Teaching NeuroImage: Bilateral Posterior Limb Internal Capsule T2 Hyperintensity and Severe Cerebellar Atrophy in 2 Lifelong Friends.

Posterior capsule opacification (PCO) significantly hinders the accurate assessment of glaucomatous visual field (VF) impairment. While pattern deviation (PD) is theoretically intended to correct for generalized sensitivity loss, its accuracy in eyes with PCO remains unverified. This study evaluated 52 eyes of 46 patients with open-angle glaucoma and PCO. Following laser capsulotomy, visual acuity significantly improved from 0.22 to 0.10 logarithm of the minimum angle of resolution (P < 0.01), and mean total deviation (mTD) improved from - 8.89 dB to -6.46 dB (P < 0.01). This post-capsulotomy mTD served as the reference for true impairment. A linear regression model incorporating pre-capsulotomy visual acuity and mTD was developed and validated using leave-one-out cross-validation. The absolute estimation error of this model was significantly smaller (median: 1.66 dB [interquartile range: 1.04-2.77 dB]) compared to that of PD (2.14 dB [1.10-3.99 dB], P < 0.01). Notably, PD-based errors were significantly influenced by both glaucoma severity and the degree of PCO-induced sensitivity loss, resulting in substantial underestimation in advanced cases. These findings indicate that PD is prone to inaccuracy in eyes with PCO, whereas the regression model offers a more precise estimation.

To evaluate the long-term safety, stability, and visual outcomes of diagonal haptic capture (DHC) of a 4-haptic hydrophilic acrylic intraocular lens (Akreos adapt, Bausch&Lomb) in eyes with posterior capsule deficiency and an intact anterior capsulorhexis. Single tertiary referral center. Retrospective interventional case series. Medical records were reviewed for patients who underwent cataract surgery complicated by posterior capsule rupture and in whom DHC was used for IOL fixation between 2015 and 2023. Twenty eyes of 20 patients were identified. Fellow eyes with uneventful in-the-bag implantation of the same IOL model served as controls. Median follow-up was 2 years (mean 2.6±2.1 years; range 0-6 years) based on data from referring ophthalmologists, and 8 years (mean 6.0±2.8 years; range 2-9 years) for patients examined at the study center. Mean postoperative corrected distance visual acuity did not differ significantly between DHC eyes and fellow eyes (p>0.4). Refractive predictability and intraocular pressure were comparable between groups. All IOLs remained well centered with normal tilt throughout follow-up. No cases of pigment dispersion glaucoma, uveitis-glaucoma-hyphema syndrome, pseudophacodonesis, or late IOL dislocation were observed. In a subset of eyes, anterior segment optical coherence tomography demonstrated adequate clearance between the IOL and posterior iris without evidence of iris chafing. Diagonal haptic capture of a 4-haptic hydrophilic acrylic IOL provided stable long-term fixation, satisfactory visual and refractive outcomes, and a low incidence of complications. However, these results may be IOL-specific.

Knee osteoarthritis is a major cause of chronic pain and functional limitation, particularly in advanced stages. Intra-articular steroid injections and genicular nerve interventions are commonly used for pain control; however, these methods mainly target the anterior knee and may not sufficiently relieve pain originating from the posterior capsule. The infiltration between the popliteal artery and the capsule of the knee (IPACK) block is a regional anesthesia technique that provides posterior knee analgesia without causing motor weakness. Evidence regarding its effectiveness in chronic, non-surgical knee osteoarthritis is limited. This study aimed to evaluate whether adding an ultrasound-guided IPACK block to intra-articular steroid injection improves pain and functional outcomes in patients with advanced knee osteoarthritis. This retrospective observational cohort study included 98 patients with Kellgren-Lawrence stage 3-4 knee osteoarthritis who had persistent pain despite conservative treatment. Patients received either intra-articular steroid injection alone (IASI group, n = 50) or intra-articular steroid injection combined with an IPACK block (IASI+IPACK group, n = 48). Pain severity was assessed using the Numeric Rating Scale (NRS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Evaluations were performed at baseline, 1 month, and 6 months after the procedure. Non-parametric tests were used for statistical analysis, and p < 0.05 was considered significant. Both groups showed significant improvement in NRS and WOMAC scores at 1 and 6 months compared with baseline (p < 0.05). The IASI+IPACK group demonstrated greater pain reduction at 1 month and significantly better WOMAC Function and Total scores at both follow-up visits compared with the IASI group (p < 0.05). Although scores increased slightly between 1 and 6 months in both groups, outcomes remained improved compared with baseline. No major complications were observed during the follow-up period. However, minor adverse events were not systematically recorded due to the retrospective nature of the study. Adding an IPACK block to intra-articular steroid injection may provide additional benefit in early pain relief and functional improvement in patients with advanced knee osteoarthritis. This combined approach appears to be a safe and useful option for patients who are not surgical candidates or are awaiting arthroplasty. ClinicalTrials.gov, NCT07269444. Retrospectively registered on 20 November 2025.

