Excimer laser advanced surface ablation for myopic anisometropic amblyopia in pediatric patients: long-term results

Poster Details

First Author: R.Autrata CZECH REPUBLIC

Co Author(s):    I. Krejcirova   K. Pramukova           

Abstract Details

Purpose:

To evaluate the efficacy, predictabilty, safety, stability, visual acuity and binocular vision results of laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy for the correction of high myopic anisometropia and amblyopia in children.

Setting:

Department of Ophthalmology, Faculty of Medicine, Masaryk University, Faculty Hospital Brno, 613 00 Brno, Czech Republic,

Methods:

This retrospective study comprised 175 eyes of 175 pediatric patients that had LASEK or PRK for high myopic anisometropia from -5.5 to -11.5 D operated between 2000-2009. All children were unable to use spectacles due to aniseikonia, and they were noncompliant with contact lenses. They were at 3 to 8 years of age in time of surgery, Children younger than 7 years were operated in general anesthesia. All patients were treated with Nidek excimer laser or Schwind Amaris and multizonal ablation technique. In all children surgery was followed by a half-day patching of the dominant eye. Main outcome measures were cycloplegic refraction, uncorrected and best spectacle-corrected visual acuity (UCVA, BSCVA resp.), keratometry, biometry, ocular alignment, corneal clarity and grade of stereopsis over 2 to 9 years of follow-up.

Results:

The preoperative mean spherical equivalent (MSE) was -8.12 ? 2.54 D( range -5.5 to -11.5 D). The postoperative MSE was –1.23 ? 0.81 D at the last visit. The mean preop UCVA 0.031 ? 0.017 increased to 0.57 ? 0.18 (P<0.05) postop. The mean preop. BSCVA was 0.36 ? 0.24 and changed to 0.87 ? 0.23 postop. The safety index was 1.82. All the eyes had no line lost in BSCVA, 60 eyes had two lines gained, 46 and 69 eyes had 3 and 4 or more lines gained, resp. Preoperative spectacle aniseikonia decreased from 11,7% to 2,4% postoperatively. Binocular vision and grade of stereopsis was improved and saved in 83% of pediatric patients. No postoperative complications were observed. All eyes have clear cornea without haze at final examination.

Conclusions:

Excimer laser surface ablation have an important role in the management of high myopic anisometropic amblyopia in CL noncompliant preschool children. Pediatric LASEK and PRK are highly effective and safe methods to reduce myopic anisometropia up to –12D, decrease spectacle aniseikoina, improve visual acuity and stereopsis in children aged 3 to 8 years with amblyopia when contact lens intolerance. Supported by grant of the Ministry of Health (IGA), Czech Republic, identification no. NT12110-5/2011 NS 9284 FINANCIAL DISCLOSURE?: No