{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:10:03Z","timestamp":1790244603527,"version":"4.1.0"},"reference-count":19,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Alcon Vision LLC","award":["#87405969"],"award-info":[{"award-number":["#87405969"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Introduction: Objective, image-based comparisons of anterior capsule visualization across conventional microscopy and digital heads-up visualization systems remain limited. This exploratory retrospective study quantitatively compared capsule contrast and capsulorhexis geometry among conventional microscopy and two successive generations of a digital heads-up system, both of which apply yellow digital filtering. Methods: This retrospective, non-randomized observational study included 67 eyes of 60 patients undergoing phacoemulsification using a conventional microscope (21 eyes) or NGENUITY with yellow filtering [version 1.4 (N1.4; 25 eyes) or 1.5 (N1.5; 21 eyes)], with visualization modality determined by clinical availability at the time of surgery. Color contrast ratio (CCR), ovality index, and concentricity were quantified from masked video analysis using linear mixed-effects models (patient as random intercept) with Holm\u2013Bonferroni-adjusted comparisons. Results: Mean CCR was significantly higher in both NGENUITY groups than the Microscope group (N1.4: 1.55 \u00b1 0.55; N1.5: 1.70 \u00b1 0.29; Microscope: 1.14 \u00b1 0.09; both p \u2264 0.008), with no difference between versions. The ovality index was significantly lower in the N1.5 group than the Microscope group (2.90 \u00b1 1.78% vs. 5.08 \u00b1 3.38%; p = 0.022), though this difference did not reach significance in the per-patient sensitivity analysis (p = 0.071); no significant difference was observed between the Microscope and N1.4 groups. Concentricity did not differ significantly among groups. Conclusions: Anterior capsule contrast, as captured in recorded surgical video, was objectively higher with NGENUITY than with conventional microscopy, whereas a modest improvement in capsulorhexis circularity was observed only with version 1.5. These exploratory, hypothesis-generating findings are intended to motivate, rather than substitute for, a prospective, randomized, within-system study; they provide a standardized measurement framework showing that contrast parameters differ across visualization modalities, while geometric advantages across system generations warrant confirmation in such future studies.<\/jats:p>","DOI":"10.3390\/jcm15197430","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:07:54Z","timestamp":1790240874000},"page":"7430","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anterior Capsule Contrast and Capsulorhexis Geometry Across Visualization Systems in Cataract Surgery: An Exploratory Image-Based Comparison"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3085-5176","authenticated-orcid":false,"given":"Hisaharu","family":"Suzuki","sequence":"first","affiliation":[{"name":"Zengyo Suzuki Eye Clinic, Fujisawa 251-0871, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0886-3350(13)80870-X","article-title":"Development, advantages, and methods of the continuous circular capsulorhexis technique","volume":"16","author":"Gimbel","year":"1990","journal-title":"J. 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