To compare the intraoperative complication rates and incidence of postoperative day 1 (POD1) intraocular pressure (IOP) elevation in primary phacoemulsification cataract surgery performed by residents and staff surgeons in a teaching hospital and determine the risk factors associated with posterior capsule tear (PCT) and POD1 IOP elevation. This retrospective study included all cases of primary phacoemulsification in patients aged 18 years or older, performed by residents and staff surgeons from May 27, 2022, to May 31, 2023 in a tertiary eyecare center in Turkey. There were no exclusion criteria. Data collected included primary surgeon, level of experience, preoperative status of cases, intraoperative complications, other operative details and POD1 IOP measurements. A total of 1500 surgeries were included; 68.8% were performed by residents. Overall intraoperative complication rates were similar in groups in simple and complex cases. There was no statistically significant difference in PCT rates between groups in simple (2.4% and 1.9%, p = 0.800) and complex cases (3.7% and 5.1%, p = 0.455). Rate of POD1 IOP elevation above 25 mm Hg was also similar in groups (22.7% and 22.6%, p = 0.903). Pseudoexfoliation + small pupil and special cataracts were significant risk factors for PCT among residents (p = 0.048 and p = 0.033, respectively). Pseudoexfoliation + small pupil, glaucoma or ocular hypertension and uveitis were significant risk factors for POD1 IOP elevation. Overall intraoperative complication and PCT rates were comparable between residents and staff surgeons in both simple and complex cases. Resident involvement was not a risk factor for POD1 IOP elevation.

To evaluate the success rate of different treatments for dissatisfaction after presbyopia-correcting intraocular lens (PrC-IOL) surgery and propose a management decision tree to maximize patient satisfaction. This was a retrospective evaluation of patients who were dissatisfied following PrC-IOL implantation. Evaluated outcomes included nature of visual complaints, treatment modalities employed for each type of complaint, and treatment success for each intervention. There were 140 eyes of 93 patients evaluated. PrCIOLs included trifocal (PanOptix), diffractive extended depth of focus (EDOF), and non-diffractive EDOF IOLs. Main drivers of dissatisfaction were blurred corrected vision (67.1%) and photic phenomena (48.6%). Interventions leading to the highest rates of improvement were IOL exchange (94%) and laser vision correction (LVC) (72%), whereas Nd:YAG capsulotomy (18.3%), spectacle correction (15.1%), and dry eye treatment (5.2%) were less successful interventions. Among the eyes that underwent IOL exchange, the cohort with intact posterior capsules had more eyes with ≥1 lines of CDVA gained (83.3% vs 0%, P < .001) and fewer eyes with ≥1 lines of CDVA lost (8.3% vs 55.6%, P = .04). The most effective treatments for patient dissatisfaction after PrC-IOL implantation were IOL exchange followed by laser vision correction, whereas glasses, Nd:YAG capsulotomy, and dry eye treatment alone were not effective. Although successful outcomes can be achieved following IOL exchange in eyes with open posterior capsules, eyes with intact capsules had better outcomes. Therefore, Nd:YAG capsulotomy should be delayed in the setting of PrC-IOL dissatisfaction until all other potential causes for dissatisfaction have been eliminated.

