Paysse Evelyn A, Coats David K, Hussein Mohamed A W, Hamill M Bowes, Koch Douglas D
Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA.
Ophthalmology. 2006 Feb;113(2):169-76. doi: 10.1016/j.ophtha.2005.06.010. Epub 2005 Dec 19.
To evaluate the long-term visual acuity (VA) and refractive error responses to excimer laser photorefractive keratectomy (PRK) for treatment of anisometropic amblyopia in children.
Prospective interventional case-control study.
Eleven children, 2 to 11 years old, with anisometropic amblyopia who were noncompliant with conventional therapy with glasses or contact lenses and occlusion therapy were treated with PRK. A cohort derived retrospectively of 13 compliant and 10 noncompliant children with refractive errors similar to those of the PRK group who were treated with traditional anisometropic amblyopia therapy served as control groups.
Photorefractive keratectomy for the eye with the higher refractive error.
(1) Refractive error reduction and stability in the treated eye, (2) cycloplegic refraction, (3) VA, (4) stereoacuity, and (5) corneal haze up to 3 years after PRK. Compliant and noncompliant children with anisometropia amblyopia were analyzed as controls for refractive error and VA.
Preoperative refractive errors were -13.70 diopters (D) (+/-3.77) for the myopic group and +4.75 D (+/-0.50) for the hyperopic group. Mean postoperative refractive errors at last follow-up (mean, 31 months) were -3.55 D (+/-2.2.5) and +1.41 D (+/-1.07) for the myopic and hyperopic groups, respectively. At last follow-up, cycloplegic refractions in 4 (50%) of 8 myopes and all hyperopes (100%) were within 3 D of that of the fellow eye. Five (63%) of 8 myopic children achieved a refraction within 2 D of the target refraction. Two (67%) of 3 hyperopic patients maintained their refractions within 2 D of the target. Refractive regressions (from 1 year after surgery to last follow-up) were 0.50+/-1.41 D (myopes) and 0.60+/-0.57 D (hyperopes). Seven children (77%) were able to perform psychophysical VA testing preoperatively and postoperatively. Five (71%) of the 7 children had uncorrected VA improvement of at least 2 lines, and 4 (57%) of 7 had best spectacle-corrected VA improvement of at least 2 lines, with 1 improving 7 lines. Five (55%) of 9 children had improvement of their stereoacuity at last follow-up. Subepithelial corneal haze remained negligible. The mean final VA of the PRK group was significantly better than that of the noncompliant control group (P = 0.003). The mean final refractive error for both myopic and hyperopic groups was also significantly better that that of the control groups (P = 0.007 and P<0.0001, respectively).
Photorefractive keratectomy for severe anisometropic amblyopia in children resulted in long-term stable reduction in refractive error and improvement in VA and stereopsis, with negligible persistent corneal haze.
评估准分子激光屈光性角膜切削术（PRK）治疗儿童屈光参差性弱视的长期视力（VA）和屈光不正反应。
前瞻性干预性病例对照研究。
11名2至11岁的屈光参差性弱视儿童，他们不依从眼镜或隐形眼镜的传统治疗以及遮盖疗法，接受了PRK治疗。回顾性选取13名依从和10名不依从的屈光不正儿童作为对照组，他们的屈光不正情况与PRK组相似，接受传统的屈光参差性弱视治疗。
对屈光不正度数较高的眼睛进行屈光性角膜切削术。
（1）治疗眼屈光不正的降低和稳定性，（2）睫状肌麻痹验光，（3）视力，（4）立体视锐度，以及（5）PRK术后长达3年的角膜 haze。将依从和不依从的屈光参差性弱视儿童作为屈光不正和视力的对照进行分析。
近视组术前屈光不正为-13.70屈光度（D）（±3.77），远视组为+4.75 D（±0.50）。最后一次随访（平均31个月）时，近视组和远视组的平均术后屈光不正分别为-3.55 D（±2.25）和+1.41 D（±1.07）。在最后一次随访时，8名近视儿童中的4名（50%）和所有远视儿童（100%）的睫状肌麻痹验光结果与对侧眼相差在3 D以内。8名近视儿童中有5名（63%）的验光结果与目标屈光不正相差在2 D以内。3名远视患者中有2名（67%）的屈光不正维持在目标值的2 D以内。屈光回退（从术后1年到最后一次随访）在近视患者中为0.50±1.41 D，在远视患者中为0.60±0.57 D。7名儿童（77%）能够在术前和术后进行心理物理学视力测试。7名儿童中有5名（71%）未矫正视力提高至少2行，7名中有4名（57%）最佳矫正视力提高至少2行，其中1名提高了7行。9名儿童中有5名（55%）在最后一次随访时立体视锐度有所提高。上皮下角膜 haze 仍然可以忽略不计。PRK组的平均最终视力明显优于不依从对照组（P = 0.003）。近视组和远视组的平均最终屈光不正也明显优于对照组（分别为P = 0.007和P<0.0001）。
儿童严重屈光参差性弱视的屈光性角膜切削术可导致屈光不正长期稳定降低，视力和立体视得到改善，持续性角膜 haze 可忽略不计。
