Surgical videos are reshaping medical education; broadening their creation will benefit all.

Posterior capsule rupture (PCR) rates are used to measure cataract surgeons’ quality. We wished to evaluate the internal non-visible surfaces of metal irrigation/aspiration (I/A) tips to identify potential mechanisms for PCR via novel metallographic imaging. Ten metal I/A instruments underwent metallographic preparation by fine sectioning to expose inner surfaces near the aspiration opening. Analysis of inner bore, lumen, and opening aperture of metal aspiration tips was performed by optical microscopy, scanning electron microscopy (SEM), and 3D volume X-ray computational tomography (XCT). Distances from external aperture to first sharp metal surface were obtained and compared with a silicone-tipped instrument. We identified metal burrs near the aspiration apertures and manufacturing defects within all tips. XCT confirmed optical and SEM findings of significant defects and metal irregularities within aspiration tips. Samples also showed variation in lumen size/thickness, rough surfaces and material inhomogeneity, most pronounced at the internal tip. Median distance from outer aperture opening to first metal burr was 30 microns (range 10–120) and to internal tip irregularity (manufacturing flaw) was 250 microns (range 100–350). By comparison, distance to metal from the silicone outer aperture opening was 850 microns. We have demonstrated the hidden sharp metallic irregularities within commonly used metal I/A tips. If an aspirated capsule encounters these sharp metal flaws, PCR could result. Minimising this risk would require lengthening potential distance between capsule and bare metal (as with polymer/silicone tips). Our study provides unique imaging evidence endorsing this principle and illustrates a hidden mechanism contributing to PCR.

By watching many surgeons, we can learn different ways of performing the same procedure. In this case, Dr Luis Escaf from Barranquilla, Colombia shows us a few pearls for increasing accuracy and ef…

To present the visual acuity (VA) results and complication rates following Artisan intraocular lens (IOL) insertion in vitrectomised eyes. Outcome data were collected for all vitrectomised patients who had undergone Artisan IOL insertion between January 2014 and May 2019 at Moorfields Eye Hospital. All those with follow-up greater than 2 months were included in the analysis. Sixty-nine eyes from 61 patients were included. Average follow up was 2 years. Fifty-five (80%) eyes had at least one ocular comorbidity prior to Artisan IOL insertion. At final follow up 46 (67%) eyes had best-corrected VA better than 6/12. Sixty-three eyes (91%) either gained or maintained VA. Mean post-operative spherical equivalent was −0.2D. Two (3%) lenses became de-enclavated requiring further surgery. Two (3%) eyes developed acute post-operative cystoid macular oedema. Two (3%) required additional topical IOP-lowering therapy to their pre-operative glaucoma regimen. One eye had mild corneal oedema, which persisted for 1 year following surgery and subsequently resolved. Artisan IOL insertion is a safe and effective option for the surgical correction of aphakia in vitrectomised eyes lacking capsular support. Refractive results comparable to posterior chamber IOL placement can be achieved with these lenses.