To characterize the morphological variations of feathery cataracts observed in post-vitrectomy gas-filled eyes using anterior segment optical coherence tomography (AS-OCT). A prospective observational study with a total of 25 eyes with transient feathery cataracts following gas-filled vitrectomy was included for AS-OCT evaluation of the posterior lens and capsule. Imaging was performed on postoperative day 1 and day 7 for all cases. The morphological variations of feathery cataracts were characterized using AS-OCT. Three distinct morphological patterns were identified based on the appearance of vacuoles on AS-OCT: dome-shaped, cuboidal-shaped, and diffuse thickening with poorly defined cystic spaces. Complete resolution of AS-OCT-defined morphological patterns was observed in all eyes within 7-10 days. The morphological characterization of feathery cataracts using AS-OCT is a novel finding and has not been previously reported. This novel imaging-based classification can aid in refining postoperative monitoring protocols and contribute to a better understanding of cataractogenesis mechanisms in gas-filled eyes.

To characterize the aqueous humor (AH) cytokine profiles across clinical subtypes of congenital cataracts with posterior polar abnormality (PPA) and to assess their associations with postoperative complications. This prospective study included 96 eyes with congenital cataracts divided into a PPA group (n = 78) and non-PPA controls (n = 18). The PPA group was stratified into four clinical subtypes: congenital cataract with persistent fetal vasculature (PFV, n = 27), posterior polar cataract (PPC; n = 16), posterior lenticonus (PL; n = 17), and posterior capsule defect (PCD; n = 18). Baseline demographics and biometrics were collected. Thirteen cytokines in AH were measured using Luminex xMAP technology. Postoperative complications, including visual axis opacification (VAO) and glaucoma-related adverse events, were evaluated with a minimum follow-up of 12 months. The PPA group showed differences in several cytokines compared with non-PPA controls, including higher vascular endothelial growth factor A (VEGF-A), fibroblast growth factor 2 (FGF2), and neurotrophin-4 (NT-4) and lower fibroblast growth factor 1 (FGF1) and platelet-derived growth factor-AA (PDGF-AA) (all q < 0.05, false discovery rate adjusted). Cytokine patterns varied across PPA subtypes, with substantial overlap. PFV showed higher levels of several markers, whereas PPC and PL showed lower levels. In exploratory Firth logistic regression, higher NT-4 (odds ratio [OR] = 1.16; 95% confidence interval [CI], 1.02-1.36; P = 0.028) and PDGF-AA (OR = 1.06; 95% CI, 1.01-1.12; P = 0.027) were associated with postoperative VAO. PPA showed AH cytokine differences compared with non-PPA controls. Across PPA subtypes, cytokine distributions showed substantial overlap despite exploratory differences in several markers. Higher NT-4 and PDGF-AA were associated with postoperative VAO in exploratory analyses and warrant further validation.

White cataracts pose substantial technical challenges during phacoemulsification because preoperative assessment of nuclear hardness is impossible and the risk of intraoperative complications is increased. The Eight-chop technique was developed to mechanically fragment the lens nucleus into eight pieces prior to ultrasound emulsification, potentially reducing intraocular stress. This study aimed to evaluate the safety and efficacy of the Eight-chop technique in eyes with white cataract and to compare surgical outcomes according to intraoperatively assessed nuclear hardness. This retrospective, single-center, single-surgeon observational study included eyes with white cataract that underwent phacoemulsification using the Eight-chop technique between January 2010 and March 2025. White cataract was defined as complete lens opacification with an absent red reflex. Nuclear hardness was classified intraoperatively using the Emery classification. Intraoperative parameters included operative time, phacoemulsification time, cumulative dissipated energy (CDE), aspiration time, and irrigation fluid volume. Postoperative outcomes included corneal endothelial cell density (CECD), endothelial morphology, intraocular pressure (IOP), and best-corrected visual acuity (BCVA), evaluated preoperatively and at 7 and 19 weeks postoperatively. Outcomes were compared among nuclear hardness groups. Of 12,642 cataract surgeries performed during the study period, 105 eyes with white cataract were included in the final analysis. Operative time, phacoemulsification time, and CDE increased significantly with increasing nuclear hardness (all p < 0.01), whereas aspiration time and irrigation fluid volume did not differ significantly among groups. Mean CECD loss at 7 and 19 weeks postoperatively was minimal, with no significant differences among nuclear hardness groups. Transient postoperative changes in corneal endothelial morphology were observed but resolved by 19 weeks. Postoperative IOP tended to decrease significantly in eyes with higher nuclear hardness. BCVA improved markedly in all groups, and early postoperative differences according to nuclear hardness disappeared over time. Posterior capsule rupture occurred in 2 of 105 eyes, and no cases of dropped nucleus were observed. The Eight-chop technique was associated with safe and efficient phacoemulsification in eyes with white cataract. By mechanically prefragmenting the lens nucleus into eight segments prior to ultrasound application, the technique may reduce intraocular stress and facilitate stable nuclear management even in eyes with advanced nuclear hardness. This approach was associated with favorable endothelial and visual outcomes with an acceptable complication rate in this retrospective series.

