title: Refractive laser surgery in children with coexisting medical and ocular pathology.
abstract: OBJECTIVE
  To report the visual, refractive, and functional outcomes of photorefractive keratectomy (PRK) and of laser-assisted subepithelial keratectomy in a group of children with significant refractive error and underlying medical conditions or ocular pathology who were noncompliant with traditional management.
  
  
  METHODS
  Nonhospital surgical facility and a hospital clinic.
  
  
  METHODS
  This case series comprised 5 individual cases of anisometropic amblyopia and/or high myopia. Underlying medical and ocular conditions were as follows: upper eyelid hemangioma with oblique myopic astigmatism, Pelizaeus-Merzbacher leukodystrophy with nystagmus, Klippel-Trenaunay-Weber syndrome with glaucoma, incontinentia pigmenti with unilateral optic nerve atrophy, and Goldenhar syndrome with unilateral optic nerve hypoplasia. Photorefractive keratectomy or LASEK was performed in 6 eyes of 5 patients. Age range at the time of surgery was 1.0 to 7.0 years. All procedures were performed under general anesthesia.
  
  
  RESULTS
  Best corrected visual acuity improved by 2 lines in 2 patients and 1 line in 2 patients by 6 months after surgery. Stereopsis and/or fusional status improved in 3 patients. Amblyopia treatment compliance improved in 1 patient. Alignment improved without strabismus surgery in 2 cases. A functional vision survey demonstrated a positive effect on the ability of all 5 children to function in their environment.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Alberta Children's Hospital, University of Calgary, Division of Ophthalmology, Canada.
authors.forename: William F
authors.initials: WF
authors.lastname: Astle
authors.forename: Andrea
authors.initials: A
authors.lastname: Papp
authors.forename: Peter T
authors.initials: PT
authors.lastname: Huang
authors.forename: April
authors.initials: A
authors.lastname: Ingram
mesh_terms: D000015:Abnormalities, Multiple; D000550:Amblyopia / Q000150:complications / Q000628:therapy*; D015858:Anisometropia / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005128:Eye Diseases / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D049008:Keratectomy, Subepithelial, Laser-Assisted; D054018:Lasers, Excimer; D008297:Male; D009216:Myopia / Q000150:complications / Q000601:surgery*; D010349:Patient Compliance; D018903:Photorefractive Keratectomy; D014792:Visual Acuity / Q000502:physiology