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The flight endurance of small unmanned aerial vehicles can be significantly extended through the exploitation of naturally occurring wind phenomena. However, due to the limited computational hardware on board such aircraft and the uncertain, stochastic nature of real-world environments, there is a need for efficient and robust strategies that exhibit generalized behavior. In addressing these objectives, recent efforts have explored the use of artificial intelligence training algorithms and neural networks for the design of autonomous control schemes that exploit such wind phenomena. This study incorporates the Neuroevolution of Augmenting Topologies algorithm with domain randomization to train robust neurocontrollers that can control an aircraft along sustained traveling dynamic soaring trajectories in the presence of uncertainties and disturbances. This work presents the developed strategy for integrating robustness in neural network control systems, provides a method for quantifying and comparing robustness, and introduces an approach for identifying the network characteristics that contribute to the evolved robust behavior.

Motorcycle-related injuries involving the eye and orbit are not well characterized, with a paucity of prospective studies focusing specifically on motorcycle-associated eye injuries nor literature reviews having been conducted on the subject. To better understand the injury types and descriptive characteristics of patients experiencing motorcycle-associated eye injuries, we sought to conduct a narrative review.The research team utilized the following databases: PubMed, EMBASE, and Web of Science to query for English articles from peer-reviewed journals that provided some patient data regarding eye injury due to motorcycle or moped accidents or usage.A total of 65 studies were included in our qualitative synthesis. Of these studies, 40 (61.5%) were case reports, 20 retrospective case series (30.8%), and five (7.69%) were observational prospective studies. Among the 25 retrospective and prospective studies, 12 (48.0%) of these studies primarily focused on motorcycle-associated injuries. These 65 studies described a wide variety of motorcycle-associated eye injuries, including but not limited to orbital fractures and associated sequelae, foreign bodies, vitreoretinal trauma, neuro-ophthalmic trauma, corneal injuries, open globe injuries, lacerations, and globe avulsions.The current state of the literature indicates that knowledge regarding the ocular manifestations of motorcycle accidents is limited to mostly case reports and few retrospective cohort studies focused specifically on motorcycle-associated eye injuries. However, it is evident that the types of motorcycle-associated eye injuries are legion and predominantly seen in adult males, potentially leading to severe injuries and loss of vision and blindness.

In 2018, the US Preventive Services Task Force endorsed primary human papillomavirus testing (pHPV) for cervical cancer screening. We aimed to describe providers’ beliefs about pHPV testing effectiveness and which screening approach they regularly recommend. We invited providers who performed 10 or more cervical cancer screens in 2019 in 3 healthcare systems that had not adopted pHPV testing: Kaiser Permanente Washington, Mass General Brigham, and Parkland Health; 53.7% (501/933) completed the survey between October and December 2020. Response distributions varied across modalities (P

Previous studies have demonstrated disparities in survival surrounding hepatocellular carcinoma (HCC) across a variety of socio-demographic factors; however, the relationship between Medicaid-status and HCC survival is poorly understood.We constructed 5-year, disease-specific survival curves using the Kaplan-Meier method and performed an adjusted survival analysis using multivariate Cox-proportional hazard regression.We analyzed 17,059 non-elderly patients (12,194 non-Medicaid, 4875 Medicaid) diagnosed between 2006 and 2013 and found that Medicaid status was not associated with higher risk of diseases-specific death compared to other insurance types (p = .232, aHR 1.02, 95% CI: 0.983-1.07) after for controlling for a variety of co-variates (ie. marital status, urbanicity, etc.). We found no difference in the risk of death between patients enrolled in Medicaid for more than three years versus those enrolled for less than three years. In all models, rurality and unmarried status were also associated with an increased risk of death (aHR 1.11, 95% CI: 1.03-1.18, p = .002 and aHR 1.18, 95% CI: 1.13-1.23, p .001, respectively).Those enrolled in Medicaid prior to HCC diagnosis may not be associated with a higher risk of disease-specific death compared to non-Medicaid enrolled patients.

The debate over whether the medical profession should accommodate its members' conscientious objections (COs) has raged on in the bioethics literature and on legislative floors for decades. Unfortunately, participants on all sides of the debate fail to distinguish among different types of CO, a failure that obstructs the view of which cases warrant accommodation and why. In this paper, we identify one type of CO that warrants consideration for accommodation, called Nature of Medicine COs (NoMCOs). NoMCOs involve the refusal of physicians to perform actions they reasonably judge to be contrary to the nature of medicine and their professional obligations. We argue that accommodating NoMCOs can be justified based on the profession's need to preserve reformability. Importantly, this previously underdeveloped position evades some of the concerns commonly raised by opponents of CO accommodations.

