Facilitation of amblyopia management by laser in situ keratomileusis in children with myopic anisometropia

ABSTRACT

To evaluate of the effects of Laser in situ keratomileusis in lowering anisomyopia in children and its validity in facilitating the treatment of the resultant anisometropic amblyopia. Laser in situ keratomileusis [LASIK] was performed to 18 eyes of 18 children having myopic anisometropia amblyopia not successfully treated with the standard amblyopia treatment for 6 months. Children were followed up at 1 week, 1, 2, 6, 12, 18 and 24 months. Postoperative amblyopia therapy was continued with occlusion of the dominant eye for 6 hours daily for the first 3 months and then for 4 hours per the synoptophore [combined with occlusion] was done to improve the binocular function. The mean spherical equivalent refraction in the operated eye had reduced significantly from-9.25 +/- 3.43 D preoperatively to 1.5 +/- 1.23 D 2 years postoperatively. The mean spherical equivalent in the non operated feNow eye was-1.0 +/- 1.18 D preoperatively and-2.25 +/- 1.05 D by 2 years. The mean spherical equivalent anisometropia was-7.75 +/- 2.34 D preoperatively and-0.5 +/- 0.31 D at 2 years, representing a 93.5% reduction in anisometropia. At 6 months, 14 eyes [77.8%] were within +/- 1.0 of the targeted refraction and at 2 years, 10 eyes [55.6%] were within +/- 1.0 D. The mean regression value was-2.25 +/- 1.7 D, however, 15 eyes [83.3%] were within 3.0 D of the fellow eye. The mean BCVA was significantly improved from 0.26 +/- 0.21 preoperatively to 0.82 +/- 0.17 by 2 years after surgery with amblyopia treatment. Binocular vision status had improved after 2 years follow up with part-time reduced occlusion treatment. No significant surgical or general anesthesia complications were noted. LASIK is a safe and effective alternative method for correcting myopic anisometropia facilitating treatment of amblyopia, not responding to conventional methods of treatment, with more better visual acuity and binocular vision. An important factor in treatment success is the compliance with the long-term amblyopia treatment regimen. It should be considered as a first-line treatment option, surpassing glasses and con tact lenses in eliminating anisometropia and aniseikonia