First Author: M.Diab SAUDI ARABIA
Co Author(s):
Purpose:
Compare the safety and efficacy of phakic intraocular lens (PIOL) implantation versus INTACS corneal rings for correcting high myopic anisometropia in amblyopic children who were non-compliant with traditional medical treatment including spectacles or contact lenses.
Setting:
: Untreated, myopic anisometropia in children may not only lead to visual loss but it may as well lead to the disruption of binocular fusion and sensory strabismus, hence the therapy of amblyopia is essential to be successful for safe vision and restoring binocular fusion and stereopsis.
Methods:
Prospective study started at 12 August 2009 to 11September 2012 include 30 children 4 – 12 years old, suffering from unilateral high myopic anisometropic amblyopia had refractive spherical power range from -7 to -16 diopters and astigmatism -1 to -6 diopters. None of the patients were compliant with spectacle correction or contact lens wear and as a result had dense amblyopia of less than 20/400 by Snellen or Allen visual acuity subdivided into group A subjected to unilateral phakic intraocular lens (PIOL) implantation and group B treated by INTACS corneal rings. Pre- and post-operative visual acuity, anterior/posterior segment examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients whenever feasible with follow-up for at least 6 months.
Results:
ICL group revealed prevention of amblyopia with improvement in visual acuity was ?6 lines (mean visual acuity of 20/60 at six months) was achieved in 81% of children and just ?3 lines restricted to 19% of children. Improvement in stereoacuity was noted in 93.33% of cases (from total mean zero seconds-arc to six-months post-operative mean of 500 seconds-arc by random stereoacuity testing). The INTACS group showed less results with successful improved vision ?6 lines in 73% of children and just ?2 lines restricted to 27% of children. Improvement in stereoacuity was noted in 86.66%of cases (from total mean zero seconds-arc to six-months post-operative mean of 500 seconds-arc by random stereoacuity testing). Enhanced physical activity, coordination, and improved social interaction were noted in patients and were reported by the parents. Two cases of cataract and one case of glaucoma with one case of uveitis noticed in ICL group, with no intra/post-operative complications were noted in INTACS group.
Conclusions:
To reduce or eliminate highly significant anisometropic amblyopia in children who are noncompliant with traditional medical treatment, phakic anterior chamber IOL implantation or intrastromal corneal ring segments may be considered as an alternative modality of treatment. INTACS is more safe and less invasive with less complications than ICL with the potential for reversing the procedure. Further studies in this field are recommended.
Financial Disclosure:
None