Existing knowledge regarding golf-associated eye injuries (GEIs) is sparse. The purpose of this study was to characterize the types of GEIs, examine the mechanisms of injury, describe the characteristics of GEI victims, and determine the incidence of GEIs during the 2002-2021 period using the National Electronic Injury Surveillance System (NEISS) database.Deidentified patient records were analyzed. Each GEI was assigned into a specific category of diagnosis, and the mechanism of injury was determined. National estimates were collected for each year, and simple linear regression modeling was used to determine trends over time. Furthermore, patient variables for sex, race, and age were analyzed.The NEISS query provided a total of 379 GEIs for analysis. GEIs were most common in adult males, with a decreasing, although not statistically significant, trend during this period (β = -17.88, p = 0.110). Children were more likely to have a GEI caused by a golf club while adults were more likely to have one caused by the surrounding environment. Across all age groups, contusions and corneal abrasions were the most common GEIs, constituting 50.4% (190/377) of all eye injuries, followed by foreign body injuries (9%, 34/377) and then irritation/inflammation of the eye (8%, 30/377). The most common mechanism of injury among all players involved adverse interactions with the environment (37.7%, 142/377).Contradictory to existing literature, we show that minor GEIs are more common than severe ones. Rather than golf clubs or balls, environmental elements are the leading cause of GEIs.

The insertion-limbus distances of the extraocular muscles are clinically relevant in the preoperative planning of strabismus surgeries, especially in reoperations when information regarding insertion sites is not accessible to the surgeon. In this systematic review, we assess the reliability of time-domain anterior segment optical coherence tomography (TD AS-OCT) in determining insertion-limbus distances preoperatively by investigating prior studies that compare preoperative TD AS-OCT measurements of the insertion-limbus distances to those of calipers, which are assumed to be the gold standard.Systematically reviewing EMBASE, PubMed, Google Scholar, Science Direct, and Web of Science, 2 members screened for studies that compared preoperative TD AS-OCT measurements to those of intraoperative calipers, the gold standard. To assess the risk of bias for individual studies, the reviewers utilized the ROBINS-I tool, a Cochrane's collaboration tool used to assess bias in studies that are not randomized. For the meta-analysis, parallel forms reliability was examined and estimated as the Pearson product-moment correlation between TD AS-OCT measurements and surgical caliper measurements.Six out of the seven eligible studies provided measures of reliability that were0.7. These six records were eligible for meta-analysis. There was no evidence of a difference between means of TD AS-OCT and caliper measurements ( = 6.81, 95% CI [6.41, 7.22]; = 6.73, 95% CI [6.18, 7.29]; = 0.08, 95% CI [-0.44, 0.61]). Reliability was estimated to be good ( = 0.91) though the lower limit was slightly below the recommended minimum acceptable level of 0.70 (95% CI [0.65,0.99]).In the setting of primary surgeries, TD AS-OCT has an acceptable reliability. However, there is insufficient data to conclude whether TD AS-OCT has an acceptable reliability in the setting of reoperations.

Green nail syndrome (GNS) is a pseudomonal nail infection that presents with characteristic green nail discoloration. It typically affects patients with preexisting nail conditions or chronic exposure to wet environments but can also be seen with local trauma. Our patient presented with a pseudomonal corneal ulcer of the left eye and was incidentally found to have GNS, which developed after home artificial nail application. This unusual case of extensive pediatric GNS illustrates a rare and serious infectious complication of prolonged artificial nails.

The controversy around the accommodation of conscientious objections (COs) in medicine persists, especially for such contentious services as abortions. COs are typically considered in their negativ...

