refractive surgery in children
TRANSCRIPT
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