Laser-assisted subepithelial keratectomy for anisometropic amblyopia in children: outcomes at 1 year.
OBJECTIVE
To assess the refractive, visual acuity, and binocular results of laser-assisted subepithelial keratectomy (LASEK) for anisomyopia, anisohyperopia, and anisoastigmatia in children with various levels of amblyopia secondary to the anisometropic causes.


METHODS
Nonhospital surgical facility with follow-up in a hospital clinic setting.


METHODS
This retrospective review was of 53 children with anisometropia who had LASEK to correct the refractive difference between eyes. All LASEK procedures were performed using general anesthesia. Patients were divided into 3 groups according to their anisometropia as follows: myopic difference greater than 3.00 diopters (D), astigmatic difference greater than 1.50 D, and hyperopic difference greater than 3.50 D. The children were followed for at least 1 year, and their refractive status, visual acuity, and binocular vision were assessed and recorded at 2 and 6 months as well as 1 year.


RESULTS
The mean age at treatment was 8.4 years (range 10 months to 16 years). The mean preoperative anisometropic difference was 6.98 D in the entire group, 9.48 D in the anisomyopic group, 3.13 D in the anisoastigmatic group, and 5.50 D in the anisohyperopic group. One year after LASEK, the mean anisometropic difference decreased to 1.81 D, 2.43 D, 0.74 D, and 2.33 D, respectively, and 54% of all eyes were within +/-1.00 D of the fellow eye, 68% were within +/-2.00 D, and 80% were within +/-3.00 D. Preoperative visual acuity and binocular vision could be measured in 33 children. Postoperatively, 63.6% of children had an improvement in best corrected visual acuity (BCVA) and the remainder had no noted change. No patient had a reduction in BCVA or a loss in fusional ability after LASEK. Of the 33 children, 39.4% had positive stereopsis preoperatively and 87.9% had positive stereopsis 1 year after LASEK.


CONCLUSIONS
Laser-assisted subepithelial keratectomy is an effective surgical alternative to improve visual acuity in anisometropic children unable to tolerate conventional methods of treatment or in whom these methods fail.
Vision Clinic, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada. william.astle@calgaryhealthregion.ca
William F
WF
Astle
Jamalia
J
Rahmat
April D
AD
Ingram
Peter T
PT
Huang
D000293:Adolescent; D000550:Amblyopia / Q000503:physiopathology / Q000601:surgery*; D015858:Anisometropia / Q000503:physiopathology / Q000601:surgery*; D001251:Astigmatism / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003867:Depth Perception / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D049008:Keratectomy, Subepithelial, Laser-Assisted / Q000379:methods*; D008297:Male; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology