Optic nerve sheath diameter in children with acute liver failure and hepatic encephalopathy.

We read with interest the research work done by Das and colleagues [1] on the role of ultrasonography measured optic nerve sheath diameter (ONSD) in pediatric acute liver failure (ALF). We appreciate the pilot effort by authors in extending the already proven non-invasive and point-of-care intracranial pressure (ICP) prediction advantage [2] of this technique to pediatric ALF. However, we have a few methodological concerns which are not addressed by the authors in the discussion.