BACKGROUND: Amphotericin B is used in pediatrics for severe fungal infections despite its known nephrotoxic side effects. Tubular injury and renal vasoconstriction range from 15-58% with exact risk factors that predispose children to developing these complications still undefined. OBJECTIVES: To determine the risk factors for nephrotoxicity with deoxycholate Amphotericin B treatment among children 6 months-18 years old at the Philippine Children‘s Medical Center from 2006-2017 METHODS: This is a retrospective case-control study of 150 patients. Cases had decrease in eGFR by at least 25% and/or developed hypokalemia after at least one dose of Amphotericin. Those who did not develop nephrotoxicity were considered controls. Risk factors evaluated were age, sex, nutritional status, underlying medical condition, cumulative dose, concomitant use of nephrotoxic drugs used, treatment with diuretics and intravenous hydration. Results were analyzed using univariate and multivariate regression models. RESULTS: Using logistic regression, underlying malignancy had the highest odds ratio of 33.1 and nutritional status of z score=0 showed the lowest at 0.158. Duration of treatment >14 days had 1.75 times chance of developing nephrotoxicity while total cumulative dose >7.1 mg/kg had 1.5 times more chance of developing nephrotoxicity. Subjects given diuretics had 5.5 times more odds, while those not given concomitant nephrotoxic medications were 5.33% less likely to develop renal toxicity. CONCLUSION: Risk factors for nephrotoxicity were malignancy as an underlying medical condition, duration of amphotericin treatment of >14 days, cumulative dose >7.1 mg/kg and diuretic use. Normal nutritional status and no other concomitant nephrotoxic medication use had lesser odds of developing nephrotoxicity. RECOMMENDATIONS Clinicians should consider these risk factors, institute measures to monitor occurrence of nephrotoxicity and the need for alternative fungal therapy in these children. With identification of the population at risk, prospective research on determining the specific onset of renal effects and possible intervention is recommended.
Amphotericin B

Objective: To compare the predictability of flap thickness, visual and refractive outcomes, and higher order aberrations in eyes that underwent myopic LASIK using either a Technolas femtosecond laser or a Zyoptix XP mechanical microkeratome for flap creation. Methods: The study involved a total of 44 eyes of 22 patients who underwent LASIK. Flap creation was randomized to using the Technolas femtosecond laser in one eye and Zyoptix XP microkeratome in the contralateral eye. Flap thickness was measured intraoperatively using ultrasonic pachymetry and postoperatively using the Visante ASOCT. Refractive outcome, visual acuity (VA), higher order aberrations, and contrast sensitivity were compared between the two groups. Results: Twenty-two patients had LASIK for myopia or myopic astigmatism. Using ultrasonic pachymetry intraoperatively, the mean flap thickness was 134 (±10) um and 124 (±23) um in the femtosecond (FS) and microkeratome (MK) groups respectively. Comparing the deviation of the actual from the intended flap thickness, the FS group had statistically lower standard deviation compared to the MK group (p=0.04). Using the AS-OCT, the mean flap thickness at 3 months postoperatively was 119 (±10.82) um and 123 (±15.77) um in the FS and MK groups respectively. The difference in standard deviation between the two groups did not reach statistical significance (p=0.19). The mean spherical equivalent at 3 months was -0.45D (±0.42) and -0.13D (±0.16) respectively. Eightynine percent (89%) of eyes had uncorrected VA of 20/20 or better in both groups. All eyes attained best corrected VA of 20/20 or better in both groups. Differences in total higher order aberrations (p=0.09) and contrast sensitivity scores (p=0.47) were not statistically different between the two groups. Conclusion Flap thickness predictability was better using the Technolas femtosecond laser compared to the XP microkeratome blade. Visual and refractive outcomes, higher order aberrations, and contrast sensitivity were comparable between the 2 groups.
Keratomileusis, Laser In Situ ; Lasers, Excimer

Objective: To present the refractive and visual outcomes of refractive surgical treatment options in high myopia. Methods This was a retrospective review of patients diagnosed with high myopia (manifest refractive spherical equivalent [MRSE] ≥-6.00D) who underwent one of the following procedures: laser-in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), phakic IOL implantation with the Staar Implantable Collamer Lens (ICL), or Alcon Cachet Phakic IOL. Eyes with best corrected distance vision of less than 20/30 due to amblyopia or other eye pathologies were excluded.
Keratomileusis, Laser In Situ ; Photorefractive Keratectomy