Tychsen Lawrence
Department of Ophthalmology, St Louis Children's Hospital at Washington University Medical Center, St Louis, Missouri 63110, USA.
Curr Opin Ophthalmol. 2008 Jul;19(4):342-8. doi: 10.1097/ICU.0b013e328302cc89.
The article summarizes current recommendations for refractive surgery and outcomes in ametropic children who are spectacle noncompliant and unsuitable for contact lens wear.
The majority of those treated have anisometropic amblyopia. The most common method employed is advanced surface ablation using the excimer laser, such as photorefractive keratectomy or laser-assisted subepithelial keratomileusis. Surface ablation is safe in children; the drawback is the high rate of refractive regression, which is most pronounced in children with myopia beyond 10.0 D and hyperopia beyond 4.5 D. Those with more extreme ametropia--beyond the effective range for surface ablation--need phakic intraocular lens implantation or clear lens extraction, with or without implantation of a posterior chamber intraocular lens (refractive lens exchange). Children with neurobehavioral disorders and high bilateral ametropia may be functionally blind without the surgery. The prevalence of complications with each of these techniques--over follow-up generally less than 5 years--has been low. Longer follow-up will be more revealing.
The majority of children with ametropia--unilateral or bilateral--do well with glasses or contact lenses, but a minority do not. Pediatric refractive surgery meets an important need for this minority.
本文总结了针对屈光不正且不适合佩戴框架眼镜和隐形眼镜的儿童进行屈光手术的当前建议及手术效果。
接受治疗的大多数儿童患有屈光参差性弱视。最常用的方法是使用准分子激光进行的表层切削术，如光性屈光性角膜切削术或准分子激光上皮下角膜磨镶术。表层切削术对儿童来说是安全的；缺点是屈光回退率较高，在近视超过10.0 D和远视超过4.5 D的儿童中最为明显。那些屈光不正程度更严重——超出表层切削术有效范围——的儿童需要植入有晶状体眼人工晶状体或摘除透明晶状体，可植入或不植入后房型人工晶状体（屈光性晶状体置换术）。患有神经行为障碍和高度双侧屈光不正的儿童如果不进行手术可能会功能性失明。在通常不到5年的随访期间，这些技术各自的并发症发生率都很低。更长时间的随访将更能说明问题。
大多数单侧或双侧屈光不正的儿童佩戴眼镜或隐形眼镜效果良好，但少数儿童并非如此。小儿屈光手术满足了这少数儿童的一项重要需求。