Near-infrared activated drug-eluting intraocular lens enable synergistic photothermal and chemotherapeutic therapy for posterior capsule opacification.

ABSTRACT Female handball players represent an underrepresented yet potentially high-risk population for shoulder injuries. This study investigated shoulder adaptations in elite female handball players by assessing posterior capsule thickness (PCT), supraspinatus tendon thickness (STT), and acromiohumeral distance (AHD) using ultrasound, alongside range of motion (ROM) and isokinetic strength. Twenty athletes (18–32 years) were evaluated bilaterally. No side-to-side differences were observed in PCT or AHD. In contrast, STT and occupation ratio were greater in the throwing shoulder. The throwing shoulder demonstrated reduced internal and greater external rotation ROM, while total rotational ROM remained similar between sides. Internal rotation strength was higher in the throwing shoulder at both angular velocities. No associations were found between PCT and ROM or strength. AHD was positively correlated with external rotation ROM and the external-to-internal rotation strength ratio. These findings suggest sport-specific asymmetrical adaptations in elite female handball players without evidence of posterior capsular thickening.

Background: Opacified posterior capsule of the human lens (PCO) is a common vision-blurring complication after cataract surgery. YAG laser capsulotomy is an effective, relatively safe procedure to treat PCO, effectively improves the visual acuity (VA) and contrast sensitivity. Increase intraocular pressure (IOP) following YAG laser is the mainly transient complication after the procedure. Aim of the study: to compare IOP elevation in diabetic versus non-diabetic patients following YAG laser of the posterior capsule to treat posterior capsular opacification. Patients and methods: This is non –randomized prospective comparative interventional study. The study was conducted on 60 eyes of 44 patients (26 males, and 18 females) who were attended to Ophthalmology department at Al-Zahraa University Hospital, with posterior capsular opacification after cataract surgery. Patients were divided into two equal groups: Group A diabetic: 30 eyes in 19 patients, and Group B non diabetic :30 eyes in 25 patients. Surgeries was carried under surface anaesthesia , in a cruciate manner technique, least number of shots and least energy power to form an opening of the posterior capsule equal in diameter to the scotopic pupil size. Follow up was done after two hours, one day, one week, and one month after laser treatment. At each visit the patient was examined and measurement of uncorrected distance visual acuity and ( UDCVA), best distance corrected visual acuity (BDCVA), anterior segment examination by using slit lamp for anterior chamber evaluation (depth and content), IOL for any injuries and decentered , applanation tonometry and indirect ophthalmoscopy ,notation for any complications . Results: In Group A, mean baseline IOP before Nd-YAG laser posterior capsulotomy was 13.45 mmHg. At two hours, one day, one week and one month following the operation, IOP was 15.47, 14.06, 13.81 and 13.64 mmHg respectively. No IOP elevation above the pre-laser level at the end of follow up visits at one month. In Group B: mean baseline IOP was 14.19 mmHg. At two hours, one day, one week and one month after capsulotomy, IOP was 16.01, 14.88, 14.92 and 13.92 mmHg respectively. No IOP elevation more than 5 mmHg was observed at the end of follow up visits. The rise in IOP was transient. The difference between mean pre-laser IOP and two hours after laser capsulotomy was statistical highly significant and was significant one day after the operation. Differences were insignificant after one week and one month. Differences between both groups were non-significant at all follow up visits. There were no persistent elevation of IOP after one month follow up period , and IOP returned to the pre-laser level in both groups. No glaucomatous fundus changes were observed in any of our cases. Conclusion: Nd-YAG is an effective a quick, painless laser procedure treatment modality for posterior capsular opacification. IOP elevation is a frequent complication after YAG laser capsulotomy, which may be directly proportional to laser energy power, the number of shots, and the cumulative energy. The maximum elevation of IOP is two hours after the procedure and is usually becomes normalized within seven days after the operation.

