The Contribution of Posterior Capsule Hypertrophy to Soft Tissue Glenohumeral Internal Rotation Deficit in Healthy Pitchers

Background: The relationship between posterior capsule adaptations and soft tissue glenohumeral internal rotation deficit (GIRD) in healthy pitchers remains unclear. Purpose/Hypothesis: This study aimed to identify if posterior capsule thickness (PCT) was associated with soft tissue GIRD in healthy pitchers. We hypothesized that there would be a positive relationship between soft tissue GIRD and PCT in the dominant arm, no relationship between soft tissue GIRD and PCT in the nondominant arm, and a strong positive relationship between soft tissue GIRD and the bilateral difference in PCT (posterior capsule hypertrophy [PCH]). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 45 healthy collegiate and professional pitchers were included. Glenohumeral internal rotation and external rotation range of motion, humeral retroversion, and PCT were measured bilaterally. PCT was determined for unilateral posterior capsule measurements, and PCH of the throwing shoulder was calculated as the bilateral difference in PCT. Soft tissue GIRD was calculated as the sum of clinical GIRD and the bilateral difference in humeral retroversion. Pearson correlation coefficients were determined to evaluate the relationships between dominant arm PCT, nondominant arm PCT, and PCH and soft tissue GIRD. Results: Pearson correlations showed that both dominant arm PCT ( R = −0.13; P = .378) and nondominant arm PCT ( R = 0.21; P = .165) were not related to soft tissue GIRD. However, Pearson correlations did show that the amount of PCH was moderately related to soft tissue GIRD ( R = 0.40; P = .007). Therefore, as the posterior capsule hypertrophied, soft tissue GIRD moderately increased. Conclusion: Increased PCH was associated with an increase in soft tissue GIRD in healthy pitchers. If PCT measurements are feasible, clinicians should consider performing bilateral ultrasound assessments to isolate posterior capsule adaptations (ie, PCH). This will allow clinicians to identify pitchers with potentially maladaptive structural adaptations and optimize management strategies throughout the season to counteract them.

Frequency of Complications Following Cataract Surgery in Diabetic Patients at Tertiary Care Hospital

OBJECTIVES: To determine the frequency of complications following cataract surgery in diabetic patients admitted in the ophthalmology unit. METHODOLOGY: A prospective descriptive interventional case series study was conducted after approval of the ethical committee, from June 2017-June 2020 at the Ophthalmology department MTI-MMC. A total of 129 patients from either gender were enrolled in study. All the study patients went through detailed history and complete ocular examination. After necessary investigations, surgical procedure was carried out. Results were analyzed through the SPSS-24 version. RESULTS: Out of the total 129 eyes of the diabetic patients, fifty-nine (45.7%) were males and seventy (54.3%) were females with a ratio of 1:1.2. Uveitis leads the chart in complications found in twenty (15.50%) eyes while PODR being the least common found in only ten (7.75%) eyes. Worse visual acuity was observed in fourteen (10.85%) eyes. Striate keratopathy and posterior capsule opacification were found in sixteen (12.40%) and fifteen (11.62%) eyes respectively. Among the patients, 15.7% were having more than one complication during follow-up visits and eighty-eight (68.2%) eyes were found to have none complication. The age group 51-60 years observed frequent complications as compared to other groups. Similarly female gender (38.57%) has frequent complications as compared to males (2.7%). CONCLUSION: The study concludes Uveitis as the most common complication observed in 15.50% 0f the eyes while worse visual acuity (10.85%) and progression of diabetic retinopathy (7.75%) being the least common. Striate keratopathy was found in 12.40% while posterior capsule opacification in 11.62% of the eyes.

Investigating the Etiology and Diagnosis of Sacroiliac Joint Pain

The sacroiliac (SI) joint is often characterized as a large, auricular-shaped, and diarthrodial synovial joint. The SI ligamentous structure is more extensive in the dorsal part due to the absence of the posterior capsule, which functions as a connecting band between the sacrum and ilium. In addition, a network of muscles supports the SI joint that helps deliver regional muscular forces to the pelvic bones. The third and fourth decades of life promote senescent changes manifested by surface irregularities, crevice formation, fibrillation, and clumping of chondrocytes.

Intravitreal injection is associated with increased posterior capsule rupture risk during cataract surgery: A meta-analysis

Background: Although observational studies have suggested that prior intravitreal therapy may predict posterior capsule rupture (PCR) during cataract surgery, this finding is still controversial. Objective: To summarize current evidence on the association between prior intravitreal injection (IVI) and PCR during cataract surgery. Methods: A systematic literature search was performed up to October 27th, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. The potential association between IVI and PCR in future cataract surgeries was assessed using the following two models: “pooling the odds ratios of PCR in eyes with and without previous IVI(s)” and “pooling the odds ratios for PCR relative to each increase in the number of prior injections.” The quality of included studies was appraised using the Newcastle-Ottawa Scale. Results: 6 cohort studies were included in this meta-analysis, with a total of 1,051,097 eyes that underwent cataract surgery. Of these, 7,034 eyes were associated with previous IVI. The pooled odds of PCR in eyes with prior IVI was 2.01 (95% CI: 1.35–3.00) times higher than that of eyes without an IVI history. An increase in the number of previous IVI conferred increased odds of PCR of 1.03 (95% CI: 1.01–1.06). After excluding studies that failed to account for confounders, the significantly increased risk was not altered, and the significant heterogeneity was minimized in both models. Conclusion: This meta-analysis provides evidence that previous IVI significantly increases the risk of PCR during future cataract surgery. The risk of PCR should be discussed preoperatively with patients. Further studies are required to validate our findings and explore the underlying mechanisms.

