, enhanced solar radiation, distinctive climatic conditions, and lifestyle patterns. Epidemiological observations consistently demonstrate lower myopia prevalence among high-altitude populations compared with lowland regions, suggesting potential protective environmental influences. This review synthesizes current epidemiological findings and mechanistic hypotheses regarding altitude-associated differences in refractive status. We discuss potential pathways involving light-induced dopaminergic signaling, hypoxia-mediated molecular regulation, behavioral adaptations, circadian synchronization, and gene–environment interactions. We further highlight limitations of existing evidence and propose future research directions integrating environmental monitoring, longitudinal cohort studies, and multi-omics approaches. Understanding altitude-related influences on ocular growth may provide novel insights into environmental interventions for myopia prevention and contribute to strategies addressing the global myopia epidemic.

BACKGROUND: Target organ damage is crucial for hypertension risk stratification. However, the lack of sensitive assessment tools for early target organ damage in the presence of elevated blood pressure limits timely intervention. This study used the retina to investigate subclinical neurovascular damage and identify early imaging biomarkers. METHODS: We monitored male spontaneously hypertensive rats and Wistar-Kyoto controls weekly from 4 to 9 weeks of age. Weekly assessments included noninvasive blood pressure and multimodal fundus imaging, including optical coherence tomography, optical coherence tomography angiography and electroretinography. Histological analyses and fluorescein fundus angiography validated structural microvascular changes and blood-retinal barrier integrity. RESULTS: The blood pressure of spontaneously hypertensive rats increased significantly from 5 weeks of age ( P P <0.001). CONCLUSIONS: In spontaneously hypertensive rats, superficial microvascular rarefaction and inner retinal dysfunction represent the initiating pathological events, preceding blood-retinal barrier breakdown and macrovascular remodeling. Optical coherence tomography angiography-quantified superficial vascular plexus density is a sensitive and objective imaging biomarker for assessing retinal damage during the prehypertensive stage, which significantly precedes macrovascular signs.

Limited data exist on long-term trajectories of functional scores before and after stroke diagnosis. We analyzed 1325, 754, 3907, and 2902 incident strokes from China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), and Survey of Health, Ageing and Retirement in Europe (SHARE), respectively. Two non-stroke participants were matched to each stroke case by age and gender. Linear mixed models estimated trajectories of functional scores over time in individuals with and without stroke. Here we show that individuals with stroke have fewer memory but more depressive symptoms than those without stroke in most years from stroke onset with the largest difference several years after stroke onset. A steeper decline in memory is found among stroke patients for several years before and after stroke onset (adjusted β (95% CI) for annual change in CHARLS: -0.062 (-0.074, -0.049), ELSA: -0.024 (-0.03, -0.018), HRS: -0.026 (-0.03, -0.023)). Stroke participants have greater limitations in activities of daily living (ADL) than non-stroke participants, starting several years before stroke onset, with the difference increasing for five years after stroke onset. After that, the difference remains stable or decreases. Similar results are seen in instrumental ADL and the frailty index. Women have greater increases in CESD, mobility limitations, and frailty index compared with men. Our analysis of data from multiple countries identifies the period when related functional scores show the greatest change, highlighting a critical window for stroke prevention and management.

With global population ageing, maintaining independence through activities of daily living (ADL) and instrumental activities of daily living (IADL) is increasingly important for older adults. Existing evidence suggests that ADL/IADL disability is associated with higher mortality, but global evidence in middle-aged and older populations remains limited. We conducted a multi-cohort pooled study using harmonized data from five major longitudinal studies in the Harmonized Gateway to Global Aging Data: the Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Ageing (ELSA), and Mexican Health and Aging Study (MHAS). We used Cox proportional hazards models to examine the associations of ADL and IADL disabilities with all-cause mortality. We further assessed additive interaction between ADL and IADL disabilities on mortality and conducted exploratory mediation analyses to explore the roles of chronic conditions and depression in these associations. The final analytic sample included 13,466 participants from CHARLS, 9,171 from ELSA, 21,042 from HRS, 13,463 from MHAS, and 35,934 from SHARE. Across all cohorts, ADL/IADL disability was associated with higher all-cause mortality. In pooled analyses, compared with no disability, the hazard ratio (HR) for mortality was 1.44 (95% CI 1.36-1.54) for one ADL disability item and 2.14 (2.01-2.27) for two or more ADL disability items. For IADL, the HR was 1.59 (1.42-1.79) for one IADL disability item and 2.41 (2.26-2.56) for two or more items. Exploratory mediation analyses suggested that the potential contribution of chronic conditions varied across cohorts and was not evident in CHARLS, whereas depression showed potential contributions across cohorts. Statistically significant additive interaction between ADL and IADL was detected in CHARLS and MHAS. Time-dependent Cox models suggested that, in some cohorts, the HR for the association between higher disability burden (≥2 items) and mortality decreased over follow-up time. ADL/IADL disability is associated with increased long-term all-cause mortality among middle-aged and older adults across five major cohorts. Chronic conditions and depression may represent potential contributors to these associations. These findings underscore health inequities faced by people with disabilities and highlight the need for health systems to better include and serve people with disabilities in policies and services.

Purpose The cross-sectional and longitudinal associations between accelerated biological ageing and the risk of cataract and other blinding eye diseases (including glaucoma and age-related macular degeneration (AMD)) remain unclear. Methods We included participants aged 40 and above with biological ages, including phenotypic age (PhenoAge), Klemera-Doubal method (KDMAge) and retinal age (RetiAge), from the US National Health and Nutrition Examination Survey (NHANES) and UK Biobank. The cross-sectional analyses were conducted to identify associations of PhenoAge or KDMAge acceleration with cataract and other blinding eye diseases using logistic regression. In a prospective UK cohort, we explored the relationships between the acceleration of PhenoAge, KDMAge or RetiAge and cataract and other blinding eye diseases using the Cox proportional hazards model. Results This study consisted of 5433 participants from the US NHANES and 269 615 participants from the UK Biobank. In both cross-sectional and longitudinal analyses, accelerated biological ageing was positively associated with an increased risk of cataract (all pConclusions Accelerated biological ageing might represent a potential target of assessment and intervention for cataract.