Astle William F, Huang Peter T, Ells Anna L, Cox Robin G, Deschenes Micheline C, Vibert Heather M
Alberta Children's Hospital, University of Calgary, Division of Ophthalmology, Calgary, Alberta, Canada.
J Cataract Refract Surg. 2002 Jun;28(6):932-41. doi: 10.1016/s0886-3350(02)01304-4.
To evaluate photorefractive keratectomy (PRK) in pediatric patients who fail traditional methods of treatment for myopic anisometropic amblyopia and high myopia.
Nonhospital surgical facility with follow-up in a hospital clinic setting.
Photorefractive keratectomy was performed in 40 eyes of 27 patients. The patients were divided into 4 groups based on the type of myopia: myopic anisometropic amblyopia (15 eyes/13 patients), bilateral high myopia (20 eyes/10 patients), high myopia post-penetrating keratoplasty (3 eyes/2 patients), and combined corneal scarring and anisometropic amblyopia (2 eyes/2 patients). All procedures were performed under general anesthesia using the VISX 20/20 B laser and a multizone, multipass ablation technique. Appropriate corneal fixation was achieved with appropriate head positioning (turn and tilt) and an Arrowsmith fixation ring. Myopia was as high as -25.00 diopter (D) spherical equivalent (SE), but no treatment was for more than -17.50 D SE.
The mean SE decreased from -10.68 D to -1.37 D at 1 year, a mean change of -9.31 D. At 1 year, the mean best corrected visual acuity improved from 20/70 to 20/40 in the entire group. Forty percent of eyes were within +/-1.0 D of the targeted refraction. There was no haze in 59.5% of eyes. Three eyes initially had 3+ haze; 1 improved to 2+ and 2 required repeat PRK with significant haze reduction. Five eyes (3 patients) with greater than -17.00 D SE myopia before PRK (range -17.50 to -25.00 D) had 3.42 D more effect than predicted (range 0.50 to 5.50 D). A functional vision survey demonstrated a positive effect on the children's ability to function in their environments after the laser treatment.
Photorefractive keratectomy in children represents another method of providing long-term resolution of bilateral high myopia and myopic anisometropic amblyopia.
评估准分子激光角膜切削术（PRK）在因近视性屈光参差性弱视和高度近视而传统治疗方法失败的儿科患者中的应用效果。
非医院手术机构，在医院门诊进行随访。
对27例患者的40只眼进行了准分子激光角膜切削术。根据近视类型将患者分为4组：近视性屈光参差性弱视（15只眼/13例患者）、双侧高度近视（20只眼/10例患者）、穿透性角膜移植术后高度近视（3只眼/2例患者）以及合并角膜瘢痕和屈光参差性弱视（2只眼/2例患者）。所有手术均在全身麻醉下使用VISX 20/20 B激光和多区、多脉冲消融技术进行。通过适当的头部定位（转动和倾斜）以及Arrowsmith固定环实现了适当的角膜固定。近视最高达-25.00屈光度（D）等效球镜（SE），但治疗的等效球镜均不超过-17.50 D。
1年时平均等效球镜从-10.68 D降至-1.37 D，平均变化为-9.31 D。1年时，整个组的平均最佳矫正视力从20/70提高到了20/40。40%的眼睛屈光度数在目标屈光度数的±1.0 D范围内。59.5%的眼睛没有出现 haze。3只眼最初出现3+ haze；1只眼改善为2+，2只眼需要重复PRK，haze明显减轻。5只眼（3例患者）在PRK前等效球镜大于-17.00 D（范围为-17.50至-25.00 D），其效果比预期多3.42 D（范围为0.50至5.50 D）。一项功能性视力调查显示，激光治疗后对儿童在其环境中的功能能力有积极影响。
儿童准分子激光角膜切削术是提供双侧高度近视和近视性屈光参差性弱视长期解决方案的另一种方法。
