Tychsen Lawrence, Hoekel James
Department of Ophthalmology and Visual Sciences, St. Louis Children's Hospital at Washington University School of Medicine, University Medical Center, One Children's Place, St. Louis, MO 63110, USA.
J AAPOS. 2006 Aug;10(4):364-70. doi: 10.1016/j.jaapos.2006.04.004.
A subpopulation of children with high myopia and neurobehavioral disorders is noncompliant with spectacle wear and ill-suited to correction using contact lenses. We report the results of refractive surgery in a series of these children treated bilaterally using excimer laser technology.
Clinical course and outcome data were collated prospectively in a group of 9 children (mean age, 10.2 years; range, 3-16 years) with neurobehavioral disorders exacerbated by chronic noncompliance with spectacle wear, causing profoundly low functional vision. Myopia in the 18 eyes ranged from -3.75 to -11.5 D (mean -16.6 D) and the desired refraction was approximately +1D. Correction was achieved by bilateral laser-assisted subepithelial keratectomy (ie, LASEK) performed under brief general anesthesia. Mean follow-up was 17 months (range, 6-36 months).
Myopia correction averaged 7.9 D. Eighty-nine percent (16/18 eyes) were corrected to within +/-1 D of goal refraction. Uncorrected acuity improved postoperatively in all 18 eyes, with commensurate gains in behavior and environmental visual interaction in 88% (15/17 children). Myopic regression averaged approximately 0.8 d/year. the only complication encountered was mild (1+) corneal haze in 35% of treated eyes.
DISCUSSION/CONCLUSIONS: Bilateral excimer laser surgery is effective for improving functional vision substantially in highly myopic, neurobehaviorally impaired children who have difficulties wearing glasses. Myopic regression is common. Further study is indicated to determine the long-term safety of these and alternative refractive procedures in similar pediatric populations.
患有高度近视和神经行为障碍的儿童亚群体不配合佩戴眼镜，也不适合使用隐形眼镜进行矫正。我们报告了一系列使用准分子激光技术对这些儿童进行双侧治疗的屈光手术结果。
前瞻性整理了一组9名儿童（平均年龄10.2岁；范围3 - 16岁）的临床病程和结局数据，这些儿童因长期不配合佩戴眼镜而使神经行为障碍加重，导致功能性视力极低。18只眼中的近视度数在-3.75至-11.5 D之间（平均-16.6 D），期望的屈光度约为+1D。通过在短暂全身麻醉下进行双侧激光辅助上皮下角膜磨镶术（即LASEK）来实现矫正。平均随访时间为17个月（范围6 - 36个月）。
近视矫正平均为7.9 D。89%（16/18只眼）矫正至目标屈光度的±1 D范围内。所有18只眼术后未矫正视力均有改善，88%（15/17名儿童）的行为和环境视觉互动也相应改善。近视回退平均约为0.8 d/年。唯一遇到的并发症是35%的治疗眼出现轻度（1+）角膜混浊。
讨论/结论：双侧准分子激光手术对于改善高度近视、有神经行为障碍且戴眼镜有困难的儿童的功能性视力非常有效。近视回退很常见。需要进一步研究以确定这些及其他屈光手术在类似儿科人群中的长期安全性。
