Pediatric refractive surgery: Corneal and intraocular techniques and beyond

Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus (Impact Factor: 1). 06/2012; 16(3):291-7. DOI: 10.1016/j.jaapos.2012.01.012
Source: PubMed


Refractive surgery has now been used successfully to treat severe anisometropia and isoametropia associated with amblyopia in children who cannot wear standard spectacles or contact lenses. Extraocular techniques include photorefractive keratectomy, laser-assisted subepithelial keratomileusis, and laser-assisted in situ keratomileusis. Intraocular techniques include refractive lensectomy and phakic intraocular lenses and are still being investigated in children for refractive errors outside the treatment dose capabilities of the excimer laser. This workshop discusses the various techniques, how and when to use each, and their risks and benefits. Newer techniques currently being used in adults that may someday be used in children are also introduced.

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    ABSTRACT: Refractive laser surgery has become one of the most successful and commonly performed elective ophthalmic procedures. Since the introduction of photorefractive keratectomy, followed closely by the advent of laser in situ keratomileusis, the field of laser refractive surgery has continued to rapidly evolve. Surgical techniques are constantly refined to improve patient outcomes and minimize complications, and technology continues to advance to provide more precise and customizable treatment options. New applications of refractive procedures continually emerge in the literature. Breakthroughs in the field have led to novel applications of refractive procedures that may offer options to patients that previously had been considered poor surgical candidates. It is important for the clinician to maintain awareness of the current trends and new developments in refractive surgery to provide appropriate counseling and treatment for their patients.
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    ABSTRACT: Introduction: Refractive surgery has the potential to be a definitive treatment for accommodative esotropia, yet it has not been widely embraced. This article reviews the current literature on refractive surgery to treat accommodative esotropia. Methods: A literature search was performed using the following terms: refractive surgery, photorefractive keratectomy, laser-assisted keratomileusis, intraocular lens, hyperopia, accommodative esotropia, children, pediatric. Results: Fifteen series of patients treated with refractive surgery for accommodative esotropia were identified and summarized. Conclusions: Refractive surgery holds promise for the treatment of accommodative esotropia, although treatment risks are present and additional investigation is needed.
    Preview · Article · Oct 2012 · European journal of ophthalmology
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    ABSTRACT: Background: The characteristics of anisometropic amblyopia in ocular morphology are becoming a hot topic in amblyopia field. And the interocular difference in corneal parameters of anisometropic amblyopia is to be understood here. Corneal topography is a non-invasive method for in vivo corneal examination and applied in our study. Objective: This study was to investigate the interocular difference of corneal topography in anisometropic amblyopic patients Methods: This was a serial cases observation. Thirty anisometropic amblyopes were selected in Center for Optometry and Visual Science, People's Hospital of Guangxi Zhuang Autonomous Region. The patients were divided into amblyopic eye group and fellow eye group based on the best corrected distance visual acuity. Corneal topography was examined with Orbscan II z, and corneal morphological parameters such as Diff values of the anterior and posterior corneal surface, Sim K's astigmatism, Kmax, angle kappa and central corneal thickness (CCT) were measured. The interocular differences in these parameters were evaluated by paired t test, and the correlations in these parameters between the amblyopic eyes and the fellow eyes were analyzed by Pearson linear correlation and simple regression analysis. Results: The Diff values of the anterior corneal surface were (0.011±0.006) mm and (0.011±0.017)mm, and those in the posterior corneal surface were (0.031±0.012) mm and (0.026±0.008) mm in the amblyopic eye group and the fellow eye group, respectively. In addition, Sim K's astigmatism were (1.8±1.1)D and (1.1±0.6)D, JCC were (77±80)° and (100±80)°, J0 values were (-0.17±0.72) D and (0.02±0.41)D, J45 values were (-0.16±0.79) D and (0.13±0.48)D, CCT values were (551±37)μm and (551±31) μm, angle kappa values were (6.4±1.4)° and (4.9±1.2)° in the amblyopic eye group and the fellow eye group, respectively. Significant differences were found in the Diff values of the anterior and posterior corneal surface, Sim K's astigmatism and angle kappa between the two groups (t= -3.041, P = 0.005; t = -4.317, P = 0.000; t = -4.571, P = 0.000). Pearson's linear correlation test demonstrated significant interocular positive correlations in parameters such as the anterior corneal surface Diff values (r = 0.444), J0 (r = 0.383), posterior Diff values (r = 0.600), and Sim K's astigmatism (r = 0.479), and CCT (r = 0.948, P < 0.05). The linear regression equation between the two groups was Y = -0.005 + 1.392X (R2=0.197, F = 6.858, P = 0.014) in the Diff values in the anterior corneal surface, Y = -0.013+0.421X (R2 = 0.360, F = 15.761, P = 0.000) in the Diff values in the posterior corneal surface, Y = 0.616 + 0.27X (R2=0.230, F=8.348, P = 0.007) in the Sim K's astigmatism, Y = 0.060 + 0.219X (R2 = 0.147, F = 4.814, P = 0.037) in the J0 and Y = 108.289 + 0.804X (R2= 0.899, F = 250.293, P = 0.000) in CCT. Conclusions Corneal morphological interocular differences exist significantly in anisometropic amblyopic patients.
    No preview · Article · Jun 2013 · Zhonghua Shiyan Yanke Zazhi/Chinese Journal of Experimental Ophthalmology
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