Whether the medical profession should accommodate conscientious objections (COs) remains an open question. I believe that doctors’ COs should be accommodated only when they are derived from their commitments about the nature of medicine (i.e., no doctor qua doctor should perform the objected-to service), and that the medical profession ought to accommodate these COs in order to maintain a system-level capacity for moral progress and self-correction [1]. The purpose of this project is to explore how, if at all, my conception of Nature of Medicine COs and their reform-based argument for accommodation apply to medical education. Specifically, I consider two questions: 1) Should medical students be able to enter specialties (i.e., apply to the residencies) that provide the objected-to services; and 2) should medical students’ COs be accommodated during their training? While some have answered the first question in the negative [2], I argue that medical students should be able to enter the specialties relevant to their Nature of Medicine COs. As potential members of the medical profession, medical students lack the rights and privileges of its present members, but they are nonetheless pivotal in determining its future moral trajectory. If anti-euthanasia students were kept out of the relevant specialties (viz., palliative care or critical care), those fields would eventually fill with pro-euthanasia doctors. Importantly, policymakers (i.e., legislators and doctors who represent the medical profession) should and do give greatest consideration to those most affected by their policies – for euthanasia, patients and active doctors in relevant specialties. Doctors who are regularly expected to perform abortions, for example, should and do have more of a voice in the abortion debate than cardiologists or retired doctors do. The medical profession would therefore become less likely to change its potentially wrong stance. Again, not just any CO will fit the bill here; they must be based on a reasonable conception of medicine and its moral obligations. Such refusals speak to what doctors qua doctors cannot do – in this case, perhaps the principle that no doctor should end or assist in ending a human life unless it would end on its own (as with withdrawal of life support) or save another life (as with emergency abortions). Assuming that principle is reasonable (in the sense that it may indeed be true), the CO is universalizable and therefore the right kind of thing to drive policy reform. The alternative would be COs that are based on personal idiosyncrasies, such as one’s religious beliefs, and would therefore not be universalizable. It would be inappropriate for such COs to drive policy reform, so my argument here would not protect them. It follows from my conclusion about the first question that medical students’ Nature of Medicine COs should be accommodated even before they become doctors. Otherwise, they might be so morally repulsed that they quit their medical education altogether. The specialties that provide the objected-to service would again fill with willing doctors, and the medical profession would find itself committed to potentially unethical policies. Importantly, this argument would fail if the empirical assumption that objecting students would quit were actually false. However, because of the United States’ long history of CO accommodations, we lack the data to verify that assumption. Ultimately, I wish to frame CO accommodations as a systemic feature of the medical profession that promotes moral self-correction, not a means of catering to the wishes of troublesome individuals. It follows from the need to maintain the profession’s ability to reform that medical students’ COs should be accommodated both during their training and when they decide which specialty to enter.

Background/aimsTo report the incidence and clinical characteristics of paediatric keratitis diagnosed over a 10-year period in a well-defined population.DesignRetrospective, population-based study.MethodsSetting: multicentre. Population: patients (ResultsA total of 294 diagnoses of keratitis occurred in 285 children during the 10-year period, yielding an incidence of 78.0 per 100 000 younger than 19 years (95% CI 69.0 to 87.1) or approximately 1 in 1282 children. The incidence increased throughout the 10-year study period (pConclusionsKeratitis, regardless of aetiology, was observed in approximately 1 in 1300 children by 19 years of age in this population-based cohort. Nearly half were related to contact lens wear and a decrease in vision to ≤ 20/40 occurred in 1 in 12 patients.

Purpose To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. Setting Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Design Retrospective case series. Methods All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group. Results The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA. Conclusions When a secondary IOL cannot be placed within the capsular bag, sulcus with optic capture is the best alternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications.

Carbon aerogel possesses unique structural and electrical properties, such as high mesopore volume, specific surface area, and electrical conductivity, which make it suitable for use as a catalyst support in Proton Exchange Membrane Fuel Cells (PEMFC). In this study, we present a novel synthesis of highly mesoporous carbon aerogel via ambient-drying and investigate its application in PEMFCs. The structural effects of activation on carbon aerogel were also studied. The TEM, XRF, Non Localized Density Function Theory (NLDFT) and BJH analysis were carried out to observe the morphology and pore structure. Pt on carbon aerogel and activated carbon aerogel show efficient activity in both oxygen reduction and hydrogen oxidation reactions compared to Pt on Vulcan XC-72, with increases up to 715% and 195% in specific power density, respectively. The enhanced performance of carbon aerogel is attributed to its large specific surface area and high mesopore to micropore ratio. Accelerated stress tests show that carbon aerogel has comparable durability with Vulcan XC-72, while activated carbon aerogel is less durable than both materials. Thus, the mesoporous carbon aerogel provides an efficient, lower-cost alternative to existing microporous carbon material as a catalyst support in PEMFCs.

