Refractive surgery for high bilateral myopia in children with neurobehavioral disorders: 2. Laser-assisted subepithelial keratectomy (LASEK).
BACKGROUND
A subpopulation of children with high myopia and neurobehavioral disorders is noncompliant with spectacle wear and ill-suited to correction using contact lenses. We report the results of refractive surgery in a series of these children treated bilaterally using excimer laser technology.


METHODS
Clinical course and outcome data were collated prospectively in a group of 9 children (mean age, 10.2 years; range, 3-16 years) with neurobehavioral disorders exacerbated by chronic noncompliance with spectacle wear, causing profoundly low functional vision. Myopia in the 18 eyes ranged from -3.75 to -11.5 D (mean -16.6 D) and the desired refraction was approximately +1D. Correction was achieved by bilateral laser-assisted subepithelial keratectomy (ie, LASEK) performed under brief general anesthesia. Mean follow-up was 17 months (range, 6-36 months).


RESULTS
Myopia correction averaged 7.9 D. Eighty-nine percent (16/18 eyes) were corrected to within +/-1 D of goal refraction. Uncorrected acuity improved postoperatively in all 18 eyes, with commensurate gains in behavior and environmental visual interaction in 88% (15/17 children). Myopic regression averaged approximately 0.8 d/year. the only complication encountered was mild (1+) corneal haze in 35% of treated eyes.


CONCLUSIONS
Bilateral excimer laser surgery is effective for improving functional vision substantially in highly myopic, neurobehaviorally impaired children who have difficulties wearing glasses. Myopic regression is common. Further study is indicated to determine the long-term safety of these and alternative refractive procedures in similar pediatric populations.
Tychsen
Lawrence
L
Department of Ophthalmology and Visual Sciences, St. Louis Children's Hospital at Washington University School of Medicine, University Medical Center, One Children's Place, St. Louis, MO 63110, USA. tychsen@vision.wustl.edu
Hoekel
James
J
D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000503:physiopathology / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D049008:Keratectomy, Subepithelial, Laser-Assisted / Q000379:methods*; D008297:Male; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology