Journal of Clinical Medicine

12 pages, 464 KB

Open AccessArticle

Intrapartum Febrile Morbidity and Maternal Birth Trauma After Vaginal Delivery: A Parity-Stratified Retrospective Cohort Study

by Eiman Shalabna, Amy Goh, Deepa Gopinath, Chen Nahshon, Esther Maor-Sagie and Rinat Gabbay-Benziv

J. Clin. Med. 2026, 15(16), 6220; https://doi.org/10.3390/jcm15166220 (registering DOI) - 11 Aug 2026

Abstract

Objective: We aimed to evaluate the association between intrapartum febrile morbidity and maternal birth trauma among women undergoing vaginal delivery, with stratification by parity. Methods: This retrospective cohort study included women with singleton, cephalic, vaginal deliveries at a university-affiliated medical center between 2018 [...] Read more.

Objective: We aimed to evaluate the association between intrapartum febrile morbidity and maternal birth trauma among women undergoing vaginal delivery, with stratification by parity. Methods: This retrospective cohort study included women with singleton, cephalic, vaginal deliveries at a university-affiliated medical center between 2018 and 2024, excluding multiple gestations and cesarean deliveries. The primary exposure was intrapartum febrile morbidity, defined as maternal intrapartum temperature ≥38.0 °C, with or without clinical chorioamnionitis. The primary outcome was maternal birth trauma, including first- through fourth-degree perineal lacerations, cervical lacerations, or episiotomy. Multivariable logistic regression models were used to assess the independent association between intrapartum febrile morbidity and birth trauma. Analyses were additionally stratified by parity. Results: Among 21,736 women with vaginal deliveries included in the study, birth trauma occurred in 41.8% of deliveries (9075/21,736). Intrapartum febrile morbidity was more common among women with birth trauma compared with those delivering with an intact perineum (4.2% vs. 1.8%, p < 0.001). After adjustment for confounders, intrapartum febrile morbidity remained independently associated with birth trauma in the overall cohort (adjusted odds ratio [aOR], 1.5; 95% CI, 1.1–1.8). In parity-stratified analyses, the association persisted among multiparous women (aOR 1.8; 95% CI, 1.2–2.9) but was not statistically significant among nulliparous women (aOR, 1.3; 95% CI, 0.9–1.7). Nulliparity and operative vaginal delivery were the strongest predictors of birth trauma. Conclusions: These findings suggest that intrapartum febrile morbidity may identify women at increased risk of lower genital tract trauma beyond established mechanical risk factors. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Pregnancy-Related Complications)

16 pages, 715 KB

Open AccessArticle

Post-TAVR Neo-Sinus Geometry and Impaired Ventricular Recovery Are Associated with Early Leaflet Thrombosis: First MDCT Insights from Vietnam

by Phi Dinh Truong, Hoai Thu Thi Nguyen, Quang Ngoc Nguyen, Linh Huynh Dinh, Nguyet Minh Thi Giap, Thai Quoc Nguyen, Minh Nhat Pham, Than Xuan Le, Long Phi Ngo, Trang Ngoc Nguyen, Hue Minh Thi Bui, Thanh Van Nguyen, Olivier Morel and Hung Manh Pham

J. Clin. Med. 2026, 15(16), 6219; https://doi.org/10.3390/jcm15166219 - 11 Aug 2026

Abstract

Background/Objectives: Leaflet thrombosis after transcatheter aortic valve replacement (TAVR), typically identified as hypoattenuated leaflet thickening (HALT) on multidetector computed tomography (MDCT), is increasingly recognized as an early manifestation of bioprosthetic valve dysfunction. However, factors associated with early HALT in Southeast Asian populations remain [...] Read more.

Background/Objectives: Leaflet thrombosis after transcatheter aortic valve replacement (TAVR), typically identified as hypoattenuated leaflet thickening (HALT) on multidetector computed tomography (MDCT), is increasingly recognized as an early manifestation of bioprosthetic valve dysfunction. However, factors associated with early HALT in Southeast Asian populations remain poorly characterized. The objective of this study was to characterize MDCT features of leaflet thrombosis and identify factors independently associated with early HALT after TAVR. Methods: In this two-center observational study, patients undergoing MDCT 1–3 months after TAVR were evaluated. Leaflet thrombosis was defined as HALT. Leaflet involvement, thrombus severity, anatomical distribution, and post-implantation geometric parameters were analyzed. Multivariable logistic regression identified factors associated with early HALT. Results: Among 65 patients, HALT was detected in 30.8%, predominantly as subclinical leaflet thrombosis (29.2%), whereas clinical valve thrombosis was rare (1.5%). Most cases involved one or two leaflets, with preferential involvement of the non-coronary cusp. Patients with HALT showed greater increases in transvalvular peak gradients, and a peak gradient increase ≥10 mmHg was more frequent than in patients without HALT (30.0% vs. 4.4%; p = 0.008). Severe RCA ostial eccentricity (grade 3–4) combined with a neo-sinus–RCA distance > 13 mm was independently associated with HALT (adjusted OR 5.52; p = 0.006). Lack of left ventricular ejection fraction improvement after TAVR was also independently associated with HALT (adjusted OR 4.44; p = 0.018), though given the limited number of HALT events (n = 20), these multivariable associations should be regarded as exploratory and hypothesis-generating. Conclusions: Early post-TAVR leaflet thrombosis is common and predominantly subclinical. CT-derived neo-sinus geometry and impaired ventricular recovery were independently associated with HALT, supporting the hypothesis that altered neo-sinus washout contributes to thrombus formation. Full article

(This article belongs to the Special Issue Advances and Future Perspectives for Transcatheter Aortic Valve Replacement (TAVR))

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11 pages, 369 KB

Open AccessArticle

Pelvic Floor Disorders in Women with Breast Cancer and Gynaecological Cancer: Real-World Data from a Prospective Multicentre Cross-Sectional Survey

by Carolin Schröder, Sheila Bonilla Moran, Verena Kirn, Andree Faridi, Philipp Meyer-Wilmes, Laila Najjari, Fabinshy Thangarajah, Sebastian Hentsch, Christian Kurbacher, Laura Tascón Padrón, Lucia A. Otten, Eva K. Egger, Alexander Mustea and Dominique Koensgen

J. Clin. Med. 2026, 15(16), 6218; https://doi.org/10.3390/jcm15166218 - 11 Aug 2026

Abstract

Background/Objectives: Women with breast cancer (BC) and gynaecological cancer (GC) often undergo extensive oncological treatment, which can lead to pelvic floor disorders (PFD). However, there is still limited evidence regarding their real-world treatment practices, patient counselling, and prevalence. This study aims to systematically [...] Read more.

Background/Objectives: Women with breast cancer (BC) and gynaecological cancer (GC) often undergo extensive oncological treatment, which can lead to pelvic floor disorders (PFD). However, there is still limited evidence regarding their real-world treatment practices, patient counselling, and prevalence. This study aims to systematically evaluate the prevalence of PFD and current treatment approaches, identify unmet needs, and improve future care. Methods: This observational multicentre survey was conducted at four university hospitals and one gynaecological oncology outpatient clinic in Germany. Women with BC and GC, who had undergone at least one oncological treatment, completed anonymously a study-specific questionnaire and the validated German Pelvic Floor Questionnaire. Recruitment was undertaken over a period of nine months, reflecting real-world daily care. Results: A total of 246 patients were included (median age 57 years, range 30–88); 74% were postmenopausal, and 52% had at least one vaginal delivery. BC was the most common diagnosis (63.8%). The most common symptoms were urinary incontinence (22.3% in BC, 38.1% in GC) and urgency (32.5% in BC, 35.7% in GC). Pelvic radiotherapy was significantly associated with increased urgency symptoms (p = 0.017), pelvic surgery with urgency symptoms (p = 0.048) and dyspareunia (p = 0.045), and antihormonal therapy with vaginal dryness (p = 0.028). The combination of chemotherapy and antihormonal therapy was associated with significantly higher rates of vaginal dryness in women with GC, whereas no such association was observed in women with BC (p = 0.036). Among the 108 patients classified as having new-onset symptoms, 51 (47.2%) reported symptom onset within one year of the cancer diagnosis. Overall, 34.1% of patients reported impairment in more than one patient-reported domain, including daily life, social life, sexual well-being, and psychological well-being. The median study-specific impact rating for the most bothersome pelvic floor symptom was 5/10. Only 28.0% of patients received prior counselling on PFD, and 19.9% were actively asked about symptoms. In total, 26.0% received urogynaecological treatment, whereas 15.4% reported unmet treatment needs. Conclusions: PFD is highly prevalent in women with BC and GC. Symptoms are clinically relevant but underestimated in routine care. Despite the availability of effective treatment options, significant gaps exist in patient counselling, early detection, and access to specialised care. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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18 pages, 1473 KB

Open AccessFeature PaperArticle

Clinical and CT-Based Outcomes of Anterior and Posterior Syndesmotic Augmentation Using Nonabsorbable Suture Tape for Acute Syndesmotic Instability: A Preliminary Case Series of Seven Patients

by Dae-Woong Kim, Eui-Dong Yeo, Ki Jin Jung, Chang Hwa Hong, Sung Hyun Lee, Jae Young Ji, Dhong-Won Lee and Woo-Jong Kim

J. Clin. Med. 2026, 15(16), 6217; https://doi.org/10.3390/jcm15166217 - 11 Aug 2026

Abstract

Background: In high-grade syndesmotic injuries involving combined disruption of the anterior inferior tibiofibular ligament (AITFL) and posterior inferior tibiofibular ligament (PITFL), most suture-tape augmentation techniques have focused on the AITFL alone. This study evaluated the clinical and radiologic outcomes of a suture-tape-only anterior [...] Read more.

Background: In high-grade syndesmotic injuries involving combined disruption of the anterior inferior tibiofibular ligament (AITFL) and posterior inferior tibiofibular ligament (PITFL), most suture-tape augmentation techniques have focused on the AITFL alone. This study evaluated the clinical and radiologic outcomes of a suture-tape-only anterior and posterior (A-P) augmentation technique, with a primary focus on technical feasibility and maintenance of syndesmotic reduction. Methods: We retrospectively reviewed consecutive patients who underwent A-P syndesmotic augmentation using nonabsorbable suture tape, based on clinical and radiologic data available from January 2022 through April 2026. Complete disruption of both the AITFL and PITFL was confirmed arthroscopically and by direct visualization. Clinical outcomes were assessed using the Olerud–Molander Ankle Score (OMAS) and visual analog scale (VAS) preoperatively and at the 1-year postoperative assessment. Syndesmotic reduction was evaluated on bilateral computed tomography (CT) scans obtained 1 year postoperatively using the direct anterior difference (DAD), direct posterior difference (DPD), fibular translation (FT), and fibular rotation (FR), with the uninjured contralateral ankle serving as the reference. Results: Seven patients (mean age, 35.1 years; mean follow-up, 26.3 months) were included. At the 1-year postoperative assessment, the mean OMAS increased from 1.4 ± 3.8 to 86.4 ± 5.6, whereas the mean VAS score decreased from 8.1 ± 0.7 to 0.3 ± 0.5 (both p = 0.016), with preoperative scores obtained in the acute injury setting. For both observers, no individual absolute side-to-side difference exceeded the predefined malreduction threshold for any of the four CT parameters. Bony union was achieved in all cases. One patient developed a superficial wound complication, and no reoperations were required. Conclusions: In this small, selected case series, A-P suture-tape augmentation was technically feasible, and syndesmotic reduction was maintained at 1 year postoperatively in patients with combined AITFL and PITFL injuries. These preliminary findings warrant further evaluation in larger comparative studies. Full article

(This article belongs to the Special Issue Foot and Ankle Fracture Management and Complication Insights)

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20 pages, 1931 KB

Open AccessReview

Idiopathic Syringomyelia: A Systematic Scoping Review

by Renata Martinelli and Luca Massimi

J. Clin. Med. 2026, 15(16), 6216; https://doi.org/10.3390/jcm15166216 - 11 Aug 2026

Abstract

Background: Idiopathic syringomyelia (IS) is defined by exclusion: an intramedullary fluid-filled cavity without Chiari malformation, spinal trauma, tumor, infection, or other identifiable cause. Growing evidence suggests IS is a progressively shrinking category as advanced imaging and intraoperative exploration uncover occult arachnoid or hydrodynamic [...] Read more.

Background: Idiopathic syringomyelia (IS) is defined by exclusion: an intramedullary fluid-filled cavity without Chiari malformation, spinal trauma, tumor, infection, or other identifiable cause. Growing evidence suggests IS is a progressively shrinking category as advanced imaging and intraoperative exploration uncover occult arachnoid or hydrodynamic substrates. To the best of our knowledge, no systematic reviews of the literature have been published on this topic. The authors aim to map operational definitions of IS, summarize proposed pathogenetic mechanisms, characterize diagnostic strategies and their yield, describe management approaches and outcomes, and identify pediatric–adult differences. Methods: A scoping review was conducted in accordance with PRISMA-ScR. PubMed and Scopus were searched from inception to May 2026. Eligible sources were original studies of any design addressing IS in pediatric or adult patients, in English. Studies on syringomyelia secondary to Chiari malformation, trauma, tumor, or infection were excluded. Data were extracted across five domains and synthesized narratively. Results: Eighteen studies (365 patients; five case reports, nine retrospective cohorts, two morphometric studies, one cine-MRI case–control, one technical note) were included. Operational definitions were markedly heterogeneous. Four pathogenetic mechanisms emerged: subarachnoid CSF obstruction with abnormal intramedullary pulse pressure, occult arachnoid pathology, posterior fossa morphometric variants overlapping with the Chiari spectrum, and persistent central canal as a developmental variant. In the four largest pediatric series (n = 214), 91–95% of children remained stable or improved on conservative management at up to 7-year follow-up, with no concordance between syrinx size change and clinical course. In symptomatic adults, targeted arachnoid lysis or web excision yielded clinical improvement in 87% of IS-occult arachnoid web patients; syringo-subarachnoid shunting was occasionally effective but risked neurological deterioration without prior substrate identification. Conclusions: The idiopathic label reflects the current limits of diagnostic investigation rather than a fixed nosological entity, since occult arachnoid or hydrodynamic substrates are identified in most adult IS cases when advanced imaging and intraoperative exploration are systematically deployed. Pathogenesis converges on a unified model of subarachnoid CSF obstruction generating abnormal intramedullary pulse pressure. Management should be driven by clinical, not radiological, evolution: arachnolysis or web excision is the primary strategy when an operable substrate is identified, while conservative management remains best supported in clinically stable patients, particularly children. Full article

(This article belongs to the Special Issue Current Challenges in Syringomyelia)

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14 pages, 1296 KB

Open AccessArticle

A Clinically Accessible Nomogram for Identifying Likely Psoriatic Arthritis Among Patients with Psoriasis: A Multicenter Cross-Sectional Study

by Qing Guo, Hong Luan, Xiaohong Chen, Xi Zhao, Mouhsun Chiang, Ling Wu, Xixi Tan, Xue Min, Xiaolin Feng, Bo Xiao, Mi Chen, Jialin Lin and Zhenying Zhang

J. Clin. Med. 2026, 15(16), 6215; https://doi.org/10.3390/jcm15166215 - 11 Aug 2026

Abstract

Background/Objectives: Psoriatic arthritis (PsA) affects up to 30% of psoriasis patients but remains underdiagnosed due to heterogeneous early manifestations. Existing tools rely on advanced imaging or biomarkers, limiting feasibility. This study aimed to develop a simple nomogram, using routinely available clinical features to [...] Read more.

Background/Objectives: Psoriatic arthritis (PsA) affects up to 30% of psoriasis patients but remains underdiagnosed due to heterogeneous early manifestations. Existing tools rely on advanced imaging or biomarkers, limiting feasibility. This study aimed to develop a simple nomogram, using routinely available clinical features to identify patients with likely PsA. Methods: This multicenter cross-sectional study enrolled adult psoriasis patients from two tertiary hospitals (training: n = 884; validation: n = 690). PsA was diagnosed using the Classification Criteria for Psoriatic Arthritis (CASPAR) by rheumatologists and dermatologists who were blinded to each other’s assessments. Thirteen candidate predictors, including demographics, disease history, and lesion characteristics, were prespecified. Independent predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression. Internal validation used 1000 bootstrap resamples, followed by temporal–geographic validation. Performance was assessed using area under the curve (AUC), calibration plots, the Hosmer–Lemeshow test, decision curve analysis (DCA), and clinical impact curves (CIC). Sensitivity analyses included E-value analysis for unmeasured confounding and alternative model specifications. Results: Five independent predictors were identified: uveitis (odds ratio (OR): 5.23, 95% confidence interval (CI): 1.94–14.10), inverse lesions (OR: 1.65, 95% CI: 1.09–2.48), scalp lesions (OR: 2.97, 95% CI: 1.45–6.10), nail lesions (OR: 5.98, 95% CI: 3.69–9.68), and arthralgia (OR: 20.23, 95% CI: 13.14–31.13). The nomogram showed good discrimination (AUC: 0.885 training, 0.874 validation), with good calibration and clinical utility confirmed by DCA and CIC. Conclusions: This nomogram, integrating five clinically accessible predictors, offers a practical tool to identify psoriasis patients with likely PsA, supporting timely referral in tertiary dermatology outpatient settings. Full article

(This article belongs to the Section Immunology & Rheumatology)

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12 pages, 609 KB

Open AccessArticle

Additional Fracture Detection by Computed Tomography After Plain Radiography in Adults with Isolated Foot and Ankle Trauma: A Retrospective Selected-Cohort Study

by Adnan Arslan, Aytekin Dikici, Ferhat Danışman, Yunus Can Ünal, Ömer Faruk Yıldırım and Şehmuz Kaya

J. Clin. Med. 2026, 15(16), 6214; https://doi.org/10.3390/jcm15166214 - 11 Aug 2026

Abstract

Background/Objectives: Plain radiography is the first-line imaging modality for acute foot and ankle trauma; however, computed tomography (CT) may provide additional information in selected patients with persistent clinical suspicion, equivocal radiographic findings, or a need for detailed fracture characterization. We hypothesized that the [...] Read more.

Background/Objectives: Plain radiography is the first-line imaging modality for acute foot and ankle trauma; however, computed tomography (CT) may provide additional information in selected patients with persistent clinical suspicion, equivocal radiographic findings, or a need for detailed fracture characterization. We hypothesized that the CT-confirmed fracture proportion would be higher among patients with suspicious radiographs than among those with normal radiographs and that CT would identify additional fractures in a clinically selected cohort. Methods: This retrospective single-center selected-cohort study included 1000 adult patients with isolated foot and/or ankle trauma who underwent both plain radiography and CT during the same clinical encounter. Plain radiographs were categorized as normal, suspicious for fracture, or definite fracture on the basis of original radiology reports and available imaging records. A CT-confirmed fracture was defined as the presence of an acute fracture on CT. Analyses focused primarily on CT-confirmed fracture proportions and conditional diagnostic yield within the selected CT cohort. Conditional apparent diagnostic performance was evaluated as a supplementary sensitivity analysis and was not intended to estimate population-level diagnostic accuracy. Results: Plain radiographs were categorized as normal in 628 patients, suspicious in 283, and definite fracture in 89. CT detected acute fractures in 386 patients (38.6%). The CT-confirmed fracture proportions were 14.8% in the normal radiograph group, 72.1% in the suspicious radiograph group, and 100.0% in the definite fracture group. The proportion of patients without a definite fracture on plain radiography but with an acute fracture on CT was 29.7%. Fracture-pattern classification was unavailable in 85 of 386 cases with CT-confirmed fractures (22.0%); therefore, fracture-pattern analyses were considered exploratory. Conclusions: In this selected CT cohort, CT identified additional acute fractures in a subset of adult isolated foot and ankle trauma cases that could not be definitively classified as fractures on plain radiography. Because CT was not systematically performed in all trauma patients, the findings represent selected-cohort CT yield rather than true population-level diagnostic accuracy. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics: 2nd Edition)

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13 pages, 385 KB

Open AccessArticle

Perceived Stress, Type D Personality and Coping Strategies Among Hospitalized Oncology Patients: A Cross-Sectional Study

by Robert Jan Łuczyk, Kamil Sikora, Agnieszka Zawada, Marta Łuczyk, Dorota Weber and Anna Charuta

J. Clin. Med. 2026, 15(16), 6213; https://doi.org/10.3390/jcm15166213 - 11 Aug 2026

Abstract

Background: Stress is regarded as one of the natural and unavoidable elements of human life and, at the same time, one of the key determinants of physical and mental health. Stress is not a new phenomenon; it has accompanied human beings since the [...] Read more.

Background: Stress is regarded as one of the natural and unavoidable elements of human life and, at the same time, one of the key determinants of physical and mental health. Stress is not a new phenomenon; it has accompanied human beings since the beginning of life as a reaction to everyday challenges. This study aimed to assess the prevalence and severity of stress, as well as stress-coping strategies, in a group of patients treated for oncological reasons. Methods: The study included 108 patients hospitalized at the Independent Public Clinical Hospital No. 1 in Lublin, Poland, in the following departments: the 2nd Department of General, Gastroenterological and Gastrointestinal Oncological Surgery; the Department of Oncological Surgery; and the Department of Hemato-Oncology and Bone Marrow Transplantation. Three standardized questionnaires were used: the Perceived Stress Scale (PSS-10), the Type D Personality Scale (DS-14), and the “How Do I Cope” Inventory (JSR). Statistical analysis was performed with IBM SPSS Statistics, version 25; statistical significance was set at α < 0.05. Results: Patients treated for oncological reasons constitute a group exceptionally exposed to stress, which accompanies them at every stage of the disease, from diagnosis, through treatment, to the terminal phase. In patients whose treatment resulted in remission, stress related to the possibility of recurrence accompanies every follow-up examination and every worrying symptom. Given the range of situations that provoke stress, the overall level of stress in this group can be regarded as high. Stress-coping strategies among oncological patients are shaped by multiple factors, including selected sociodemographic characteristics; taking into account the diversity of these factors, coping strategies varied considerably across the sample. The level of coping strategies was not associated with age or sex but was significantly associated with educational attainment. Conclusions: Oncological patients experience a high and pervasive level of stress that persists throughout diagnosis, treatment, and follow-up. Stress-coping strategies are heterogeneous, are not determined by age or sex, but are shaped by education, indicating a need for individualized psychosocial and educational support integrated into routine oncological care. Full article

(This article belongs to the Section Mental Health)

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12 pages, 759 KB

Open AccessArticle

Clinical Factors Affecting the Surgical Outcomes of Endoscopic Dacryocystorhinostomy

by Min Seok Kim, Hahn Jin Jung, Soo Kyoung Park, Seung Hyuk Yang, Shin Hyuk Yoo and Ji-Hun Mo

J. Clin. Med. 2026, 15(16), 6212; https://doi.org/10.3390/jcm15166212 - 11 Aug 2026

Abstract

Objectives: Factors influencing outcomes of endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction remain unclear. We evaluated clinical factors associated with surgical success. Methods: We retrospectively reviewed patients who underwent endoscopic DCR for this indication (2012–2022). Allergic rhinitis, obstruction level and type, [...] Read more.

Objectives: Factors influencing outcomes of endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction remain unclear. We evaluated clinical factors associated with surgical success. Methods: We retrospectively reviewed patients who underwent endoscopic DCR for this indication (2012–2022). Allergic rhinitis, obstruction level and type, canalicular intubation stent (CIS) insertion, and adjunctive procedures were analyzed against surgical success, epiphora scores, and SNOT-22 change using multivariate logistic regression. Results: Among 300 eyes (259 patients), the success rate was 82.0%. Epiphora scores improved from 7.6 ± 1.3 to 4.0 ± 2.3 and SNOT-22 from 17.3 ± 19.1 to 11.1 ± 14.2 (both p < 0.001). Sac-level and duct–sac junction obstructions had higher success than canalicular obstruction, and allergic rhinitis was associated with less epiphora improvement. CIS insertion was associated with lower success; however, this was confined to functional (42.0% vs. 92.0%) and canalicular-level (53.3% vs. 77.6%) obstruction—where CIS was selectively used—and absent in drainage-level obstruction (85.3% vs. 85.7%), indicating confounding by indication. Conclusions: Endoscopic DCR yields favorable outcomes with significant epiphora and quality-of-life improvement. Obstruction level, allergic rhinitis, and CIS insertion were associated with surgical outcomes; the CIS association, however, likely reflects confounding by indication rather than a direct adverse effect, as CIS was selectively used in functional and canalicular-level obstruction. Full article

(This article belongs to the Section Otolaryngology)

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21 pages, 3597 KB

Open AccessReview

Artificial Intelligence for Personalized Prediction of Post-TIPS Outcomes: Integrating Clinical, Biochemical, and Radiomics Data—A Narrative Review

by Alessio Barrancotto, Simone Di Cola, Fabio Melandro, Lucia Lapenna, Anthony Vignone, Antonio Bencivenga, Arianna Brancati, Pierleone Lucatelli, Mario Corona, Stefania Gioia and Silvia Nardelli

J. Clin. Med. 2026, 15(16), 6211; https://doi.org/10.3390/jcm15166211 - 11 Aug 2026

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension, but hepatic encephalopathy (HE), liver dysfunction, rebleeding, and mortality remain difficult to predict in otherwise eligible candidates. However, predicting post-TIPS outcomes remains challenging using conventional risk scores such as [...] Read more.

Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension, but hepatic encephalopathy (HE), liver dysfunction, rebleeding, and mortality remain difficult to predict in otherwise eligible candidates. However, predicting post-TIPS outcomes remains challenging using conventional risk scores such as MELD 3.0 and Child–Turcotte–Pugh. This narrative review critically evaluates how clinical, biochemical, procedural, conventional imaging, handcrafted radiomics, and deep-learning features can be integrated for personalized post-TIPS risk prediction, supplemented by backward and forward reference checking. Thirty-two original post-TIPS studies met the core inclusion criteria: 18 focused primarily on clinical, biochemical, hemodynamic, microbiome, or procedural predictors and 14 on imaging, body composition, radiomics, or multimodal models. AI, ML, and radiomics models, by the aim of logistic regression, tree-based ensembles, support vector machines, artificial neural networks, and hybrid deep-learning models, able to capture non-linear interactions, have consistently demonstrated improved predictive performance compared with conventional scores, particularly for HE, with reported incidences of approximately 20–47%, mortality, and liver dysfunction. Their advantage lies in the ability to model complex, non-linear relationships and integrate heterogeneous data sources, including laboratory parameters, ammonia levels, hemodynamic variables, and imaging-derived features. Radiomics and deep learning approaches further enhance predictive accuracy. CT is currently the principal imaging substrate, while direct post-TIPS radiomics evidence for MRI and ultrasound remains sparse. Studies of liver and spleen morphology, portal-vein geometry, muscle and adipose tissue, and radiomic texture suggest incremental information beyond conventional scores, particularly when clinical and imaging features are combined; however, negative volumetric findings show that additional image features do not automatically improve prediction. However, most studies are retrospective, single-center, and lack external validation and no validated transformer-based or other sequence model has yet been established for post-TIPS outcomes. Standardization issues in radiomics and limited model interpretability remain significant barriers. Future directions should lead to prospective multicenter cohort validation, increasing sample sizes, harmonized imaging and endpoint definitions, locked external validation with recalibration, and the development of clinically interpretable tools to make it easier to identify those patients suitable for TIPS and their post-procedural management. Full article

(This article belongs to the Special Issue Transjugular Intrahepatic Portosystemic Shunt: Challenges and Perspectives—2nd Edition)

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12 pages, 1416 KB

Open AccessArticle

Concomitant Polytrauma in Fall-Related Proximal Humerus Fractures: A Fracture-Subtype-Stratified Analysis of In-Hospital Outcomes

by Abdullah Raizah

J. Clin. Med. 2026, 15(16), 6210; https://doi.org/10.3390/jcm15166210 - 11 Aug 2026

Abstract

Objectives: To determine whether concomitant polytrauma is independently associated with worse in-hospital outcomes among fall-related proximal humerus fracture (PHF) patients and whether fracture subtype is associated with heterogeneity in this association. Methods: Retrospective cohort study using the American College of Surgeons [...] Read more.

Objectives: To determine whether concomitant polytrauma is independently associated with worse in-hospital outcomes among fall-related proximal humerus fracture (PHF) patients and whether fracture subtype is associated with heterogeneity in this association. Methods: Retrospective cohort study using the American College of Surgeons Trauma Quality Program Participant Use File (ACS TQP-PUF; 2019–2022). Adults with PHF and a fall mechanism were included. Multivariable logistic regression adjusted for age, sex, the five mFI-5 components, anticoagulant use, and calendar year. Non-home discharge (NHD) was restricted to survivors. Sensitivity analyses used 1:1 PSM (all primary covariates in propensity model; post-matching SMDs assessed) and restriction to ground-level falls. Results: Among 63,995 fall-related PHF patients (70.5% female; 75.8% aged ≥65 years), 3884 (6.1%) met polytrauma criteria (ISS ≥ 16); polytrauma patients were more often male (45.1% vs. 28.5%) and slightly younger (mean age 69.3 vs. 72.0 years). Polytrauma was independently associated with in-hospital mortality (aOR 7.05, 95% CI 6.14–8.09) and non-home discharge among survivors (aOR 1.95, 95% CI 1.79–2.12; crude 72.0% vs. 64.6%). ICU utilization (aOR 13.25, 95% CI 12.34–14.22) and any complication (aOR 3.41, 95% CI 3.07–3.79) are reported as descriptive markers subject to triage and ascertainment bias, respectively. The ICD-10 subtype-stratified mortality aORs ranged from 3.36 to 8.28 across five strata (exploratory; no formal interaction test performed). PSM (3884 pairs; n = 7768) and ground-level fall restriction produced estimates consistent with the primary analyses. Conclusions: Concomitant polytrauma was independently associated with substantially higher in-hospital mortality and non-home discharge after fall-related PHF, identifying a high-risk subgroup that warrants closer clinical attention. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics: 2nd Edition)

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22 pages, 752 KB

Open AccessArticle

Detection of Myopia from Colour Fundus Photographs Using YOLO-Based Computer-Vision Models: A Comparison with Expert Ophthalmologists

by Nicola Rizzieri, Luca Dall’Asta and Maris Ozolinš

J. Clin. Med. 2026, 15(16), 6209; https://doi.org/10.3390/jcm15166209 - 11 Aug 2026

Abstract

Objectives: The purpose of this study was to evaluate the ability of computer vision models to detect myopia from standard colour fundus photographs and to compare their diagnostic performance with that of experienced ophthalmologists. Methods: A previously published dataset of 324 retinal fundus [...] Read more.

Objectives: The purpose of this study was to evaluate the ability of computer vision models to detect myopia from standard colour fundus photographs and to compare their diagnostic performance with that of experienced ophthalmologists. Methods: A previously published dataset of 324 retinal fundus images labelled as myopic or non-myopic based on cycloplegic refraction as used for model training and internal validation. Images were acquired using a non-mydriatic 45° fundus camera. Final model evaluation was performed on an independent test set of 50 images from different patients who were not included in the original dataset. YOLOv8 and YOLOv11 variants were trained for binary classification. Internal validation used patient-level cluster bootstrap confidence intervals, whereas image-level bootstrap confidence intervals were estimated for the independent test set. Pairwise model comparisons were adjusted using the Holm–Bonferroni correction. Five experienced ophthalmologists independently classified the test set, and their consensus was compared with the selected YOLO models using DeLong’s and exact McNemar tests. Results: Internal validation identified YOLOv8-m and YOLOv11-n as the best-performing models according to a predefined composite score used exclusively for model selection. On the independent test set, YOLOv11-n achieved the highest area under the curve (AUC = 0.889), followed by YOLOv8-m (0.806), although the difference was not statistically significant (DeLong test, p > 0.05). The clinical consensus achieved an AUC of 0.832, with no significant difference compared with either model. Exact McNemar testing likewise revealed no statistically significant differences in paired classification outcomes between either AI model and the clinical consensus. Limitations include the small, single-centre, class- and age-imbalanced dataset and the limited number of expert observers. Conclusions: Although neither YOLOv8-m nor YOLOv11-n showed statistically significant differences from the clinical consensus on this independent test set, these findings should be interpreted cautiously given the relatively small, single-centre study population. Larger multicentre studies with independent external validation are warranted to confirm the generalisability, robustness, and potential role of clinician-driven computer vision models as decision support tools for myopia screening. Full article