Ultrasound (US) is the most accurate tool for the assessment of thyroid nodules (TNs). Despite the subcapsular position of TNs may represent a game changer for clinical practice in selecting cases for biopsy or surgery, this parameter is not included in US-based risk stratification systems. The present study evaluated the agreement of endocrinologists using US in clinical practice with the experts' results employed as reference standard. A sub-series of TNs for which the agreement between US expert endocrinologists and radiologists was perfect was assumed as reference. Participants of the 2025 Thyroid Update of Associazione Medici Endocrinologi (AME) were asked to assess TNs in a 3-choice answer: subcapsular, non-subcapsular, or uncertain. The agreement was determined according to majority consensus (i.e., ratings > 50% = final consensus outcome) and Fleiss κ (from 0.1 to 1.0). The series included 13 TNs (6/13 cancer, 7/13 echographically at high risk) whose median distance from the anterior and posterior thyroid capsule was 0 and 1.5mm, respectively. One hundred and six endocrinologists (females, 62%; age, < 40 years 33%; specialized professionals, 81%) participated as raters. The TNs assessed by experts as subcapsular were judged as subcapsular in 90% to 97% of votes. The TNs assessed as non-subcapsular by experts were classified as non-subcapsular by 3% to 48% of votes. The majority consensus fully matched the experts' assessment (κ = 1.0, p = 0.0003). The distance from the anterior thyroid capsule was an independent factor of assessment (p = 0.005, R2 = 0.86). Clinical endocrinologists largely agree with experts' assessment in subcapsular cases where experts had perfect concordance while uncertainty is present for non-subcapsular nodules. Future studies should establish a standardized definition of subcapsular TN.

Effect of prior intravitreal injections on the risk of posterior capsule rupture during cataract surgery: a single-surgeon matched case-control study

PurposeTo determine the incidence of posterior capsule rupture (PCR) and vitreous loss (VL) during cataract surgery in a Swiss tertiary care center. Furthermore, we aimed to evaluate preoperative risk factors associated with PCR/VL, including pseudoexfoliation (PEX), age, type of anesthesia, and the Triemli Cataract Score (TCS), a locally implemented preoperative risk assessment tool for surgical complexity.MethodsThis retrospective single-center cohort study included all phacoemulsification and refractive lens exchange procedures performed at Stadtspital Zürich between January 2021 and late August 2024. Data were retrieved from the Dendrite clinical database of the TCS and supplemented through manual chart review and surgical reports for identification of intraoperative complications. Univariable and multivariable logistic regression analyses were performed to evaluate associations between preoperative factors and the occurrence of PCR and/or VL.ResultsA total of 2’719 eyes were included in the study. PCR and/or VL occurred in 52 eyes (1.9%), including 45 cases of PCR (5 with concomitant VL) and 7 additional cases of isolated VL due to zonulolysis. In univariate analysis, PEX and a TCS ≥3 were significantly associated with an increased risk of PCR and/or VL (OR 2.72; p=0.003 and OR 2.38; p=0.002, respectively), while topical (vs. general) anesthesia was associated with a reduced risk (OR 0.51, p=0.019). In multivariate analysis, only PEX remained an independent risk factor (OR 2.38; p=0.013). The association between TCS ≥3 and PCR/VL just missed statistical significance (OR 1.79; p=0.057).ConclusionThe rate of PCR and/or VL during cataract surgery at a Swiss tertiary care center is comparable to international statistics. PEX is a strong and independent predictor for these complications; although the predictive power of TCS did not reach statistical significance in multivariable analysis, the observed trend suggests that risk-based preoperative scores such as the TCS may support risk-stratification and surgical planning in clinical practice.

