Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
Ophthalmology. 2022 Nov;129(11):1323-1331. doi: 10.1016/j.ophtha.2022.06.022. Epub 2022 Aug 18.
To review the published literature assessing the safety and effectiveness of laser refractive surgery to treat anisometropic amblyogenic refractive error in children aged ≤ 18 years.
A literature search of the PubMed database was conducted in October 2021 with no date limitations and restricted to publications in English. The search yielded 137 articles, 69 of which were reviewed in full text. Eleven articles met the criteria for inclusion and were assigned a level of evidence rating.
The 11 included articles were all level III evidence and consisted of 1 case-control study and 10 case series. Six studies used laser-assisted in situ keratomileusis (LASIK), 1 used photorefractive keratectomy (PRK), 1 used refractive lenticule extraction/small incision lenticule extraction, and the rest used a combination of LASIK, PRK, laser epithelial keratomileusis (LASEK), or refractive lenticule extraction/small incision lenticule extraction. Five studies enrolled patients with anisometropic myopia, 2 studies enrolled patients with anisometropic hyperopia, and the remainder were mixed. Although all studies demonstrated an improvement in best-corrected visual acuity (BCVA), the magnitude of improvement varied widely. As study parameters varied, a successful outcome was defined as residual refractive error of 1 diopter (D) or less of the target refraction because this was the most commonly used metric. Successful outcomes ranged between 38% and 87%, with a mean follow-up ranging from 4 months to 7 years. Despite this wide range, all studies demonstrated an improvement in the magnitude of anisometropia. Regression in refractive error occurred more frequently and to a greater degree in myopic eyes and eyes with longer follow-up, and in younger patients. Although one study reported 2 free flaps, most studies reported no serious adverse events. The most common complications were corneal haze and striae.
Findings from included studies suggest that laser refractive surgery may address amblyogenic refractive error in children and that it appears to decrease anisometropia. However, the evidence for improvement in amblyopia is unclear and long-term safety data are lacking. Long-term data and well-designed clinical studies that use newer refractive technologies in standardized patient populations would help address the role of refractive surgery in children and its potential impact on amblyopia.
回顾评估激光屈光手术治疗≤18 岁儿童屈光性弱视性屈光不正的安全性和有效性的已发表文献。
2021 年 10 月，在 PubMed 数据库中进行了文献检索，未设置时间限制，仅检索英语文献。检索出 137 篇文章，其中 69 篇进行了全文审查。11 篇文章符合纳入标准，并被评定为证据等级。
11 篇纳入的文章均为 III 级证据，包括 1 项病例对照研究和 10 项病例系列研究。6 项研究使用了激光辅助原位角膜磨镶术（LASIK），1 项使用了光性角膜切削术（PRK），1 项使用了屈光性晶状体切除术/小切口晶状体切除术，其余则使用了 LASIK、PRK、激光上皮下角膜切除术（LASEK）或屈光性晶状体切除术/小切口晶状体切除术的组合。5 项研究纳入了屈光性近视患者，2 项研究纳入了屈光性远视患者，其余则为混合患者。尽管所有研究均显示最佳矫正视力（BCVA）得到改善，但改善幅度差异很大。由于研究参数不同，成功的定义是残余屈光误差为目标屈光度的 1 屈光度（D）或更小，因为这是最常用的指标。成功的结果在 38%至 87%之间，平均随访时间从 4 个月到 7 年不等。尽管范围很广，但所有研究都显示出了屈光不正程度的改善。近视眼和随访时间较长的眼以及较年轻的患者，屈光误差的回退更为频繁，程度也更大。虽然有一项研究报告了 2 例游离瓣，但大多数研究报告没有严重的不良事件。最常见的并发症是角膜混浊和条纹。
纳入研究的结果表明，激光屈光手术可能解决儿童的弱视性屈光不正，并且似乎可以降低屈光参差。然而，改善弱视的证据尚不清楚，且缺乏长期安全性数据。长期数据和使用标准化患者人群中的新技术进行的精心设计的临床研究将有助于确定儿童屈光手术的作用及其对弱视的潜在影响。
