title: Phakic intraocular lens correction of high ametropia in children with neurobehavioral disorders.
abstract: OBJECTIVE
  A subset of children with high ametropia and neurobehavioral disorders have chronic difficulties with spectacle or contact lens wear. We report the results of refractive surgery in a series of these children treated using bilateral or unilateral phakic intraocular lenses (IOLs) for ametropia >10 D.
  
  
  METHODS
  Clinical course and outcome data were collated prospectively in a group of 12 children (mean age, 10.1 years; range, 4-17 years) with neurobehavioral disorders exacerbated by poor compliance with spectacles. Myopia in 18 eyes ranged from -10.0 to -22.75 D (mean, -15.2 D) and in 2 hyperopic eyes from +10.25 to +10.75 (mean, +10.5 D). Goal refraction was approximately 0 to +1 D. Correction was achieved by implantation of an iris-enclaved phakic IOL under general anesthesia. Mean follow-up was 9.1 months (range, 3-15 months).
  
  
  RESULTS
  Myopia correction averaged 14.5 D and hyperopia correction 9.4 D. Eighty-six percent of eyes (17/20 eyes) were corrected to within +/- 1 D of emmetropia and the remaining 14% (3 eyes) to within +/- 2 D. Uncorrected visual acuity improved substantially in all 20 eyes (60-fold; from a mean of 20/3400 to a mean of 20/57). Ocular comorbidities in each child accounted for residual postoperative, subnormal visual acuity (eg, amblyopia, nystagmus, albinism, regressed retinopathy of prematurity). Visual functions (measured using a 23-item validated survey) improved. One eye required IOL exchange; no other clinically significant complications have been encountered.
  
  
  CONCLUSIONS
  Phakic IOL implantation improves visual function substantially in neurobehaviorally impaired children who have high ametropia and difficulties wearing glasses.
authors.affiliation: Department of Ophthalmology and Visual Sciences, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO 63110, USA. tychsen@vision.wustl.edu
authors.forename: Lawrence
authors.initials: L
authors.lastname: Tychsen
authors.forename: James
authors.initials: J
authors.lastname: Hoekel
authors.forename: Fatema
authors.initials: F
authors.lastname: Ghasia
authors.forename: Gi
authors.initials: G
authors.lastname: Yoon-Huang
mesh_terms: D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000150:complications*; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007498:Iris / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D008297:Male; D009216:Myopia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D054120:Phakic Intraocular Lenses; D011446:Prospective Studies; D011474:Prosthesis Design; D012029:Refraction, Ocular; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome