Photorefractive keratectomy in children.

PURPOSE

To evaluate photorefractive keratectomy (PRK) in pediatric patients who fail traditional methods of treatment for myopic anisometropic amblyopia and high myopia.

SETTING

Nonhospital surgical facility with follow-up in a hospital clinic setting.

METHODS

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.

RESULTS

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.

CONCLUSION

Photorefractive keratectomy in children represents another method of providing long-term resolution of bilateral high myopia and myopic anisometropic amblyopia.