title: Correction of large amblyopiogenic refractive errors in children using the excimer laser.
abstract: OBJECTIVE
  We sought to determine whether laser subepithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) are effective methods for correcting amblyopiogenic refractive errors in children.
  
  
  METHODS
  Thirty-six eyes in 35 amblyopic children, who ranged in age from 4 to 16 years (mean, 8.4 years), received treatment for large magnitude ametropia. Seventy-two percent (25/35) of the children had a neurobehavioral disorder and/or were noncompliant with spectacle or contact lens wear. Myopia ranged from -3.25 to -24.25 D (mean, -11.48 D); one patient had hyperopia of +5.87 D. Correction was tailored to match the refractive error of the nonamblyopic eye. VISX Star S2/S3 excimer lasers were used in manual or auto-tracking modes, and corneal centration was achieved using brief, general anesthesia. Mean follow-up was 29.2 months (range, 4-42 months).
  
  
  RESULTS
  Myopia correction averaged -8.95 +/- 2.89 D (range, -3.25 to -15.50). Eighty-nine percent (31 children) were corrected to within +/- 1.00 D of goal refraction and the remaining 11% to within 2.0 D of the goal (most were undercorrected). Acuity improved postoperatively in 97%; by 1 optotype line in 37% and by 2 or more in 60%. No child lost acuity. Binocularity improved in 69% (24/35) and remained the same in 31%. Corneal haze measured grade 0-1 in 78%, grade 2 in 14%, and grade 3-4 in 8%. Myopic regression exceeding congruent with 1.0 D/year (0.08 D/month) occurred in 50% (18/36) of eyes treated. No substantial differences were observed in PRK- (n = 18) versus LASEK- (n = 17) treated children.
  
  
  CONCLUSIONS
  Laser refractive surgery is effective for correcting anisometropic myopia in amblyopic children. Recurrence of myopia is common. Further study is indicated to determine long-term stability and safety of the procedure in this population.
authors.affiliation: Department of Ophthalmology and Visual Sciences, St. Louis Children's Hospital at Washington University School of Medicine, Missouri 63110, USA. tychsen@vision.wustl.edu
authors.forename: Lawrence
authors.initials: L
authors.lastname: Tychsen
authors.forename: Eric
authors.initials: E
authors.lastname: Packwood
authors.forename: Gregg
authors.initials: G
authors.lastname: Berdy
mesh_terms: D000293:Adolescent; D000550:Amblyopia / Q000150:complications*; D002648:Child; D002653:Child Behavior Disorders / Q000150:complications; D002675:Child, Preschool; D003318:Corneal Opacity / Q000209:etiology / Q000503:physiopathology; D019573:Epithelium, Corneal / Q000503:physiopathology; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000601:surgery; D049008:Keratectomy, Subepithelial, Laser-Assisted / Q000009:adverse effects; D054018:Lasers, Excimer; D008297:Male; D009216:Myopia / Q000601:surgery; D009422:Nervous System Diseases / Q000150:complications; D018903:Photorefractive Keratectomy / Q000009:adverse effects; D011184:Postoperative Period; D012008:Recurrence; D012030:Refractive Errors / Q000209:etiology* / Q000503:physiopathology; D054140:Refractive Surgical Procedures; D012038:Regeneration; D012720:Severity of Illness Index; D013285:Strabismus / Q000150:complications; D016896:Treatment Outcome; D015348:Vision, Binocular; D014792:Visual Acuity