Refractive laser surgery in children with coexisting medical and ocular pathology.
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.
Astle
William F
WF
Alberta Children's Hospital, University of Calgary, Division of Ophthalmology, Canada.
Papp
Andrea
A
Huang
Peter T
PT
Ingram
April
A
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