Laser-assisted subepithelial keratectomy and photorefractive keratectomy versus conventional treatment of myopic anisometropic amblyopia in children

Abstract

Purpose: To evaluate the visual and refractive results of photorefractive keratectomy (PRK) and laser-assisted subepithelial keratectomy (LASEK) for high myopic anisometropia with amblyopia and contact lens (CL) intolerance in children.

Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Methods: This prospective comparative study comprised 27 children with high myopic anisometropia and amblyopia. The mean age of the children was 5.4 years (range 4 to 7 years). Multizonal PRK (13 eyes) or LASEK (14 eyes) was performed in the more myopic eye under general anesthesia using the Nidek EC-5000 excimer laser. After surgery, the dominant eye was patched. The postoperative visual and refractive outcomes were analyzed; all children had a 2-year follow-up. The 27 children (Group A) were compared with a control group of 30 children (mean age 5.1 years) (Group B) in whom myopic anisometropia and amblyopia were treated conventionally by CLs and patching the dominant eye. The visual acuity and binocular vision outcomes in both groups were analyzed and compared.

Results: In Group A, the mean spherical equivalent refraction was -8.25 diopters (D) +/- 2.37 (SD) (range -6.00 to -11.25 D) preoperatively and -1.61 +/- 0.73 D (range +0.50 to -2.25 D) postoperatively. The mean best corrected visual acuity (BCVA) was 0.23 +/- 0.21 preoperatively and 0.78 +/- 0.19 at 2 years. In Group B, the mean BCVA was 0.16 +/- 0.19 at the start of CL correction and amblyopia therapy and improved to 0.42 +/- 0.15 after 2 years. The mean BCVA at the final examination was significantly better in Group A (P<.05). Binocular vision improvement expressed by the proportion of patients who gained fusion and stereopsis was better overall in Group A (78%) than in Group B (33%) (P<.05). There were no complications postoperatively.

Conclusions: Photorefractive keratectomy and LASEK were effective and safe methods for correcting high myopic anisometropia and improving amblyopia in children aged 4 to 7 years who were CL intolerant. Visual acuity and binocular vision outcomes were better in children who received permanent surgical correction of anisometropia than in those who were treated conventionally by CLs.