Knee osteoarthritis (OA) is increasingly understood as a whole-joint disorder involving not only articular cartilage but also synovium, capsule, ligaments, tendon insertions, and adjacent periarticular soft tissues. Fascial and interfascial tissues have attracted growing interest in musculoskeletal medicine because of their continuity, force-transmission properties, sensory innervation, and potential relevance to pain generation and movement dysfunction. We describe a novel ultrasound-guided posteromedial knee injection targeting the posteromedial fascial-periarticular convergence zone, referred to operationally in this report as the "popliteal fascial retinaculum." This term is used as a descriptive procedural framework rather than a formally established anatomical structure. This convergence region involves the semimembranosus insertion, popliteus, oblique popliteal ligament (OPL), posterior capsule, proximal superficial medial collateral ligament (MCL), and adjacent popliteal fascial layers. The technique uses a structured scanning sequence beginning with transverse safety mapping of the popliteal neurovascular bundle, followed by posteromedial landmark identification and longitudinal localization of the target convergence zone. A 5-inch 22-gauge spinal needle is advanced in plane under real-time ultrasound guidance, and 30 mL of 5% dextrose with 0.1% lignocaine is distributed across five predefined target planes. Cadaveric feasibility was assessed in four lower limbs using 30 mL of 0.1% methylene blue delivered under ultrasound guidance according to the described technique. Gross layered dissection demonstrated dye staining of the intended target structures together with substantial extension into adjacent fascial, periarticular, perineural, and perivascular planes, with proximal interfascial spread along the posterior thigh. Histologic confirmation of intraneural or intravascular spread was not performed. These findings support preliminary anatomical feasibility of regional access and spread, but do not establish selective targeting, procedural safety, histologic precision, or clinical efficacy. This technical report describes a reproducible ultrasound-guided posteromedial knee injection technique supported by cadaveric dye-distribution findings, detailed sonoanatomic landmarks, and procedural video documentation. The technique appears anatomically plausible and technically feasible as a regional interfascial-periarticular access approach, but further prospective work is needed to determine reliability, safety, mechanism, targeting specificity, and clinical effectiveness.

Visualization of delicate membranous structures during cataract surgery is often limited under conventional surgical microscopes, particularly when tissues are transparent or obscured. This study aimed to evaluate the intraoperative visualization of delicate membranous structures during cataract surgery using swept-source intraoperative optical coherence tomography (SS-iOCT). This retrospective observational case series was conducted at the ophthalmology center of a Grade-A tertiary hospital in China. Six eyes of six patients [mean age, 55.3 years; 5 males (83.3%)] undergoing cataract surgery were included in the case series. The cases included Descemet's membrane detachment, cataract with exfoliative material, traumatic cataract, and age-related cataract. A microscope-integrated SS-iOCT system was used to obtain real-time, depth-resolved, cross-sectional images during surgery. SS-iOCT successfully captured high-resolution images of all eyes (100%), revealing subtle membranous structures undetectable under the surgical microscope. The system delineated fine separation planes, penetrated opaque media to reveal hidden lesions, identified posterior capsule ruptures, and visualized transparent structures, including the anterior hyaloid membrane. In five of the six eyes (83.3%), the intraoperative findings directly influenced the surgical strategy, enabling procedural modifications that enhanced safety and accuracy. SS-iOCT expands the intraoperative field of view, providing real-time recognition of subtle pathological and normal anterior segment membranes beyond the capacity of surgical microscopes. These actionable insights may guide surgical decision-making and support safer, more precise cataract surgery.

