Refractive surgery in children: Treatment options, Outcomes and Controversies

By Hany EL-DefrawyPediatric fellow, Bristol Eye hospital

Medline Literature review (1950-2007) Cochrane library Cumulative index for nursing and allied health

literature English language articles using MeSH terms and key

words

Pediatric refractive errors & amblyopia, ansiometropia, hyperopia, myopia, LASIK, PRK,excimer laser, refractive intraocular lens

Alhazen (Ibn al-Haytham)(965 – 1040)

Spectacles

Problems with high powered spectacles

Contact lenses

Myopia Hyperopia Anisometropia Monocular aphakia Astigmatism (Toric)

Contact lens problems

LASIK

PRK

LASEK

COMPLICATIONS OF REFRACTIVE SURGERY

Regression Flap related complications Interface deposits Infection Post LASIK Kerato-ectasia

Cornea refractive surgery for myopic anisometropia

Refractive surgery in children

IOL insertion in congenital cataract. Epikeratophakia

Refractive surgery in High myopia, preliminary studies

Cornea refractive surgery for hyperopic anisometropia

Artisan Iris Claw lens

Intraocular surgery studies for myopic Anisometropia

Risks and benefits of phakic IOLs

ARE WE READY?

Controversies

At what age should refractive surgery be performed? Should the same limit of residual corneal thickness used in

adults applied to children? Should conventional antiamblyopia therapy be carried out in

conjunction to refractive surgery? How much myopic regression can be expected in pediatric

patients with high myopia? What is the true rate of corneal haze? Can mitomycin be used safely to lessen the haze? What are the risks of general anesthesia ? Which technique?

Discussion

Small number Selection bias Healing in children Flap related complications Visual acuity affected by amblyopia Regression Haze

Conclusion

No multicenter long term controlled trial has been published on the use of refractive surgery in children

Small retrospective short term studies show that refractive surgery is promising