Photorefractive keratectomy in children

Astle, William F.; Huang, Paul; Ells, Anna L.; Cox, Robin G.; Deschênes, Micheline C.; Vibert, Heather M.

doi:10.1016/s0886-3350(02)01304-4

Cited by 81 publications

(90 citation statements)

References 20 publications

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“…The paediatric eyes with some amount of amblyopia have improved (one line gain) and became independent of glasses. Few previous studies are available, conducting LASIK and PRK in children using Excimer Laser, [23][24][25][26] but this study included paediatric eyes for LASEK using solid state laser. It proves that it is easy to perform LASEK for the paediatric patients (12-14 years).…”

Section: Discussionmentioning

confidence: 99%

Laser Assisted Sub Epithelial Keratectomy for Hyperopia Using 213 Nm Wavelength Solid State Laser, 3 Year Follow Up Study of Refractive and Visual Outcomes

Yenugandula¹,

Goud²,

J³

2015

jemds

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PURPOSE:To evaluate the visual and refractive outcomes, using 213 nm solid lasers for the correction of broad range of hyperopia, covering pediatric age group to presbyopic age group. MATERIALS AND METHODS:The Present study is a prospective case series in a private practice setup, analysed series of eyes, with low to high hyperopia, who underwent conventional LASEK. Long term (3 year) visual and refractive outcomes and overall patient satisfaction studied. RESULTS: This cohort study of 37 eyes included broad range of hyperopia between +1.5 D to +7.5 D. For 70.27% of eyes, there was no change in CDVA post operatively and there was a significant Gain of one line in 21.62% of eyes and the paediatric eyes (4) CONCLUSION:The conventional LASEK can be performed using solid laser, safely and effectively for hyperopia covering broad age groups and it can achieve effective visual outcomes with excellent overall patient satisfaction. KEYWORDS: LASEK, CDVA, UDVA, logMAR and PRK. INTRODUCTION:Corneal photo ablation has been performed over the years using refractive excimer laser 193nm wavelength safely and effectively. [1][2][3][4] In recent times, solid state refractive laser platform has been developed, [5][6] providing an alternative to excimer lasers with certain added advantages. The newer solid state laser is a quintupled Nd: Yag laser with a 213nm wavelength, small spot size 0.6mm. Experimental studies indeed found that solid lasers (213nm wavelength) don't induce thermal damage or collateral damage in deep corneal layers. [6][7] Photo ablation of the stromal tissue within the wavelength ranging from 190nm to 220nm is with high degree of accuracy and minimal collateral damage. [4][5] This laser has higher pulse to pulse energy stability.There is no need of using toxic gas and it has least noise levels in the operation theatre, less maintenance costs and the greatest advantage is its ready to use option anytime unlike with excimer laser. The repetition rate of solid state laser is 300hz, much higher than in the excimer laser. This laser provides true Gaussian profile of the beam. The 213 nm wavelength is less sensitive to corneal hydration than 193 nm, due to its better transmissibility in hydrated cornea. [8] The hydrated cornea has bearing on corrections. The over hydrated cornea results in frequent under corrections, dry stromal bed (under hydrated) results in over corrections. [9] The solid state lasers are more complex to manufacture and needs frequent and meticulous maintenance of the machine.

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Section: Discussionmentioning

confidence: 99%

Laser Assisted Sub Epithelial Keratectomy for Hyperopia Using 213 Nm Wavelength Solid State Laser, 3 Year Follow Up Study of Refractive and Visual Outcomes

Yenugandula¹,

Goud²,

J³

2015

jemds

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“…Loss of two lines of BCVA was 2-7.5 % for all groups. Only one study had shown severe haze at the rate of 2.5 % with one patient who had lost six lines of VA. 16 Endothelial cell loss increased from 1.4 % at 6 months to 3.6 % at 12 months. 13 Recently, a case of an acute hydrops with secondary bacterial keratitis as a sequela of paediatric refractive surgery was reported in a young adult with a history of trabeculectomy and PRK and RK around 5-6 years of age.…”

Section: -44mentioning

confidence: 93%

Update on Paediatric Refractive Surgery

Pirouzian¹,

Hashemian²,

Khodaparast³

2015

European Ophthalmic Review

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Purpose: To provide a summary of the most recent evidence-based data on the paediatric refractive surgery. Methods: A review of the published studies from 1990 to 2015 was undertaken with emphasis on recent articles from 2010 to 2015. Results: Searching Scopus and PubMed, using the keywords of refractive surgery, phakic, paediatric, IOL, children and amblyopia alone or in various combinations yielded a total of about 48 articles on this topic from 1990 to 2015. Excluding review articles, fewer than 35 articles were included. Original research articles were only in the form of case reports/series on corneal laser surgery and phakic intraocular lens implantation or clear lens extraction. A total of fewer than 800 patients and 700 eyes had undergone a form of refractive surgery listed above. No randomised clinical trial (RCT) study was available on the topic. Age varied from 7 months to 17 years for non-corneal cross-linking studies. Most commonly performed operations were corneal laser ablative procedures (photorefractive keratectomy [PRK], laser-assisted sub-epithelial keratectomy[LASEK], laser-assisted in situ keratomileusis [LASIK]), phakic intraocular lens implantations (p-IOL, anterior or posterior chamber) and clear lens extraction. The indications for surgical intervention were for refractive -high amplitude iso-ametropic or anisometropic -amblyopia in the setting of the previously failed medical interventions and spectacle intolerance or non-compliance (physical or neurobehavioral in nature) and high accommodative esotropia with/without amblyopia. The main objective of the studies was to assess for visual acuity gained or lost following surgery and for correction of strabismus, i.e. achieving orthophoria. Further search on the keywords 'cross-linking, cornea, rings and children' from the same databases resulted in 130 articles. No RCT study was available on the topic. Age varied from 7 months to 17 years for non-corneal cross-linking studies. The focus of the most recent refractive surgery articles has been on the treatment and stabilisation of irregular myopic astigmatism from kerato-ectatic conditions by means of corneal cross-linking and intrastromal ring/in-lay implantation. Discussion: Refractive surgery remains a controversial topic in paediatric age population. However, the evidence clearly supports refractive surgery for treatment of children with refractive amblyopia and for treatment of accommodative esotropia in children unable or unwilling to wear spectacles or contact lenses. Conclusion: Consensus exists among published authors that refractive surgery may be considered in children with refractive amblyopia after exhausting various therapeutic medical options for amblyopia. Published authors have universally endorsed undertaking prospective multi-centred RCTs to conclusively establish the long-term safety and efficacy of various types of refractive surgery in the paediatric patients of different age groups. KeywordsChildren, myopia, refractive surgery, laser, intraocular lens, anisometr...

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“…7,8 The high rate of regression is attributable to the enhanced healing properties in young eyes, eg, keratocyte-mediated regrowth and epithelial hyperplasia. Average regression can be about 1 D/y, 6,21,23,42 mainly in highly myopic eyes. For myopic children with treatment beyond 10 D, or hyperopic beyond 4.5 D, the regression may be 33% over a span of approximately 3 years.…”

Section: Gains In Visual Acuity and Visual Functionmentioning

confidence: 99%

“…6,21,23,42 Seldom is this due to increasing axial length. After age 2 to 3 years, axial length changes tend to be minor in highly ametropic phakic pediatric eyes.…”

Section: Gains In Visual Acuity and Visual Functionmentioning

confidence: 99%