Refractive surgery for children: excimer laser, phakic intraocular lens, and clear lens extraction

The article summarizes current recommendations for refractive surgery and outcomes in ametropic children who are spectacle noncompliant and unsuitable for contact lens wear.

The majority of those treated have anisometropic amblyopia. The most common method employed is advanced surface ablation using the excimer laser, such as photorefractive keratectomy or laser-assisted subepithelial keratomileusis. Surface ablation is safe in children; the drawback is the high rate of refractive regression, which is most pronounced in children with myopia beyond 10.0 D and hyperopia beyond 4.5 D. Those with more extreme ametropia--beyond the effective range for surface ablation--need phakic intraocular lens implantation or clear lens extraction, with or without implantation of a posterior chamber intraocular lens (refractive lens exchange). Children with neurobehavioral disorders and high bilateral ametropia may be functionally blind without the surgery. The prevalence of complications with each of these techniques--over follow-up generally less than 5 years--has been low. Longer follow-up will be more revealing.

The majority of children with ametropia--unilateral or bilateral--do well with glasses or contact lenses, but a minority do not. Pediatric refractive surgery meets an important need for this minority.