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Photorefractive keratectomy in children
William F Astle1, Peter T Huang, Anna L Ells
1Alberta Children's Hospital, University of Calgary, Division of Ophthalmology, Calgary, Alberta, Canada.
Insights
Photorefractive keratectomy (PRK) effectively treats high myopia and amblyopia in children when other methods fail. This laser eye surgery significantly improves vision and daily functioning for pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric eye care
- Refractive surgery
Background:
- Pediatric myopic anisometropic amblyopia and high myopia often resist traditional treatments.
- Effective interventions are crucial for long-term visual development in children.
Purpose of the Study:
- To assess the efficacy of photorefractive keratectomy (PRK) for pediatric patients.
- To evaluate PRK outcomes in cases of treatment-resistant myopic anisometropic amblyopia and high myopia.
Main Methods:
- PRK was performed on 40 eyes of 27 pediatric patients under general anesthesia.
- Patients were categorized into groups based on myopia type: anisometropic amblyopia, bilateral high myopia, post-keratoplasty, and combined corneal scarring/amblyopia.
- The VISX 20/20 B laser with a multizone, multipass ablation technique was used, with myopia up to -25.00 D SE treated (max -17.50 D SE).
Main Results:
- Mean spherical equivalent (SE) improved from -10.68 D to -1.37 D at 1 year (mean change -9.31 D).
- Mean best-corrected visual acuity improved from 20/70 to 20/40; 40% of eyes achieved +/-1.0 D of target refraction.
- Functional vision surveys indicated a positive impact on children's daily activities post-treatment, with 59.5% of eyes showing no haze.
Conclusions:
- PRK offers a viable long-term solution for pediatric high myopia and myopic anisometropic amblyopia.
- The procedure demonstrates significant visual acuity improvement and functional benefits in children.
- PRK provides an alternative treatment option for complex pediatric refractive errors.
Purpose:
To evaluate photorefractive keratectomy (PRK) in pediatric patients who fail traditional methods of treatment for myopic anisometropic amblyopia and high myopia.
Setting:
Nonhospital surgical facility with follow-up in a hospital clinic setting.
Methods:
Photorefractive keratectomy was performed in 40 eyes of 27 patients. The patients were divided into 4 groups based on the type of myopia: myopic anisometropic amblyopia (15 eyes/13 patients), bilateral high myopia (20 eyes/10 patients), high myopia post-penetrating keratoplasty (3 eyes/2 patients), and combined corneal scarring and anisometropic amblyopia (2 eyes/2 patients). All procedures were performed under general anesthesia using the VISX 20/20 B laser and a multizone, multipass ablation technique. Appropriate corneal fixation was achieved with appropriate head positioning (turn and tilt) and an Arrowsmith fixation ring. Myopia was as high as -25.00 diopter (D) spherical equivalent (SE), but no treatment was for more than -17.50 D SE.
Results:
The mean SE decreased from -10.68 D to -1.37 D at 1 year, a mean change of -9.31 D. At 1 year, the mean best corrected visual acuity improved from 20/70 to 20/40 in the entire group. Forty percent of eyes were within +/-1.0 D of the targeted refraction. There was no haze in 59.5% of eyes. Three eyes initially had 3+ haze; 1 improved to 2+ and 2 required repeat PRK with significant haze reduction. Five eyes (3 patients) with greater than -17.00 D SE myopia before PRK (range -17.50 to -25.00 D) had 3.42 D more effect than predicted (range 0.50 to 5.50 D). A functional vision survey demonstrated a positive effect on the children's ability to function in their environments after the laser treatment.
Conclusion:
Photorefractive keratectomy in children represents another method of providing long-term resolution of bilateral high myopia and myopic anisometropic amblyopia.