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Circumferential, even anterior capsular overlap maximizes IOL stability and PCO mitigation to provide best long-term outcomes for the cataract patient. P1 and P4 Purkinje reflections at patient fixation may provide a reliable marker for capsulotomy centration. However, patient fixation may be hindered during surgery due to anesthesia or light sensitivity. Here, we demonstrate that the relationship between the P1 and P4 Purkinje reflections previewed prior to surgery when the patient is fixating may be recreated intraoperatively if fixation becomes difficult. The final position of P1 and P4 relative to one another at fixation is invariant in a given patient but there are variations among patients. Knowledge of the P1 and P4 relationship can be used as a surrogate sign of patient fixation to assist in capsulotomy centration during cataract surgery.

Circumferential, even anterior capsular overlap maximizes IOL stability and PCO mitigation to provide best long-term outcomes for the cataract patient. P1 and P4 Purkinje reflections at patient fixation may provide a reliable marker for capsulotomy centration. However, patient fixation may be hindered during surgery due to anesthesia or light sensitivity. Here, we demonstrate that the relationship between the P1 and P4 Purkinje reflections previewed prior to surgery when the patient is fixating may be recreated intraoperatively if fixation becomes difficult. The final position of P1 and P4 relative to one another at fixation is invariant in a given patient but there are variations among patients. Knowledge of the P1 and P4 relationship can be used as a surrogate sign of patient fixation to assist in capsulotomy centration during cataract surgery.

To study the effect of decentration on the quality of vision in two aspheric intraocular lenses (IOLs) aspheric balance curve(ABC) design Vivinex iSert XY1(Hoya Surgical Opticals, Inc.) and posterior aspheric design AcrySof IQ SN60WF (Alcon Laboratories, Inc.).

Advanced Eye Centre, PGIMER, Chandigarh, India.

Randomised Prospective Trial using Random number table.

Eighty-five eyes were randomized to Group 1 (Vivinex XY1) and Group 2 (Acrysof IQ) with 40 and 45 eyes respectively. The HOA profile, Strehl's ratio, decentration of IOL from the visual axis (DVA) and the geometric axis (DGA), angle Alpha and Kappa were recorded on the iTrace aberrometer and contrast sensitivity was measured using the Functional Acuity Contrast Test at 12 weeks post-surgery.

The mean values of the Strehl's ratio (p=0.48) and the HOA's (p=0.12) of both IOLs were comparable. The HOA's gradually increased with increasing DVA for both lenses at 3, 4 and 5mm pupil sizes. On comparing the HOA's with the DGA a statistically insignificant positive correlation was observed. The Strehl's ratio did not deteriorate with increasing angle alpha in the Vivinex XY1 group, however worsened in the Acrysof IQ group. The contrast sensitivity was comparable in both the IOLs except at 1.5cpd under photopic conditions where Acrysof IQ was better.

Decentration of the lens is best measured with respect to the visual axis. In eyes with a large alpha, the ABC design induced lesser HOA's and maintained a better Strehl's ratio.

Decentration of the lens is best measured with respect to the visual axis. In eyes with a large alpha, the ABC design induced lesser HOA's and maintained a better Strehl's ratio.

To evaluate the effects of phakic intraocular lens (pIOL) implantation on the IOL power calculation, and subsequently to evaluate the effectiveness of concomitant use of anterior segment optical coherence tomography (AS-OCT) against biometric changes.

Masayuki Ouchi Eye Clinic, Kyoto, Japan.

Prospective consecutive case series.

One hundred patients (100 eyes) who underwent pIOL implantation were enrolled. In each eye, biometry was performed using partial coherence interferometry (PCI) and anterior segment optical coherence tomography (AS-OCT). Pre- and post-pIOL implantation IOL power calculation using SRK/T (S), Haigis (H), and Barret Universal [Combining Enclosing Square] (B) formulae were compared.

Anterior chamber depth (ACD) was significantly shorter at post-pIOL implantation, for both PCI (p < 0.001) and AS-OCT (p = 0.05). When using PCI, the crystalline lens surface was misidentified in 75% of eyes, and in these eyes, the ACD difference between pre- and post-pIOL implantation exceeded that with both PCI and AS-OCT. The estimated IOL power was significantly lower at post-pIOL implantation according to the H and B formulae (both p < 0.001) but remained unchanged by the S formula. However, no difference was observed when AS-OCT-derived ACD and lens thickness (LT) values were introduced in the H (p = 0.16) and B (p = 0.55) formulae.

Misidentification of lens surface occurs in many pIOL-implanted eyes with PCI measurements, and could influence the power calculation with H and B formulae, while leaving the S formula unaffected. AS-OCT-derived ACD and LT values substitution is recommended for H and B formula.

Misidentification of lens surface occurs in many pIOL-implanted eyes with PCI measurements, and could influence the power calculation with H and B formulae, while leaving the S formula unaffected. AS-OCT-derived ACD and LT values substitution is recommended for H and B formula.

Evaluation of intra-operative aphakic axial eye length (AL) measurements using swept source optical coherence tomography.

Hanusch Hospital, Vienna, Austria.

Prospective single-center study.

Patients scheduled for cataract surgery were measured using swept-source optical coherence tomography (ss-OCT, IOLMaster 700, Carl Zeiss Meditec AG, Jena, Germany) to assess the axial eye length. Intra-operatively, swept source optical coherence tomography (ss-OCT) measurements were performed with a prototype device (IOLMaster 700 connected to an OPMI Lumera 700 microscope, CZM) at the beginning of cataract surgery furthermore of the aphakic eye and 2 months after surgery.