(This article belongs to the Special Issue Multifactorial Causation and Therapies of Myopia: 2nd Edition)

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17 pages, 1087 KB

Open AccessArticle

Comparison of Percutaneous Achilles Tendon Lengthening and Open Z-Plasty in Children with Idiopathic Achilles Tendon Contracture

by Piotr Morasiewicz, Anna Robinson, Łukasz Tomczyk, Krystian Kazubski, Marta Laszkowska Morasiewicz and Paweł Leyko

J. Clin. Med. 2026, 15(16), 6208; https://doi.org/10.3390/jcm15166208 - 11 Aug 2026

Abstract

Background: Achilles tendon contracture is a prevalent issue in pediatric populations, often leading to complications such as toe walking and limited ankle dorsiflexion. This study aims to compare the clinical outcomes of two surgical techniques for Achilles tendon lengthening—conventional percutaneous lengthening and Z-plasty—in [...] Read more.

Background: Achilles tendon contracture is a prevalent issue in pediatric populations, often leading to complications such as toe walking and limited ankle dorsiflexion. This study aims to compare the clinical outcomes of two surgical techniques for Achilles tendon lengthening—conventional percutaneous lengthening and Z-plasty—in children with idiopathic Achilles tendon contracture, while assessing the adequacy of a six-week postoperative immobilization period. Methods: A retrospective analysis was conducted on 60 pediatric patients (ages 5–17) who underwent Achilles tendon lengthening at our institution between 2021 and 2025. Patients were divided into two groups: 25 receiving percutaneous lengthening and 35 undergoing Z-plasty. Inclusion criteria encompassed idiopathic contracture with a follow-up of over 12 months. Outcomes measured included ankle dorsiflexion, time to resume normal activities, length of hospital stay, duration of cast immobilization, complications, the likelihood of choosing the same treatment method again, taking analgesics, AOFAS score, and patient/guardian satisfaction. Results: Both surgical methods resulted in significant improvements in ankle dorsiflexion and functional outcomes. The percutaneous group demonstrated a mean increase of 30° in dorsiflexion, while the Z-plasty group showed a mean increase of 32.5°. The time from surgery to resuming normal activities in the Z-plasty group ranged from 6 to 11 weeks, which was significantly higher than the range of 6 to 7 weeks in the percutaneous lengthening group, p = 0.024. Guardian and patient satisfaction was high in both groups, with 94.3% of patients from the Z-plasty group and 100% of patients from the percutaneous group expressing willingness to choose the same treatment again. Four patients (11.4%) from the Z-plasty group and one patient (4%) from the percutaneous lengthening group developed complications. Conclusions: The period of cast immobilization of six weeks helped achieve good outcomes and caused few complications in children from both study groups. The conventional percutaneous approach to Achilles tendon lengthening in children helps achieve substantial correction of ankle dorsiflexion with a low risk of complications. Due to the risk of selection bias, the results should be interpreted with caution. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Current Advances and Prospects)

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9 pages, 448 KB

Open AccessArticle

Baseline Neutrophil-to-Lymphocyte Ratio and Two-Year Incident Distant Metastasis in Stage I–III Lung Cancer: A Single-Center Retrospective Cohort Study

by Yuntao Wang, Jihong Zhang, Xiaopeng Liu, Xibing Zhuang and Qi Zhang

J. Clin. Med. 2026, 15(16), 6207; https://doi.org/10.3390/jcm15166207 - 11 Aug 2026

Abstract

Background: Distant metastatic relapse remains a major problem after treatment for lung cancer. We examined the association between pre-treatment neutrophil-to-lymphocyte ratio (NLR) and newly documented distant metastasis within 2 years among patients without distant metastasis at baseline. Methods: We retrospectively screened [...] Read more.

Background: Distant metastatic relapse remains a major problem after treatment for lung cancer. We examined the association between pre-treatment neutrophil-to-lymphocyte ratio (NLR) and newly documented distant metastasis within 2 years among patients without distant metastasis at baseline. Methods: We retrospectively screened 527 consecutive unique patients with a hospital diagnosis of lung cancer who were managed between 1 January and 31 December 2022; follow-up continued for 24 months after initial treatment (administrative cutoff, 31 December 2024). After hierarchical exclusions, 186 complete cases remained. The primary analysis included 148 patients with stage I–III disease and used record-based incident distant metastasis within 24 months, determined by comprehensive clinical assessment. Logistic regression estimated the association between continuous NLR and the endpoint before and after adjustment for age, sex, and clinical stage. Stage IV patients were retained only in a secondary analysis of the original heterogeneous composite endpoint. Results: Thirty-one out of 148 patients with stage I–III disease (20.9%) developed distant metastasis within 2 years. Mean pre-treatment NLR was 2.83 in patients with an event and 2.07 in those without an event. Each one-unit increase in NLR was associated with higher odds of distant metastasis in the unadjusted model (odds ratio [OR] 2.71, 95% confidence interval [CI] 1.65–4.45; p < 0.001) and after adjustment for age, sex, and stage (adjusted OR 2.70, 95% CI 1.60–4.57; p < 0.001). In the secondary full-cohort analysis, 49 of 186 patients met the heterogeneous composite endpoint. Conclusions: Higher pre-treatment NLR was associated with 2-year incident distant metastasis in this stage I–III cohort. The result does not establish causality or a clinically actionable cut point and requires prospective external validation. Full article

(This article belongs to the Section Oncology)

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13 pages, 949 KB

Open AccessArticle

Risk Stratification of Patients Being Considered for Open Abdominal Aortic Aneurysm Repair

by Mitri K. Khoury, R. Trey Rogers, Hasan Aldailami, Tiziano Tallarita and Shiv Patel

J. Clin. Med. 2026, 15(16), 6206; https://doi.org/10.3390/jcm15166206 - 11 Aug 2026

Abstract

Background/Objectives: Endovascular repair (EVAR) is the default for most abdominal aortic aneurysms (AAAs), yet open repair (OR) remains necessary, and the decision hinges on fitness for open surgery. No standardized preoperative tool defines who is “unfit” for OR. We derived and validated [...] Read more.