A BSTRACT Introduction: Cataract surgery in patients with small pupils presents significant challenges and potential complications. This study aimed to evaluate visual outcomes and effectiveness of various management strategies for small pupils during manual small incision cataract surgery (MSICS). Methods: This interventional study, conducted at a tertiary care center in Maharashtra, included 95 patients with pupils less than 5 mm in diameter undergoing MSICS between March 2023 and March 2025. Various management strategies were employed including pharmacological methods (intracameral phenocaine and adrenaline), mechanical dilation (stretch pupilloplasty and sphincterotomy), and expansion devices (iris hooks, BHEX ring). All surgeries were performed by a single surgeon. Patients were followed up on postoperative days 1, 3, 7, 21, and 6 weeks. Visual outcomes and complications were documented and analyzed. Results: The majority of patients (71.6%) were aged 61–80 years with nearly equal gender distribution. Diabetes mellitus (31.6%), pseudoexfoliation syndrome (18.9%), and posterior synechiae (7.4%) were the main causes of small pupils. Intracameral phenocaine was the most frequently used management strategy (38.9%). Posterior capsule rent was the most common intraoperative complication (5.3%), while 24.2% of surgeries had no complications. By 6 weeks postoperatively, 89.4% of patients achieved vision of 6/24 or better. There was no statistically significant difference in visual outcomes among different management techniques ( P &gt; 0.05). Conclusion: Small pupils in cataract surgery require a tailored approach based on the underlying etiology. With appropriate preoperative assessment and management strategy selection, good visual outcomes can be achieved regardless of the specific technique used. These findings have significant implications for resource-limited settings, suggesting that simpler techniques can achieve results comparable to more complex devices in appropriately selected cases.

Background The most common long-term complication of phacoemulsification cataract surgery is posterior capsule opacification or secondary cataract. Currently, neodymium-doped yttrium aluminum garnet is the most efficacious treatment for visually significant posterior capsule opacification in pseudophakic eyes. Laser capsulotomy is another option. Aims This study aimed to evaluate the central retina’s response to yttrium aluminum garnet laser capsulotomy using optical coherence tomography. Patients and methods This cross-sectional comparative study was carried out on 30 pseudophakic eyes of 30 patients who underwent phacoemulsification at the Ophthalmic Department, Faculty of Medicine, Tanta University. All patients underwent examination of visual acuity, intraocular pressure measurement, fundus examination, spectral domain optical coherence tomography, and slit lamp biomicroscopy. Results The mean central retinal thickness and all retinal quadrants in the inner circle (3 mm diameter) showed a highly significant difference ( P &lt;0.01) between the preoperative and 1-month postoperative values. In comparison to preoperative and 1-month postoperative values, the mean central retinal thickness and all retinal quadrants in the outer circle (5 mm diameter) exhibited a statistically significant difference ( P &lt;0.05). The two parameters exhibited a highly significant positive correlation ( r =0.8201, P &lt;0.001). Conclusions Immediately following the neodymium-doped yttrium aluminum garnet laser capsulotomy, the visual axis was cleared of opacification, resulting in an immediate enhancement in visual functions.

Intraoperative extension deficiency (IED) may arise after trial component implantation during total knee arthroplasty (TKA), a condition conceptually distinct from preoperative fixed flexion contracture (FFC). This study utilised a robotic system to quantify the incremental mechanical effect of sequential surgical actions-posterior capsule release (PCR), posterior cruciate ligament (PCL) excision and incremental distal femoral resections-to correct IED. A secondary objective was to evaluate their impact on manually assessed mediolateral laxity. Twenty-nine robotic TKAs were performed on 15 fresh-frozen cadaveric specimens. Nineteen knees presented with IED. All knees underwent PCR as the initial corrective manoeuvre. Subsequently, a quasi-experimental design based on laterality was employed to evaluate two sequences: right knees underwent PCL excision followed by up to four 1-mm distal femoral recuts; left knees followed the reverse order. Extension gains and manually assessed mediolateral laxities were recorded after each step. Baseline IED averaged 6.6° ± 4.9°. Posterior capsule release corrected IED in 36.8% of the knees, yielding a mean extension gain of 1.68° ± 1.11°. The mechanical impact of distal femoral resections varied depending on PCL status: when the PCL remained intact, distal femoral recuts produced a substantial mean gain of 4.3° ± 0.6° per millimetre; however, following PCL excision, the gain per millimetre decreased to 2.8° ± 0.8°. PCL excision alone improved extension by a mean of 1.1° ± 1.3°. No significant changes in manually assessed mediolateral laxity at 0° and 90° of flexion were observed across manoeuvres. Robotic quantification demonstrates that the mechanical effectiveness of distal femoral resection is significantly enhanced by an intact PCL. While PCR is an impactful initial step for mild IED, distal femoral recuts provide greater extension gains. These objective data provide the foundation for a structured strategy to guide the intraoperative management of IED in both robotic and conventional TKA. N/A (cadaveric).