Diabetes mellitus is a global epidemic which is growing in prevalence, and diabetic macular edema (DME) is a leading cause of visual impairment among patients affected by this disease. Our objective is to review current and upcoming therapeutic approaches to DME. Once considered the gold standard in treatment of DME, focal/grid laser is now reserved mostly for non-center-involving DME, while anti-vascular endothelial growth factor (anti-VEGF) therapy has become the first-line treatment. However, suboptimal responders to anti-VEGF and the burden of frequent injections have stimulated the development of novel approaches. Corticosteroids can be effective in treating DME, but adverse effects such as intraocular pressure elevation and cataract formation must be considered. Emerging therapeutics and drug delivery systems in the pipeline offer exciting potential solutions to this vision-threatening disease. Multiple types of therapeutics targeting various pathways implicated in the pathogenesis of DME may help lessen the global burden of vision loss from diabetes.

1. Calculation of surgically induced astigmatism (SIA) is based on the summation of two obliquely crossed spherocylindrical lenses. 2. Astigmatism is a vector quantity, and SIA can be calculated if the pre- and postoperative astigmatism values are known. 3. Fourier analysis can be applied to represent spherocylinders as power vectors for the analysis of surgically induced refractive change (SIRC). 4. The SIRC can be calculated if the pre- and postoperative keratometric K readings are known. 5. With-the-wound and against-the-wound astigmatic change can be calculated by using the meridian of the incision as the reference meridian.

Implantation of toric IOLs is a predictable method of treating corneal astigmatism and results in good visual and refractive outcomes. The ideal toric IOL candidate has regular and symmetric astigmatism, but patients with mild, stable irregular astigmatism may also benefit. Ignoring the effect of the posterior corneal astigmatism on the total corneal astigmatism leads to astigmatism prediction errors when implanting toric IOLs. It is preferable to leave patients with a slight amount of with-the-rule astigmatism to compensate for the against-the-rule shift that occurs with advancing age. The most important complication of toric IOLs is misalignment of the IOL, which can occur due to (1) inaccurate calculation of the ideal IOL alignment, (2) inaccurate alignment of the IOL during surgery, or (3) postoperative rotation of the IOL.

The recapitulation of the material properties and structure of the native aortic valve leaflet, specifically its anisotropy and laminate structure, is a major design goal for scaffolds for heart valve tissue engineering. Poly(ethylene glycol) (PEG) hydrogels are attractive scaffolds for this purpose as they are biocompatible, can be modified for their mechanical and biofunctional properties, and can be laminated. This study investigated augmenting PEG hydrogels with polycaprolactone (PCL) as an analog to the fibrosa to improve strength and introduce anisotropic mechanical behavior. However, due to its hydrophobicity, PCL must be modified prior to embedding within PEG hydrogels. In this study, PCL was electrospun (ePCL) and modified in three different ways, by protein adsorption (pPCL), alkali digestion (hPCL), and acrylation (aPCL). Modified PCL of all types maintained the anisotropic elastic moduli and yield strain of unmodified anisotropic ePCL. Composites of PEG and PCL (PPCs) maintained anisotropic elastic moduli, but aPCL and pPCL had isotropic yield strains. Overall, PPCs of all modifications had elastic moduli of 3.79±0.90 MPa and 0.46±0.21 MPa in the parallel and perpendicular directions, respectively. Valvular interstitial cells seeded atop anisotropic aPCL displayed an actin distribution aligned in the direction of the underlying fibers. The resulting scaffold combines the biocompatibility and tunable fabrication of PEG with the strength and anisotropy of ePCL to form a foundation for future engineered valve scaffolds.

When diseased, aortic valves are typically replaced with bioprosthetic heart valves (BPHVs), either porcine valves or bovine pericardium that are fixed in glutaraldehyde. These replacements fail within 10–15 years due to calcification and fatigue, and their failure coincides with a loss of glycosaminoglycans (GAGs). This study investigates this relationship between GAG concentration and the tensile and viscoelastic properties of aortic valve leaflets. Aortic valve leaflets were dissected from porcine hearts and digested in hyaluronidase in concentrations ranging from 0 to 5 U/mL for 0–24 h, yielding a spectrum of GAG concentrations that was measured using the uronic acid assay and confirmed by Alcian Blue staining. Digested leaflets with varying GAG concentrations were then tested in tension in the circumferential and radial directions with varying strain rate, as well as in stress relaxation. The GAG concentration of the leaflets was successfully reduced using hyaluronidase, although water content was not affected. Elastic modulus, the maximum stress, and hysteresis significantly increased with decreasing GAG concentration. Extensibility and the radius of transition curvature did not change with GAG concentration. The stress relaxation behavior and strain-rate independent nature of the leaflet did not change with GAG concentration. These results suggest that GAGs in the spongiosa lubricate tissue motion and reduce stresses experienced by the leaflet. This study forms the basis for predictive models of BPHV mechanics based on GAG concentration, and guides the rational design of future heart valve replacements.

To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange.Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.Retrospective case series.Patients had multifocal IOL explantation followed by IOL implantation. Outcome measures included type of IOL, surgical indication, corrected distance visual acuity (CDVA), and refractive prediction error.The study comprised 29 patients (35 eyes). The types of IOLs implanted after multifocal IOL explantation included in-the-bag IOLs (74%), iris-sutured IOLs (6%), sulcus-fixated IOLs with optic capture (9%), sulcus-fixated IOLs without optic capture (9%), and anterior chamber IOLs (3%). The surgical indication for exchange included blurred vision (60%), photic phenomena (57%), photophobia (9%), loss of contrast sensitivity (3%), and multiple complaints (29%). The CDVA was 20/40 or better in 94% of eyes before the exchange and 100% of eyes after the exchange (P = .12). The mean refractive prediction error significantly decreased from 0.22 ± 0.81 diopter (D) before the exchange to -0.09 ± 0.53 D after the exchange (P .05). The median absolute refractive prediction error significantly decreased from 0.43 D before the exchange to 0.23 D after the exchange (P .05).Multifocal IOL exchange can be performed safely with good visual outcomes using different types of IOLs. A lower refractive prediction error and a higher likelihood of 20/40 or better vision can be achieved with the implantation of the second IOL compared with the original multifocal IOL, regardless of the final IOL position.

Treatments for patients suffering from severe temporomandibular joint (TMJ) dysfunction are limited, motivating the development of strategies for tissue regeneration. In this study, co-cultures of fibrochondrocytes (FCs) and articular chondrocytes (ACs) were seeded in agarose wells, and supplemented with growth factors, to engineer tissue with biomechanical properties and extracellular matrix composition similar to native TMJ fibrocartilage. In the first phase, growth factors were applied alone and in combination, in the presence or absence of serum, while in the second phase, the best overall treatment was applied at intermittent dosing. Continuous treatment of AC/FC co-cultures with TGF-β1 in serum-free medium resulted in constructs with glycosaminoglycan/wet weight ratios (12.2%), instantaneous compressive moduli (790 kPa), relaxed compressive moduli (120 kPa) and Young's moduli (1.87 MPa) that overlap with native TMJ disc values. Among co-culture groups, TGF-β1 treatment increased collagen deposition ∼20%, compressive stiffness ∼130% and Young's modulus ∼170% relative to controls without growth factor. Serum supplementation, though generally detrimental to functional properties, was identified as a powerful mediator of FC construct morphology. Finally, both intermittent and continuous TGF-β1 treatment showed positive effects, though continuous treatment resulted in greater enhancement of construct functional properties. This work proposes a strategy for regeneration of TMJ fibrocartilage and its future application will be realized through translation of these findings to clinically viable cell sources.

Purpose To evaluate the accuracy of toric intraocular lens (IOL) alignment in femtosecond laser–assisted cataract surgery using the Truevision 3-dimensional (3-D) computer-guided visualization system compared with a manual marking method. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Design Retrospective comparative case series. Methods Preoperatively, all patients had corneal topography measurements with a color light-emitting diode topographer. The 3-D system used the anterior keratometry values to create an optimized plan for the toric IOL alignment. Intrastromal marks were created by the femtosecond laser at the intended toric meridian, guided by manual ink marks placed at the 3 o'clock and 9 o'clock limbus with the patient sitting upright. Intraoperatively, the 3-D system was used to align the IOL and measure the angular position of the femtosecond marks relative to the IOL meridian. Three weeks postoperatively, the manifest refraction, corrected distance visual acuity, and toric IOL alignment were recorded. Results The mean 3-D imaging error was −0.58 degrees ± 3.90 (SD) (range −9 to 5 degrees), and the mean manual ink error was −0.27 ± 3.65 degrees (range −8 to 5 degrees); neither was statistically significantly different from zero ( P = .28 and P = .76, respectively). The mean absolute errors were 2.96 ± 2.54 degrees and 2.88 ± 2.18 degrees, respectively. Conclusion The 3-D computer-guided system and manual marking combined with femtosecond laser marks were similar in accuracy for toric alignment. Financial Disclosures Dr. Wang received research support from Ziemer USA, Inc. Dr. Weikert is a consultant to Ziemer USA, Inc. Dr. Koch is a consultant to Alcon Laboratories, Inc., and Abbott Medical Optics, Inc., and received research support from Ziemer USA, Inc., i-Optics Corp, and Truevision Systems. None of the other authors has a financial or proprietary interest in any material or method mentioned.

To evaluate the repeatability of the Galilei G4 dual Scheimpflug analyzer in measuring simulated keratometric, total, and posterior corneal curvature in normal and post-refractive surgery eyes.Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.Prospective evaluation of diagnostic technology.A single observer performed 3 consecutive measurements in 1 eye of each subject. The following were evaluated in both eyes and in eyes that had previous myopic excimer-laser surgery: (1) simulated keratometric corneal power and astigmatism, (2) total corneal power and astigmatism, and (3) posterior corneal power and astigmatism. Repeatability was assessed by calculating the within-subject standard deviation (Sw), coefficient of variation (CoV), and intra-class correlation coefficient (ICC).The study evaluated 41 normal eyes and 36 post-refractive surgery eyes. In normal eyes, the Sw was 0.08 diopters (D), 0.10 D, and 0.03 D for simulated keratometric, total, and posterior corneal power, respectively. The CoV ranged from 0.16% to 0.40%, and the ICC was 0.992 or more (P.001) for all corneal powers. In post-refractive surgery eyes, the Sw was 0.09 D, 0.09 D, and 0.02 D for simulated keratometric, total, and posterior corneal power, respectively. The CoV ranged from 0.19% to 0.32%, and the ICC was 0.990 or more (P.001) for all corneal powers. For posterior corneal astigmatism, the ICC was 0.814 and 0.886 for normal and post-refractive surgery eyes, respectively.In normal corneas and corneas that had undergone myopic excimer laser ablation, the dual Scheimpflug analyzer showed high intra-observer repeatability for simulated keratometric, total, and posterior corneal power measurements and moderate repeatability for posterior corneal astigmatism.Drs. Koch, Weikert, and Wang received research support from Ziemer USA, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

To report the short-term outcomes and complications of implantation of scleral-fixated capsular tension rings and/or capsular tension segments with intraocular lenses (IOL) in pediatric patients with ectopia lentis.Retrospective, observational case series.Thirteen consecutive pediatric patients (19 eyes) underwent placement of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring between January 1, 2009 and March 30, 2013 by 3 anterior segment surgeons at a single academic center. The scleral fixation suture was 9-0 polypropylene in 16 eyes and CV-8 Gore-Tex (expanded polytetrafluoroethylene) in 3 eyes. Outcome measures included change in corrected distance visual acuity (CDVA) and complications.The mean age was 10.2 years ± 4.8 (SD) and the median follow-up, 23.4 months. A Cionni modified capsular tension ring was implanted in 5 eyes and a capsular tension segment with an unsutured capsular tension ring was implanted in 12 eyes. In 2 eyes, capsular tension segment alone was placed. The mean CDVA at the final follow-up (0.10 ± 0.11 logMAR, 18 eyes) was significantly better than preoperatively (0.58 ± 0.26 logMAR, 15 eyes) (P.001). The CDVA at the final follow-up was 20/40 or better in 18 eyes (94.7%). All IOLs were well centered. Posterior capsule opacification developed in 11 eyes (57.9%), 9 eyes (47.4%) required neodymium-yttrium-aluminum-garnet capsulotomy, and 3 eyes (15.8%) required pars plana vitrectomy and posterior capsulotomy. Other complications included broken suture (5.3%) (9-0 polypropylene at CTR eyelet, repaired with CV-8 Gore-Tex), conjunctival dehiscence (5.3%), suture exposure (5.3%) (trans-scleral 9-0 polypropylene), and vitreous strand at inferior paracentesis (5.3%).Implantation of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring appears to be a safe and effective technique for visual rehabilitation in pediatric ectopia lentis.