gms | German Medical Science

To evaluate the visual and refractive outcomes of multizonal photorefractive keratectomy (PRK) and laser subepithelial keratomileusis (LASEK) for high myopic anisometropia and contact lens intolerance in 48 children treated from January 1996.

Group 1: Twenty one patients aged 7 to 15 years underwent multizonal PRK on the more myopic eye and were retrospectively analyzed. Group 2: Twenty-seven patients aged 4 to 7 years (mean, 5.4 years) with high myopic anisometropia and amblyopia had performed multizonal PRK (13 eyes) or LASEK (14 eyes) on the more myopic eye in general anesthesia, Scanning-slit excimer laser Nidek EC 5000 was used. The examination included cycloplegic refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), biomicroscopy, grading of postoperative haze based on 5-point scale, corneal topography, pachymetry, intraocular pressure, biometry, orthoptic status, binocular vision, and fundus evaluation. Refractive surgical data reported in standard format to describe safety, efficacy, predictability and stability of the procedure. A long term binocular vision outcome was analyzed. All patients completed 2 to 8 years follow-up postoperatively. In Group 2, surgery was followed by patching of the dominant eye.

Group 1: The mean preoperative spherical equivalent (SE) refraction was -8.93±1.39 diopters (D) and the mean postop. SE -1.66±0.68 D (P<0.05). The mean preop UCVA 0.034±0.016 increased to 0.35±0.15 (P<0.05) postop. The mean preop. BSCVA was 0.53±0.19 and changed to 0.64±0.16 postop. The safety index was 1.21. All the eyes had no line lost in BSCVA, 9 eyes had one line gained and 5 eyes had two lines gained with comparison to their preoperative values. Postoperative binocular vision was saved or improved. Group 2: The mean preoperative spherical equivalent (SE) refraction in Group A was -8.25±2.37 diopters (D) decreased to -1.51±0.73 D at 2 years postop. The mean preop. BSCVA 0.23±0.21 improved to 0.78±0.19 by 2 years after the surgery. Binocular vision improvement expressed by the proportions of subjects gained fusion and stereopsis after surgery, was 78% of children in group 2. None of the eyes had grade +3 of haze. There were no significant complications.

PRK and LASEK, are effective and safe methods for correction of high myopic anisometropia in children aged 4 to 15 years and for significant improvement of amblyopia in children aged 4 to 7 years, when contact lens intolerance. Visual acuity and binocular vision outcomes may be better in children who receive a permanent surgical correction of anisometropia, than in children conventionally treated by contact lenses.