Pediatric refractive surgery and its role in the treatment of amblyopia: meta-analysis of the peer-reviewed literature.
OBJECTIVE
To provide an overview of the visual outcomes after pediatric refractive surgery in anisometropic amblyopia and to analyze the relationship of these outcomes with age and type of refractive surgery.


METHODS
Systematic searches in PubMed, Embase, and Web of Science databases without data restrictions and a search by surveillance of the literature regarding pediatric refractive surgery were performed. Only studies reporting individual data of pediatric cases (age 1 to 17 years) undergoing photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), and LASIK were included. A total of 15 articles including data from a total of 213 amblyopic eyes were considered: LASIK in 95 eyes and surface ablation in 118 eyes. Changes in uncorrected (UDVA) and corrected distance visual acuity (CDVA) were investigated as well as their relation with age and ablation type.


RESULTS
A significant increase in logMAR UDVA and CDVA was found in the overall sample of amblyopic eyes after surgery (P<.001). A significant correlation was found between age and preoperative CDVA (r=0.34, P<.001) as well as between age and the change in CDVA after surgery (r=-0.38, P<.001). The change in UDVA was significantly superior for eyes undergoing surface ablation compared to those undergoing LASIK (P=.04). Corneal haze was the predominant complication, which was reported in 5.3% of LASIK cases and 8.5% of surface ablation cases.


CONCLUSIONS
Laser refractive surgery is an effective option for improving the visual acuity in children with an amblyopic eye in association with anisometropia.
Alió
Jorge L
JL
Instituto Oftalmológico de Alicante, Vissum Corporación, Avda Denia, Alicante, Spain. jlalio@vissum.com
Wolter
Nathaly V
NV
Piñero
David P
DP
Amparo
Fransisco
F
Sari
Esin Sogutlu
ES
Cankaya
Cem
C
Laria
Carlos
C
D000550:Amblyopia / Q000601:surgery*; D002648:Child; D006801:Humans; D010380:Peer Review / Q000379:methods*; D012029:Refraction, Ocular; D054140:Refractive Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome