A young girl with constant exotropia was planned for surgery. Thorough preoperative workup was done and the patient underwent strabismus surgery. The girl developed preseptal haematoma on the third postoperative day with marked chemosis and oozing of blood from the conjunctival cul-de-sac. A history of factor XIII (FXIII) deficiency was later revealed by the caretakers. The patient was admitted and fresh frozen plasma was transfused for 5 days along with intravenous tranexamic acid. Orbital ultrasound and CT scan were done to confirm the location of the haematoma. The child improved significantly after 5days and the proptosis subsided. FXIII deficiency is a rare form of bleeding disorder that is not revealed on routine coagulation profile tests. Fresh frozen plasma and recombinant FXIII are now available for treatment. =C2=A9 BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Objective To report our operative experience with precision pulse capsulotomy (PPC) for anterior capsulotomy in a paediatric cataract series. Methods and analysis This study is a retrospective interventional, descriptive series of consecutive paediatric eyes (<=3D 16 years) undergoing cataract surgery using PPC. Surgical time and the time required to perform PPC was recorded. Any intraoperative and postoperative adverse events were noted. Postoperatively, visual acuity, anterior segment examination and intraocular pressure (IOP) were recorded for all children at day 1, 1 week and 1 month. Results 21 eyes of 14 patients were included in the study, with the median age at surgery of 6.0 years (IQR; 5-7.75, range=3D1-16 years). Male to female ratio was 11: 3. 13 eyes had lamellar cataract, 3 eyes had total cataract, 2 had posterior subcapsular cataract, 2 had traumatic cataract, while 1 eye had sutural cataract. Median surgical time was 26 min (IQR 21-32) and median PPC time was 75.0 secs (IQR 56-86.5). The anterior capsulotomy was round and complete in most cases, except in one case due to faulty suction. All patients underwent a successful in the bag implantation of intraocular lens with capsulotomy margins overlapping the optic edges in 19 eyes (90%). Median PPC size was 5.54 mm (n=3D9, IQR 5.39 -5.75) which was slightly larger than expected. None of the cases had any intraoperative or postoperative adverse events with no radial tears of capsulotomy. Postoperatively, the mean final follow-up was 5.71+3.20 weeks. Conclusion To conclude PPC can be used as an alternative to manual continuous curvilinear capsulorhexis in paediatric cataract surgery producing round well-centred and strong capsulotomy with an easier learning curve.