Daoud Yassine J, Hutchinson Amy, Wallace David K, Song Jonathan, Kim Terry
Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Ophthalmol. 2009 Apr;147(4):573-582.e2. doi: 10.1016/j.ajo.2008.12.028.
To summarize the evolution of the treatment of pediatric refractive errors, with an emphasis on recent advancements in the use of refractive surgery to treat children.
Literature review.
We searched MEDLINE (1950 through October 2007), the Cochrane library (December through October 2007), and the Cumulative Index for Nursing and Allied Health Literature (December 1982 through October 2007) for English language articles using the following search strategy with MeSH terms and key words: pediatric refractive errors and amblyopia, anisometropia, hyperopia, myopia, laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), excimer laser, refractive intraocular lens (IOL). We also searched the bibliographies of all identified articles.
No multicenter, long-term, controlled trial has been published on the use of refractive surgery in children. The current literature shows that LASIK, PRK, and LASEK show promising results in children with refractive amblyopia over the intermediate follow-up period. Corneal haze and myopic regression are the main complications, especially in very high myopia (> 12 diopters). In such patients with extremely high myopia, small studies have reported phakic IOLs or clear lens extraction with or without IOL implantation to be a useful alternative.
Refractive surgery is appropriate in children with severe anisometropia or bilateral high ametropia that is resistant to conventional therapy. More information is needed before pediatric refractive surgery can be widely adopted by the ophthalmic community. This could be achieved with a large, prospective, multicenter, randomized, controlled clinical trial.
总结儿童屈光不正治疗方法的演变，重点关注屈光手术治疗儿童的最新进展。
文献综述。
我们使用以下检索策略，通过医学主题词和关键词，在MEDLINE（1950年至2007年10月）、Cochrane图书馆（2007年12月至10月）以及护理及相关健康文献累积索引（1982年12月至2007年10月）中检索英文文章：儿童屈光不正与弱视、屈光参差、远视、近视、准分子原位角膜磨镶术（LASIK）、光性屈光性角膜切削术（PRK）、准分子激光上皮下角膜磨镶术（LASEK）、准分子激光、屈光性人工晶状体（IOL）。我们还检索了所有已识别文章的参考文献。
尚无关于屈光手术治疗儿童的多中心、长期、对照试验发表。当前文献表明，LASIK、PRK和LASEK在屈光性弱视儿童的中期随访中显示出有前景的结果。角膜混浊和近视回退是主要并发症，尤其是在高度近视（>12屈光度）患者中。在这类超高度近视患者中，小型研究报告有晶状体眼人工晶状体或透明晶状体摘除联合或不联合人工晶状体植入是一种有用的替代方法。
屈光手术适用于患有严重屈光参差或对传统治疗有抵抗的双侧高度屈光不正的儿童。在眼科界广泛采用儿童屈光手术之前，还需要更多信息。这可以通过一项大型、前瞻性、多中心、随机、对照临床试验来实现。