Background/Objectives: Endovascular repair (EVAR) is the default for most abdominal aortic aneurysms (AAAs), yet open repair (OR) remains necessary, and the decision hinges on fitness for open surgery. No standardized preoperative tool defines who is “unfit” for OR. We derived and validated a preoperative risk score for severe major adverse events (MAE) after elective OR and examined whether high-risk patients had fewer perioperative events with EVAR. Methods: Using the Vascular Quality Initiative (VQI) Open AAA registry, we identified 9833 elective AAA OR patients without prior aortic surgery. Severe MAE was a 30-day composite of death, myocardial infarction (MI), stroke, new dialysis, or bowel ischemia. A multivariable model was converted to an integer score, validated, and benchmarked against the Revised Cardiac Risk Index (RCRI), E-PASS, and a Vascular Quality Initiative Frailty Index. High-risk (score ≥ 7) OR patients were propensity score matched 1:1 to elective EVAR patients and outcomes were compared. Results: Severe MAE occurred in 10.8% of OR patients. The 0–18-point score had an optimism-corrected C-statistic of 0.67 and calibration slope of 0.96, and it outperformed RCRI (C 0.57), E-PASS (C 0.61), and a Vascular Quality Initiative Frailty Index (C 0.63) (all ΔAUC p < 0.001). Severe MAE rose across low (4%), intermediate (9%), and high (20%) tiers; performance was stable on temporal validation (AUC 0.67, slope 0.94). Among 2357 matched high-risk pairs, severe MAE was 20.3% (OR) vs. 4.4% (EVAR) (risk difference +15.9 percentage points; relative risk 4.6), with the largest absolute benefit in the highest-risk patients. Conclusions: A simple preoperative score stratifies perioperative risk for elective open AAA repair and outperforms generic indices. High-risk patients would have had markedly fewer perioperative adverse outcomes if treated with EVAR. These associational findings can inform shared decision-making. Full article

(This article belongs to the Special Issue Clinical Advances in the Management of Abdominal and Thoracoabdominal Aortic Aneurysms)

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27 pages, 3384 KB

Open AccessArticle

Diagnostic Yield of Comprehensive Etiologic Evaluation in Young Adults with Ischemic Stroke: Toward a Phenotype-Driven Approach

by Aishah Ibrahim Albakr, Alia Alokley, Feras AlSulaiman, Mustafa Ahmed Alqarni, Saud A. Alnaaim, Ali Hafiz Alhashim, Mohammed Alshurem, Abrar J. Alwaheed, Safi G. Alqatari, Erum Sharif, Azra Zafar, Kawther Mohammed Hadhiah, Foziah Jabbar Alshamrani, Rizwana Shahid, Ammar S. Bukhamsin, Fahad Hammad F. Alrayes, Rahaf Marhoom Alsaadi and Farah Abdullah Alsaqr

J. Clin. Med. 2026, 15(16), 6205; https://doi.org/10.3390/jcm15166205 - 11 Aug 2026

Abstract

Background/Objectives: Young-onset ischemic stroke shows substantial etiologic heterogeneity. However, the value and diagnostic yield of advanced cardiac and autoimmune evaluations in young adults remain uncertain. Methods: Patients aged 25–55 years admitted with acute ischemic stroke to King Fahd University Hospital in [...] Read more.

Background/Objectives: Young-onset ischemic stroke shows substantial etiologic heterogeneity. However, the value and diagnostic yield of advanced cardiac and autoimmune evaluations in young adults remain uncertain. Methods: Patients aged 25–55 years admitted with acute ischemic stroke to King Fahd University Hospital in Saudi Arabia between January 2020 and December 2025 were included. Evaluation followed a multidisciplinary young-stroke pathway, incorporating neurovascular imaging, cardiac assessment, and targeted autoimmune and rheumatologic investigations. A Clinically Meaningful Diagnostic Yield (CMDY) was defined as a diagnostic finding that resulted in etiologic reclassification, management modification, or changes to secondary prevention strategy. Results: A total of 480 patients were included (median age, 40 years; 67.7% men). CMDY was observed in 200 (41.7%) patients. Among 79 patients initially classified as having embolic stroke of an undetermined source, 35 (44.3%) were assigned a determined etiologic mechanism following evaluation and follow-up. Patients with undetermined stroke etiology decreased from 16.5% after first-pass evaluation to 9.2% after diagnostic completion. Patent foramen ovale/atrial septal defect-associated stroke mechanisms were identified in 61 patients (12.7%), autoimmune/inflammatory stroke mechanisms in 26 patients (5.4%), and atrial fibrillation-related cardioembolic stroke in 18 patients (3.8%). Clinically relevant mechanisms were identified in 169 patients (35.2%) whose primary etiologic classification remained unchanged. Independent predictors of CMDY were hypertension, prior stroke or transient ischemic attack, multi-territory infarction, and cortical infarction. Conclusions: Etiologic evaluation yielded clinically meaningful findings in over two-fifths of young adults with ischemic stroke and influenced etiologic assessment, treatment, and secondary prevention. Diagnostic yield was greatest among patients with prior cerebrovascular events and cortical or multi-territory infarctions, supporting a selective, phenotype-driven approach that warrants prospective multicenter validation. Full article

(This article belongs to the Special Issue Ischemic Stroke: Diagnosis and Treatment)

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11 pages, 832 KB

Open AccessArticle

Development of a Preoperative Difficulty Score for Retroperitoneal Laparoscopic Adrenalectomy: A Single-Center Retrospective Study

by Jinhu Chen, Cheng Zhang, Ligang Zhang, Hexi Du and Changsheng Zhan

J. Clin. Med. 2026, 15(16), 6204; https://doi.org/10.3390/jcm15166204 - 11 Aug 2026

Abstract

Background: Retroperitoneoscopic laparoscopic adrenalectomy (RLA) is widely adopted for benign adrenal lesions due to its direct access and minimal bowel interference. However, expanding indications to larger tumors and complex anatomies increase technical difficulty because of the confined retroperitoneal space and obscured hilar landmarks. [...] Read more.