Comparison of Diathermic high-frequency capsulorhexis and Femtosecond laser-assisted capsulorrhexis in white cataract surgery

Aim: To compare the integrity, roundness and diameter of the capsulotomy in the white cataract between femtosecond laser assisted capsulotomy and high-frequency capsulorhexis.Methods: The prospective study included 32 patients with white-nuclear cataracts, 16 of whom underwent femtosecond capsulorhexis and another 16 underwent diathermic high-frequency capsulorhexis. The integrity roundness and diameter of the capsulorhexis post-operation were compared.Results: Femtosecond group obtained 6 cases(37.5%)of complete capsular. No anterior capsule tear occurred. Diathermy high-frequency achieved continuous complete capsulor in 3 eyes(18.75%) and anterior capsule was teared in 13 eyes(81.25%). The femtosecond group has a mean capsular diameter of 5.4 mm, and the diathermic high-frequency group has an average capsular diameter of 6 mm. No posterior capsule tear occurred in both surgical procedures. Conclusions: Femtosecond laser-assisted cataract surgery can achieve high capsulor integrity and stable capsulorhexis diameter. Compared with the diathermic high-frequency capsulorhexis, the frequency of injecting the viscoelastic agent was reduced, and the tear of the capsule was less likely to occur. The continuous complete capsular(CCC) by femtosecond laser is more round, more complete ,more controllable and smoother than diathermy high-frequency(DHC).

Introduction of longstanding complicated sulcus intraocular lens into the intact capsular bag

AIM: To propose a surgical technique that successfully reopened the empty and intact capsular bag after long periods of closure, with repositioning of the intraocular lens (IOL) from the ciliary sulcus into its preferred habitat inside the capsular bag. METHODS: This is a case series, prospective, and interventional study. The technique was first performed on an aphakic high myope with a closed posterior capsule for 18y. Afterwards, five patients with recurrently displaced sulcus IOLs for a range of 1mo to 7y were performed for the same technique. During surgery, identifying a “telltale white line” was an important landmark for detecting the site of major adhesions between the edge of the capsulorhexis and the posterior capsule. These adhesions were freed using combined manual and viscoelastic dissection, followed by an easier freeing of adhesions along the whole capsular bag. The IOL was safely implanted, exchanged, or introduced from the sulcus into the fibrotic and closed capsular bag. Patients were followed up for a period ranging from 6 to 17mo postoperatively. RESULTS: All the patients experienced a remarkable improvement in their subjective refraction. Slit lamp examination showed a postoperative centralized IOL in the bag. The follow up visits confirmed visual and IOL stability. CONCLUSION: This newly-introduced surgical technique facilitates the reopening of the empty yet intact capsular bag that has been closed by fibrotic proliferations, with secured implantation of the IOL inside the capsular bag. Patients with inadvertent implantation of IOLs into the ciliary sulcus, yet having an intact capsular bag, can benefit from this technique.

Removing residual cortical material during cataract surgery: Visco polishing and the grindstone effect as a new surgical technique

Purpose To describe a new technique for removing residual cortical material adjacent to posterior lens capsule during cataract surgery with the help of cohesive ophthalmic viscosurgical devices. Methods In this technique, if there are still cortical remnants and lens epithelial cells left after the routine irrigation–aspiration and polishing at the final steps of cataract surgery, the capsule is filled to about one-third with a highly viscous cohesive ophthalmic viscosurgical device. Rinsing is performed from the anterior chamber with the water jet directed tangentially to the ophthalmic viscosurgical device bolus and towards the posterior capsule, which creates a turbulence creating a “grindstone effect”. The ophthalmic viscosurgical device bolus transforms into a ball and starts to rotate very quickly within the capsule, grinding away the cortical remnants. Results In the first series of 62 cases, there were no intra-operative or post-operative complications. At day 1 there was no corneal oedema and no hypertension of intraocular pressure. Visual outcomes were good with a mean best corrected distance visual acuity of −0.01 ± 0.11 logMAR. Conclusion This technique appears to be effective and fast in removing persistent cortical remnants from the surface of the posterior capsule, while minimising risks such as capsule aspiration during irrigation/aspiration. There is limited pressure and mechanical force applied on the capsule; the anterior chamber and the corneal endothelium remain safe since the ophthalmic viscosurgical device stays inside the capsular bag to its high cohesiveness and molecular weight. More data on a larger cohort of patients is planned to confirm these results and evaluate long-term effects on posterior capsule opacification.