Refractive surgery in children: is it ready for prime time?

Area of Science:

• Ophthalmology
• Pediatric Optometry
• Refractive Surgery

Background:

• Excimer laser procedures are potential treatments for pediatric accommodative esotropia, high ametropia, and severe anisometropia.
• Traditional treatments like spectacles and contact lenses are often ineffective for these conditions, particularly in children with neuropsychological disorders.
• Refractive surgery presents a viable alternative for managing complex pediatric refractive errors.

Purpose of the Study:

• To evaluate the visual and refractive outcomes of photorefractive keratectomy in pediatric anisometropic amblyopia.
• To review existing literature on excimer laser procedures for pediatric accommodative esotropia, high anisometropia, and bilateral high ametropia.

Main Methods:

• Analysis of visual and refractive results from photorefractive keratectomy studies in children.
• Comprehensive review of global scientific literature on excimer laser applications for pediatric refractive conditions.

Main Results:

• Significant improvement in uncorrected and best-corrected visual acuity observed in 7/9 and 6/9 patients, respectively, at 36 months.
• Excellent refractive accuracy achieved, with 50% of myopic and 100% of hyperopic patients within 2D of target at 36 months.
• Demonstrated good refractive error stability and minimal corneal haze post-procedure.

Conclusions:

• Pediatric refractive surgery using excimer lasers is relatively stable for reducing amblyopiogenic refractive errors.
• Procedures lead to improvements in both best-corrected and uncorrected visual acuity.
• Excimer laser surgery appears effective for pure accommodative esotropia, with further research needed to establish definitive safety and efficacy through randomized trials.