Background: Retroperitoneoscopic laparoscopic adrenalectomy (RLA) is widely adopted for benign adrenal lesions due to its direct access and minimal bowel interference. However, expanding indications to larger tumors and complex anatomies increase technical difficulty because of the confined retroperitoneal space and obscured hilar landmarks. Current predictive models mainly focus on transperitoneal approaches and lack specificity for RLA. This study aimed to develop and internally validate a preoperative nomogram for predicting RLA-specific surgical difficulty. Methods: All patients undergoing RLA from April 2024 to February 2025 at a single center were included. Operative time and postoperative hemoglobin (Hb) reduction were used as surrogate markers of difficulty. Patients were classified into high- and standard-risk groups. Univariate and multivariate analyses were performed to identify predictors of difficult RLA and develop a composite difficulty score. Results: Tumor position (between the upper renal pole and renal pedicle: OR 8.819, 95% CI 3.981–21.462, p < 0.001) and pheochromocytoma (PHEO) pathology (OR 34.881, 95% CI 3.841–4719.428, p < 0.001) were the strongest independent predictors of high surgical difficulty, whereas tumor size (≥40 mm: OR 3.926, p = 0.071) showed limited predictive value. The composite score demonstrated excellent discrimination, with an optimism-corrected area under the curve (AUC) of 0.828 (95% CI 0.796–0.835). The nomogram showed robust calibration, and a cutoff score ≥ 2 yielded a negative predictive value of 0.940. Conclusions: This study developed an RLA-specific nomogram incorporating tumor size, position, and pathology. The tumor–renal pedicle relationship was more predictive of surgical difficulty than tumor size alone, providing risk stratification to guide surgical planning, optimize patient selection, and enhance safety as RLA indications expand. External validation is required to confirm its generalizability. Full article

(This article belongs to the Special Issue Urologic Oncology: From Diagnosis to Treatment)

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9 pages, 937 KB

Open AccessTechnical Note

Ultrasound-Guided Retroperitoneoscopic Lumbar Sympathetic Chain Selective Clamping with Indocyanine Green-Assisted Access: A Technical Note

by Vincenzo Schiavone, Gennaro Giulio Melone, Pierpaolo Castagliuolo, Giuseppe Sgarlato, Alessandro Costa, Rossana Alloni, Gianluca Mascianà and Enrico Davoli

J. Clin. Med. 2026, 15(16), 6203; https://doi.org/10.3390/jcm15166203 - 11 Aug 2026

Abstract

Background: Primary plantar hyperhidrosis is a disabling condition characterized by excessive plantar sweating and impaired quality of life. Lumbar sympathectomy is reserved for patients with symptoms refractory to conservative treatment, but minimally invasive techniques remain technically heterogeneous. This study describes a modified retroperitoneoscopic [...] Read more.

Background: Primary plantar hyperhidrosis is a disabling condition characterized by excessive plantar sweating and impaired quality of life. Lumbar sympathectomy is reserved for patients with symptoms refractory to conservative treatment, but minimally invasive techniques remain technically heterogeneous. This study describes a modified retroperitoneoscopic lumbar sympathectomy and reports its preliminary perioperative outcomes. Methods: A single-center case series included consecutive patients who underwent modified retroperitoneoscopic lumbar sympathectomy for primary plantar hyperhidrosis between June 2019 and May 2024. The technique combined ultrasound-guided retroperitoneal access, indocyanine green (ICG)-assisted creation of the retroperitoneal working space, and temporary selective clamping of the lumbar sympathetic trunk with an intraoperative assessment of plantar temperature and perfusion before definitive clipping. Results: Forty-five patients underwent 81 procedures, including 35 bilateral procedures (70 sides), 10 unilateral procedures, and one unilateral reoperation for recurrent symptoms. All patients resumed oral intake and ambulation on the day of surgery and were discharged within 24 h according to institutional protocol. No intraoperative or postoperative complications were observed and resolution of plantar sweating in subsequent follow-ups was achieved. Conclusions: Modified retroperitoneoscopic lumbar Sympathetic Chain Selective Clamping appears to be a feasible and safe technique for the surgical treatment of primary plantar hyperhidrosis. These technical refinements may facilitate retroperitoneal access and intraoperative confirmation of the target sympathetic level. Larger comparative studies with standardized outcomes and longer follow-up are needed to confirm the durability and clinical value of this approach. Full article

(This article belongs to the Section General Surgery)

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11 pages, 550 KB

Open AccessArticle

Evolving Strategies in Pediatric Cataract Surgery: A 7-Year Analysis of Ocular Biometry and IOL Localization

by Luca Schwarzenbacher, Belma Strugalioska, Gregor S. Reiter, Lorenz Wassermann, Sandra Rezar-Dreindl, Stefan Sacu and Eva Stifter

J. Clin. Med. 2026, 15(16), 6202; https://doi.org/10.3390/jcm15166202 - 11 Aug 2026

Abstract

Objectives: To evaluate temporal trends in ocular biometrics, patient demographics and surgical strategies for intraocular lens (IOL) localization in pediatric cataracts. Methods: This retrospective study included 291 eyes of 148 pediatric patients operated at a tertiary referral center between 2019 and 2025, comprising [...] Read more.

Objectives: To evaluate temporal trends in ocular biometrics, patient demographics and surgical strategies for intraocular lens (IOL) localization in pediatric cataracts. Methods: This retrospective study included 291 eyes of 148 pediatric patients operated at a tertiary referral center between 2019 and 2025, comprising 219 operated eyes and 72 unaffected fellow eyes serving as intra-individual controls. Eyes were stratified into three chronological cohorts (2019–2020, 2021–2022, 2023–2025). Axial length (AL), white-to-white (WTW) diameter and central corneal thickness were analyzed in relation to the anatomical IOL placement. A generalized linear mixed model with a random intercept per patient accounted for the within-patient correlation between fellow eyes. Results: Mean AL increased from 18.91 ± 2.83 mm to 20.32 ± 3.19 mm (p = 0.004), whereas the increase in WTW diameter was not significant (p = 0.450). The age at surgery increased significantly across the periods (median 1.08, 1.33 and 3.13 years; p < 0.001), a general temporal effect that was not modified by the site of implantation (p = 0.32). Underlying etiology strongly influenced the approach: all eyes with Marfan syndrome received an iris-fixated IOL, whereas 90% of uveitic eyes remained aphakic. Femtosecond laser-assisted cataract surgery (FLACS) was used in 13 eyes and confined to the most recent period. Conclusions: Pediatric cataract surgery shows a progressive increase in the age at surgery that is not specific to any IOL localization, while the surgical approach is frequently determined by the underlying etiology. The increasing use of FLACS represents an institutional trend; the small number of cases and absence of outcome data preclude conclusions regarding its safety or feasibility. Full article

(This article belongs to the Special Issue Clinical Advances in Ocular Surgeries: Innovations in Cataract, Retinal, and Beyond)

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