Laser-assisted subepithelial keratectomy in children

To evaluate whether laser-assisted subepithelial keratectomy (LASEK) achieves effective targeted myopic correction with less post-treatment corneal haze than observed with photorefractive keratectomy (PRK) in children who fail traditional forms of treatment for myopic anisometropic amblyopia and high myopia.

Nonhospital surgical facility with follow-up in a hospital clinic setting.

This prospective study comprised 36 eyes of 25 patients. The mean patient age at treatment was 8.27 years (range 1.0 to 17.4 years). Patients were divided into 3 groups: those with myopic anisometropic amblyopia (13 patients/13 eyes), those with bilateral high myopia (11 patients/22 eyes), and those with high myopia post-penetrating keratoplasty (1 patient/1 eye). All patients were treated with LASEK under general anesthesia using the Visx 20/20 B excimer laser and a multizone, multipass ablation technique. Although the myopia was as high as -22.00 diopters (D) spherical equivalent (SE) in some eyes, no eye was treated for more than -19.00 D SE.

At 1 year, the mean SE decreased from -8.03 D to -1.19 D. Forty-four percent of eyes were within +/-1.0 D of the targeted correction; 78% of eyes had clear corneas with no haze. In the entire group, the mean best corrected visual acuity improved from 20/80 to 20/50. A functional-vision survey demonstrated a positive effect on the patients' ability to function in their environments after LASEK.

Laser-assisted subepithelial keratectomy in children represents another method of providing long-term resolution of bilateral high myopia and myopic anisometropic amblyopia with minimal post-laser haze. The reduction in post-laser haze with LASEK compared to that with the standard PRK technique may represent an advantage in treating these complex patients.