Refractive laser surgery in children with coexisting medical and ocular pathology

Abstract

During the period of visual cortical plasticity, refractive surgery, by eliminating the refractive component of amblyopia and by promoting fusional ability, provides considerable improvement in children, even those with underlying medical conditions associated with ocular pathology.

Refractive Surgery for Special Needs Children

“…Obtaining the preoperative quantitative information needed often requires multiple sets of measurements by examiners skilled in examining uncooperative children, supplemented by a confirmatory set obtained during a brief examination under anesthesia. 6,9 The surgical devices and techniques used, progressing from least to most invasive, are advanced surface ablation (ASA) using the excimer laser (ie, photorefractive keratectomy) 6,8,15,[19][20][21][22][23][24][25] ; implantation of a phakic intraocular lens (IOL) 9,[26][27][28][29][30][31] ; and clear lens extraction (CLE) with or without insertion of a posterior chamber IOL (refractive lens exchange [RLE] 7,10 ). The following is a general strategy.…”

“…[7][8][9] Modest but consistent gains are achieved in the amblyopic eyes of children with anisometropia. 6,8,15,[19][20][21][22][23][24][25] The qualification is that tolerances are wider in pediatric refractive surgery; seldom does one achieve the precision commonplace in adult surgery.…”

“…7 The majority of reports on pediatric refractive surgery have described using ASA to treat anisometropic amblyopia. 6,8,15,[19][20][21][22][23][24][25] These case series show a reliable response, ie, initial correction of large refractive error to ±1.5 D of emmetropia in approximately 90% of treated eyes. The gains in UCVA or BCVA range from mild to excellent (2-7 lines' improvement), with no reported losses of acuity.…”

“…plications (derived from a metaanalysis of a total of approximately 260 pediatric ASA-treated eyes in the ophthalmic literature spanning 1998-2008). 6,8,18,[20][21][22][23][24][25]33,[36][37][38][39][40][41][42][43][44] Laserassisted in situ keratomileusis has been used in older children, 17,38,[45][46][47][48] but ASA is the preferred method in children of any age for important reasons. Trauma-induced displacement of a LASIK flap is a potentially permanent sight-threatening complication.…”

Nystagmus – A Brief Review

“…Moreover, modern refractive surgery techniques also make it possible to correct high levels of astigmatism with outstanding results by allowing a marked reduction of the refractive defect, if not the total elimination of the optical correction. [19][20][21][22][23][24] Studies conducted by our group showed that patients suffering from pathological ocular nystagmus show high astigmatic-type refractory defects at a much higher rate than the general population. 25 This demonstrates the value of correction of the refractive error by excimer laser surgery in order to definitively avoid optical correction, which is often either insufficient in patients with ocular torticollis, as in the case of correction with eyeglasses, or potentially uncomfortable or dangerous, as in the case of contact lenses (often of the semi-rigid type).…”