Of the 59 eyes of 59 patients, the phakic median AL pre-operatively (pre-OP) and intra operatively (intra-OP) were 23.61 mm ± 0.96 (SD) and 23.51 mm ± 0.96 (SD). Absolute median difference was 0.028 ± 0.02 (SD) (p=0.049). Median phakic AL intra-OP versus 2 months post operatively (post-OP) was 23.51 mm ± 0.97 (SD) vs 23.49 mm ± 0.95 (SD). see more Absolute median difference was 0.049 ± 0.04 (SD) (p=0.000).Median AL intra-OP aphakic versus vs 2 months post-Op pseudophakic were 23.42 mm ± 0.97 (SD) versus 23.42 mm ± 0.97 (SD). Absolute median difference was 0.038 ± 0.04 (SD) (p=0.379).

Intra-OP swept source OCT technology of the phakic and aphakic eye shows excellent comparability to pre- and post-operative measurements. This technique allows axial eye length measurements with high precision in cases where pre-op biometric measurements are not possible.

Intra-OP swept source OCT technology of the phakic and aphakic eye shows excellent comparability to pre- and post-operative measurements. This technique allows axial eye length measurements with high precision in cases where pre-op biometric measurements are not possible.

To compare agreement of anterior segment parameter measurements using an intraoperative optical coherence tomography (iOCT) of a femtosecond laser (LenSx) during interface docking to the eye to preoperative Scheimpflug-tomography (Pentacam AXL) and swept-source optical coherence tomography (IOL Master 700).

Department of Ophthalmology, Goethe University, Frankfurt, Germany.

Retrospective study.

Ninty-five eyes of 66 patients who had planned OCT-guided femtosecond laser-assisted lens surgery were included. Anterior segment measurements were performed in mydriasis prior to surgery using Scheimpflug-tomography and swept-source optical coherence tomography. After surgery iOCT images were analysed using a modification of the FIJI image processing program. Outcome measures included external anterior chamber depth (ACD), central corneal thickness (CCT) and central lens thickness (LT).

The ACD measured with the iOCT was -0.011±0.126mm smaller (p=0.389) than with theswept-source OCT and -0.059±0.185mm than wrding the ACD and the lens thickness. However, Scheimpflug-tomography versus intraoperative optical coherence tomography measures a small clinically relevant difference for ACD.Eltrombopag is approved for the treatment of chronic immune thrombocytopenia purpura (ITP) in pediatric patients 1 year and older who have demonstrated an insufficient response to corticosteroids and intravenous immunoglobulin. We present the case of a 2-year-old boy with chronic immune thrombocytopenia purpura who developed life-threatening adverse effects of acute liver failure, metabolic acidosis and encephalopathy with standard drug dosing. To our knowledge, this is the first case of eltrombopag-induced hepatic encephalopathy highlighting the critical need for prescribers to exercise caution when prescribing eltrombopag in the pediatric setting.

Candidemia and Candida-associated catheter-related bloodstream infections (CRBSIs) are the significant cause of mortality and morbidity in patients with malignancy.

A retrospective analysis including all pediatric hematologic/oncologic malignancies patients with CRBSIs treated in Dr. Behçet Uz Children Diseases and Surgery Training and Research Hospital between the period of 2009 and 2020.

During the study period, 53 children with CRBSIs associated with Candida species were included. The most common malignancy was acute lymphoblastic leukemia (45.3%) and acute myeloid leukemia (15.1%). A total of 56 Candida isolates were present including non-albicans Candida species (80.4%) and Candida albicans (19.6%). The most common isolated Candida species was Candida parapsilosis (42.9%) and followed by C. albicans (19.6%). The ratio of azole prophylaxis was significantly higher in patients with the non-albicans Candida group (P=0.031). Candida-related endocarditis (vegetation) was present in 2 (3.8%) patients, and the overall rate of hepatosplenic candidiasis was 3.8%. Seven days Candida attributable mortality was 7.5% (4 patients) and 30 days Candida attributable mortality was 11.3% (6 patients). The Candida species responsible for the Candida-related deaths were as following Candida tropicalis (n=3), C. parapsilosis (n=2), and C. lusitanae (n=1).

In pediatric cancer patients with Candida-associated CRBSIs, evaluation of the patient for organ involvement including liver and spleen ultrasonography and cardiac involvement with echocardiography are essential regardless of the patients' clinical picture.

In pediatric cancer patients with Candida-associated CRBSIs, evaluation of the patient for organ involvement including liver and spleen ultrasonography and cardiac involvement with echocardiography are essential regardless of the patients' clinical picture.

Stroke is one of the major complications of sickle cell disease (SCD). Stroke features either occlusion of, or stenosis at, the origin of one of the large intracerebral arteries, the internal carotid artery (ICA), and/or the middle cerebral artery (MCA).

We sought correlations between cerebral blood flow velocities and the laboratory and clinical findings of patients with SCD.

Fifty-three pediatric SCD patients (39 with HbSS, 14 with HbSβ0) were analyzed. The mean patient age was 12.9±3.9 years. The control group contained 24 healthy individuals. The time-averaged maximum mean velocity (TAMMV) and resistive index (RI) of the MCA, the TAMMVs of the ICA and vertebral artery (VA), and the diameter of the VA were estimated through transcranial Doppler ultrasonography using a 2.5 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. We evaluated the relationships between the TAMMVs, laboratory parameters, and clinical findings.

The mean±SD MCA TAMMV was 161.2±35.